TMJ Arthrocentesis: Possible Complications

[DrAnil]

Complications:

Complications after puncture of the TMJ depend on the
anatomy of the joint and its relations.

Possible complications of TMJ / Jaw Joint Arthrocentesis
also depend on the technique used. The complication rate
following TMJ / Jaw Joint Arthrocentesis is given as
between 2 – 10%.

Complications usually present in the immediate post-
operative phase and are mostly associated with fluid
collection and vascular injury.

Facial Muscle Weakness (< 1.0%) (temporary / permanent) resulting from injury to the Facial Nerve whilst gaining access to the jaw joint space. The most common problem resulting from this, is the inability to wrinkle the brow, raise the eyebrow or gain tight closure of the eyelids. Numbness (< 2.5%) (temporary / permanent) of certain areas of skin in the region of the jaw joint and sometimes in more remote areas of the face or scalp. Bleeding within the jaw joint which cannot be adequately controlled and could require immediate intervention by open joint surgery. Ear problems (< 9.0%), including inflammation of the ear canal, middle / inner ear infections, vertigo, perforation of the ear-drum and temporary / permanent hearing loss. Instrument Separation (that is, the needle breaks off within the joint space) which may require open joint surgery. Facial Scarring from the entry injection. Damage to the jaw joint surface during the arthrocentesis procedure, usually of a reversible nature but which could permanently affect joint function. Unsuccessful entry into the jaw joint or inability to accomplish the desired procedure because of limited motion of the jaw joint / scarring. Worsening of present TMJ symptoms which may require repeat arthrocentesis, arthroscopy or open joint surgery. Changes in the bite after arthrocentesis which may affect chewing functions. In addition, there may be temporary / permanent limited mouth opening. Post-operative infection requiring additional treatment. Adverse / Allergic reactions to any of the medications used in the procedure. Pre-Auricular Hæmatoma. Extravasation of fluid from the jaw joint into the surrounding tissues. Rare complications include: • Horner syndrome • Upper airway compression • Para-pharyngeal swelling • Variant petro-tympanic fissure • Infection of the infra-temporal space • Pseudo-aneurysm and arterio-venous fistula • Superficial temporal artery aneurysm • Trans-articular perforation • Intra-cranial perforation & extra-dural haematoma