TMJ Arthroscopy is a procedure performed through one or more small skin incisions in front of the ear. A small telescope-like instrument is inserted through the incision and directly into the jaw joint to inspect the inside of the joint. Occasionally a second skin incision is required for manipulating a second instrument. If necessary, fibrous adhesions (scar tissue within the jaw joint) will be removed.
This procedure is used for treatment and/or diagnosis of the Temporomandibular joint. Although the procedure may be sufficient to alleviate some of the joint symptoms, a more involved procedure may be required, depending on the findings of your surgery.
You may have received a prescription for pain medication, anti-inflammatory and an antibiotic. The pain medication should be started about 4 hours after leaving the facility. The anti-inflammatory should be started about 2 hours after leaving the facility and should be taken twice a day for the next 2 weeks. The antibiotic should be started about 6 hours after leaving the facility and taken as directed on the bottle until finished. Please have the prescription filled at a pharmacy on your way home and follow the directions on the bottles.
Postoperative pain is a normal response of the body to any surgical procedure. The local anesthetic or freezing that was administered during your surgery may last up to six hours. It is advisable to have pain medication onboard prior to the freezing wearing off and pain is actually experienced. You will be given oral pain medication before you leave; please take another within 4 hours and continue taking regularly until the freezing wears off.
SWELLING AND STIFFNESS
Swelling or stiffness may occur following your procedure. This is nature’s way of aiding the healing process by splinting and resting the area. Ice packs should be applied for at least 30 minutes, four times a day and may be applied continuously if so desired. You should also apply ice for 30 minutes after your Physical therapy exercises.
Restrict talking or excessive movement of your jaw as this can cause increased inflammation.
PHYSICAL THERAPY EXERCISES
Return of normal jaw movement may take up to 3 weeks; during this time we recommend exercises to reduce stiffness. These should start the day after surgery.
Exercising the jaw maintains mandibular mobility as well as helps decrease pain and swelling. Avoid overstretching of the joint and muscle, this may cause an inflammatory process and the risk of excess scar formation. All exercises should be performed slowly and comfortably and should not cause sharp pain. Before beginning exercises, warm your face muscles with warm moist heat. A warm wet face cloth applied to each side of your face for 15 minutes before beginning exercises. Exercises should be performed 20 times each, 4 times a day.
Vertical opening: The tip of the tongue is placed on the roof of the mouth. Open and close your mouth slowly maintaining a straight midline jaw position
Lateral excursion: Place the exercise tube provided between your teeth on the right side, slide your bottom jaw sideways to the right then return to center. The exercise tube should waggle up and down when performed correctly
Repeat the same process on the left side, move exercise tube to the left side.
Protrusive or gliding motion: Place the exercise tube provided between your front teeth. Slide your bottom jaw forward and back. The exercise tube should waggle up and down when performed correctly.
DIET AND NUTRITION
Your body requires adequate fluids and nourishment. It may be necessary to start with a liquid or very soft diet. You should remain on a soft diet for the next 2 months. Please follow the instructions given on your day of surgery.
DISC SUTURE OR BUTTON, SUTURES AND WOUND CARE
If you had disc reconstruction with a suture or wire button, your bite may feel off for a few weeks. It is important to keep the button pad dry. You may have to return to have a wire removal in approximately 2 weeks.
Sutures are routinely used. You will be given an appointment to have these removed in 1 week. To clean the wounds use a mixture of ½ peroxide and ½ water on a Q-tip, then apply Polysporin®. This should be done twice a day until your sutures have been removed in 1 week. You may cover with a Band-aid, or leave the wounds open.
You will be given a follow-up appointment approx. 1 week after your surgery. It is important you attend this appointment to assess proper healing and remove your sutures. Please follow the instruction given you the day of your surgery. If the prearranged appointment(s) are not suitable, please contact our office to change your date or time.
The first 3 days following surgery you should be resting and restraining from all exercise programs. You may resume normal activity and a reasonable exercise program after this. Restrain from strenuous physical activity for the next 2 weeks.
When resting or sleeping, please elevate your head with a couple pillows so the edema can subside.
INTRAVENOUS SEDATION AND GENERAL ANAESTHETIC PATIENTS
Patients who have had general anaesthetic may experience muscle pains especially around the neck and shoulders, this can occur anywhere including the chest, back, legs and arms. The pain is often like that which occurs after heavy exercise. It is caused by an anaesthetic drug, and although it is inconvenient and uncomfortable, it is not unusual or dangerous to experience these symptoms. The stiffness and discomfort usually lasts for two to three days, but can linger for up to one week. It is best treated by rest, heat and your post-operative pain pills. Patients having a general anaesthetic will have had a nasal breathing tube while they were asleep. It may appear that you have had a nosebleed or your nose may be stuffy. It is recommended that you NOT blow your nose for several days. Nasal sprays or decongestants may be used to relieve these symptoms. It is not uncommon to have a sore throat from this tube. The sore throat is best treated with your pain medication, plenty of fluids and lozenges such as Bradasol™ or Sucrets™. If discomfort or pain persists at IV site for more than 2 weeks please call our office.
HERE ARE A FEW THINGS THAT MUST BE OBSERVED
DO NOT leave the patient alone until the morning following surgery.
ABSOLUTELY NO driving or operating any machinery for the first 24 hours following surgery, or as long as you’re taking prescription pain medication.
ABSOLUTELY NO alcohol or recreational drugs for two weeks following surgery, or as long as you’re taking prescription medications.
If you have any questions or problems, do not hesitate to call our office at 454-6565 or 1-800-379-9474. If your call is not answered by the answering service, hang up and call again in five minutes. We apologize for this inconvenience as the lines may be occupied by other callers. There is an Oral and Maxillofacial Surgeon on-call ALL HOURS OF THE DAY.
WE PREFER THAT YOU CALL OUR OFFICE FIRST RATHER THAN YOUR OWN DENTIST OR FAMILY DOCTOR. However, if you are experiencing severe bleeding or breathing problems requiring IMMEDIATE ATTENTION, please proceed to the nearest Emergency Department or Dial 911.