Revisiting the Holmlund and Hellsing Line: An Evaluation of the Anatomical Landmarks for Temporomandibular…

Cohort studyJournal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons· Jul 2026

Revisiting the Holmlund and Hellsing Line: An Evaluation of the Anatomical Landmarks for Temporomandibular Joint Arthroscopy.

Daniel D Choi, Alyssa Manski, Yingning Sang, Clayton Davis

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Sports Medicine & ArthroscopyCohort studyClinical practiceQ1IF 1.6

Anterior recess arthroscopy portal sits about 10 mm from the traditional H-H landmark.

Revisiting the Holmlund and Hellsing Line: An Evaluation of the Anatomical Landmarks for Temporomandibular Joint Arthroscopy.

Daniel D Choi … Clayton Davis

Journal of oral and maxillofacial surgery · Jul 2026

Background

Historical surface landmarks along the Holmlund-Hellsing (Holmlund-Hellsing) line (10/-2 and 20/-10) are commonly used for temporomandibular joint (temporomandibular joint) arthroscopy, but prior studies suggest these points may be inaccurate.

Purpose

Identify differences in puncture site locations between the Holmlund-Hellsing landmarks and an anatomical-based technique (anatomical-based technique) for temporomandibular joint arthroscopy.

Methods

STUDY DESIGN, SETTING, SAMPLE: The researchers implemented a prospective cohort study.

n = 50 subjects

Results

10.2

mm

the entry point sits about a centimeter forward of that landmark

n = 50 subjects

More results

The study sample included 50 subjects, with a mean age of 36.7 ± 17.2 years (46, 92% female).

For the fossa (posterior) portal, mean horizontal difference from the H-H landmark was 0.7 ± 1.5 mm anterior.

Mean vertical difference was 2.1 ± 3.9 mm superior.

More results

Both differences were statistically significant from the historical landmark (horizontal, P = .0004; vertical, P < .0001).

“

Conclusion

The traditional 20/-10 landmark approximates the fossa portal but does not accurately represent anterior recess portal location achieved using anatomical-based technique.

Revisiting the Holmlund and Hellsing Line: An Evaluation of the Anatomical Landmarks for Temporomandibular Joint Arthroscopy.

Revisiting the Holmlund and Hellsing Line: An Evaluation of the Anatomical Landmarks for Temporomandibular Joint Arthroscopy.

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