TMJ Arthroscopy

Please bring your splint to the hospital on the day of surgery.  It will be removed before surgery and then replaced immediately after surgery.  This is very important!

Following TMJ arthroscopy, you will be discharged from the ambulatory care or day surgery unit.  At that time, you will have a Band-Aid on your head that will be removed on the second day following surgery and replaced as needed.  At home, we recommend that for the next 24 to 48 hours you follow these instructions:

• Full liquid or non-chew diet.
• Ice to the side of the face.
• Shower as needed taking care to keep the surgical site dry for the first four days.
• Changing of Band-Aids as needed (replace Band-Aid daily or if it becomes wet).  Apply Neosporin or other antibiotic ointment to surgical site each time Band-Aid is changed.
• The occlusal appliance or splint should be worn full time unless otherwise instructed.
• Arrangement to see your physical thereapist for an appointment ideally on the second or third postoperative day.

NOTE: You may experience some bleeding from the arthroscopy site.  This would probably include a small amount of oozing and should be easily stopped with direct pressure over the area using a small guaze pad.  If there is blood in your ear, a rinse of half water and half vinegar put through a dropper three times a day would be helpful.  Sometimes there is swelling on the side of the arthroscopy due to water which has escaped from the joint space.  This often disappears within 24-48 hours.

Medications

You should have the following medications either prior to the arthroscopy or upon being discharged from the ambulatory unit:

1. Antibiotics:  A prescription for antibiotics should be give and you should take this medication for approximately one week.
2. Analgesics:  A prescription for analgesics will be given either in the ambulatory care unit or prior to surgery.  This is usually a narcotic analgesic (e.g. Vicodin or Tylenol with Codeine).  A non-steroidal anti-inflammatory prescription (e.g. Naprosyn, Motrin, Indocin, Toradol, etc.) may also be given in conjunction with the above narcotic medication.  Please follow the prescription directions when taking these medications.
3. Muscle relaxants:  Patients who have had parafunctional muscle activity (e.g. clenching or grinding) may benefit from a skeletal muscle relaxant (e.g. Valium, Fleoril, Robaxin, Soma, etc.) prior to bedtime for the first week.  It is not unusual for these patients to have increased muscular spasm during the early postoperative period.  Again, take these medications as directed.

Appointments

You should expect to return to our office on the first, third and sixth weeks postoperatively.  If there are any complications or problems that arise prior to the first visit, please call our office immediately.

Physical Therapy

You should see a physical therapist at least one time prior to your arthroscopy for a preoperative evaluation.  Following arthroscopy, it is recommended that the physical therapist use modalities to decrease the swelling and increase the range of motion.  We recommend a minimum of six physical therapy visits after surgery.  We have instruction sheets which we will give you if your physical therapist is unfamiliar with the appropriate physical therapy protocol.  If there are any questions regarding physical therapy, please make sure that you have asked these questions prior to surgery or in the immediate postoperative period.  It is the doctor’s firm belief that physical therapy is very important in the success of the TMJ arthroscopy.

Dental Appointments

You should make arrangements prior to arthroscopy to be seen by the dentist who manages your splint therapy within the first few weeks after surgery.  This will allow for the correction of any split imbalances which may have resulted from surgery.

POSTOPERATIVE FINDINGS: The doctor will make every attempt to inform you of the postoperative findings immediately.  He will often look for a member of your family or friend in the waiting room to discuss the findings.  However, it has been our experience that you will best understand the postoperative findings at your first postoperative visit.  At that time, we can further discuss what we have visualized. 

A usual waiting period of five to six weeks after surgery is allowed for evaluation of the arthroscopic result.  We anticipate that you will follow the above instruction and on the sixth week we can closely examine the benefits of the arthroscopy.

PLEASE READ THE ABOVE PRIOR TO ARTHROSCOPY AND IF THERE ARE ANY QUESTIONS, PLEASE FEEL FREE TO DISCUSS THEM AT ANY TIME WITH OUR OFFICE STAFF OR THE DOCTOR.

Post-op Excercises

PURPOSE: These jaw exercises are designed to increase the mobility of your jaw and restore normal functional ability.

PRECAUTIONS: The exercises should be done gently, never forcefully, and should not cause excessive pain. If any of the exercises cause undue pain, discontinue them for a short time, then gradually start them again. Your physical therapist will discuss any special precautions with you.

INSTRUCTIONS: Start with five repetitions and increase to ten to fifteen for each exercise. Do entire sequence of exercises four times daily.

EXERCISE ROUTINE:

1. Make a “clicking” sound with the tongue, opening mouth wide each time.
2. Keeping tongue on roof of mouth, open and close mouth in the pain and noise-free range.
3. Place your tongue on the upper back teeth on one side, open your mouth as wide as you can. Do this slowly and hold the wide open position for five seconds. Open your mouth as wide as you can and move your jaw slowly from side to side.
4. Attempt to jut jaw forward by opening mouth slightly and move the lower teeth in front of the upper jaw.
5. Stretch jaw by placing index finger on the very last lower tooth on each side. Gently stretch mouth open in this manner.
6. Attempt to put two knuckles on first two fingers between upper and lower teeth.

FREQUENCY OF PHYSICIAL THERAPY: Two times per week, then once weekly for two weeks or as recommended by the physical therapist. The physical therapist may use ice, heat, electrical stimulation, or ultrasound as needed for pain relief.

OTHER SPECIAL INSTRUCTION:

1. Patient is to follow a full liquid (non-chew) diet for the first three weeks progressing to a soft diet for the next three weeks. After receiving doctor approval, a regular diet can often be resumed approximately six weeks after surgery.
2. Patient is to see a physical therapist on the second or third postoperative day.
3. Patient should return to the surgeon’s office approximately one week after surgery for postoperative evaluation and removal of facial sutures.