Adverse events of intra-articular temporomandibular joint injections: a systematic search and review

Natalia Turosz, Kamila Chęcińska, Maciej Chęciński, Adam Michcik, Dariusz Chlubek, Maciej Sikora


Temporomandibular joint (TMJ) disorders manifest as joint pain and limited mobility of the mandible. Treatment options include arthrocentesis and intra-articular drug administration. Adverse events associated with such interventions are rarely described in separate articles and may be overlooked when presented in clinical trial reports. Their identification in the medical literature is difficult due to the need to develop a rich set of keywords. This systematic search and review aims to identify and map adverse events associated with injections into the TMJ. Primary clinical trials of TMJ disorders treated with joint irrigation and/or drug administration were included. Data were extracted using a predesigned form and presented in text, ta bles, and graphs. A total of 58 adverse events were identified, more than half of which were pain and/or swelling. Overall, 14 types of events were c lassified into 3 categories (distant, local, and articular), none of which were fatal or life-threatening. These were, in order of most frequently diagnosed: pain and/or swelling (52%), ear pressure (5%), eyelid paresthesia (5%), periarticular tissue atrophy (5%), generalized rash (4%), hypoesthesia (4%), open bite (4%), skin hypopigmentation (4%), headache (3%), local rash (3%), malocclusion (3%), mandibular hypomobility (3%), TMJ noises (3%), and fever (2%).


temporomandibular joint; intra-articular injections; temporomandibular joint arthrocentesis; adverse events; postoperative complications; corticosteroids

Full Text:



Liapaki A, Thamm JR, Ha S, Monteiro JLGC, McCain JP, Troulis MJ, et al. Is there a difference in treatment effect of different intra-articular drugs for temporomandibular joint osteoarthritis? A systematic review of randomized controlled trials. Int J Oral Maxillofac Surg 2021;50(9):1233-43. doi: 10.1016/j.ijom.2021.01.019.

Derwich M, Mitus-Kenig M, Pawlowska E. Mechanisms of action and efficacy of hyaluronic acid, corticosteroids and platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis – a systematic review. Int J Mol Sci 2021;22(14):7405. doi: 10.3390/ijms22147405.

Chęcińska K, Chęciński M, Sikora M, Nowak Z, Karwan S, Chlubek D. The effect of zirconium dioxide (ZrO2) nanoparticles addition on the mechanical parameters of polymethyl methacrylate (PMMA): a systematic review and meta-analysis of experimental studies. Polymers (Basel) 2022;14(5):1047. doi: 10.3390/polym14051047.

Nitecka-Buchta A, Marek B, Baron S. CGRP plasma level changes in patients with temporomandibular disorders treated with occlusal splints – a randomised clinical trial. Endokrynol Pol 2014;65(3):217-23. doi: 10.5603/EP.2014.0030.

Tran C, Ghahreman K, Huppa C, Gallagher JE. Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg 2022;51(9):1211-25. doi: 10.1016/j.ijom.2021.11.009.

Sikora M, Czerwińska-Niezabitowska B, Chęciński MA, Sielski M, Chlubek D. Short-term effects of intra-articular hyaluronic acid admin-istration in patients with temporomandibular joint disorders. J Clin Med 2020;9(6):1749. doi: 10.3390/jcm9061749.

Chęciński M, Sikora M, Chęcińska K, Nowak Z, Chlubek, D. The administration of hyaluronic acid into the temporomandibular joints’ cavi-ties increases the mandible’s mobility: a systematic review and meta-analysis. J Clin Med 2022;11(17):1901. doi: 10.3390/jcm11071901.

Rodhen RM, de Holanda TA, Barbon FJ, de Oliveira da Rosa WL, Boscato N. Invasive surgical procedures for the management of internal de-rangement of the temporomandibular joint: a systematic review and meta-analysis regarding the effects on pain and jaw mobility. Clin Oral Investig 2022;26(4):3429-46. doi: 10.1007/s00784-022-04428-7.

Sikora M, Chęciński M, Nowak Z, Chlubek, D. Variants and modifications of the retroauricular approach using in temporomandibular joint surgery: a systematic review. J Clin Med 2021;10(10):2049. doi: 10.3390/jcm10102049.

Sikora M, Chęciński M, Chlubek D. Retro-Auricular Approach to the Fractures of the Mandibular Condyle: A Systematic Review. J Clin Med 2021;10(2):230. doi: 10.3390/jcm10020230.

Yongvikul A, Kim JY, Ku JK, Jung JH, Huh JK. Needle orientation for temporomandibular joint arthrocentesis in Koreans. Cranio 2022:1-7. doi: 10.1080/08869634.2022.2047509.

Gutiérrez IQ, Sábado-Bundó H, Gay-Escoda C. Intraarticular injections of platelet rich plasma and plasma rich in growth factors with ar-throcenthesis or arthroscopy in the treatment of temporomandibular joint disorders: a systematic review. J Stomatol Oral Maxillofac Surg 2021;123(5):e327-e335. doi: 10.1016/j.jormas.2021.12.006.

Kałużyński K, Trybek G, Smektała T, Masiuk M, Myśliwiec L, Sporniak-Tutak K. Effect of methylprednisolone, hyaluronic acid and pioglita-zone on histological remodeling of temporomandibular joint cartilage in rabbits affected by drug-induced osteoarthritis. Postepy Hig Med Dosw (Online) 2016;70:74-9. doi: 10.5604/17322693.1194616.

Pihut M, Szuta M, Ferendiuk E, Zeńczak-Więckiewicz D. Evaluation of pain regression in patients with temporomandibular dysfunction treated by intra-articular platelet-rich plasma injections: a preliminary report. Biomed Res Int 2014;2014:132369. doi: 10.1155/2014/132369.

Sikora M, Sielski M, Chęciński M, Nowak Z, Czerwińska-Niezabitowska B, Chlubek D. Repeated intra-articular administration of platelet-rich plasma (PRP) in temporomandibular disorders: a clinical case series. J Clin Med 2022;11(15):4281. doi: 10.3390/jcm11154281.

Stoustrup P, Kristensen KD, Verna C, Küseler A, Pedersen TK, Herlin T. Intra-articular steroid injection for temporomandibular joint arthri-tis in juvenile idiopathic arthritis: a systematic review on efficacy and safety. Semin Arthritis Rheum 2013;43(1):63-70. doi: 10.1016/j.semarthrit.2012.11.003.

Parra DA, Chan M, Krishnamurthy G, Spiegel L, Amaral JG, Temple MJ, et al. Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis. Pediatr Radiol 2010;40(9):1498-504. doi: 10.1007/s00247-010-1581-2.

Kumar AR, Lu GN, Lee E, Kontis TC. The rhytidectomy scar: analysis of patient and surgeon perspectives. Facial Plast Surg 2023;39(2):105-9. doi: 10.1055/s-0042-1749183.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169(7):467-73. doi: 10.7326/M18-0850.

Samson D, Schoelles KM. Chapter 2: medical tests guidance (2) developing the topic and structuring systematic reviews of medical tests: utility of PICOTS, analytic frameworks, decision trees, and other frameworks. J Gen Intern Med 2012;27 Suppl 1(Suppl 1):S11-9. doi: 10.1007/s11606-012-2007-7.

Chiappelli F., Kasar VR, Balenton N, Khakshooy A. Quantitative consensus in systematic reviews: current and future challenges in transla-tional science. Bioinformation 2018;14(2):86-92. doi: 10.6026/97320630014086.

PubMed Overview. (12.09.2023).

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan – a web and mobile app for systematic reviews. Syst Rev 2016;5:210. doi: 10.1186/s13643-016-0384-4.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for re-porting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

Rosenthal R, Hoffmann H, Clavien PA, Bucher HC, Dell-Kuster S. Definition and Classification of Intraoperative Complications (CLASSIC): Delphi Study and Pilot Evaluation. World J Surg 2015;39(7):1663-71. doi: 10.1007/s00268-015-3003-y.

Arabshahi B, Dewitt EM, Cahill AM, Kaye RD, Baskin KM, Towbin RB, et al. Utility of corticosteroid injection for temporomandibular arthri-tis in children with juvenile idiopathic arthritis. Arthritis Rheum 2005;52(11):3563-9. doi: 10.1002/art.21384.

Bjørnland T, Gjærum AA, Møystad A. Osteoarthritis of the Temporomandibular Joint: an evaluation of the effects and complications of corti-costeroid injection compared with injection with sodium hyaluronate. J Oral Rehabil 2007;34(8):583-9. doi: 10.1111/j.1365-2842.2007.01759.x.

Fritz J, Thomas C, Tzaribachev N, Horger MS, Claussen CD, Lewin JS, et al. MRI-guided injection procedures of the temporomandibular joints in children and adults: technique, accuracy, and safety. AJR Am J Roentgenol 2009;193(4):1148-54. doi: 10.2214/AJR.09.2473.

Stoll ML, Good J, Sharpe T, Beukelman T, Young D, Waite PD, et al. Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis. J Oral Maxillofac Surg 2012;70(8):1802-7. doi: 10.1016/j.joms.2011.11.003.

Skármeta NP, Hormazábal FA, Alvarado J, Rodriguez AM. Subcutaneous lipoatrophy and skin depigmentation secondary to TMJ intra-articular corticosteroid injection. J Oral Maxillofac Surg 2017;75(12):2540.e1-5. doi: 10.1016/j.joms.2017.07.174.

Isacsson G, Schumann M, Nohlert E, Mejersjö C, Tegelberg Å. Pain relief following a single-dose intra-articular injection of methylpredniso-lone in the temporomandibular joint arthralgia – a multicentre randomised controlled trial. J Oral Rehabil 2019;46(1):5-13. doi: 10.1111/joor.12718.

Memis S, Can M. Bilateral temporomandibular joint dislocation following arthrocentesis plus hyaluronic acid injection. J Coll Physicians Surg Pak 2022:32(5):677-9. doi: 10.29271/jcpsp.2022.05.677.

Joint Injection (Joint Aspirations). American College of Rheumatology. (15.08.2022).

Chavda S, Rabbani SA, Wadhwa T. Role and Effectiveness of Intra-Articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoar-thritis: A Systematic Review. Cureus 2022;14(4):e24503. doi: 10.7759/cureus.24503.

Evans A, Ibrahim M, Pope R, Mwangi J, Botros M, Johnson SP, et al. Treating hand and foot osteoarthritis using a patient’s own blood: a sys-tematic review and meta-analysis of platelet-rich plasma. J Orthop 2020;18:226-36. doi: 10.1016/j.jor.2020.01.037.

Boffa A, Previtali D, Di Laura Frattura G, Vannini F, Candrian C, Filardo G. Evidence on ankle injections for osteochondral lesions and osteo-arthritis: a systematic review and meta-analysis. Int Orthop 2021;45(2):509-23. doi: 10.1007/s00264-020-04689-5.

Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: a systematic review. Semin Arthritis Rheum 2018;48(2):168-75. doi: 10.1016/j.semarthrit.2018.01.009.

Pavone V, Vescio A, Turchetta M, Giardina SMC, Culmone A, Testa G. Injection-based management of osteoarthritis of the knee: a systematic review of guidelines. Front Pharmacol 2021;12:661805. doi: 10.3389/fphar.2021.661805.

Lane JCE, Craig RS, Rees JL, Gardiner MD, Shaw AV, Spiteri M, et al. Low rate of subsequent surgery and serious complications following in-tra-articular steroid injection for base of thumb osteoarthritis: national cohort analysis. Rheumatology (Oxford) 2021;60(9):4262-71. doi: 10.1093/rheumatology/keaa925.

Tarar MY, Choo XY, Khan S. The risk of bleeding complications in intra-articular injections and arthrocentesis in patients on novel oral an-ticoagulants: a systematic review. Cureus 2021;13(9):e17755. doi: 10.7759/cureus.17755.

Cheng J, Abdi S. Complications of joint, tendon, and muscle injections. Tech Reg Anesth Pain Manag 2007;11(3):141-7. doi: 10.1053/j.trap.2007.05.006.

Understanding Post-Injection Inflammation. Saint Luke’s. (15.08.2022).

Omiunu A, Talmor G, Nguyen B, Vakil M, Barinsky GL, Paskhover B. Septic arthritis of the temporomandibular joint: a systematic review. J Oral Maxillofac Surg 2021;79(6):1214-29.

Jovanović M, Milosavljević M, Zdravković D, Živić M, Veličković S, Janković S. Septic arthritis of the temporomandibular joint in adults: Systematic review. J Stomatol Oral Maxillofac Surg 2022;123(4):465-72.

Chęciński M, Chęcińska K, Nowak Z, Sikora M, Chlubek D. Treatment of mandibular hypomobility by injections into the temporomandibular joints: a systematic review of the substances used. J Clin Med 2022;11(9):2305. doi: 10.3390/jcm11092305.


Copyright (c) 2023 Natalia Turosz, Kamila Chęcińska, Maciej Chęciński, Adam Michcik, Dariusz Chlubek, Maciej Sikora

License URL: