TMJ injection?

[specepic]

---

Members don't see this ad.

Has anyone here done much inj's for TMJ with either U/S or Fluoro?

Any info would be great

 

[lobelsteve]

Used to do plenty, but they were never too successful and did not change outcomes. FLuoro and blind. Now I do SPG and gasserian for those folks. Plus, I have Gary Bouloux at Emory who is a "Guru" in TMJ. He replaces parts that are worn out or that don't fit. I think ost of the time he is fixing someone elses work.

 

[specepic]

Used to do plenty, but they were never too successful and did not change outcomes. FLuoro and blind. Now I do SPG and gasserian for those folks. Plus, I have Gary Bouloux at Emory who is a "Guru" in TMJ. He replaces parts that are worn out or that don't fit. I think ost of the time he is fixing someone elses work.

If I do it (Pt with 2 weeks of new TMJ pain who I told it was too early to think about injection) I was going to do fluoro, land on styloid of mandible and walk off cephalad until I hit something that felt like a joint. Not sure if that is the typical way to do it. I took a look with U/S and could not really see the joint well, just the styloid of the mandible and lots of blood vessels in the way of long axis approaches and something that looked like a nerve just cephalad to the styloid (facial n?) in the way of a short axis approach

 

[Ligament]

Used to do plenty, but they were never too successful and did not change outcomes. FLuoro and blind. Now I do SPG and gasserian for those folks. Plus, I have Gary Bouloux at Emory who is a "Guru" in TMJ. He replaces parts that are worn out or that don't fit. I think ost of the time he is fixing someone elses work.

Really, gasserians for TMJ? Seems like a high risk procedure for this problem. I had not thought of that. Does it provide decent relief? Seems TMJ joint injections work well for me, usually steroid, sometimes prolo or PRP.

 

[lobelsteve]

Really, gasserians for TMJ? Seems like a high risk procedure for this problem. I had not thought of that. Does it provide decent relief? Seems TMJ joint injections work well for me, usually steroid, sometimes prolo or PRP.

I do not get to see the FMS of the face type of TMJ. I only see post surgical folks. I was unimpressed with benefit of more than 3-4 weeks with ia steroids and never found useful meds. Now I get to see the folks post-op 6+months out to wean opiates and come up with other ideas. Sphenopalatine, gasserian, and pns are the only things not previously done. They have all had ia ink, Botox, and bite plates.

 

[Ligament]

I do not get to see the FMS of the face type of TMJ. I only see post surgical folks. I was unimpressed with benefit of more than 3-4 weeks with ia steroids and never found useful meds. Now I get to see the folks post-op 6+months out to wean opiates and come up with other ideas. Sphenopalatine, gasserian, and pns are the only things not previously done. They have all had ia ink, Botox, and bite plates.

Makes sense, particularly the post op folks. Nasty facial pain. They are lucky to have somebody that can offer these treatments to them. Kudos. 😀

 

[specepic]

Would appreciate info on injection technique with fluoro or U/S

 

[lobelsteve]

Feel for the upper and lower bones of the joint while the patient wiggles their mouth with their pterygoids. The joint typically lies 1.5cm anterior to the tragus. Use a 30G 1" and head straight in to the capsule. 0.75cc Marcaine and 0.75cc Celestone.

If you use fluoro, line up both joints in cross face lateral, once you encounter resistance of capsule of hit bone, go AP to verify depth.