21073 Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care)

Name of the Procedure:

Manipulation of Temporomandibular Joint(s) (TMJ), therapeutic, requiring an anesthesia service (i.e., general or monitored anesthesia care)

Summary

This procedure involves the therapeutic manipulation of the temporomandibular joint (TMJ), which may require services of anesthesia such as general anesthesia or monitored anesthesia care. The TMJ connects the jawbone to the skull and is crucial for activities such as chewing and speaking.

Purpose

The procedure aims to address TMJ disorders which can cause pain, swelling, and restricted movement of the jaw. The main goal is to alleviate pain, improve joint function, and restore range of motion.

Indications

• Chronic or severe TMJ pain
• Lockjaw or limited jaw movement
• Inflammation or swelling of the TMJ
• Unsuccessful results from less invasive treatments such as medications, physical therapy, or splints

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Adjustments to medications, particularly blood thinners, as prescribed by the healthcare provider.
• A pre-procedure evaluation, including diagnostic imaging (e.g., X-rays, MRI) and medical history review.

Procedure Description

1. The patient is positioned comfortably and connected to monitoring equipment.
2. An anesthesia service is administered to ensure the patient is unconscious or comfortably sedated.
3. The physician carefully manipulates the TMJ, using precise movements to alleviate dysfunction and restore alignment.
4. Throughout the procedure, medical imaging may be used to guide and assess the adjustments.
5. The patient's vital signs are monitored continuously by an anesthesiologist.

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

The procedure is performed in a hospital operating room, outpatient clinic, or specialized surgical center.

Personnel

• Oral and Maxillofacial Surgeon or another specialized physician
• Anesthesiologist
• Surgical nurse or assistant

Risks and Complications

• Pain or discomfort at the manipulation site
• Temporary swelling or bruising
• Risk of infection
• Adverse reactions to anesthesia
• Rarely, dislocation or worsening TMJ symptoms

Benefits

• Reduction in pain and inflammation
• Improved jaw function and mobility
• Enhanced quality of life within days to weeks

Recovery

• Patients generally rest in a recovery area until the effects of anesthesia wear off.
• Prescription pain relievers or anti-inflammatory medications may be provided.
• Limited jaw movement for a few days as recommended by the physician.
• Follow-up appointments to monitor progress and address any concerns.

Alternatives

• Non-surgical treatments like oral splints, physical therapy, and medication
• Minimally invasive procedures such as arthrocentesis
• Each alternative has its pros and cons, including varying degrees of effectiveness and recovery times.

Patient Experience

Patients may feel groggy and need assistance initially after the procedure. Post-procedure discomfort is usually manageable with prescribed medications. Swelling and slight bruising are common but typically resolve within a few days. Regular follow-ups are important for optimal recovery and monitoring progress.