Minimally Invasive TMJ Surgery: An Indispensable Treatment Modality in Contemporary Oral and Maxillofacial Surgery Practice

Minimally invasive Temporomandibular Joint Surgery (MITMJS) is a treatment modality for patients suffering from temporomandibular disease (TMD), particularly TMJ internal derangement (ID) and osteoarthrosis, who have not responded to conservative and pharmacologic treatment. It is considered as a definitive surgical tool for alleviating pain and function, without the surgical risks and long-term recovery of open joint surgery (TMJ disk plication, arthroplasty, and replacements), and with minimal expected morbidity as well. MITMJS includes TMJ arthrocentesis and TMJ arthroscopy, combined in both cases with lysis and lavage, the latter being performed either without direct visualization of the joint or arthroscopically.

Decision making for MITMJS is primarily based upon the combination of the clinical and radiological findings. Cardinal clinical signs of TMJ dysfunction include acute or chronic orofacial pain, limitation of mandibular movement along with pain associated with mandibular function, and joint clicking or popping sounds. Radiological findings (MRI) of major concern refer to disk form, disk location during the neutral position, reduction with movement, range of motion, joint effusion, structure of the articular surfaces, and bone marrow anomalies.

Indications for arthrocentesis include: a) acute and subacute limitation of opening (closed lock) of the TMJ, because of anteriorly displaced disk without reduction of less than 3 months evolution, b) chronic pain with good range of motion and anterior disk displacement with reduction, c) degenerative osteoarthritis, and d) TMJ open lock condition where condyle is entrapped anterior to a lagging disk.

Arthroscopy is recommended: a) for the treatment of chronic closed lock of the TMJ, usually of more than 3 months evolution, b) ID of the TMJ, mainly Wilkes stages II, III, and IV, c) degenerative joint disease (osteoarthritis), d) synovitis, e) painful hypermobility or recidivist luxation of discal cause, and f) hypomobility caused by intra-articular adherences.

MITMJS seems to be a safe, simple, and effective alternative surgical method for the treatment of TMJ dysfunction, having limited potential complications during or immediately after the procedure, the oral and maxillofacial surgeon must be aware of. Future trends for MITMJS include computer-assisted arthroscopy, navigation and arthroscopy, improvements in camera and optical lens technology, designing of smaller and more flexible scopes as well as of nonhuman synthetic models for training in MITMJS.