Nickolas S. Maskas DDS, MD
What is arthrocentesis and how is it performed?
Arthrocentesis is a minor procedure that involves the insertion of 2 small needles through the skin in front of the ear and into the TMJ which are used to perform various beneficial tasks. First, a local anesthetic is administered in the area of the joint(s). Next, the 2 needles are inserted into the joint and a solution is used to rinse the joint space, break up joint adhesions (scar tissue) and finally steroids are injected into the joint. There are no incisions and no scars.
Which patients benefit from arthrocentesis the most?
It is important to note that not all patients are good candidates for arthrocentesis. Patients who can benefit from the procedure the most are those with specific pain localized to the TMJ(s) and those with limited mouth opening which has been determined to be due to a problem with your TMJ disk (see TMJ/facial pain section of website). Your consultation visit with Louisiana OIS will determine if you are a good candidate for the procedure.
What are the potential benefits of arthrocentesis?
~80% of patients undergoing arthrocentesis will see a decrease in their pain and an increase in their mouth opening at approximately 2-3 weeks out from their procedure. Although ~80% of patients will see significant relief from the procedure, it is important to recognize that ~1 in 5 patients will not experience relief of symptoms. This is a risk of undergoing the procedure.
How quickly will I get the benefits of arthrocentesis?
It is important to note that arthrocentesis does not provide immediate relief. Maximum benefit from arthrocentesis (decreased pain) will usually be achieved about 2-3 weeks after the procedure.
Does arthrocentesis provide significant relief for 100% of patients?
Arthrocentesis is a very successful procedure; however, pain can be difficult to treat, and no procedure known to the medical field can guarantee alleviation of pain 100% of the time. The good news is that arthrocentesis is effective for the vast majority of people who are good candidates for the procedure (see above). Studies show that ~80% of patients will have significant relief within about 2-3 weeks after undergoing arthrocentesis.
Why does rinsing the joint and injecting steroids work?
An important concept in understanding why arthrocentesis works is to know that the main cause of TMJ pain is joint inflammation. This inflammation is caused by molecules produced by your body known as inflammatory mediators. Irrigating (rinsing) the joint flushes away these molecules from the joint and decreases inflammation and pain. Damaged joints also contain bits of scar tissue called adhesions which can limit mouth opening. The pressure created during the arthrocentesis can effectively break up these adhesions and improve mouth opening. Finally, a steroid (triamcinolone) will be injected into the joint after the irrigation is complete. Steroids are anti-inflammatory drugs which will decrease inflammation and pain in the joint.
What are the anesthesia options for arthrocentesis?
Most arthrocentesis procedures are performed with IV sedation. Please see the anesthesia options section of the website for information regarding IV sedation.
What are the risks of arthrocentesis?
Arthrocentesis is a minor procedure with minimal risk. However, as with anything in life there are risks. The main risk associated with arthrocentesis is failure to improve symptoms. Although ~80% of patients will see significant relief from the procedure, it is important to recognize that ~1 in 5 patients will not experience relief of symptoms and this is a risk of undergoing the procedure. Other, more rare risks of the procedure will be discussed during the informed consent process prior to the procedure.
What can I expect after arthrocentesis?
Several symptoms are normal and expected after the procedure. You can expect mild swelling in front of the ear. You can also expect a soreness in front of the ear resembling a dull ache which may persist for 2-3 days before subsiding. A “squishing” sound may also be heard in the ear due to fluid in the joint space for 2-3 days. Finally, the way your teeth bite together may feel differently for 2-3 days due to fluid in the joint. You will be given a paper after your procedure outlining all of the post-op instructions and expectations.
Is there anything I should do to maximize my benefits from the procedure?
Most importantly, you should perform aggressive range of motion (jaw stretching) exercises in order to maximize your mouth opening benefits after the procedure. This is accomplished by opening your mouth as wide as possible every 30 minutes while you are awake.
Will the arthrocentesis procedure need to be repeated?
If you experience significant relief from the procedure, it is possible that your symptoms may return. If you responded well to the procedure initially and your symptoms later return, the procedure may be repeated approximately every 6 months to 1 year.