Overview

Temporomandibular joints (TMJs)

The TMJs are the jaw joints that are just in front of your ears. The TMJs are made up of:

• 2 bones (the lower jaw and socket)
• the disc which sits inside the joint, separating the 2 bones, and allows you to smoothly open and close your mouth
• the muscles that move the jaw, that are attached to the joint

Arthrocentesis is usually used to treat disc and joint problems of temporomandibular disorders (TMDs), not the jaw muscles.

Temporomandibular disorders (TMDs)

TMDs affect the movement of the jaw. Although this can be serious, it usually gets better on its own.

It is important to identify which structure is affected as this affects how it can be managed.

TMDs that are related to the disc

A healthy disc should glide with the lower jaw bone as it moves. The most common disorder related to this is disc displacement. This is when the disc is in an abnormal position within the joint. This is very common and can often go unnoticed as there are no symptoms. The different positions of the disc can cause pain when you use your mouth.

We do not try to change the disc’s position, but we try to treat the symptoms that it’s causing.

Arthroscopy

An arthroscopy is keyhole surgery that allows the surgeon to see inside your TMJ. They use a camera inserted through a small cut in your skin in front of your ear. It helps us to diagnose and treat your condition.

Arthrocentesis

Arthrocentesis is when the jaw joint is washed out with sterile fluid. It aims to wash out any inflamed tissue from the joint, to reduce pain and swelling. The treatment can also improve function.

Having arthroscopy and arthrocentesis

The operation is done under a general anaesthetic, and takes about 45 minutes for each joint.

The surgeon will disinfect the skin and give an injection of local anaesthetic to numb the area.

When the procedure is complete, bandages are placed over the treatment area and sometimes stitches are used to close the wound.

This is day surgery, meaning you should be able to go home on the same day.

While you’re under anaesthetic, your lower jaw is moved to try and get better jaw movement for you. Sometimes, local anaesthetic or steroids are injected into the joint to temporarily ease pain and inflammation.

Alternative treatment options

Sometimes the symptoms of TMD can be managed by using a combination of:

• soft diet
• painkillers
• local heat application
• physiotherapy (jaw exercises)
• bite-raising appliances (mouthguard)
• acupuncture
• physiotherapy

Sometimes, antidepressants can be used to treat chronic (long-term) pain.

Benefits of arthrocentesis

Most patients get 30% less pain from this procedure. Some patients also have improved jaw movement.

Risks of arthrocentesis

The main risk is that the procedure will be unsuccessful in treating your symptoms.

Specific risks and complications for TMJ surgery are rare, affecting up to 1 person in 10 (2 to 10%). These complications include:

• unsuccessful entry into the jaw joint because of limited joint space
• the current TMD symptoms get worse
• ear problems including inflammation of the ear canal, middle- or inner-ear infection, vertigo, perforation of the eardrum, and temporary or permanent hearing loss (rare)
• temporary or permanent numbness of the skin around the temple (rare)
• Temporary or permanent facial muscle weakness, making it difficult to raise eyebrows or tightly close eyelids (rare)

After the arthrocentesis

The area in and around the jaw joint will feel uncomfortable for a couple of days after the procedure. There is likely to be some swelling in front of your ear. It might be difficult to open your jaw for a few weeks.

Pain after the procedure

If you have pain after the procedure, it is important that you take your painkillers on a regular basis for the first few days. Taking them regularly will keep the medicine at a constant level in your body, so will control your pain better. After a few days, you can gradually reduce your painkillers until you do not need them. Please contact the hospital or your GP if you find the pain difficult to manage.

Anti-inflammatory medicine (such as ibuprofen) and paracetamol can be taken regularly as prescribed. If you can’t take anti-inflammatory medicine, other painkillers can also be used.

Always follow the instructions on the packet, and never take more than the recommended amount (dose).

Other medicines

Dihydrocodeine (a stronger painkiller) should only be taken for breakthrough (sudden or short-term increases) pain when needed, as prescribed.

Muscle relaxants might be prescribed to reduce muscle spasms and muscle pain.

Getting back to your normal activities

Generally, there are no limits to physical activity or using your jaw. Your surgeon might give you advice about jaw exercises, and you will usually be advised to eat a soft diet for up to a few weeks.

Aftercare advice

• Keep all wounds dry for 48 hours after surgery. Avoid getting the areas wet by covering with a large waterproof bandage.
• Eat soft foods, such as soup, porridge, mashed potato, well-done pasta, peas.
• Avoid vigorous exercise, such as running and aerobics, and do not lift anything heavy, for the first month. Gently build up your exercise, as you feel able to.
• Do not chew gum, and avoid too much jaw movement.
• Use your mouthguard, if you have one, for clenching and grinding.

Jaw exercises

It’s important that you do the jaw exercises as instructed. These should:

• give you an increased range of movement
• restore and improve function
• reduce long-term soreness

Without a full range of motion, the scar tissue (adhesions) within the joint can limit your mouth-opening, and pain can increase significantly. There will be some discomfort at first when you do these exercises, but try to move your jaw as much as possible. Taking anti-inflammatory medicines, such as ibuprofen, an hour before your exercises will help.

You can watch our films about jaw exercises

Follow-up appointments

You will need to return a few weeks or months after surgery to have your jaw joint checked by your surgeon. Arthrocentesis is not always successful. Sometimes, even people who improve after the procedure do not benefit in the long term.