TMJ Injection Technique

Temporomandibular joint injection (TMJ Injection) with steroid is used to treat acute or chronic capsulitis of TMJ.

Capsulitis of the temporomandibular joint may be caused by:

1. OA,
2. Nocturnal teeth grinding,
3. Trauma,
4. Headaches,
5. Eating especially hard or large foods,
6. Clicking or locking.

Clinically

Temporomandibular joint capsulitis symptoms include:

1. Pain over joint line,
2. Poor jaw alignment,
3. Painful opening,
4. Deviation or protrusion of jaw with asymmetry of movement.

Related Anatomy

The temporomandibular joint space can be palpated just in front of the ear as the patient opens and closes the mouth. A meniscus lies within the joint, and the needle must be placed below this to enter the joint space. The joint can be infiltrated most easily when the jaw is held wide open. Occasionally the meniscus is torn during trauma.

Equipment Needed

• Syringe: 1 ml
• Needle: Orange, 25 gauge / 0.5 inch (16 mm)
• Kenalog 40: 10 mg
• Lidocaine: 0.75 ml, 2%
• Total volume: 1 ml

TMJ Injection Technique

• The patient lies on unaffected side, with head supported and mouth held open
• Identify and mark joint space
• Insert needle vertically into inferior compartment of joint space, below meniscus
• Inject solution as a bolus

Avoid excessive movement of the jaw, such as biting on a large apple or eating hard food. Gentle active movements and isometric exercises can be carried out. A mouth guard to prevent grinding the teeth at night and/or the advice of an orthodontist might be required.

Notes

It might be necessary to maneuver the needle about to avoid the meniscus. If the meniscus is displaced, reduction by manipulation should be attempted about a week after giving the injection, when the inflammation has subsided.

In resistant cases, surgery may be necessary. Occasionally this condition arises in a patient suffering from severe tension; in this case an appropriate stress relieving approach is worth trying.

A study found that TMJ steroid injection technique can be safely performed by experienced oral and maxillofacial surgeons without a requirement for computed tomographic guidance. In addition, these results show that TMJ steroid injection may be effective in the management of TMJ arthritis, although further studies are required.

Another study found that intra-articular TMJ injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ.

References & More

1. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition
2. Stoll ML, Good J, Sharpe T, Beukelman T, Young D, Waite PD, Cron RQ. Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis. J Oral Maxillofac Surg. 2012 Aug;70(8):1802-7. doi: 10.1016/j.joms.2011.11.003. Epub 2012 Jan 21. PMID: 22265164.
3. Machado E, Bonotto D, Cunali PA. Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review. Dental Press J Orthod. 2013 Sep-Oct;18(5):128-33. doi: 10.1590/s2176-94512013000500021. PMID: 24352399.
4. Agus B, Weisberg J, Friedman MH. Therapeutic injection of the temporomandibular joint. Oral Surg Oral Med Oral Pathol. 1983 Jun;55(6):553-5. doi: 10.1016/0030-4220(83)90367-5. PMID: 6576284.
5. de Souza RF, Lovato da Silva CH, Nasser M, et al. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev. 2012;(4):CD007261.