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ARTHROCENTESIS

Jan 16, 2014

Arthrocentesis is often the first surgical procedure that will be done for a patient who has a displaced disc. It can be done as an in-office procedure, when it involves merely the placement of two hyperdermic needles into the joint, or as an outpatient procedure in the hospital if it is done arthroscopically. In the office, it can be done either under local anesthesia and IV sedation or general anesthesia. In the hospital, it is generally done under general anesthesia as an outpatient. When done with hyperdermic needles, the surgeon cannot visualize the joint. However, the literature shows that the results are similar to those obtained when the procedure is done arthroscopically.

Once the joint is numbed or you are put to sleep, the needles or the arthroscope are placed into the joint, and it is flushed with a sterile saline solution or a lactated Ringers solution. The purpose of this procedure is to remove tissue breakdown products and reduce inflammation. The surgeon will generally also manipulate the jaw to remove scar tissue adhesions that may have formed. Removal of adhesions is also done arthroscopically. At the end of the procedure, some surgeons inject a steroid into the joint.

Some surgeons claim that the disc can be repositioned arthroscopically. However, this is generally not possible. As long as there is good jaw mobility, most patients can function without the disc in normal position because the retrodiscal tissue adapts and acts as a pseudodisc.

When you get home (a few hours after the procedure), your joint and the surrounding area will be numb. If your doctor has given you a prescription for pain medication, this would be the best time to take it, as the pain will begin when the numbing medication wears off. You might have some swelling for a few days; however, most people are back at work after two to three days. There are generally no limits on physical activity or use of the jaw; usually the surgeon will recommend a jaw exercise program. You may be told to maintain a soft diet for a little while, but chances are you are already on one.

Latest Scientific Research for Arthrocentisis:

  • Arthrocentesis and Lavage for Treating Temporomandibular Joint Disorders
    "When the joint between the lower jaw and the base of the skull is not working well, the signs and symptoms such as movement problems, noises (clicking or grating), muscle spasms or pain could take place. It is so-called temporomandibular joint disorders. A range of treatment options for treating temporomandibular joint disorders are available such as arthrocentesis and arthroscopy. The review found that there is no enough evidence to judge whether arthrocentesis is more helpful for people with temporomandibular joint disorders than arthroscopy. Reported side effects were mild and transient."
  • Arthrocentesis With or Without Additional Drugs in Temporomandibular Joint Inflammatory-Degenerative Disease: Comparison of Six Treatment Protocols  Although the washing out of the temporomandibular joint (TMJ) associated with arthrocentesis has been shown to be helpful in the management of inflammatory and degenerative conditions, there is a question of whether the additional use of a corticosteroid or hyaluronic acid (HA) improves the results.
     
    In this randomized blinded study, 72 patients with osteoarthritis of the TMJ were randomly assigned to treatment by a single arthrocentesis, a single arthrocentesis followed by injection of either a steroid or high or low molecular weight hyaluronic acid, or by five weekly arthrocenteses followed by injection of a steroid or one of the two forms of HA. When the patients were evaluated for the presence of pain at rest, pain on chewing and chewing efficiency after three months, the results showed no difference among any of the groups. This would indicate that arthrocentesis was the effective modality and that the adjunctive steroid and HA were of no clinical value.

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