1. Injection into the joint
2. Closed manipulation
3. Arthroscopy
4. Arthrocentesis
1. Injection into the joint
¨ Entry into the joint with a needle, may be necessary for the instillation of steroid or local anaesthetic solution
¨ A prerequisite for insertion of an arthroscope as the joint needs to be distended with fluid from within
2. Closed manipulation
¨ In cases of disc displacement without reduction, it is common that adhesions prevent the normal movement of the disc in the upper joint space.
¨ It is sometimes possible to release the lock and increase mobility by closed manipulation
¨ Closed manipulation
¨ The thumb is placed on the posterior teeth and fingers beneath the jaw. The joint is distracted downward then the jaw is pulled forward to disrupt the adhesions
¨ Local anaesthetic is required and post op NSAIDs
3. Arthroscopy
¨ The insertion of a specially designed 2.8mm endoscope into the upper joint space
¨ Patients selected for TMJ arthroscopy surgery have properly diagnosed symptomatic TMJ intracapsular disorders that have not been resolved by conservative measures.
¨ Treatment of muscle or ligament problems, stress and parafunctional jaw habits has been initiated and are in management phase
¨ By inspection alone it is possible to detect disc displacement, adhesions, degenerative changes in the disc and cartilage over the glenoid fossa and articular eminence and synovial inflammation
¨ It is possible if adhesions are detected to sweep around within the joint and break them down
¨ Double-cannula technique:
¨ If two arthroscope ports are used it is possible to perform surgery within the joint under direct vision
¨ Procedures including disrupting adhesions, biopsy and smoothing roughened areas are possible
4. Arthrocentesis
There are several reports of great benefit from simply irrigating the joint with a considerable flow of saline
Irrigation (TMJ lavage) is best performed with two needles in the joint, placed as for arthroscopy, and can be used either alone to flush out inflammatory mediators, or combined with closed manipulation
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