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| TMJ Arthrocentesis (Jaw Joint Washout) |
What is Jaw Joint Arthrocentesis?
TMJ / Jaw Joint Arthrocentesis (the washing out
of the jaw joint space) is a procedure during
which the jaw joint is washed out with sterile
saline ± anti-inflammatory steroids, long-acting
local anæsthetics, painkillers or collagen
components.
TMJ / Jaw Joint Arthrocentesis (the washing out
of the jaw joint space) is a procedure during
which the jaw joint is washed out with sterile
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:
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:
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.
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.
| Photos showing needles placed within the TMJ for TMJ Arthrocentesis & arthrocentesis taking place (lower photo) |
Will anything else be done at the same time?
While you are asleep, your lower jaw will often be
manipulated in an attempt to encourage the TMJ / Jaw
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, wearing of BRA's etc.
What are the possible 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.
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
While you are asleep, your lower jaw will often be
manipulated in an attempt to encourage the TMJ / Jaw
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, wearing of BRA's etc.
What are the possible 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
Useful Websites:
The Mayo Clinic
Useful Articles:
BJOMS 1995. Temporomandibular joint arthrocentesis
and lavage for the treatment of closed lock - a follow-up
study
British Journal of Neurosurgery 2000. Extradural
hæmatoma following Temporomandibular Joint
Arthrocentesis and lavage.
BJOMS 2003. An audit of 405 Temporomandibular Joint
Arthrocentesis with intra-articular morphine infusion.
Cochrane Database of Systematic Reviews 2003.
Hyaluronate for Temporomandibular Joint Disorders.
Rev Bras Otorrinolaryngol 2006. Temporomandibular Joint
Arthrocententesis - Evaluation of results and review of the
literature.
Eur J Dent. 2007. The Use of Double-Needle Canula
Method for Temporomandibular Joint Arthrocentesis.
Clinical Report.
Cochrane Database of Systematic Reviews 2009.
Arthrocentesis and lavage for treating Temporomandibular
Joint Disorders.
BJOMS 2009. Therapeutic benefits of TMJ Arthroscopy
and Arthrocentesis - a prospective outcome assessment.
BJOMS 2009. Technical note. A new anatomical
landmark to simplify Temporomandibular Joint
Arthrocentesis.
BJOMS 2009. Technical note. Single Needle
Arthrocentesis.
J Oral Maxillofac Surg 2009. Single-Puncture
Arthrocentesis. Introducing a New Technique and a Novel
Device
J Oral Maxillofac Surg 2009. Horner Syndrome After
Temporomandibular Joint Arthroscopy. A New
Complication
BJOMS 2010. Review. A Review of Techniques of Lysis
and Lavage of the TMJ.
BJOMS 2010. Short communication. TMJ Arthroscopy -
rare neurological complications associated with breach of
the skull base.
The Mayo Clinic
Useful Articles:
BJOMS 1995. Temporomandibular joint arthrocentesis
and lavage for the treatment of closed lock - a follow-up
study
British Journal of Neurosurgery 2000. Extradural
hæmatoma following Temporomandibular Joint
Arthrocentesis and lavage.
BJOMS 2003. An audit of 405 Temporomandibular Joint
Arthrocentesis with intra-articular morphine infusion.
Cochrane Database of Systematic Reviews 2003.
Hyaluronate for Temporomandibular Joint Disorders.
Rev Bras Otorrinolaryngol 2006. Temporomandibular Joint
Arthrocententesis - Evaluation of results and review of the
literature.
Eur J Dent. 2007. The Use of Double-Needle Canula
Method for Temporomandibular Joint Arthrocentesis.
Clinical Report.
Cochrane Database of Systematic Reviews 2009.
Arthrocentesis and lavage for treating Temporomandibular
Joint Disorders.
BJOMS 2009. Therapeutic benefits of TMJ Arthroscopy
and Arthrocentesis - a prospective outcome assessment.
BJOMS 2009. Technical note. A new anatomical
landmark to simplify Temporomandibular Joint
Arthrocentesis.
BJOMS 2009. Technical note. Single Needle
Arthrocentesis.
J Oral Maxillofac Surg 2009. Single-Puncture
Arthrocentesis. Introducing a New Technique and a Novel
Device
J Oral Maxillofac Surg 2009. Horner Syndrome After
Temporomandibular Joint Arthroscopy. A New
Complication
BJOMS 2010. Review. A Review of Techniques of Lysis
and Lavage of the TMJ.
BJOMS 2010. Short communication. TMJ Arthroscopy -
rare neurological complications associated with breach of
the skull base.
| Last Updated 24th November 2010 |