What is a TMJ arthroscopy?

A temporomandibular joint arthroscopy is a type of advanced keyhole surgery which has both diagnostic and therapeutic benefits. An arthroscope (less than 2 mm tube with a camera) is inserted into the joint. This allows the joint to be examined and instrumented to achieve benefit with minimal risk when compared to open jaw joint operations. It is indicated when medical and conservative management alone are not satisfactory. This is carried out under general anaesthetic.

What is TMJ arthrocentesis?

TMJ arthrocentesis is a procedure where the joint is washed out with sterile fluid under pressure. This can be combined with instillation of intra articular medicines or protein rich plasma which is taken from your blood to help reduce inflammation. It has no particular benefit.

Before surgery

For the best outcome we advise jaw physiotherapy prior to the surgery, which needs to be continued after surgery. You might have been advised to see your dentist to obtain a mandibular anterior repositioning splint prior to the surgery.

If you smoke, consider giving up for several weeks prior to the operation. Smoking reduces the amount of oxygen in your blood and increases the risk of breathing difficulties during the operation.

You will have an appointment with our pre-operative assessment team prior to the surgery. Continue to take your medications as normal unless you have been advised otherwise. If you are taking any blood thinners or anticoagulants it is important to let us know.

During surgery

Diagnostic arthroscopy (level one)

The procedure is carried out under general anaesthetic as a day-case. A surgical port measuring less than 2mm is made in front of the ear and camera introduced into the joint space. This allows for washing out of the joint as well as accurate diagnosis of the condition. The outcomes are excellent in selected cases.

Therapeutic arthroscopy (levels two and three)

The procedure is carried out under general anaesthetic as a day-case. Two or three surgical ports measuring less than 2mm are introduced in front of the ear and under the cheek bone to introduce two or three sets of instruments, including a camera, to directly visualise, diagnose, washout, possibly biopsy, reposition the abnormal disc structure and surgically remove inflamed tissue within the joint space.

Medication is also introduced into the joint. The patient would expect two or three stitches, which will usually dissolve. There is minimal scarring, and rarely noticeable. The outcomes are excellent in selected cases. Less so in the most advanced cases of joint arthritis. It is worth noting that selected patients might require more than one intervention.

After surgery

The area around your jaw joint may be swollen and stiff for a few days after the operation. Painkillers (for example paracetamol and ibuprofen, if safe to use) can be used to help manage the pain and can be bought at the pharmacy over the counter. You will have two stitches, one in front of the other, about one and two centimetres from your ear. You will not be asked to return to have these stitches removed as they dissolve.

In most cases, you will go home on the same day however you will need someone to pick you up from the hospital.

After you go home

  • Swelling is common and ice packs for 24 hours can be used to help reduce this.
  • Keep your head elevated with two or three pillows to help reduce swelling.
  • In some circumstances, you may feel your bite may also temporarily change.
  • Your hearing might be temporarily affected, and your ears might feel blocked for few weeks following the surgery and this will gradually improve.
  • Eat soft foods for about a week. Avoid crunchy and chewy foods for one to two weeks.
  • You should undertake jaw exercises beginning two weeks after the surgery, four times a day for at least six weeks following the surgery and continue to see your physiotherapist. This is important to prevent stiffness of the jaw which can delay recovery.

Side effects

More common risks include pain, bleeding, bruising, and swelling. Infection is a rare complication with serious consequences which can happen. It is important to keep the area clean to reduce the risk of infection. Less common risks include hearing loss, temporary weakness of the facial muscles. You can expect two small scars (around 2mm in length) in front of the ear. Selected patients benefit from arthroscopies and some patients will requirecfurther interventions specially if the disease is advanced.

Do I need to take time off work?

This changes from person to person. Most people may require between two to seven days off work after the procedure. You cannot operate machinery or drive for 24 hours after a general anaesthetic.

When should I contact the hospital?

  • If you have difficulty breathing.
  • An increase in swelling two or three days after the surgery.
  • If you have difficulty closing your eyes after the surgery.
  • If you have severe pain that is not relieved by pain medication.
  • If you experience a rash, vomiting, severe headache or other unexpected reactions.

Will I need to come back after the surgery?

You will have a follow up appointment in our clinic around six weeks post-surgery.