TMJ Arthroscopy & Arthrocentesis
TEMPOROMANDIBULAR JOINT ARTHROSCOPY AND/OR ARTHROCENTESIS
Arthroscopic surgery of the temporomandibular joint involves the insertion of a fine “needle arthroscope” into the temporomandibular joint via a small external skin puncture located just beside the ear. Depending on the nature and the severity of the condition, several additional punctures may be required to facilitate arthroscopic instrumentation and the introduction of various medications within the joint.
Arthrocentesis is a simpler procedure than arthroscopy involving a wash out of the joint using two needles and irrigation of the joint. It can be carried out as a “stand alone” procedure or in combination with arthroscopy.
Generally the procedures are carried out as day surgery cases in hospital.
The information below is a guide for patients to follow on discharge from hospital:
- HYGIENE/CARE OF WOUNDS.
A dressing is usually applied in the operating theatre which generally can be removed after 24 hours. It is possible to shower providing the wounds are not directly placed under the shower head. The wounds can become a little damp but should be carefully dried off with a clean towel following your shower. It is also permissible to wash your hair after 24 hours but once again the wounds should not get soaking wet.
No additional dressing should be necessary and it is permissible to have the sutures exposed. No sutures are usually necessary for arthrocentesis procedures. Dressings should be kept in place whilst using an ice pack.
- SWELLING AND BRUISING.
Temporomandibular joint arthroscopy is carried out using a fibreoptic light which is cooled using copious quantities of saline. Some of this leaks out into the tissues and for the first 6-8 hours you may have a large “squishy” swelling over the joint which should gradually dissipate. It is unusual to sustain bruising following arthroscopy but occasionally you can experience some minor bruising tracking out onto the face. You may be provided with an ice pack to use on your face. This should NOT be applied DIRECTLY to wounds which must be covered with dressings whilst you are using the ice packs. Usually you would not need ice packs for longer than 48 hours. The ice packs can be refrozen and reused and kept going for 48 hours.
Local anaesthetic is injected into the joint during the procedure and you will experience post-operative numbness which may last 6-8 hours and occasionally longer. On rare occasions a nerve may be bruised by the procedure and you may have some prolonged numbness over the joint which may even become a permanent patch of altered sensation.
Bleeding is unusual following temporomandibular joint arthroscopy. If the wound oozes or bleeds rest quietly with your head elevated and place a pressure pack over the wound. If bleeding persists beyond 30 minutes please contact Dr. Bowler or the hospital in which you were treated.
Your diet should consist of soft food for the first 48 hours and you can slowly increase the texture of your food over the following 7-10 days.
Patients who smoke run the risk of wound breakdown. Heavy smokers may be asked to cease smoking at least three months before surgery. For other smokers it is highly recommended you do not smoke for at least ten days following the surgery to allow the wounds to heal.
- SPECIAL ASPECTS
It is important to minimise your jaw movements for the first 24 hours and patients should avoid excessive talking, yawning, chewing or attempting to open wide within the first 24 hours. From 24 hours onwards it should be possible to slowly stretch the jaw and ideally you should aim to achieve two fingers breadth of opening by the time you re-attend a week later for suture removal. This may cause some discomfort within the joint and the jaw should not be “forced” open. Your jaw movements will gradually improve with slow and gentle exercises.
As indicated earlier, local anaesthetic is used during the surgery. This, together with the surgical manipulation, may cause you to have a degree of facial palsy resulting in an inability for you to raise an eyebrow on the affected side following arthroscopic surgery. This should resolve in 6-8 hours but occasionally may take up to three months. Very rarely the facial nerve may be damaged by the procedure and you may have some permanent facial palsy of a varying degree.
You will frequently be given a copy of one of the video prints taken from the video printer in the operating theatre. Dr. Bowler will usually explain the findings either on discharge or when you return the following week. The copy of the video print is for you to keep. There is no need to bring it with you when you return for suture removal as Dr. Bowler keeps a copy in your notes and also a copy in the hospital notes. He will explain the findings from his own copy.
- POST-OPERATIVE MEDICATIONS AND SUPPLIES ETC
You will be provided with the following on discharge:
A course of antibiotics.
You will have been given intravenous antibiotics in the operating theatre and possibly on the ward. A prescription for your oral antibiotics will be available for you to take home or alternatively the ward may have the prescription filled for you before discharge. IT IS ESSENTIAL YOU COMPLETE ALL OF THE ANTIBIOTICS as indicated on the label.
These are also prescribed and the prescription will be available for you to take home or, as with the antibiotics, the ward may have the prescription filled for you before discharge. Generally “middle of the range” analgesics are satisfactory for pain control following T.M.J. arthroscopy.
Chloromycetin ointment (small tube).
You will also receive a tube of antibiotic ointment (Chloromycetin ointment) to apply as a thin smear to your external “stab wounds” twice a day.
- FOLLOW-UP CARE
It is essential you make arrangements for follow-up. Generally you will have been given an appointment to see Dr. Bowler prior to booking your surgery however if for some reason you do not have an appointment please telephone the practice on 4942 1211 to make an appointment. There are usually one or two non-resorbable sutures placed in the punctures used for arthroscopy and these are removed the day of your follow-up visit.
If you have any concerns following your surgery please do not hesitate to contact the hospital in which you were treated. Dr. Bowler can be reached through the hospital and is available most times. If for some reason this is not possible, there is a 24 hour service available through Lake Macquarie Private Hospital Emergency Department Tel 02 4947 5700