The temporomandibular joint (TMJ) is a complex, load-bearing structure that may requiresurgical modification or reconstruction, depending on the diagnosis, chronicity and level of dysfunction.Methods: Broad categories of temporomandibular disorders (TMD), including myofascial pain, internalderangement (ID) and degenerative joint disease (DJD), are outlined. While traditional treatment of TMDis generally limited to conservative and reversible regimes, the TMJ surgeon may bypass conventionaltreatment in favor of surgical options. Surgical decision-making and a variety of surgical treatment for ID andDJD, among other disorders, are reviewed. Surgical options include intra-articular surgery and total jointreconstruction. 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 obstructivesleep apnea and joint degeneration for those who require maxillomandibular advancement.Practical implications: General dentists and dental specialists often manage TMD patients with a varietyof conservative treatments but may miss an opportunity to obtain an early surgical opinion from a TMJsurgeon for patients with specific signs and symptoms. The traditional TMD treatment pyramid does notalways apply; therefore, the surgery-first paradigm may help get patients prompt definitive care.
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