Arthrocentesis and lavageThis minimally invasive surgical technique involves joint puncture (TMJ arthrocentesis), where the temoromandibular joint is drained using a needle. Often the joint fluid has collected in the upper joint cavity in the presence of an inflammation. This forms "TMJ effusion". 

This collection of joint fluid containing many aggressive protein compounds is first drained. The joint compartment is then dilated with increased pressure and adhesions on the articular disc with the skull base and the joint capsule are released. The disc can immediately move better in the joint. The joint space is then punctured with a second needle and rinsed with approximately 200 ml saline solution. The rinsing fluid eliminates the aggressive protein not only from the joint space, but also from the deeper layers of the joint capsule and the articular fibrocartilage. The next step is to inject hyaluronic acid or another medication into the joint space. Finally the displaced articular disc is mobilised with guided movements of the mandible, and the joint capsule is dilated.

This minor surgery, performed with either local anaesthesia only, sedoanalgesia or under general anaesthesia, is suitable for treating any form of inflammation in the temporomandibular joint. In cases where there is acute disc displacement without reduction, TMJ arthrocentesis and lavage can be used to quickly reposition the disc in many cases. This should, in any case, be accompanied by splint therapy and physiotherapy.