Day Surgery Leaflet: TMJ Arthroscopy

TMJ Arthroscopy: You will be able to go home on the day of your surgery after you are able to eat and drink. You would stay in the hospital for a minimum of one to two hours for observations. You will need a responsible adult to pick you up from the hospital and stay with you overnight.

Leaflet Details

Patient Information

After your surgery

• You will be able to go home on the day of your surgery after you are able to eat and drink. You would stay in the hospital for a minimum of one to two hours for observations. You will need a responsible adult to pick you up from the hospital and stay with you overnight.

Wound care

• Swelling is expected for the first 24 hours and should gradually ease off within this time. Ice packs should be applied on the side of your face regularly for as long as you can tolerate them at a time, with a minimum of eight hours after surgery.
   
• Your face will become swollen and puffy for a couple of days, but it is unlikely that this will increase significantly to be concerning.
   
• You may have small plasters on the top of your jaw/s. These can be removed after 24-48 hours. You can have a shower after this time.
   
• Your hearing can be affected and your ears may feel blocked for around 6-8 weeks; this is due to the fluids used during your surgery. This is common and will gradually ease off.

Diet

• You should be able to eat and drink after surgery but you need to avoid too much chewing. It is therefore important that you only have soft foods for at least a week.

Medications

You will be prescribed medications to take home. The prescription will be given to you to take to your nearest pharmacy and should be taken regularly for at least three weeks.

This will include the following:

• naproxen (used for pain relief and to help decrease the swelling)
   
• esomeprazole (to protect the lining of your stomach)
   
• Diazepam (to help relax your jaw muscles and prevent you from clenching your jaw especially when you are asleep)

Jaw exercises

• You will be given instructions for jaw exercises by your surgeon. This involves using a spatula or spatula and syringe to help ease your mouth opening (please see below for specific instructions). You will be provided with these items before you leave the hospital.
   
• These should be started as soon as possible and done every four hours or six times a day. This will need to continue for a minimum of six weeks and/or until you have attended your outpatient appointment.
   
• It is important to make sure these exercises are done regularly as they will prevent your jaw from getting very stiff and delay your recovery.

Jaw exercises using spatula only

1. Jaw exercises will be started as soon as you are reasonably awake.
    
2. Insert 16 pieces of spatula (or less if you are unable to tolerate this amount) in the mouth against the side where the surgery was done. If you had surgery on both sides, you need to have two sets of spatula to insert on each side.
    
3. Increase by one spatula until it starts to be painful. This amount will then stay in for 15 minutes.
    
4. Exercises should be done every four hours/six times a day.
    
5. The spatula should be increased by one every two days until you are seen in the clinic.

Jaw exercises using spatula and syringe

1. Jaw exercises will be started as soon as you are reasonably awake.
    
2. You will be given a set of spatula attached in the middle of a 50-ml syringe.
    
3. Insert one end of the spatula into your mouth and squeeze the other end until your mouth starts to be painful. This will need to stay in this position for 15 minutes.
    
4. Exercises should be done every four hours/six times a day.
    
5. This needs to be done regularly until you are seen in the clinic.

Activity

• You should be able to return to normal activities after a few days.
   
• Do not drive for at least 24 hours and until you feel you are able to so. It is advisable to check with your insurance company as they may have different policies.

Blood clot prevention

• It is important that you resume normal activities as advised and keep active. You must wear the anti-embolic stockings given to you for 7 days, both during the day and at night. They can be removed while you have a shower and applied again afterwards.
   
• Depending on your medical risk factors, you may be prescribed blood-thinning injections to take after your operation. These help prevent blood clots such as in the leg (deep vein thrombosis) or the lung (pulmonary embolus).

Follow up appointment

• You will have a follow-up appointment in the outpatient clinic after four to six weeks. An appointment letter will be sent to you with the details by your surgeon’s secretary.

What to watch out for:

Please contact the maxillofacial department if:

• The swelling increases, gets very painful and you have a temperature as these are signs of infection
   
• If the swelling persist for more than 3 days.
   
• If you have any other concerning symptoms and they will advise you on further actions.

Please contact your GP if:

• Your hearing has not returned to normal after 6-8 weeks.

Please attend the Accident and Emergency department (Royal Surrey County Hospital) if:

• The swelling has increased significantly

Useful contact numbers:

• Maxillofacial Department on 01784 884009 (nurses desk, OPD, Ashford Hospital) or 01932 722028 (OPD, St. Peter’s Hospital) between 9am-5pm.
   
• After 5pm, all day weekends and bank holidays, please contact ASPH Main switchboard on 01932 872000 and ask to speak to the maxillofacial doctor on call. Occasionally, your call might be transferred to the Royal Surrey County Hospital in Guildford as some of our doctors are based there.
   
• Day Surgery Unit Ashford hospital 01784 884609 or 01784 884189 between 8am-9pm Monday to Friday
   
• ASPH Main Switchboard 01932 872000 and ask to be connected to your surgeon’s secretary for appointment queries

If you feel unwell and needed urgent medical care, please go to your nearest Accident and Emergency Department immediately and bring your discharge letter with you.