tm j surgery C D A J O U R N A L , V O L 4 9 , Nº 3
Modern Temporomandibular Joint Surgery: A Review Rebeka G. Silva, DMD; Stephen T. Connelly, DDS, MD, PhD; and Kenneth A. Holman, DDS
abstract Background: The temporomandibular joint (TMJ) is a complex, load-bearing structure that may require surgical modification or reconstruction, depending on the diagnosis, chronicity and level of dysfunction. Methods: Broad categories of temporomandibular disorders (TMD), including myofascial pain, internal derangement (ID) and degenerative joint disease (DJD), are outlined. While traditional treatment of TMD is generally limited to conservative and reversible regimes, the TMJ surgeon may bypass conventional treatment in favor of surgical options. Surgical decision-making and a variety of surgical treatment for ID and DJD, among other disorders, are reviewed. Surgical options include intra-articular surgery and total joint reconstruction. The role of splint therapy for surgical and nonsurgical patients is also discussed. Results: Specific TMJ disorders benefit from a surgery-first approach to achieve mandibular and occlusal stability. Selected patients may be offered TMJ surgery in lieu of conservative therapy in the setting of symptomatic ID, severe DJD, ankylosis, condylar fracture, primary joint pathology and in the context of a co-diagnosis of obstructive sleep apnea and joint degeneration for those who require maxillomandibular advancement. Practical implications: General dentists and dental specialists often manage TMD patients with a variety of conservative treatments but may miss an opportunity to obtain an early surgical opinion from a TMJ surgeon for patients with specific signs and symptoms. The traditional TMD treatment pyramid does not always apply; therefore, the surgery-first paradigm may help get patients prompt definitive care. Key words: Temporomandibular joint, TMJ surgery, TMJ reconstruction, degenerative joint disease, internal derangement
AUTHORS Rebeka G. Silva, DMD, is a Clinical Professor of Oral and Maxillofacial Surgery at the University of California, San Francisco. She is a board-certified oral and maxillofacial surgeon and practices in a private practice and in the Oral and Maxillofacial Surgery Section, Dental Service, at the San Francisco VA Healthcare System.
Stephen T. Connelly, DDS, MD, PhD, is Associate Clinical Professor of Oral and Maxillofacial Surgery at the University of California, San Francisco. He is a board-certified oral and maxillofacial surgeon and practices in a private practice and in the Oral and Maxillofacial Surgery Section, Dental Service, at the San Francisco VA Healthcare System.
Kenneth A. Holman, DDS, maintains a private orthodontics practice in Redwood City, Calif. Conflict of Interest disclosure for all authors: None reported.
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he evolution of temporomandibular joint (TMJ) surgery has taken oral and maxillofacial surgeons on a long journey that includes direct surgical procedures on the joint complex (through disc surgery, arthroplasty and joint replacement) and surgery that indirectly affects the relationship of the joint-disc relationship (condylotomy). Due to the beautiful yet complex anatomy and function of the TMJ, many oral and M ARC H 2 0 2 1
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