After Arthroscopy

Please bring your splint if you have one to the hospital on the day of surgery. It will be removed before surgery and then replaced immediately after surgery.

Following TMJ arthroscopy/arthrocentesis, you will be discharged from the ambulatory care or day surgery unit. At that time, you will have a piece of bandage tape covering the surgical sites that can be removed on the second day following surgery and replaced as needed. You may notice a small suture once the tape is removed which will be removed at your follow-up visit. 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.
  • Once the surgical tape is off, apply Neosporin or other antibiotic ointment to surgical site and a small Band-aid can be placed.
  • The occlusal appliance or splint should be worn full time except during meals, unless otherwise instructed.
  • Arrangement to see your physical therapist for an appointment ideally on the second or third postoperative day should be made. If you do not see a physical therapist, follow the below instructions for home PT.

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 gauze 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: Keflex 500mg: Take 1 pill 4 times per day for 7 days after surgery if not allergic to penicillin. If allergic, Clindamycin 300mg: Take 1 pill 3 times per day for 7 days.
  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 5/300: Take ½ to 2 tablets every 4-6 hours as needed for surgical pain or Percocet 5/325 taken in a similar dose as Vicodin). A non-steroidal anti-inflammatory prescription (Relafen 500mg: Take 1 pill twice per day) 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 (Zanaflex 4mg: Take ½-1 pill 30 minutes before bed-time) 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.

POST-OP HOME 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 front teeth.

Alternatively, you may open your mouth as widely as you can within comfort attempting to keep your upper and lower midlines in a straight alignment. Hold for five to ten seconds. Then rest for five to ten seconds. Then move your jaw to the left and hold for five to ten seconds followed by another rest period. Next, move your jaw to the right for five to ten seconds then rest again. Lastly, protrude your lower jaw trying to keep the midlines aligned and hold again for five to ten seconds. You may repeat this cycle for five repetitions and perform this activity 5 times per day.

FREQUENCY OF PHYSICIAL THERAPY: If using a professional physical therapist, we recommend two visits per week, then once weekly or as recommended by the physical therapist. The physical therapist may use ice, heat, electrical stimulation, or ultrasound as needed for pain relief.

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. 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. This can be in the form of professional therapy however; home physical therapy is also critical.

DIET

Patient is to follow a full liquid (non-chew) diet for the first several days and progress to a soft non-loading diet for the following three to six weeks. After receiving doctor approval, a regular diet can often be resumed approximately six weeks after surgery. Foods such as yogurt, scrambled eggs, fish, ground beef/chicken/pork, canned fruits and vegetables, pasta, etc. are all appropriate soft foods.

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. WE 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.