Nerve blocks and interventional procedures in the management of temporomandibular joint disorders: a scoping review

Background: Temporomandibular disorders (TMDs) often present significant challenges in diagnosis and management. The temporomandibular joint (TMJ) is the primary joint involved in mastication, speech and to a lesser extent in activities such as breathing. It is subjected to constant function and friction while performing day to day activities. and TMDs can significantly hamper quality of life of affected individuals. The purpose of this scoping review is to discuss the use of injections as a possible, convenient, economical and minimally invasive management options in temporomandibular joint disorders (TMJDs). Methods: To compile this scoping review, 8,567 were identified through an electronic search using databases such as PubMed (Medline), Scopus and Google Scholar with key words “TMDs”, “temporomandibular disorders”, “temporomandibular joint disorders”, “arthrocentesis”, “arthroscopy”, “intraarticular injections” and “nerve block”. After exclusion, a total of 69 articles published in English language only from January 1st 1974 to December 31st 2021 were included in the review. Results: Conservative methods are recommended as first line management by major organizations across the world. Surgical modalities are invasive and involve higher risks with possibilities for more serious adverse outcomes. TMJ interventions are useful, economical, less invasive methods of treatment with good success rates and should be performed before invasive surgical procedures are considered. Various TMJ interventions include auriculotemporal nerve (ATN) block, arthrocentesis, arthroscopy, and intraarticular injections using pharmaceutical agents are discussed in this scoping review. Conclusions: If carefully performed by a skilled operator with knowledge of the local anatomy, these interventions are relatively safe. Intraarticular injections with or without arthroscopy and arthrocentesis for better results may be considered for treatment of resistant cases of internal derangements and degenerative joint disease, non-responsive to conservative management.