Temporomandibular Joint Injection




Indications and Clinical Considerations


Injection of the temporomandibular joint is indicated as an important component in the management of temporomandibular joint dysfunction, in the palliation of pain secondary to internal derangement of the joint, and in the treatment of pain secondary to arthritis of the joint. Temporomandibular joint dysfunction (also known as myofascial pain dysfunction of the muscles of mastication ) is characterized by pain in the joint itself that radiates into the mandible, ear, neck, and tonsillar pillars. Headache often accompanies the pain of temporomandibular joint dysfunction and is clinically indistinguishable from tension-type headache. Stress is often the precipitating or exacerbating factor in the development of temporomandibular joint dysfunction. Dental malocclusion may also play a role in the evolution of temporomandibular joint dysfunction. Internal derangement and arthritis of the temporomandibular joint may manifest as clicking or grating when the joint is opened and closed and may be easily heard on auscultation of the opening and closing joint ( Figures 1-1 and 1-2 ). Plain radiographs and computerized tomography may help identify arthritic changes, with magnetic resonance imaging useful in identifying articular disk abnormalities ( Figure 1-3 ). If the condition is not promptly treated, the patient may experience increasing pain in the just-mentioned areas and limitation of jaw movement and opening. Recently, the injection of autologous blood and platelet-rich plasma into the temporomandibular joint has gained popularity in the treatment of recurrent temporomandibular joint hypermobility dislocation ( Figure 1-4 ). This injection technique is also useful in the injection of other substances into the temporomandibular joint, such as hyaluronic acid derivatives and tenoxicam.




FIGURE 1-1


Osteoarthritis compared in a specimen radiograph (A) and photograph (B) of a sagittally sectioned specimen. The joint space is narrow and the disk is dislocated anteriorly, with thinning and fraying of the meniscal (m) posterior attachment or bilaminar zone. The condylar head cortex is thickened, with small osteophytes (arrows) . The mandibular fossa is sclerotic and remodeled, and only a shallow concavity is seen where the articular eminence once was.

(From Resnick D: Diagnosis of bone and joint disorders , ed 4, Philadelphia, 2002, Saunders.)



FIGURE 1-2


Internal derangement and arthritis of the temporomandibular joint may manifest as clicking or grating when the joint is opened and closed and may be easily heard on auscultation of the opening and closing joint.

(From Olson KA, editor: Examination and treatment of temporomandibular disorders. In Manual physical therapy of the spine , ed 2, St. Louis, 2016, Saunders; Fig. 7-16.)



FIGURE 1-3


Computed tomography images acquired on a GE high-density 64-slice scanner (GE Healthcare, Cleveland, OH) in spiral acquisition and reformatted in multiplanar reconstructions. A, Left mandible and condyle. B, Right mandible and condyle. The bilateral temporomandibular joints show flattening, lipping, and erosion of the condyle, suggestive of degenerative changes.

(From Brazelton J, Louis P, Sullivan J, et al.: Temporomandibular joint arthritis as an initial presentation of acute myeloid leukemia with myelodysplasia-related changes: a report of an unusual case. J Oral Maxillofac Surg 72[9]:1677–1683, 2014; Fig. 1.)



FIGURE 1-4


Injection of autologous blood into the temporomandibular joint.

(From Daif ET: Autologous blood injection as a new treatment modality for chronic recurrent temporomandibular joint dislocation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:31–36, 2010.)

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Feb 1, 2019 | Posted by in PAIN MEDICINE | Comments Off on Temporomandibular Joint Injection
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