Nano-Arthroscopy Now in Use for Diagnosis of Jaw Joint Disorders in Dogs

Disorders of the temporomandibular joint (TMJ) have long been known as contributors to orofacial pain and dysfunction in a dog’s ability to maintain a good quality of life, including eating, drinking, vocalizing, and using their mouth for useful activities. Treatment of TMJ conditions—such as cancerous tumors, severe inflammatory diseases, and septic arthritis—have progressed significantly over the past decade with research and clinical breakthroughs by veterinarians dedicated to oral health. Now, a new breakthrough in the diagnosis of TMJ disorders is the new accepted protocol of care at the UC Davis William R. Pritchard Veterinary Medical Teaching Hospital (VMTH).

In 2023, Dr. Boaz Arzi, chief of the VMTH’s Dentistry and Oral Surgery Service (DOSS), became the first non-physician member of the American Society of TMJ Surgeons. Through this connection, he was able to network with human oral surgeons who had been utilizing nano-arthroscopy for several years in their practices as the standard of care in human medicine.

Arthroscopy, the use of a tiny camera inserted into tissue (in this case, the TMJ structure), allows for direct visualization and inspection of the internal structure of any affected area of the body. The device also allows for observation and the collection of tissue samples for biopsies of tumors or other potentially diseased tissue. Previously, veterinarians had to rely on CT and/or PET scans.  

“This type of imaging can be extremely valuable to see bone structure and soft tissue,” said Arzi. “But it does not allow us to see articular surfaces and the synovial membrane surrounding the joint. And perhaps most importantly, we cannot biopsy a tumor using just a CT scan.”

Arzi, along with Dr. Stephanie Goldschmidt and their DOSS colleagues, worked with Drs. Po-Yen Chou and Barbro Filliquist from the VMTH’s Orthopedic Surgery Service to translate the advantages of nano-arthroscopy in human medicine to veterinary medicine. The research, recently published in Frontiers in Veterinary Science journal, explores the utilization of the technology from initial use in cadavers to clinical application in medium- to large-breed dogs.

All four cases to date have yielded positive results.

“Each one of these cases showed significant findings,” said Arzi. “We have never looked at the joint in this way through a scope, and our discoveries are promising. In fact, we identified a disease in one of the cases—immune-mediated TMJ arthritis—that we did not even know existed in that clinical format in dog joints. Theoretically, I knew it could happen, but I had never seen it until the use of this scope.”

Arzi is eager to share the technique to help other dogs and for nano-arthroscopy for TMJ disorders to become the standard of care everywhere in veterinary medicine.

“Given its novelty in veterinary medicine—UC Davis is the only facility currently using it in a clinical setting—we recently held the first-ever TMJ Arthroscopy Workshop for our residents and oral and maxillofacial surgery fellows from the University of Wisconsin, the University of Pennsylvania, and Cornell University,” Arzi confirmed. “We look forward to sharing and advancing this new application even more in the future.”

The TMJ is an extremely narrow joint with very little space between the two bones that form the joint. The scope is only 1.9 millimeters and can be inserted through a small incision in the dog’s jaw.

Scopes for use in smaller breed dogs or cats have not been created yet. Arzi states that a scope small enough to be used on a cat’s TMJ would have to involve small fiber technology.

While the scope is only being used for diagnostic purposes in veterinary medicine, its use in human medicine also includes an operative aspect, as well as advanced interventions, such as repairing TMJ disc damage or surgical correction of a displaced disc. Arzi hopes these additional levels of use can be incorporated into veterinary medicine in the future.

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