After TMJ Procedures

TMJ medication or biologic concentrate injection

The purpose of medication or biologic concentrate injection into the temporo-mandibular joint is to reduce pain, assist healing and improve function. Whether the injection consists of a steroid, hyaluronic acid, or platelet rich plasma, the after care is the same.

  1. Rest the affected joint. This means a diet that is non-chewing for the first few days (3-5) and then progressing to a diet that is mechanically soft, e.g.: scrambled eggs, well cooked vegetables and fish or soft chicken. To be avoided are foods like bagels, beef jerky, nuts, and tougher meats. Chewing Ice is to be avoided as well.
  2. It is normal for the upper and lower teeth on the side of the injected joint not to touch for few days. This occurs because the fluid in the joint pushes the lower jaw downward and opens the bite. The fluid in the joint must be absorbed by the body before the teeth touch again. Do not try to force the teeth to touch, but let this happen naturally.
  3. It is normal to have increased discomfort in the joint area for a few days after the injection. Continue to take the anti-inflammatory you have been prescribed (usually Meloxicam) and use the narcotic pain reliever as needed for the first couple of days.
  4. It is normal to have limited movement for a few days after the injection. If you have been advised to do range of motion exercises, start these as instructed a week after the injection.The exercises should be done to the point of mild discomfort that resolves after the exercise. If the pain increases during the exercise, or afterward, reduce or discontinue the exercise until the pain resolves.
  5. Application of ice to the affected joint, 20 minutes on and 20 minutes off, for the first 24-48 hours will help with discomfort and swelling.
  6. You may remove the Band-Aid after 24 hours and allow water from a bath or shower over the joint after 48 hours.
  7. Bruising of the skin around the injection site happens occasionally and will resolve on its own.
  8. Range of motion exercises, if specified, consist of mouth opening to maximum movement, chin protrusion to maximum movement, and right and left lateral jaw movements, 10 times each per exercise session, three times a day
  9. You may have temporary loss of movement in the muscles that elevate your eyebrow and close your eye tightly, on the side of the treated TMJ. This is because the local anesthetic solution injected to numb the joint also can temporarily block the nerve that moves these muscles. Usually the loss of muscle movement will wear off as the local anesthetic is metabolized.

TMJ Arthrocentesis ( Jaw Joint Irrigation)

The purpose of TMJ arthrocentesis, or jaw joint irrigation, is to reduce the inflammatory, pain causing chemicals that accumulate in the joint after injury or prolonged inflammation and immobility. An arthrocentesis can also help to re-mobilize a joint that has temporarily lost movement due to an injury. All of the above after care instructions apply, with the addition of the following:

  1. Swelling is normal after arthrocentesis as a side effect of the fluid used to rinse out the joint diffusing into the surrounding tissues. The swelling will resolve on its own and can be helped by applying ice as discussed above, for the first 24-48 hours. Thereafter, a daily application of heat for 20 minutes, at the end of the day will be helpful in swelling resolution as well.

TMJ Arthroscopy

The purpose of TMJ arthroscopy is to reduce pain and re-establish normal range of motion in a temporo-mandibular joint that demonstrates long-standing loss of movement and pain, where injection and /or arthrocentesis has failed, or would not be effective in restoring normal joint function. The TMJ arthroscopy is performed in an out-patient surgery facility under general anesthesia. If intra-operative photographs are taken, you will be given copies. All of the above after care instructions apply, with the addition of the following:

  1. You will have a small (about 1/4inch) incision in front of your ear canal that will be sutured. Please keep the incision covered for 48 hours with a Band-Aid and antibiotic ointment (Bacitracin or Neosporin). After 48 hours, you may shower and dress the incision with a small dab of the antibiotic ointment 3 times daily. This will minimize the chance of infection and scar formation. The sutures will be removed about 1 week post-operatively.
  2. You may have decreased hearing in the ear on the side of the treated TMJ, for a few days. This occurs because biologic fluid from the procedure congests the middle ear and dampens the transmission of sound, until the fluid clears. This may take a few days, but your hearing will return to its pre-treatment state.
  3. As mentioned above in #9, the nerve that animates the forehead and eye-closing muscles can be blocked by the local anesthetic used to numb the joint. Usually this side- effect resolves as the local anesthetic wears off, but with arthroscopy, can persist longer because of pressure put on the nerve by the fluid in the tissues around the joint. It is extremely unusual to have this temporary loss of nerve function not resolve completely.
  4. TMJ remobilization exercises are always given 1 week post-operatively and should continue until full jaw range of motion is achieved.