Temporomandibular Joint

Muscle pain can be related clenching and grinding. Stress, anxiety and tiredness can make the symptoms worse. This is usually managed by Facial Pain Consultants. The management may include medications, physiotherapy, and acupuncture. Some patients benefit from Botulinum Toxin injections into their muscles this can give temporary relief and require repeating after 4 months. These injections tend to be administered by the surgeons.

The assessment of the joints requires an MRI. This is done with the mouth closed and mouth open allowing you determine if the articular disc within the joint is stuck out of place. For a patient with a displaced none reducing disc an arthroscopy is indicated. Approximately 80% of patients will respond to the arthroscopy. This is a day case procedure carried out under general anaesthetic. 2 needles 1.9mm in diameter are placed into the joint through the skin in front of the ear. One has a small camera, the other is a port. The joint can be washed out and disc freed. Where there are degenerative changes (arthritis) it has been recently shown that injecting PRF (platelet rich fibrinogen) is beneficial.

When there is significant loss function and pain associated with joints total joint replacement can be considered as a last resort.