Temporomandibular joint arthrocentesis complications: A rare arteriovenous fistula

Temporomandibular joint (TMJ) arthrocentesis is a minimally invasive procedure for internal derangements and degenerative conditions. Although generally safe, rare but serious complications can occur, requiring clinical vigilance.

A 37-year-old male with bilateral TMJ osteoarthritis presented with severe pain (VAS 8/10), restricted opening (34 mm), and MRI-confirmed bilateral anterior disc displacement without reduction and effusion. After unsuccessful conservative therapy, he underwent three single-needle arthrocentesis sessions with intra-articular hyaluronic acid. Post-treatment, he developed a pulsatile preauricular swelling and tinnitus. Imaging identified an arteriovenous fistula between the superficial temporal artery and external jugular vein. Endovascular repair was unfeasible, so surgical ligation, discectomy, and arthroplasty with amniotic membrane interposition were performed, achieving full recovery and improved mouth opening (45 mm at 6 months).

This rare vascular complication highlights the need for early recognition of atypical postoperative signs. Prompt imaging and a multidisciplinary approach ensure safe management and favorable outcomes.