Injection of steroid into TMJ
REF;  Dr. Michael F. E. Jones, MD, P.C.
622 Fourth St. Sioux City, Iowa 51104, USA
jonesmfe@hotmail.com, Voice: (712) 255-0985, Fax:   (712) 255-0977

Compiled By;  Dr. Hafiz Shahid Amin (MBBS, DCA, DLO)  ENT Surgeon,  Sargeon Naak  Kaan  Gala   Gujranwala-Pakistan

I have given steroid injections for years without problems.  Of course, you  have to realize that that steroid has a tendency to injure the joint cartilage, and also realize the fact that it does not just stay intra-articular.  I like to have them over 65 years old.  I can't remember where I picked up the technique, but it was over 20 years ago.
I use dental syringes which have cartridges.  I use the cartridges (not quite 2 cc's) with two percent Xylocaine (lidocaine) and 1:100,000 solution of epinephrine in my practice.  I usually use a 30 gauge or a 27 gauge needle.  For the temporal mandibular joint injection I use the 27 gauge needle because you can get a better feel of the penetrating tip up to the
bone of the joint capsule.  I have them bring a small vial from the pharmacy of Aristocort Forte (triamcinolone) 40 milligrams per one CC for intra-articular injection.  Inject out about half of the Xylocaine with epinephrine.  I then draw up 1/2 CC of the triamcinolone (20 milligrams), usually in a tuberculin syringe, and then inject the triamcinolone into the Xylocaine with epinephrine cartridge.  I usually just unscrew the 27 gauge needle from the syringe, and inject the steroid through the rubber
diaphragm.
You now have a mixture of Xylocaine, epinephrine, and triamcinolone.  This you inject into the joint while palpating it.  Usually there is some point tenderness.  Try to inject some of that there.  Also have them open their mouth, and slide the tip of the needle into the joint space.  As you inject,the Xylocaine will anesthetize the area of pain.  Then you can dump the rest
of the load here. I know it's not very sterile.  I only prep with some alcohol sponges and rub the rubber diaphragm on the end of the cartridge.  I've never got an infection.  Just palpate enough so that you do not impale the branches of
the temporal artery, or you could get a hematoma.  About half the time they will get a partial facial nerve paralysis, just reassure them that it will go away when the Xylocaine wears off. One of these injections may last only 4-6 weeks, but most of the time three months or longer.  At least I don't see too many of them back--or maybe they have had enough of me!
Sometimes also works for 'tic', localized headaches (supraorbital), and atypical facial pain.  I always tell them we can try, but make no guarentees.

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