C-06: Ultrasound-Guided Injections for the TMJ

Course Chairs: Ricardo Tesch, Aurelio Alonso

When conservative therapies are not sufficient for management of temporomandibular joint (TMJ) osteoarthritis, minimally invasive procedures – such as joint lysis and lavage via arthrocentesis, followed by intra-articular injections of biologically active products – can provide substantial benefits. Biologics have shown efficacy in controlling tissue damage and alleviating associated symptoms, offering hope for improved quality of life for affected individuals.

While these procedures have historically relied on anatomical landmarks for guidance, recent advances in ultrasound-guided techniques have helped transform the landscape of TMJ interventions. By enabling real-time visualization, ultrasound guidance greatly enhances precision and effectiveness of procedures – improving patient outcomes and minimizing procedural risks.

Despite the potential benefits of ultrasound-guided procedures, teaching these advanced techniques presents unique challenges. Unlike other medical interventions that can be easily simulated, TMJ procedures require a deep understanding of the joint’s complex anatomy and pathology. Furthermore, opportunities for hands-on practice in clinical settings are often limited, making it crucial to provide extensive training to ensure competency.

To overcome these challenges, this workshop aims to bridge the gap between theory and practice by offering participants comprehensive training in minimally invasive TMJ procedures, with a particular focus on ultrasound guidance. Participants can acquire the knowledge and skills necessary to confidently integrate these techniques clinically thanks to this course’s blend of didactic lectures, demonstrations, and hands-on exercises.

Learning Objectives:

Identify the indications and contraindications for lysis and lavage therapies, as well as intra-articular injections, in patients with TMJ osteoarthritis.
Demonstrate the techniques for performing blind arthrocentesis and intra-articular injections using anatomical landmarks in the upper TMJ compartment.
Perform arthrocentesis and intra-articular injections in the lower TMJ compartment using ultrasound guidance, including proper probe manipulation and interpretation of ultrasound images.

Ricardo Tesch, DDS, MS, PhD

Professor | UNIFASE/Faculdade de Medicina de Petropolis

Dr. Ricardo Tesch is a distinguished academic and clinician with a respected career in Temporomandibular Disorders (TMD) and Regenerative Medicine. He earned his DDS from the Federal University of Rio de Janeiro (1992), a Master’s in Head and Neck Surgery from Heliópolis Hospital/São Paulo (2003), and a PhD in Internal Medicine from the Federal University of Rio de Janeiro (2018). His work seamlessly integrates clinical expertise with innovative research, focusing on chronic pain management and joint tissue regeneration.

Dr. Tesch is a Full Professor and Vice-Dean of Research and Innovation at the Faculty of Medicine of Petrópolis/UNIFASE, where he also serves as Director of the Regenerative Medicine Laboratory and Coordinator of the Chronic Pain Research Center. His research interests include exploring the genetic and physiopathological mechanisms of chronic pain and developing innovative cell-based therapies for joint regeneration.

He is also a Visiting Professor at Universidad del Desarrollo in Chile, where he consults for the Postgraduate Program in TMD and Orofacial Pain, and at Pontificia Universidad Católica Madre y Maestra in the Dominican Republic, where he is the Director of the Postgraduate Program in TMD and Orofacial Pain.

Dr. Tesch is a leader in clinical research in temporomandibular joint (TMJ) regenerative medicine, having pioneered the first in-human clinical trial using autologous nasal septum chondrocytes for TMJ regeneration. His academic contributions include numerous publications in peer-reviewed journals, advancing the fields of diagnostics and therapeutic interventions for TMD.

As a passionate advocate for translational research, Dr. Tesch collaborates with national and international institutions to improve healthcare outcomes. His work has earned recognition and support, including highly competitive government funding for the development of an advanced therapeutic platform for joint diseases. This funding supports the creation of technological solutions aimed at reducing healthcare vulnerabilities, increasing access to care, and promoting technological and productive autonomy within Brazil’s Health Industrial Economic Complex.

Aurelio Alonso, DDS, PhD, MS

Associate Professor | Duke University, Department of Anesthesiology

Dr. Alonso is an Associate Professor in the Department of Anesthesiology at Duke University School of Medicine and Director of Orofacial Pain at Duke Innovative Pain Therapies. Dr. Alonso is an internationally respected Orofacial Pain specialist and is a Diplomate of the American Board of Orofacial Pain and Diplomate of the American Board of Dental Sleep Medicine, and a Fellow of the American Academy of Orofacial Pain.

Dr. Alonso provides patients with innovative pain therapies as a member of the Center for Translational Pain Medicine (CTPM) team. The CTPM further expands Duke’s existing clinical and research program in innovative pain therapies by bringing together leading basic scientists, clinicians, and clinical researchers. Dr. Alonso shares with the CTPM team the common core mission of unraveling the causes of painful conditions to better improve patient care. Dr. Alonso’s focus area includes Orofacial Pain, Temporomandibular Disorders, Primary Headaches, Neuropathic Orofacial Pain, and Dental Sleep Medicine.

Dr. Alonso received his DDS degree from the University of Ribeirao Preto (UNAERP), Brazil and a certificate in Prosthodontics from Sao Paulo State University (UNESP Araraquara, Brazil), followed by a Fellowship in Orofacial Pain at the University of Medicine and Dentistry of New Jersey and a residency in Temporomandibular Disorders and Orofacial Pain from the University of Minnesota, where he also received a MS in Dentistry and PhD in Oral Biology.