TMJ Arthrocentesis

[drsushant]

What is Jaw Joint Arthrocentesis?

TMJ / Jaw Joint Arthrocentesis (the washing out
of the jaw joint space) is a procedure during
saline ± anti-inflammatory steroids, long-acting
local anæsthetics, painkillers or collagen
components.
TMJ / Jaw Joint Arthrocentesis reduces jaw joint pain,
improves jaw joint function and reduces jaw joint clicking.

TMJ / Jaw Joint Arthrocentesis of the (upper) joint space
reduces jaw joint pain by:

diluting / flushing out the inflammatory chemicals from
the jaw joint
increasing mandibular (lower jaw) movements by
removing intra-articular adhesions (scarring within the
joint space)
eliminating the negative pressure within the jaw joint
recovering disc and fossa space and improving disc
mobility (return the disc of cartilage to its normal
position within the joint) which reduces the mechanical
obstruction caused by the anterior (forward) position
of the disc.

The majority of restricted opening is secondary to upper
joint space problems, particularly ‘anchored disc’
phenomenon, where arthrocentesis is particularly beneficial.

When is Jaw Joint Arthrocentesis used?

Indications for arthrocentesis are:

dislocation of the articular disc ± reduction
limitations of mouth opening originating in the jaw joint
joint pain and other internal derangements of the TMJ.

What does the treatment involve?

TMJ / Jaw Joint Arthrocentesis usually takes place under a
General Anæsthetic – this means you will be asleep for the
entire procedure. Whilst you are asleep, two small
needles will be inserted into the TMJ / Jaw Joint. One of
these needles allows sterile saline to be pumped into the
joint under pressure whilst the other needle allows the
saline to drain out of the joint.

Will anything else be done at the same time?

While you are asleep, your lower jaw will often be
Joint disc back into its normal position and break down any
adhesions within the jaw joint.

How will I feel after the operation?

The area in and around the TMJ / Jaw Joint is often
uncomfortable for several days after the procedure.

You may find it necessary to take simple painkillers,
such as Ibuprofen, during this time.

There will be some swelling in front of your ear.

You may also find it difficult to open your jaw for a few
weeks.

Will I need another appointment?

You will need to return a few weeks after surgery to have
your jaw joint checked by your surgeon. TMJ / Jaw Joint
arthrocentesis is not always successful and even in those
people who have an improvement following the procedure,
it can take several months for this to occur.

Also, you will need to continue with TMJ / Jaw Joint
exercises, physiotherapy etc.

        

[drsushant]

 

 

 

Photos showing needles 

placed within the TMJ for 

TMJ Arthrocentesis & 

arthrocentesis taking 

place (lower photo)

 

        

[DrAnil]

Complications:

Complications after puncture of the TMJ depend on the
anatomy of the joint and its relations.

Possible complications of TMJ / Jaw Joint Arthrocentesis
also depend on the technique used. The complication rate
following TMJ / Jaw Joint Arthrocentesis is given as
between 2 – 10%.

Complications usually present in the immediate post-
operative phase and are mostly associated with fluid
collection and vascular injury.

Facial Muscle Weakness (< 1.0%) (temporary / permanent) resulting from injury to the Facial Nerve whilst gaining access to the jaw joint space. The most common problem resulting from this, is the inability to wrinkle the brow, raise the eyebrow or gain tight closure of the eyelids. Numbness (< 2.5%) (temporary / permanent) of certain areas of skin in the region of the jaw joint and sometimes in more remote areas of the face or scalp. Bleeding within the jaw joint which cannot be adequately controlled and could require immediate intervention by open joint surgery. Ear problems (< 9.0%), including inflammation of the ear canal, middle / inner ear infections, vertigo, perforation of the ear-drum and temporary / permanent hearing loss. Instrument Separation (that is, the needle breaks off within the joint space) which may require open joint surgery. Facial Scarring from the entry injection. Damage to the jaw joint surface during the arthrocentesis procedure, usually of a reversible nature but which could permanently affect joint function. Unsuccessful entry into the jaw joint or inability to accomplish the desired procedure because of limited motion of the jaw joint / scarring. Worsening of present TMJ symptoms which may require repeat arthrocentesis, arthroscopy or open joint surgery. Changes in the bite after arthrocentesis which may affect chewing functions. In addition, there may be temporary / permanent limited mouth opening. Post-operative infection requiring additional treatment. Adverse / Allergic reactions to any of the medications used in the procedure. Pre-Auricular Hæmatoma. Extravasation of fluid from the jaw joint into the surrounding tissues. Rare complications include: • Horner syndrome • Upper airway compression • Para-pharyngeal swelling • Variant petro-tympanic fissure • Infection of the infra-temporal space • Pseudo-aneurysm and arterio-venous fistula • Superficial temporal artery aneurysm • Trans-articular perforation • Intra-cranial perforation & extra-dural haematoma

        

[drmithila]

The surgery is usually done under light sedation (“twilight” or IV sedation). The arthrocentesis is done by inserting needles into the affected joint space by the ear, while sterile solution is used to wash out the joint and surrounding areas. The idea is that this ‘wash out’ will remove any extra scar tissue and increase mobility in the joint. At this point steroids, lubricants, or other medications may be injected. Typically, there is no scar or stitches.

Recovery Time

After the arthrocentesis, recovery time is minimal. Many patients report that they take one to two days off work, mostly to recover from the IV sedation. Surgeons usually advise the patient to continue their soft diet and use ice and heat as directed. As always, please consult your doctor with any questions about your care.

 

Advantages & Disadvantages

Arthrocentesis is the least invasive TMJ surgery. It is also the least expensive. Since it is usually done in the office or in an outpatient surgical center and has a relatively easy recovery, many patients believe that these are advantages. However, the surgeon can not see inside the joint during this procedure, and even though some patients experience relief, many have told us that they notice no difference in pain relief at all or feel worse. 

        

[Author]

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