Transcutaneous forceps-assisted en-bloc removal of a large intra-articular loose body during operative temporomandibular joint arthroscopy.

Large intra-articular loose bodies of the temporomandibular joint can limit operative arthroscopy when their size prevents retrieval through working trocars. Fragmentation, portal enlargement, accessory approaches, or open conversion may increase intra-articular manipulation and morbidity. This technical note describes a transcutaneous forceps-assisted maneuver for en-bloc removal of a large loose body under continuous arthroscopic visualization. The technique is illustrated in a 52-year-old woman with Wilkes stage IV internal derangement, pain of 7/10 on a visual analog scale, and maximal mouth opening of 32 mm. During operative arthroscopy, an approximately 8 mm intra-articular loose body, macroscopically consistent with an osteochondral fragment, could not be extracted through the anterior working trocar. Owing to its size and consistency, attempted electrocautery fragmentation for piecemeal removal through the anterior portal was also unsuccessful. The trocar was removed while preserving the anterior portal trajectory, and a mosquito forceps was introduced transcutaneously through the same access under direct posterior-portal visualization. The loose body was grasped and extracted intact through the skin. Complete removal was achieved in one step, using 450 mL of Ringer's lactate irrigation, with no complications. At 6 months, pain decreased to 3/10 and maximal mouth opening increased to 38 mm. This maneuver may provide a controlled and minimally invasive option for selected cases in which a clearly visible intra-articular loose body is too large to pass through standard arthroscopic instrumentation.