Historical Perspectives and Comparisons of TMJ Surgery for Internal Disk Derangements and Arthropathy

Abstract

A high degree of success has been reported for many surgical procedures done to relieve pain, improve altered function, and correct pathologic conditions of the temporomandibular joint. In this article, the author reviews the literature to give perspective on the various surgical treatments of this joint dating back to the 1850s. The criteria for TMJ disk surgery developed by an ad hoc committee of the American Association of Oral and Maxillofacial Surgeons in 1984 is presented in part. The committee agreed that the pathology within the joint dictates the category of the surgical procedure. Surgery may include variations of disk repositioning and repair, articular contouring, meniscectomy with and without implants, condylotomy, and high condylectomy.

The article also presents the author's results of surgical treatment on 509 joints in 391 patients with arthropathy and internal disk derangement (1968 to 1983). Procedures done in significant numbers and their success rates were: high condylectomy (84%), meniscectomy with permanent alloplastic implant secured to the fossa eminence (91%), disk reposition and repair with condylar reduction (74%), and disk reposition and repair without bone reduction (91%). The most bothersome complication was the development of fibrous adhesions between repaired disks and condyles that had been reduced.

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Ralph G. Merrill

Ralph G. Merrill, D.D.S., M.Sc.D.

Dr. Merrill received his D.D.S. degree from the University of Washington School of Dentistry in 1959 and his M.Sc.D. from Boston University School of Medicine in 1962. He completed residencies in Norfolk, Virginia: Boston; and Detroit. He is currently a professor in and chairman of the Department of Oral and Maxillofacial Surgery at the Oregon Health Sciences University in Portland.

Dr. Merrill holds appointments at several hospitals in Oregon and Washington. He belongs to the American Dental Association, the International Association for Dental Research, the American Association of Oral and Maxillofacial Surgeons, the International Association of Oral Surgeons, the International College of Dentistry, and other professional societies. He has had a number of articles printed in professional publications.