Needle-based level II temporomandibular joint arthroscopy under local anesthesia.

OBJECTIVE: To describe a novel office-based Level II temporomandibular joint (TMJ) arthroscopy technique performed using only two 16-gauge needle punctures, achieving the same level of invasiveness as conventional arthrocentesis while allowing direct visualization and therapeutic intervention. METHODS: This technical note describes a minimally invasive arthroscopic approach performed under intravenous sedation and local anesthesia using two 16-gauge needle portals. A 0.7-mm diameter fiber-optic endoscope is introduced through one needle for visualization, while a 600-µm optical fiber connected to a 450 nm diode laser (TheraBlue®, DMC, Brazil) is introduced through the second needle for controlled retrodiscal tissue ablation under direct visualization. RESULTS: This technique enables Level II arthroscopic capabilities while maintaining needle-level invasiveness. At 6-month follow-up, the patient demonstrated significant clinical improvement, with bilateral TMJ pain decreasing from a preoperative Visual Analog Scale (VAS) score of 8 to 1, and maximum interincisal mouth opening (MMO) increasing from 33 mm to 42 mm, with no complications observed. The procedure can be performed in an office setting under local anesthesia, reducing the need for hospital-based infrastructure. CONCLUSION: Office-based Level II TMJ arthroscopy using 16-gauge needle portals appears to represent a feasible, minimally invasive evolution of arthrocentesis, enabling visualization and targeted therapeutic intervention with minimal morbidity in this initial case. Controlled studies with larger cohorts are required before broader clinical implications can be established.