{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:32:15Z","timestamp":1781670735849,"version":"3.54.5"},"reference-count":47,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Temporomandibular joint (TMJ) injections and arthrocentesis are commonly used minimally invasive methods for treating temporomandibular disorders (TMDs). Although considered safe, they can cause neurological complications. The aim of this systematic review was to synthesize all identified evidence for neurological adverse events following intra-articular TMJ interventions. Methods: This review was based on a systematic search with BASE, DOAJ, PubMed, SciELO, and Semantic Scholar on 28 May 2025. It included primary studies involving patients diagnosed with TMDs who underwent intra-articular injections into the TMJ or were treated with arthrocentesis, and in whom neurological adverse effects associated with the intra-articular intervention were reported. Studies reporting non-specific symptoms or unrelated systemic conditions were excluded. The risk of bias was assessed using the Joanna Briggs Institute\u2019s critical appraisal tools. Results were presented in summary tables. Results: The search yielded five eligible studies comprising 319 patients, of whom 320 neurological adverse events were reported. Included studies comprised a randomized controlled trial, two retrospective studies, and two case reports. Four studies had a low risk of bias, and one had a moderate risk of bias according to the Joanna Briggs Institute appraisal tools. The proportion of patients affected ranged from 14% to 65% depending on the study design and intervention type. The most common adverse event was transient facial nerve (cranial nerve VII) paralysis, mainly involving the temporal and zygomatic branches. Less commonly reported complications involved the trigeminal nerve branches (V1, V3). There is also a single case of epidural hematoma with palsy of the oculomotor nerve (III). Most symptoms resolved spontaneously within a few hours to a few days. The use of local anesthesia and large volumes of irrigation (60 mL) during arthrocentesis increases the risk of complications. Attempts to explain the mechanisms of complications include local anesthetic diffusion, compression neuropraxia due to lavage fluid leakage, and corticosteroid neurotoxicity. One of the limitations of the study is the scarcity of data. Conclusions: Although most adverse events are mild and reversible, these findings highlight that precise, real-time guided injection and careful control of lavage volumes can minimize extra-articular spread of anesthetics or fluids, thereby reducing the likelihood of neurological complications. This study received no funding. PROSPERO ID number: CRD420251088170.<\/jats:p>","DOI":"10.3390\/jcm14165770","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T08:39:07Z","timestamp":1755247147000},"page":"5770","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Neurological Complications Following Temporomandibular Joint Injections in Patients with Temporomandibular Disorders: A Systematic Review of Reported Adverse Events"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6199-4753","authenticated-orcid":false,"given":"Maciej","family":"Ch\u0119ci\u0144ski","sequence":"first","affiliation":[{"name":"National Medical Institute of the Ministry of the Interior and Administration, Wo\u0142oska 137 Str., 02-507 Warsaw, Poland"},{"name":"Department of Maxillofacial Surgery, Hospital of the Ministry of the Interior and Administration, Wojska Polskiego 51, 25-375 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5113-9817","authenticated-orcid":false,"given":"Kamila","family":"Ch\u0119ci\u0144ska","sequence":"additional","affiliation":[{"name":"National Medical Institute of the Ministry of the Interior and Administration, Wo\u0142oska 137 Str., 02-507 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabella","family":"Chy\u017cy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Leszek Giec Upper-Silesian Medical Center, Medical University of Silesia in Katowice, Zio\u0142owa 45\u201347, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamila","family":"Walkowiak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Leszek Giec Upper-Silesian Medical Center, Medical University of Silesia in Katowice, Zio\u0142owa 45\u201347, 40-635 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8075-9989","authenticated-orcid":false,"given":"Natalia","family":"Turosz","sequence":"additional","affiliation":[{"name":"National Medical Institute of the Ministry of the Interior and Administration, Wo\u0142oska 137 Str., 02-507 Warsaw, Poland"},{"name":"Department of Maxillofacial Surgery, Hospital of the Ministry of the Interior and Administration, Wojska Polskiego 51, 25-375 Kielce, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartosz","family":"Kosi\u0144ski","sequence":"additional","affiliation":[{"name":"Faculty of Architecture, Civil Engineering and Applied Arts, Academy of Silesia, Rolna 43, 40-555 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Zdu\u0144ski","sequence":"additional","affiliation":[{"name":"National Medical Institute of the Ministry of the Interior and Administration, Wo\u0142oska 137 Str., 02-507 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4497-4395","authenticated-orcid":false,"given":"Dariusz","family":"Chlubek","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3348-1950","authenticated-orcid":false,"given":"Maciej","family":"Sikora","sequence":"additional","affiliation":[{"name":"National Medical Institute of the Ministry of the Interior and Administration, Wo\u0142oska 137 Str., 02-507 Warsaw, Poland"},{"name":"Department of Maxillofacial Surgery, Hospital of the Ministry of the Interior and Administration, Wojska Polskiego 51, 25-375 Kielce, Poland"},{"name":"Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ferreira, N.D.R., Sanz, C.K., Raybolt, A., Pereira, C.M., and DosSantos, M.F. (2022). Action of Hyaluronic Acid as a Damage-Associated Molecular Pattern Molecule and Its Function on the Treatment of Temporomandibular Disorders. Front. Pain Res., 3.","DOI":"10.3389\/fpain.2022.852249"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Derwich, M., Mitus-Kenig, M., and Pawlowska, E. (2021). Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis\u2014A Systematic Review. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22147405"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.jcms.2024.04.010","article-title":"Classifications for the Temporomandibular Joint (TMJ): A Systematic Review of the Literature","volume":"52","author":"Elledge","year":"2024","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Warzocha, J., Gadomska-Krasny, J., and Mrowiec, J. (2024). Etiologic Factors of Temporomandibular Disorders: A Systematic Review of Literature Containing Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC\/TMD) from 2018 to 2022. Healthcare, 12.","DOI":"10.3390\/healthcare12050575"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/joor.13840","article-title":"Efficacy of Hyaluronic Acid in Temporomandibular Disorders Evaluated with Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD)","volume":"52","author":"Kukreja","year":"2025","journal-title":"J. Oral Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Siewert-Gutowska, M., Pokrowiecki, R., Kami\u0144ski, A., Zawadzki, P., and Stopa, Z. (2023). State of the Art in Temporomandibular Joint Arthrocentesis-A Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134439"},{"key":"ref_7","first-page":"123","article-title":"Physiotherapy in Hypomobility of Temporomandibular Joints","volume":"60","author":"Piech","year":"2020","journal-title":"Folia Medica Cracoviensia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"s40463-023","DOI":"10.1186\/s40463-023-00639-4","article-title":"Advanced Mandibular Reconstruction with Fibular Free Flap and Alloplastic TMJ Prosthesis with Digital Planning","volume":"52","author":"Pyne","year":"2023","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ijom.2022.05.014","article-title":"Temporomandibular Joint Prosthesis as Treatment Option for Mandibular Condyle Fractures: A Systematic Review and Meta-Analysis","volume":"52","author":"Niezen","year":"2022","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Penlington, C., Bowes, C., Taylor, G., Otemade, A.A., Waterhouse, P., Durham, J., and Ohrbach, R. (2022). Psychological Therapies for Temporomandibular Disorders (TMDs). Cochrane Database Syst. Rev., 2022, Available online: https:\/\/www.cochranelibrary.com\/cdsr\/doi\/10.1002\/14651858.CD013515.pub2\/full.","DOI":"10.1002\/14651858.CD013515.pub2"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1111\/joor.13693","article-title":"Psychological Treatments for Temporomandibular Disorder Pain\u2014A Systematic Review","volume":"51","author":"Christidis","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.17219\/dmp\/188273","article-title":"Single Intra-Articular Administration of Injectable Platelet-Rich Fibrin (I-PRF) in Alleviating Temporomandibular Joint Pain: A Pilot Clinical Trial","volume":"62","author":"Sielski","year":"2025","journal-title":"Dent. Med. Probl."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Shi, J., Di, W., Teo, K.Y.W., and Toh, W.S. (2024). Mesenchymal Stem Cell-Based Therapies for Temporomandibular Joint Repair: A Systematic Review of Preclinical Studies. Cells, 13.","DOI":"10.3390\/cells13110990"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13005-021-00261-7","article-title":"Application of Auriculotemporal Nerve Block and Dextrose Prolotherapy in Exercise Therapy of TMJ Closed Lock in Adolescents and Young Adults","volume":"17","author":"Zhou","year":"2021","journal-title":"Head Face Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"151882","DOI":"10.1016\/j.aanat.2021.151882","article-title":"Temporomandibular Joint Innervation: Anatomical Study and Clinical Implications","volume":"240","author":"Kucukguven","year":"2022","journal-title":"Ann. Anat. Anat. Anz."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s12663-019-01202-3","article-title":"Complications of Diagnostic TMJ Arthroscopy: An Institutional Study","volume":"18","author":"Chowdhury","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hunt, B.R., Johson, S.A., and Klukkert, Z.S. (2025). Distribution, Scaling, and Depiction of the Temporal Branches of the Facial Nerve. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-96316-9"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/s12663-021-01570-9","article-title":"The Facial Nerve Injury After Temporomandibular Joint Surgery after Endaural Approach with Sharp Dissection","volume":"21","author":"Pauwels","year":"2022","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.ijom.2022.10.009","article-title":"Complications of Total Temporomandibular Joint Replacement: A Systematic Review and Meta-Analysis","volume":"52","author":"Rios","year":"2023","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"609","DOI":"10.5603\/EP.a2021.0078","article-title":"Orbital Decompression for Thyroid Eye Disease: Surgical Treatment Outcomes in Endocrinological Assessment","volume":"72","author":"Krzeski","year":"2021","journal-title":"Endokrynol. Pol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s00586-025-08775-3","article-title":"Optimal Timing for Decompression in Post-Operative Epidural Hematoma: A Retrospective Analysis and Treatment Flowchart","volume":"34","author":"Chang","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1097\/IOP.0000000000002556","article-title":"Orbital Decompression: Conceptual Approach for Orbital Volume Expansion","volume":"39","author":"Goldberg","year":"2023","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"48","DOI":"10.21164\/pomjlifesci.1000","article-title":"Adverse Events of Intra-Articular Temporomandibular Joint Injections: A Systematic Search and Review","volume":"69","author":"Turosz","year":"2023","journal-title":"Pomeranian J. Life Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_25","unstructured":"(2024, November 14). PROSPERO\u2014International Prospective Register of Systematic Reviews. Available online: https:\/\/www.crd.york.ac.uk\/prospero\/."},{"key":"ref_26","unstructured":"(2025, June 14). JBI Critical Appraisal Tools | JBI. Available online: https:\/\/jbi.global\/critical-appraisal-tools."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.joms.2024.12.012","article-title":"What Are the Complications of Temporomandibular Joint Arthrocentesis?","volume":"83","author":"Singer","year":"2025","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1080\/02688690050004633","article-title":"Extradural Haematoma Following Temporomandibular Joint Arthrocentesis and Lavage","volume":"14","author":"Carroll","year":"2000","journal-title":"Br. J. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"115","DOI":"10.17245\/jdapm.2019.19.2.115","article-title":"An Unusual Complication during Arthrocentesis: N. Facialis Paralysis, with N. Lingualis and N. Alveolaris Inferior Anesthesia","volume":"19","author":"Aliyev","year":"2019","journal-title":"J. Dent. Anesth. Pain Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/joor.12718","article-title":"Pain Relief Following a Single-dose Intra-articular Injection of Methylprednisolone in the Temporomandibular Joint Arthralgia\u2014A Multicentre Randomised Controlled Trial","volume":"46","author":"Isacsson","year":"2019","journal-title":"J. Oral Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1080\/08869634.2017.1341138","article-title":"Complications and Post-Operative Sequelae of Temporomandibular Joint Arthrocentesis","volume":"36","author":"Vaira","year":"2018","journal-title":"CRANIO\u00ae"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"bcr-2017-223563","DOI":"10.1136\/bcr-2017-223563","article-title":"Septic Arthritis of the Temporomandibular Joint Leading to an Epidural Abscess","volume":"2018","author":"Wittig","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.joms.2014.11.018","article-title":"Temporomandibular Joint Arthrocentesis: Outcomes Under Intravenous Sedation Versus General Anesthesia","volume":"73","author":"Mehra","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_34","first-page":"4206275","article-title":"Evaluation of Patient Comfort and Impact of Different Anesthesia Techniques on the Temporomandibular Joint Arthrocentesis Applications by Comparing Gow-Gates Mandibular Block Anesthesia with Auriculotemporal Nerve Block","volume":"2022","author":"Garip","year":"2022","journal-title":"Pain Res. Manag."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"12","DOI":"10.5604\/01.3001.0016.1076","article-title":"Clinical Characteristics of Acute Rhinosinusitis in COVID-19 a Post Hoc Analysis of a Longitudinal Study","volume":"77","author":"Burska","year":"2022","journal-title":"Otolaryngol. Pol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Tsui, H.C., Lam, C.M., Leung, Y.Y., Li, K.Y., Wong, N.S.M., and Li, D.T.S. (2022). Lavage Volume of Arthrocentesis in the Management of Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12112622"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.1007\/s00784-020-03408-z","article-title":"Ultrasonography-Guided Arthrocentesis versus Conventional Arthrocentesis in Treating Internal Derangement of Temporomandibular Joint: A Systematic Review","volume":"24","author":"Leung","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"647","DOI":"10.17219\/dmp\/146820","article-title":"Advantages of Ultrasound Guidance for TMJ Arthrocentesis and Intra-Articular Injection: A Narrative Review","volume":"59","author":"Tesch","year":"2022","journal-title":"Dent. Med. Probl."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Huang, L., Huang, Z., Bi, S., and Mai, H. (2024). A Clinical Trial of Ropivacaine in Arthocentesis for TMD. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04606-x"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4103\/abhs.abhs_14_21","article-title":"Minimally Invasive Surgeries for the Treatment of Temporomandibular Disorders: Prognostic Indicators and Persistence of Treatment Outcomes over a 5-Year Follow-Up","volume":"1","author":"Talaat","year":"2022","journal-title":"Adv. Biomed. Health Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13005-021-00305-y","article-title":"Correlation of MRI and Arthroscopic Findings with Clinical Outcome in Temporomandibular Joint Disorders: A Retrospective Cohort Study","volume":"18","author":"Vervaeke","year":"2022","journal-title":"Head Face Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S87","DOI":"10.1080\/07853890.2021.1897446","article-title":"Clinical Outcomes in TMD Patients after Arthrocentesis with Lysis, Lavage and Viscossuplementation","volume":"53","author":"Ferreira","year":"2021","journal-title":"Ann. Med."},{"key":"ref_43","first-page":"11","article-title":"Gradient sequential treatment of temporomandibular joint disorders","volume":"28","author":"Zhang","year":"2020","journal-title":"Kouqiang Jibing Fangzhi"},{"key":"ref_44","first-page":"e962","article-title":"Clinical and Radiological Outcome of Arthrocentesis Followed by Autologous Blood Injection for Treatment of Chronic Recurrent Temporomandibular Joint Dislocation","volume":"9","author":"Patel","year":"2017","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.ijom.2014.05.004","article-title":"Arthrocentesis Followed by Intra-Articular Autologous Blood Injection for the Treatment of Recurrent Temporomandibular Joint Dislocation","volume":"43","author":"Bayoumi","year":"2014","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.bjoms.2010.11.010","article-title":"Accidental Use of Alcohol during Arthrocentesis of the Temporomandibular Joint","volume":"49","author":"Etoz","year":"2011","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_47","first-page":"602","article-title":"Auriculotemporal Syndrome after Injection into the Temporomandibular Joint: Report of Case","volume":"26","author":"Simpson","year":"1968","journal-title":"J. Oral Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5770\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:28:01Z","timestamp":1760034481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5770"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,15]]},"references-count":47,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165770"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165770","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,15]]}}}