TMJ Injection

TMJ Injection
Indication	TMJ Pain
Syringe	1mL
Needle	27-gauge 3.2 mm
Injectate	steroid, 20% dextrose, or PRP
Steroid	20mg triamcinolone
Volume	1mL

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Technique

Landmark Guided

Injection entry site, located 0.75 to 1 cm below the apex of the zygomatic arch.^[1]

Injection angle of 45° cranial and 10° posterior, using a 1-in 30-G needle.^[1]

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 10° posterior angulation, and 45° 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, facial nerve palsy.

Aftercare

Avoid NSAIDs if prolotherapy or PRP.

References

↑ ^1.0 ^1.1 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,

[dextroserct-1] 1.0 ^1.1 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.

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