# Recovery of Post-Traumatic Temporomandibular Joint after
## 3 Rehabilitation of TMJ
### Surgical Treatment  
Primary treatment of TMDs is often non-surgical and includes physical therapy, medication (non-steroidal anti-inflammatory drugs), kinetic/exercise therapy, and occlusal appliances. However, in patients irresponsive to conservative therapies, minimally invasive options (intraarticular injections, arthroscopy, arthrocentesis) or surgical options should be considered.  
Intraarticular injections represent another therapeutic option to control and treat TMJ derangement. Pain related to TMJ destructive processes can be reduced by intraarticular injections with different therapeutic solutions [28; 34; 35]. Two main types of drugs can be injected into TMJ, retard glucocorticoids and hyaluronic acid, aiming to improve pain, increase range of motion, and delay the progression of articular/cartilage damage.  
Glucocorticoids/corticosteroids  
Glucocorticoids/corticosteroids are powerful effective anti-inflammatory drugs, as they promote clinical manifestations of TMJ inflammatory processes. [17; 35]. The most systemic effects of oral steroids can be avoided by intraarticular injections. Research regarding the efficacy of the intra-articular TMJ injections has shown improvement in some patients (lower TMJ pain, improved joint mobility). However, a few studies reported the progression of TMJ disorders.  
Hyaluronic Acid (HA)  
Hyaluronic acid is a polysaccharide derived from the synovial fluid and articular cartilage. It is used in intraarticular injections to restore the viscoelasticity of the synovial fluid. The benefits are as follows: lubrication, shock absorption, and TMJ protection effects [17; 35; 36; 37].  
Along with glucocorticoids, the intra-articular injection of the viscoelastic hyaluronic acid solution has proven useful in the treatment of certain degenerative arthitic conditions, leading to significant improvement in both pain and function.  
Comparative benefits, efficacy data, and adverse events of glucocorticoids and hyaluronic acid injected in affected TMJ are summarized in Table 2.  
Arthrocentesis and Arthroscopy  
Arthrocentesis is a minimally invasive procedure, defined as the lavage of the TMJ without viewing the joint space. Arthrocentesis uses sterile needles and irrigants. To avoid patients' discomfort, arthrocentesis must be performed under local anesthesia or intravenous conscious sedation. [6; 8; 27; 28; 36].  
Arthrocentesis aims to reduce the pain by removing inflammatory mediators and to ensure mandibular mobility by removing intra-articular adhesions factors [6; 8].  
The classical technique of TMJ arthrocentesis uses double access to the joint cavity by two needles, one for injecting and the other for aspirating the solution. A variant of arthrocentesis uses a single-needle technique to provide the underpressure fluid injection that will allow a volume increase in the joint cavity and breakage of the joint adherences that reduces translatory movement of the condyle. [6; 8].  
Arthroscopy is a technique widely used in the diagnostic and treatment of TMDs. Arthroscopy is performed either under local or general anesthesia [6; 8].  
Open Joint Surgery  
Open surgical treatment TMDs is used in specific clinical situations: TMJ ankylosis (fibrous or bony) and synovial chondomatosis. The goal is to limit the condylar movement beyond the articular eminence, by creating a mechanical obstruction beyond the condylar pathway. Surgical interventions address capsular plication, reduction or augmentation of the articular eminence, osteophyte and pathological tissues removal, TMJ biopsy, lateral pterygoid myotomy, and condylectomy [6; 8; 27; 28].