TMJ Injection: Difference between revisions
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|syringe=1mL | |syringe=1mL | ||
|needle=27-gauge 3.2 mm | |needle=27-gauge 3.2 mm | ||
|injectate=steroid, dextrose, or PRP | |injectate=steroid, 20% dextrose, or PRP | ||
|steroid=20mg triamcinolone | |steroid=20mg triamcinolone | ||
|local= | |local= | ||
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[[File:TMJ Injection.jpg|Injection angle of 45ยฐ cranial and 10ยฐ posterior, using a 1-in 30-G needle.<ref>{{#pmid:30878157}}</ref>|thumb|right|200px]] | [[File:TMJ Injection.jpg|Injection angle of 45ยฐ cranial and 10ยฐ posterior, using a 1-in 30-G needle.<ref>{{#pmid:30878157}}</ref>|thumb|right|200px]] | ||
*Relaxed, closed-mouth approach. ย | *Relaxed, closed-mouth approach. ย | ||
* | *Place finger in the depression under the zygomatic arch, against the zygoma, and draw a curved line approximating the bottom of the arch. ย | ||
*Ask the patient to open and close their mouth and confirm the location of the posterior mandible. Feel the head of the mandible pass anteriorly underneath your finger and then resume its posterior position | *Ask the patient to open and close their mouth and confirm the location of the posterior mandible. Feel the head of the mandible pass anteriorly underneath your finger and then resume its posterior position | ||
*Needle (27-gauge 3.2 mm) entry is 1cm below the apex of the zygomatic arch with slight | *Needle (27-gauge 3.2 mm) entry is 1cm below the apex of the zygomatic arch with slight 10ยฐ posterior angulation, and 45ยฐ of cephalad angulation | ||
*If the needle inadvertently made bony contact shallower than 25 mm, withdraw the needle several mm and redirect superiorly to avoid the mandibular condyle. | *If the needle inadvertently made bony contact shallower than 25 mm, withdraw the needle several mm and redirect superiorly to avoid the mandibular condyle. | ||
*After aspiration, inject 1 mL was at 25 mm depth | |||
===Ultrasound Guided=== | ===Ultrasound Guided=== | ||
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{{Reliable sources|synonym1="temporomandibular joint injection"}} | {{Reliable sources|synonym1="temporomandibular joint injection"}} | ||
[[Category:Head & Jaw Procedures]] | |||
[[Category:Infobox Templates]] | [[Category:Infobox Templates]] | ||
[[Category:Infoboxes]] | [[Category:Infoboxes]] | ||
Revision as of 16:49, 5 April 2021
TMJ Injection | |
---|---|
Indication | |
Syringe | 1mL |
Needle | 27-gauge 3.2 mm |
Injectate | steroid, 20% dextrose, or PRP |
Steroid | 20mg triamcinolone |
Volume | 1mL |
Anatomy
Indications
Contraindications
Pre-procedural Evaluation
Equipment
Technique
Landmark Guided
- Relaxed, closed-mouth approach.
- Place finger in the depression under the zygomatic arch, against the zygoma, and draw a curved line approximating the bottom of the arch.
- Ask the patient to open and close their mouth and confirm the location of the posterior mandible. Feel the head of the mandible pass anteriorly underneath your finger and then resume its posterior position
- Needle (27-gauge 3.2 mm) entry is 1cm below the apex of the zygomatic arch with slight 10ยฐ posterior angulation, and 45ยฐ of cephalad angulation
- If the needle inadvertently made bony contact shallower than 25 mm, withdraw the needle several mm and redirect superiorly to avoid the mandibular condyle.
- After aspiration, inject 1 mL was at 25 mm depth
Ultrasound Guided
- Challenging, consider using if failed landmark guided injection
- Use a high-frequency linear small footprint probe
- Place longitudinally over the TMJ.
- Visualise superficial temporal vessels overlying the joint.
- Move probe cranially to allow needle to enter skin
- Enter joint space in plane with 23G needle
- Inject solution into joint space
Complications
damage to the collateral ligaments of the disc and the adjacent soft tissue
Aftercare
Avoid NSAIDs if prolotherapy or PRP.
Videos
See Also
External Links
References
- โ Louw et al.. Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover. Mayo Clinic proceedings 2019. 94:820-832. PMID: 30878157. DOI.
- โ Louw et al.. Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover. Mayo Clinic proceedings 2019. 94:820-832. PMID: 30878157. DOI.
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,