TMJ Injection

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


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. 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