Many patients present to our pain and spine clinic with complaints of
- Aching pain in and around the ear
- Difficulty chewing or pain while chewing
- Aching facial pain
- Difficulty or pain while opening and closing the mouth
- These are typically attributed to TMJ problems. This pain can radiate to the temples and mandible. Clinical examination can confirm the probable diagnosis but final confirmation and severity of TMJ damage can be assessed using a cone beam CT scan (CBCT).
What are the causes of TMJ pain?
- Various types of arthritis, such as rheumatoid arthritis and osteoarthritis
- Jaw injury
- Long-term (chronic) grinding or clenching of teeth
- Certain connective tissue diseases that cause problems that may affect the temporomandibular joint
Can stress and anxiety lead to TMJ pain?
Stress and anxiety are your body’s natural way of reacting to difficult situations, and when persistent, can be detrimental to your health. Common symptoms of stress can be an inability to sleep, headaches, teeth grinding, and muscle pain.
Because of the common link between stress and teeth grinding, it is easy to develop TMJ disorder as a result. Dr. Aggarwal explains that temporomandibular joint disorder (TMJ) can develop over time. This is as a result of restless, stress-induced sleep where you are grinding your teeth and jaw clenching unconsciously. Constant wear and tear can misalign your jaw and cause chronic neck and muscle strain as well. When you’re in constant pain and lacking quality sleep, your body remains in a heightened state of stress creating a vicious cycle.
Treatment
- Dental mouthguard with NSAIDS, muscle relaxants and anxiolytics
- Physiotherapy: TENS, Ultrasonics and strengthening exercises
- TMJ arthrocentesis and Intraarticular steroid
- PRP therapy and growth factor concentrate injection
- Botox therapy
- Surgery
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 anesthetics, painkillers or collagen components.
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 local anaesthesia. The 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 (right photo)
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.
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.
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.
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.
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.
Pre-Auricular Hematoma. A blood clot can develop in front of the ear.
You can write at www.painxtotal@gmail.com or Whatsapp me at +919958830005. We are committed to providing the best Interventional Pain Management solutions in Delhi NCR.
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