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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
f
ollowing 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