TMJ arthrocentesis

I opened my eyes. It took some time until I realised where I was and what just happened. A nurse stood on the left side of my bed, checking my blood pressure in intervals of few minutes. "How are you feeling?", she asked. "Thirsty..."

My first word after waking up from the arthrocentesis came out strange. Not the voice, but the mouth movement. It felt odd as if my lower teeth wouldn't fit into the upper, being the whole jaw misaligned. I tried to open and close my mouth slightly a few times to check how was the right TMJ. Spongy. That's the best word to describe it - spongy. There was something spongy inside my right TMJ, some extra volume that somehow felt like a thick cushion preventing the right side of my lower jaw to close completely.

"How is the pain?"

"It hurts..."

"Can you tell me from one to five how bad is the pain?"

"Errr... Don't know... Four?...", I asked myself out loud. I was still confused from the anaesthesia, although I was awake enough to start feeling the pain kicking in. I saw the nurse injecting a fluid through the needle I had in my left hand.

Sometime passed, although I can't precise how long it was.

"How's the pain now from one to five?"

"Still hurts... A four, I think..."

"Can you take codeine? Are you allergic to it?"

"I don't know... Never had it..." I never even heard that name before. What was codeine for?

Well, codeine and I would become "best friends" later.

I was waking up after a TMJ arthrocentesis performed whilst under general anaesthesia. But what kind of procedure is this? What have they done to me exactly?

As I mentioned on my previous post, a TMJ arthrocentesis is a minor surgical procedure where the TMJ is  flushed or washed. The procedure is done by inserting two needles in the joint capsule from which a saline and anti-inflammatory solution is injected in and out (see image below), in order to remove any possible adhesions or scar tissue formed during the inflammatory process of a TMJ disorder. It is intended to alleviate the pain and discomfort by lubricating the joint and promoting jaw mobility.

 TMJ arthrocentesis: fluid injection and removal through needles inserted in the joint capsule 

(image source)

In all our arthrocentesis-related research, Davide and I couldn't find any independent references that would give real scientific evidence of the success of this intervention for any specific cases of TMJ disorder. The information available is generally very vague, and in most cases given by TMJ specialists who clearly benefit from  advertising TMJ cures. This is true for all kinds of TMJ surgeries and more conservative methods of TMJ disorder management. Bare in the mind that both of us are PhD level researchers at Cardiff University and we do have almost unlimited access to scientific publications.

The only independent website we were able to find was TMJ Hope, a group whose main goal is to provide support and information for people affected by TMJ disorders. You can read their article on TMJ arthrocentesis here.

We found this intervention is usually performed under light sedation at an oral-maxillofacial surgeon's office. In my case, I was an outpatient of the main hospital and was under general anaesthesia, which I would definitely recommend.

After the arthrocentesis, I was under observation for a few hours only because of the general anaesthesia. I left the hospital later that day, with the right side of my face slightly swollen and with a small plaster in front of my right ear. Apart from my slightly absent look (only because of the anaesthesia), nobody would say I had gone through a surgery. However, and despite all the codeine I was given, I was in pain.

It took me a week to recover from the anaesthesia, as I felt really tired and weak.

Regarding the right TMJ, slowly I felt my lower jaw returning to its "normal" position, with my upper and lower teeth fitting nicely as before. The spongy sensation inside the TMJ also disappeared within the first two weeks. However, that horrible feeling of having sand grains inside the joint remained. Now, the only noises I was hearing from the joint were these "grains" being crushed upon mouth movement.

Something else had changed - I couldn't open my mouth as wide as before. Despite all the pain, I was continuously doing my best to get my mouth open wider. I couldn't do more than 23mm (0.9inch). It was physically impossible. There was something blocking my jaw on the right side. Because there was full rotation and translation of the condyle on the left TMJ but no movement whatsoever on the right whilst opening my mouth, my lower jaw was even more offset to the right side than before.

I couldn't eat. I couldn't chew. I was only able to drink. So I was on a liquid diet - soups, milkshakes and smoothies. This wasn't what my surgeon's told me. He said I would be able to eat normally after the first few days!...

But the worse was the pain. I was expecting some degree of pain related to the surgery, but nothing like this. The pain was unbearable! The anti-inflammatories and paracetamol I was prescribed were not helping at all. I needed something strong, so we got co-codamol over the counter. This drug is a mixture of 3mg of codeine with 500mg of paracetamol. To take 1-2 pills every four hours. I was taking the maximum dosage I could. It wasn't enough to numb the pain.

The second week has passed, and so has the third and the fourth. Nothing changed. I couldn't open my mouth fully, I couldn't eat normally, I couldn't sleep, I couldn't work. And the pain. Oh, the pain! I wished  I could cut the whole right side of my head!

Was this normal? Was this part of the normal arthrocentesis recovery? We couldn't find anything that would describe a situation like mine. The testimonials were either "it changed my life completely, I have no pain" advertised on TMJ specialists' websites, or "nothing has changed for me" in independent forums. No one complaining "it made things worse for me".

But four weeks had passed and I was having my first post-surgery appointment with Mr. C.. Finally I would be able to discuss my current condition with a specialist. I was just hoping he would say "this is part of the normal recovery process, you'll be fine in a couple of days". But he didn't...