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Jaw Joint Washout
(
TMJ Arthrocentesis)
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.
Jaw Joint / TMJ Arthrocentesis reduces jaw joint pain,
improves jaw joint function and reduces jaw joint clicking.

Jaw Joint / TMJ 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
palce (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.

  • Facial Muscle Weakness (< 1.0%) (temporary /
    permanent) resulting from injury to the Facial Nerve
    whilst gaining access to the 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 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:

Emedicine – TMJ Arthrocentesis Treatment

The Mayo Clinic


Useful Articles:

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.  Leading article.  Current thinking in
Temporomandibular Joint management.

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.

BJOMS 2010.  Review article - Oral Surgery and TMJ-
related papers published in BJOMS in 2008 and 2009.

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 1st March 2011