Int. J. Oral Maxillofac. Surg.

2005; 34: 107113

doi:10.1016/j.ijom.2004.06.011, available online at http://www.sciencedirect.com

Invited Review Paper

TMJ Disorders

The role of surgery in the

G. Dimitroulis
St. Vincents Hospital Melbourne, Suite 5,
10th Floor, 20 Collins Street, Melbourne, Vic.
3000, Australia

management of disorders of the

Temporomandibular Joint:
a critical review of the literature
Part 1
G. Dimitroulis:The role of surgery in the management of disorders of the
Temporomandibular Joint: a critical review of the literature Part 1. Int. J. Oral
Maxillofac. Surg. 2005; 34: 107113. # 2004 International Association of Oral
and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. Despite the controversy surrounding the role of surgery in the

management of Temporomandibular Disorders (TMD), studies in peer review
journals continue to support the role of surgery as a legitimate means of treating
pain and dysfunction in the Temporomandibular Joint (TMJ). To better understand
the role of surgery in the management of TMJ disorders, a critical review of the
literature will be presented in two parts. Part 1 reviews the evolution of TMJ
surgery together with the biological evidence for surgical disease. History teaches
Key words: Temporomandibular Joint; surgery;
us that we are destined to repeat the mistakes of the past if we fail to properly history of molecular biology.
reect on what has already been achieved and where the failures have occurred.
With the help of molecular biology, the future of TMD management may Accepted for publication 8 June 2004
comprise more carefully targeted and less radical treatment modalities. Available online 10 November 2004

In the current practice of Oral & Max-
illofacial Surgery, controversy continues
to surround the role of surgery in the
management of Temporomandibular
Disorders (TMD). While studies in peer
review journals largely support the role
of surgery as a legitimate means of
treating pain and dysfunction in the
Temporomandibular Joint (TMJ), there
are, however, publications which trivia-
lize the role of surgery in the manage-
ment of TMD based on the assumption
that the great majority of patients can be
successfully treated through non-surgical
means67a,93a. Furthermore, surgical inter-
vention for TMD has often been consid-
0901-5027/020107+07 $30.00/0
ered as an option of last resort after all
non-surgical avenues of treatment are
exhausted rst. As we shall see in this
article, the rst of two papers, TMJ
research at the molecular level appears
to indicate that perhaps arthrocentesis or
arthroscopic lavage may well have a
useful role to play in the early stages of
TMD management.
To better understand the role of sur-
gery in the management of TMJ disor-
ders a critical review of the literature
will be presented. Part 1 will look at the
evolution of TMJ surgery together with
the biological evidence for surgical dis-
ease. Part 2 will scrutinize the indica-
# 2004 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
tions for surgery and review the
controversies surrounding the various
surgical procedures available for the
management of TMJ disorders.
The history of TMJ surgery
In the rst half of the 20th century,
publications on TMJ surgery were
sporadic which reected the poor under-
standing of TMJ pathology9,65. By the
second half of the 20th century the evo-
lution of TMJ surgery gathered momen-
tum as improved understanding of TMJ
disorders paralleled advances in diag-
nostic imaging4,10,33,57,114. In recent
108 Dimitroulis
decades TMJ arthroscopy has opened
up a vast new eld of molecular biol-
ogy which has led to an improved
understanding of the pathosis of TMJ
pain and dysfunction which, in turn, has
provided critical support for the role of
surgery in the management of TMJ dis-
orders.
Ankylosis and dislocation of the TMJ
were both recognized as far back as the
time of Hippocrates in the fth century
B.C. Methods of manual reduction of dis-
located jaws were described similar to
the techniques used today. By the 19th
century, various forms of chin straps
were used to treat jaw dislocations. The
19th century also heralded the earliest
TMJ operations which were predomi-
nantly performed for the release of joint
ankyloses90. In 1856, a Cambridge sur-
geon, described the condylectomy from
the level of the condylar neck to treat
TMJ ankylosis51. The procedure had
evolved from the simple division of
brous bands or osteotomy of the fused
joint with attempts to create a pseudoar-
throsis close to the original joint. In
1860, VEREUIL109 reported the use of the
temporalis ap as an interpositional bar-
rier within the surgical defect created
after release of the ankylosis. The high
recurrence rate of re-ankylosis prompted
wider gap arthroplasties in a bid to
increase the distance between bone ends
and help reduce new bone formation3,65.
In 1914, MURPHY82 described the use of
autogenous fat as interpositional material
while in 1934, RISDON97 employed free
muscle grafts to address the problem of
re-ankylosis. It was not until the papers
by GEORGIADE et al.39 and TOPA-
107,108
ZIAN appeared in the 1950s and
1960s that the wide gap arthroplasty
with interpositional grafting gained
universal acceptance as the standard pro-
cedure for TMJ ankylosis manage-
ment11,12,62,90,98.
Operative procedures for dislocation
were more complex and varied and
hence were not introduced until well
into the 20th century. In 1951, MYR-
83
HAUG described the eminectomy for
the treatment of condylar dislocation
that was adapted by IRBY55 in 1957 for
the treatment of painful TMJ dysfunc-
tion. Later procedures which evolved
for the treatment of dislocation included
capsulorrhaphies, lateral pterygoid myo-
tomies and osteotomies of the zygo-
matic arch and eminence to limit the
translation of the condyle70,90,96,102.
Anterior synovial sulcus ablation using
electrocautery and lasers via surgical
arthroscopic techniques have been more
recent developments in the management
of recurrent TMJ dislocation and hyper-
mobility73,74.
Other forms of TMJ internal
derangement involving disc integrity
and position were not recognized until
well into the 19th century. Surgery for
TMJ internal derangement involving
the disc can be traced back to a British
surgeon ANNANDALE1 who, in 1887,
published an article describing two
cases of discoplasty for the manage-
ment of disc displacement in the TMJ.
The rst published case of discectomy
for painful TMJ dysfunction was
reported in the German literature by
LANZ68 in 1909. From then until the
1950s discectomy remained the proce-
dure of choice in the surgical treatment
of painful TMJ dysfunction5,34,42,66.
The renement of X-rays of the TMJ
by the 1950s suggested that a reduction
in joint space might well explain the
painful TMJ dysfunction as a conse-
quence of increased joint pressure. Pio-
neering surgeons of the day adopted
the theory and devised techniques for
increasing the joint space as a means
of decompressing irritated tissues.
IRBYs55 use of the eminectomy as a
means of increasing joint space for the
treatment of painful TMJ has already
been mentioned. FRED HENNY, a trail-
blazing pioneer of American Oral Sur-
gery, advocated the technique of high
condylectomy as a way of increasing
the joint space48. Critics of the techni-
que were quick to argue that whatever
space was created by the condylectomy
would be immediately lost by the
superior collapse of the ramus. About
the same time, a British team led by
Sir TERENCE WARD looked at a different
method for increasing the joint space
without breaching the joint cap-
sule111,112. Building on Campbells
observations of condylar fractures they
described the mandibular condylotomy
based on Kosteckas original procedure
for treating anterior open bite90,111. The
condylotomy involved a simple osteot-
omy that separated the condylar process
from the rest of the mandible. The idea
was the surgically separated condyle
would increase the joint space through
sag and therefore relieve the pressure
within the TMJ. What made this tech-
nique interesting was the osteotomy of
the condylar neck could be undertaken
as a closed procedure using the gigli
saw. The fact the joint capsule was not
breached was considered advanta-
geous2. NICKERSON and later HALL re-
popularized the technique in the 1980s
with the modied condylotomy that uti-
lized the direct intraoral approach for
separating the condyle from the mand-
ible45.
The 1960s witnessed a hiatus in the
evolution of TMJ surgery as the concept
of myofascial pain and dysfunction syn-
drome developed by LASKIN69 oversha-
dowed developments in the intracapsular
pathology of TMD4. Building on
SCHWARTZs theory104 of muscle pain,
LASKIN69 emphasized the importance of
psychological inuence and parafunc-
tional habits that largely obscured the
joint as a source of pathology. Despite
this, LASKIN helped establish the impor-
tant distinction between muscle and joint
problems that had important implications
in the diagnosis and management of
TMD22,69.
Proof for the role of the disc in TMJ
pain and dysfunction was not available
until 1970s when TMJ arthrography tech-
niques were improved and rened64,113.
TMJ arthrography provided crucial
evidence for the existence of intra-articu-
lar pathology such as disc displacement
that could be clearly demonstrated in
surgically undisturbed joints28,33,44,57.
The 1970s proved to be a watershed
in the history of TMJ surgery.
Largely as a result of the pioneering
works of WILKES114,115, FARRAR35 and
MCCARTY36,75, TMJ disc displacement
was universally adopted as the mechan-
ism which helped explain the pain, click-
ing and joint locking experienced in
patients diagnosed with internal derange-
ment24,28,31,44. It was not long before a
new generation of surgeons turned their
attention to the articular disc. As a result,
TMJ surgery gathered momentum in
North America as various procedures
were devised to reposition, repair or
remove the diseased disc19,24,26,2932,46.
Unfortunately, the early optimism of
TMJ surgery was quickly followed by
disasters in the form of alloplastic disc
replacements that were implanted in
thousands of patients between 1978 and
198625,26,47,63,67,103,118. As a result, the
initial euphoria of TMJ surgery turned to
despair as surgeons were faced with a
generation of patients who had multiply
operated and painfully degenerated
joints13,49,110. It is often said that the
TMJ surgery undertaken in the 1980s
helped create and dictate the TMJ surgery
performed in the 1990s. The dilemma
faced by surgeons in the 1990s was the
increasing numbers of patients facing dis-
cectomy following initial disc preserva-
tion procedures that failed to alleviate
symptoms24 as well as the failed alloplas-

tic implants that required urgent atten-
tion49. There was an understandable shift
away from alloplastic implants to autoge-
nous grafts such as temporalis fascia and
muscle37,38, conchal cartilage43 and der-
mis grafts40 to replace missing discs.
Unfortunately, long-term studies which
showed good results of discectomy with-
out disk replacement were largely
ignored. Curiously, many surgeons felt
disc replacement was mandatory follow-
ing discectomy and so channeled their
efforts to nd the ideal disc replacement
material that still remains elusive to this
day42,53,54.
In 1975, OHNISHI92 adapted and minia-
turized the orthopaedic arthroscope for
use in the small dimensions of the TMJ.
It took almost a decade before the ther-
apeutic applications of TMJ arthroscopy
became evident following extensive
research into the diagnostic capabilities
of the technique by Japaenese81 and
Swedish50 researchers. SANDERS101 and
MCCAIN72 published landmark papers on
the therapeutic application of TMJ
arthroscopy during the mid 1980s espe-
cially in the management of closed lock
utilizing the simple technique of arthro-
lysis and lavage of the TMJ14,32. By the
late 1980s and early 1990s TMJ surgery
had undergone a renaissance with the
adoption of minimally invasive surgery
as the main surgical treatment modality
of the TMJ. Complex operative or surgi-
cal TMJ arthroscopy was developed lar-
gely by the efforts of US surgeons
MCCAIN & DE LA RUA73 and others52,93.
The aim of operative arthroscopy was to
emulate many of the open joint proce-
dures that had fallen out of vogue.
Through small portholes, these super
talented arthroscopists attempted to
show the world that most surgical proce-
dures on the TMJ could be undertaken
without the need for a formal arthrot-
omy74. Like all new surgical techniques,
the zealots who promoted them were
swept up in the frenzied pace of keyhole
surgery developments that were sweep-
ing across almost all the surgical spe-
cialties. It seemed like keyhole surgery
had limitless potential until the passage
of time and experience carved out a well
dened role with certain limitations that
eventually dampened the initial enthu-
siasm.
While TMJ arthrography helped focus
attention on the phenomenon of disc dis-
placement as the pathology of the most
common type of internal derangement,
the introduction of TMJ arthroscopy and
later, arthrocentesis cast doubt as to the
true mechanism of TMJ pain and lock-
Role of surgery in management of disorders of TMJ
ing20,23,27,8486. The effectiveness of
simple lavage and lysis to treat closed
lock raised important questions about
the central pathosis of the most
common forms of internal derange-
ment20,21,23,27,84,85. TMJ arthroscopy and
arthrocentesis also provided the opportu-
nity for researchers to investigate and
compare the synovial uid of healthy
and diseased joints5861,94,117. This ush-
ered in a new era of molecular biology
in TMJ research that helped researchers
such as STEPHEN MILAM & JOHN
SCHMITZ79 propose the molecular mecha-
nisms of degenerative TMJ disease. A
better understanding of the pathological
mechanisms of TMJ disease was essen-
tial in devising more effective treatment
modalities and helped redene the role
of surgery in TMJ pain and dysfunc-
tion86.
The multiply operated patients who
continued to suffer from TMJ pain and
joint dysfunction spurned a whole new
industry of total prosthetic joint replace-
ment. While total joint replacements for
TMJ have been around since the 1970s,
the failure of the early prosthetic joints
did not deter the development of new
models and designs which are currently
available on the market78. The Christen-
sen total joint prosthesis is perhaps the
most widely used prosthesis in TMJ
replacements76. The numerous metal
and plastic components trialed over the
years have closely followed the evolu-
tion of joint prostheses developed in the
eld of orthopaedic surgery100. While
numerous indications for the use of
prosthetic TMJs have been cited in the
literature, it perhaps is not surprising
that most are used in patients with mul-
tiply operated joints77,78,95,116. The
repercussions of early surgical disasters
are still felt today as many patients
with iatrogenic end stage joint disease
are undergoing prosthetic joint replace-
ments. The North American experience
of unmitigated TMJ surgery has pro-
vided us with good reason to be cau-
tious about the kind of patients we
select for surgery. History teaches us
that we are destined to repeat the mis-
takes of the past if we fail to properly
reect on what has already been
achieved and where the failures have
occurred8,11.
The molecular biology of TMJ
disease
In the 1950s, Ireland claimed that dis-
placement of the articular disc was the
rst stage in a sequence of events that
109
led to osteoarthritis56. Later reports sug-
gested that the articular disc had a pro-
tective effect on the underlying articular
tissues within the TMJ which was com-
promised when the disc is displaced,
thereby exposing underlying tissues
to excessive loads with consequent
degenerative changes41,71,106. An alter-
native view proposed by various
workers16,17,105 suggested that disc dis-
placement was a consequence of pre-
existing degenerative conditions within
the TMJ. Such propositions, however,
did not explain why disc displacement
has been observed in both symptomatic
and asymptomatic patients. Furthermore,
it has also been shown that repositioning
of a displaced disc is unnecessary in
treating pain and dysfunction in the
TMJ as results of TMJ arthroscopy and
arthrocentesis have proved23,27,84. As a
result of these observations, investigators
have turned their attention to the mole-
cular biology of articular health and dis-
ease in order to understand the factors
that lead to, or result from, internal
derangement and osteoarthrosis of the
TMJ58,59,79,80,87,89.
At the molecular level, the difference
between adaptive changes and disease
depends on the balance between ana-
bolic (i.e., reparative) and catabolic (i.e.,
destructive) molecular events within the
affected tissues. Therefore, the disease
state is when tissue destruction outpaces
tissue repair. The most signicant nd-
ing in recent decades is the TMJ
responds to a wide range of dynamic
forces through its remarkable adaptive
capacity6,7,15,18,91. Changing load de-
mands on the joint caused by clenching
or bruxism leads to mechanical stress.
The adaptive capacity of the TMJ
responds to mechanical stress by meta-
bolic events that result in remodeling
within the articular tissues10. This may
explain the structural variations found
within asymptomatic joints not asso-
ciated with active disease. This also
explains why not all people who clench
or brux go on to develop symptoms of
TMJ disease99.
In those who do develop TMJ symp-
toms, the joint may have a reduced
adaptive potential and so responds to
mechanical stress in a maladaptive way
that results in disease. Increasing age is
the most common factor which reduces
the adaptive potential of articular tis-
sues. Female hormones such as oestro-
gen and prolactin are also thought to
adversely affect the adaptive capacity of
the TMJ by tipping the balance of mole-
cular events in favour of catabolic or
110 Dimitroulis
destructive tissue degradation. Degenera-
tive changes within joint tissues are also
promoted by factors which enhance
sympathetic tone such as nicotine inges-
tion or psychological stress resulting
from chronic pain and anxiety79.
Based on the data derived from clini-
cal and animal research, MILAM &
SCHMITZ79 proposed three mechanisms of
injury to explain degenerative TMJ dis-
orders. These are; direct mechanical
injury, hypoxia-reperfusion injury and
neurogenic inammation. The tripartate
theory proposes that excessive mechani-
cal loading of the joint disturbs the
delivery of vital nutrients to the cells
within the joint and disrupts the elimina-
tion of harmful metabolic waste pro-
ducts. Further damage is done when the
mechanical load on the joint results in
intra-capsular pressure that exceeds the
end capillary-perfusion pressure which
disrupts the blood ow to the joint and
leads to tissue hypoxia. When the pres-
sure is released, the resultant reperfusion
of the joint in the form of a sudden
surge in blood ow may result in
oxygen being converted to damaging
free radicals. Finally, the release of
pro-inammatory neuropeptides from
mechanically stressed or irritated nerve
terminals in retrodiscal tissues, espe-
cially in cases of disc displacement, can
invoke an inammatory response in sur-
rounding tissues causing pain and swel-
ling (i.e., dysfunction). The diagnostic
spin-off from such research is the estab-
lishment of markers for TMJ disease.
The main obstacle, at present, is it is
still unclear which molecular and bioac-
tive compounds are involved in joint
adaptation (i.e., repair) and which are
indicative of disease (i.e., tissue destruc-
tion)80.
According to MILAM et al.80, mechan-
ical stresses to the joint lead to the accu-
mulation of damaging free radicals
which, under normal conditions, are neu-
tralized by scavenging mechanisms in
the form of enzymes, antioxidants and
some hormones (e.g., melatonin). A dis-
ease state can occur in susceptible indivi-
duals who are unable to respond to the
accumulation of free radicals within the
TMJ because of the intrinsic deciency
of their free radical scavenging or repair
mechanisms. MILAM et al.80 refer to this
as oxidative stress which triggers
further molecular events that amplify the
destruction of articular tissues and result
in degenerative disease in the TMJ.
NITZAN & DOLWICK85 rst suggested
the suction cup phenomenon to explain
the mechanism for closed lock of the
TMJ. The suction cup theory failed
because it implied excessive and sus-
tained negative intra-articular pressures
which was not physiologically possible.
In response to the limitations of the ori-
ginal theory, NITZAN & MARMARY87
coined the term the anchored disc phe-
nomenon or ADP to describe the pro-
cess where the disk is stuck or adhered
to the glenoid fossa, not by negative
pressure, but by chemical means through
surface adhesion. A similar concept of
lubrication deciency was previously 3. Blair VP. Operative treatment of anky-
alluded to by BOERING4, OGUS & TOL-
91a
LER and STEGENGA et al.105.
In an attempt to explain the adhesive
forces, NITZAN88 took the theory of
uncontrolled free radicals further by
speculating that oxidative stress may
also damage the lubrication system that
allows the smooth translation of the disc
during function of the TMJ. The phos-
pholipids and hyaluronic acid, which are
essential in an efcient system of joint
lubrication, are attacked and broken
down by excess free radicals. This
results in damage to the joint lubrication
system which leads to increase friction
between the articular disc and the sur-
rounding articular surfaces. According to
NITZAN & ETSION89, this leads to either
ADP or displacement of the articular
disk. NITZAN & ETSION89 went on to
explain that ADP occurs when the sur-
faces are pressed together under repeti-
tive function load in the absence of
adequate lubrication. By injecting uid
in the superior joint space, the surfaces
are prized apart by hydro-dissection.
This model helps to explain why simple
arthrocentesis and lavage of the TMJ is
effective in re-establishing joint motion
in a joint with closed lock without
affecting the position of the disc.
The failure of disc repositioning tech-
niques in the past has resulted in a con-
certed effort by researchers to
understand the physiology of joint func-
tion and dysfunction at the molecular
level23,27. Research in molecular biology
may one day result in a test that will
help identify those patients most suscep-
tible to TMJ disorders80. Improvements
in diagnostic and therapeutic approaches
to TMJ disease are what researchers in
molecular biology are attempting to
achieve. With the help of molecular
biology, the future of TMD management
may comprise more carefully targeted
and less radical treatment modalities.
Treatments such as TMJ arthrocentesis
using different agents such as specic
enzymes or antioxidants may well obvi-
ate the need for more radical open surgi-
cal intervention. The future holds great
promise.
References
1. Annandale T. On displacement of the
inter-articular cartilage of the lower jaw
and its treatment by operation. Lancet
1887: 1: 411.
2. Banks P, MacKenzie I. Condylotomy.
A clinical and experimental appraisal of
a surgical technique. J Maxillofac Surg
1975: 3: 170181.
losis of the mandible. Trans Southern
Surg Gynecol Assoc 1914: 26: 435.
4. BOERING G. Temporomandibular Joint
Arthrosis: An Analysis of 400 Cases.
Leiden: Staeu 1966.
5. Boman K. Temporomandibular joint
arthrosis and its treatment by extirpation
of the disc. Acta Chir Scand Suppl 1947:
118: 95.
6. Boyne PJ. Osseous repair and mandib-
ular growth after subcondylar fractures. J
Oral Surg 1967: 25: 300.
7. BRADLEY PF. Condylar injuries. In: Rowe
NL, Williams JLI, eds: Maxillofacial
Injuries. Vol 1, Chapter 10. Edinburgh:
Churchill-Livingstone 1985.
8. Bradrick JP, Indresano AT. Failure
rate of repetitive tempormandibular joint
surgical procedures. J Oral Maxillofac
Surg 1992: 50: 145.
9. Burman M, Sinberg SE. Condylar
movement in the study of internal
derangement of the temporomandibular
joint. J Bone Joint Surg 1946: 28: 351
373.
10. Carlsson GE, Oberg T. Remodeling of
the temporomandibular joints. Oral Sci
Rev 1974: 4: 5386.
11. Chossegros C, Guyot L, Cheynet F,
Blanc JL, Cannoni P. Full-thickness
skin graft interposition after temporo-
mandibular joint ankylosis surgery. A
study of 31 cases. Int J Oral Maxillofac
Surg 1999: 28: 330334.
12. Chossegros C, Guyot L, Cheynet F,
Blanc JL, Gola R, Bourezak Z,
Courath J. Comparison of different
materials for interpositional arthroplasty
in the treatment of temporomandibular
joint ankylosis surgery; long-term fol-
low-up in 25 cases. Br J Oral Maxillofac
Surg 1997: 35: 157160.
13. Chuong R, Piper MA. Cerebrospinal
uid leak associated with proplast
implant removal from the temporoman-
dibular joint. Oral Surg Oral Med Oral
Pathol 1992: 74: 422425.
14. Clark GT, Moody DG, Sanders B.
Arthroscopic treatment of temporoman-
dibular joint locking resulting from disc
derangement. J Oral Maxillofac Surg
1991: 49: 157.
15. Dalhlstrom L, Kahnberg K-E, Lin-
dahl L. 15 years follow-up on condylar
fractures. Int J Oral Maxillofac Surg
1989: 18: 18.

16. de Bont LGM, Boering G, Liem RSB,
et al. Osteoarthritis and internal derange-
ment of the temporomandibular joint: a
light microscopic study. J Oral Maxillo-
fac Surg 1986: 44: 634643.
17. de Bont LGM, Stegenga B. Pathology
of temporomandibular joint internal
derangement and osteoarthrosis. Int J
Oral Maxillofac Surg 1993: 22: 71.
18. Dimitroulis G. Condylar injuries in
growing patients. Aust Dent J 1997:
42: 367371.
19. Dimitroulis G, Dolwick MF, Gremil-
lion HA. Temporomandibular disorders
3. Surgical treatment. Aust Dent J 1996:
41: 1620.
20. Dimitroulis G, Dolwick MF, Marti-
nez A. Temporomandibular joint arthro-
centesis and lavage for the treatment of
closed lock: a follow-up study. Br J Oral
Maxillofac Surg 1995: 33: 2327.
21. Dimitroulis G. A review of 56 cases
of chronic closed lock treated with
temporomandibular joint arthroscopy. J
Oral Maxillofac Surg 2002: 60: 519
524.
22. Dolwick MF. Clinical diagnosis of tem-
poromandibular joint internal derange-
ment and myofascial pain and
dysfunction. Oral Maxillofac Surg Clin
North Am 1989: 1: 16.
23. Dolwick MF. Intra-articular disc dis-
placement part 1: its questionable role
in temporomandibular joint pathology.
J Oral Maxillofac Surg 1995: 53:
1069.
24. Dolwick MF. Disc preservation surgery
for the treatment of internal derange-
ments of the temporomandibular joints.
J Oral Maxillofac Surg 2001: 59: 1047
1050.
25. Dolwick MF, Aufdemorte TB. Sili-
cone induced foreign body reaction and
lymphadenopathy after temporomandib-
ular joint arthroplasty. Oral Surg Oral
Med Oral Pathol 1985: 59: 449452.
26. Dolwick MF, Dimitroulis G. Is there a
role for temporomandibular joint sur-
gery? Br J Oral Maxillofac Surg 1994:
32: 307313.
27. Dolwick MF, Dimitroulis G. A re-
evaluation of the importance of disc
position in temporomandibular disor-
ders. Aust Dent J 1996: 41: 184
187.
28. Dolwick MF, Katzberg RW, Helms
CA. Internal derangement of the tempor-
omandibular joint: fact or ction? J Pros-
thet Dent 1983: 49: 415418.
29. Dolwick MF, Nitzan DW. TMJ disk
surgery: 8-year follow-up evaluation.
Fortschr Kiefer Gesichtschir 1990: 35:
162167.
30. Dolwick MF, Nitzan DW. The role of
disc repositioning surgery for internal
derangements of the temporomandibular
joint. Oral Maxillofac Surg Clin North
Am 1994: 6: 271.
31. Dolwick MF, Riggs RR. Diagnosis and
treatment of internal derangements of
Role of surgery in management of disorders of TMJ
the temporomandibular joint. Dent Clin
North Am 1983: 27: 561572.
32. DOLWICK MF, SANDERS B. TMJ Internal
Derangement and ArthrosisSurgical
Atlas. St. Louis: CV Mosby Co. 1985.
33. Eriksson L, Westersson P-L. Clinical
and radiological study of patients with
anterior disc displacement of the tempor-
omandibular joint. Swed Dent J 1983: 7:
5564.
34. Ericksson L, Westersson P-L. Tem-
poromandibular joint discectomy. Oral
Surg Oral Med Oral Pathol 1992: 74:
259272.
35. Farrar WB. Diagnosis and treatment of
anterior dislocation of articular disc.
New York J Dent 1971: 41: 348351.
36. Farrar WB, McCarty WL. Inferior
joint space arthrography and character-
istics of condylar paths in internal
derangements of TMJ. J Prosthet Dent
1979: 41: 458.
37. Feinberg SE. Use of composite tempor-
alis muscle aps for disc replacement.
Oral Maxillofac Clin North Am 1994: 6:
335337.
38. Feinberg SE, Larsen PE. The use of a
pedicled temporalis muscle-pericranial
ap for replacement of the TMJ disc:
preliminary report. J Oral Maxillofac
Surg 1989: 47: 142146.
39. Georgiade N, Altany F, Pickrell K.
An experimental and clinical evaluation
of autogenous dermal grafts used in the
treatment of temporomandibular joint
ankylosis. Plast Reconstr Surg 1957:
19: 321326.
40. Georgiade N. The surgical correction
of temporomandibular joint dysfunction
by means of autogenous dermal grafts.
Plast Reconstr Surg 1962: 30: 68.
41. Glineburg RW, Laskin DM, Blaus-
tein DI. The effects of immobilisation
on the primate temporomandibular joint
a histological and histochemical study. J
Oral Maxillofac Surg 1982: 40: 3.
42. Hall HD. The role of discectomy for
treating internal derangements of the
temporomandibular joint. Oral Maxillo-
fac Surg Clin North Am 1994: 6: 287
294.
43. Hall HD, Link JL. Diskectomy alone
and with ear cartilage interposition grafts
in joint reconstruction. Oral Maxillofac
Clin North Am 1989: 1: 329340.
44. Hall HD, Nickerson JW. Is it time to
pay more attention to disc position? J
Orofacial Pain 1994: 8: 9095.
45. Hall HD, Nickerson JW, McKenna
SJ. Modied condylotomy for treatment
of the painful temporomandibular joint
with a reducing disc. J Oral Maxillofac
Surg 1993: 51: 133142.
46. Hall MB. Meniscoplasty of the dis-
placed temporomandibular meniscus
without violating the inferior joint space.
J Oral Maxillofac Surg 1984: 42: 788
792.
47. Heffez L, Mafee MF, Rosenberg H,
et al. CT evaluation of temporomandib-
111
ular disc replacement with a proplast-
teon laminate. J Oral Maxillofac Surg
1987: 45: 657660.
48. Henny FA, Baldridge OL. Condylect-
omy for the persistently painful tempor-
omandibular joint. J Oral Surg 1957: 15:
24.
49. Henry CH, Wolford LM. Treatment
outcomes for temporomandibular joint
reconstruction after proplast-teon
implant failure. J Oral Maxillofac Surg
1993: 51: 352358.
50. Holmlund A, Gynther G, Axelsson
S. Efcacy of athroscopic lysis and
lavage in patients with chronic locking
of the tempromandibular joint. Int J Oral
Maxillofac Surg 1994: 23: 262265.
51. Humphrey GM. Excision of the condyle
of the lower jaw. Br Assoc Med J 1856:
160: 61.
52. Indresano AT. Surgical arthroscopy as
the preferred treatment for internal
derangements of the temporomandibular
joint. J Oral Maxillofac Surg 2001: 59:
308312.
53. Ioannides C, Freihofer HPM. Repla-
cement of the damaged inter-articular
disc of the TMJ. J Craniomandib Pract
1988: 16: 273276.
54. Ioannides C, Maltha JC. Lyophilized
auricular cartilage as a replacement for
the intra-articular disk of the cranioman-
dibular joint. An experimental study in
guinea pigs. J Craniomaxillofac Surg
1988: 16: 295300.
55. Irby WB. Surgical correction of chronic
dislocation of the TMJ not responsive to
conservative therapy. J Oral Surg 1957:
15: 307312.
56. Ireland VE. The problem of the click-
ing jaw. J Prosthet Dent 1953: 3: 2000.
57. Isberg AM, Westesson P-L. Move-
ment of the disc and condyle in tempor-
omandibular joints with clicking. An
arthrographic and cineradiographic
study on autopsy specimens. Acta Odon-
tol Scand 1982: 40: 151164.
58. Israel HA. Synovial uid analysis. Oral
Maxillofac Surg Clin North Am 1989: 1:
8592.
59. Israel HA. Current concepts in the sur-
gical management of temporomandibu-
lar joint disorders. J Oral Maxillofac
Surg 1994: 52: 289294.
60. Israel HA. The use of athroscopic sur-
gery for treatment of temporomandibu-
lar joint disorders. J Oral Maxillofac
Surg 1999: 57: 579582.
61. Israel HA, Saed-Nejad F, Ratcliffe
A. Early diagnosis of osteoarthritis of the
temporomandibular joint: correlation
between arthroscopic diagnosis and ker-
atin sulfate levels in the synovial uid. J
Oral Maxillofac Surg 1991: 49: 708.
62. Kaban LB, Perrott DH, Fisher K. A
protocol for management of temporo-
mandibular ankylosis. J Oral Maxillofac
Surg 1990: 48: 1145.
63. Kaplan PA, Tu HK, Williams SM.
Erosive arthritis of the temporomandib-
112 Dimitroulis
ular joint caused by Teon-Proplast
implants: plain lm features. Am J
Roentgenol 1988: 151: 337340.
64. Katzberg RW, Keith DA, Guralnick
WC, et al. Internal derangement and
osteoarthritis of the temporomandibular
joint. Radiology 1983: 146: 107112.
65. Kazanjian VH. Ankylosis of the tem-
poromandibular joint. Am J Orthod
1937: 24: 333.
66. Kiehn CL. Menisectomy for internal
derangement of the temporomandibular
joint. Am J Surg 1952: 83: 364373.
67. KIERSCH TE. The use of Proplast-Teon
implants for menisectomy and disc
repair in the temporomandibular joint.
In: AAOMS Clinical Congress on
Reconstruction with Biomaterials, San
Diego, CA, January 1984.
67a. KLINEBERG I. Craniomandibular Disor-
ders and Orofacial Pain. Diagnosis and
Management. Oxford: Butterworth-Hei-
nemann (Wright) 1991.
68. Lanz AB. Discitis mandibularis. Zen-
tralbl Chir 1909: 36: 289291.
69. Laskin DM. Etiology of the pain dys-
function syndrome. J Am Dent Assoc
1969: 79: 147.
70. Laskin DM. Myotomy for the manage-
ment of recurrent and protracted man-
dibular dislocations. Trans Congr Int
Assoc Oral Surg 1973: 4: 264268.
71. Laskin DM. The role of the meniscus in
the etiology of post traumatic temporo-
mandibular joint ankylosis. Int J Oral
Surg 1978: 7: 340345.
72. McCain JP. Arthroscopy of the human
temporomandibular joint. J Oral Maxil-
lofac Surg 1988: 46: 648652.
73. McCain JP, de la Rua H. Principles
and practice of operative arthroscopy of
the human temporomandibular joint.
Oral Maxillofac Surg Clin North Am
1989: 1: 135152.
74. McCain JP, Sanders B, Koslin MG,
et al. Temporomandibular joint arthro-
scopya 6-year multicenter retrospec-
tive study of 4831 joints. J Oral
Maxillofac Surg 1992: 50: 926930.
75. McCarty WL, Farrar WB. Surgery
for internal derangement of the tempor-
omandibular joint. J Prosthet Dent 1979:
42: 191196.
76. Mercuri LG. The Christensen prosthe-
sis. Oral Surg Oral Med Oral Pathol
1996: 81: 135.
77. Mercuri LG. Alloplastic temporoman-
dibular joint reconstruction. Oral Surg
Oral Med Oral Pathol 1998: 85: 631.
78. Mercuri LG. The use of alloplastic
prostheses for temporomandibular joint
reconstruction. J Oral Maxillofac Surg
2000: 58: 7075.
79. Milam SB, Schmitz JP. Molecular biol-
ogy of temporomandibular joint disor-
ders: proposed mechanisms of disease. J
Oral Maxillofac Surg 1995: 53: 1448
1454.
80. Milam SB, Zardeneta G, Schmitz JP.
Oxidative stress and degenerative tem-
poromandibular joint disease: a pro-
posed hypothesis. J Oral Maxillofac
Surg 1998: 56: 214223.
81. Murakami K, Hosaka H, Moriya Y,
et al. Short-term treatment outcome
study for the management of tempro-
mandibular joint closed lock. Oral Surg
Oral Med Oral Pathol 1995: 80: 253
257.
82. Murphy J. Arthroplasty for intra-articu-
lar bony and brous ankylosis of the
temporomandibular articulation. J Am
Med Assoc 1914: 62: 1783.
83. Myrhaug H. A new method of opera-
tion for habitual dislocation of the mand-
iblereview of former methods of
treatment. Acta Odont Scand 1951: 9:
247261.
84. Nitzan DW, Dolwick MF, Heft MW.
Arthroscopic lavage and lysis of the
temporomandibular joint: a change in
perspective. J Oral Maxillofac Surg
1990: 48: 798801.
85. Nitzan DW, Dolwick MF. An alter-
native explanation for the genesis of
closed-lock symptoms in the internal
derangement process. J Oral Maxillofac
Surg 1991: 49: 810815.
86. Nitzan DW, Dolwick MF, Martinez
GA. Temporomandibular joint arthro-
centesis: a simplied treatment for
severe, limited mouth opening. J Oral
Maxillofac Surg 1991: 49: 11631167.
87. Nitzan DW, Marmary Y. The
anchored disc phenomenon: a pro-
posed etiology for sudden onset, severe
and persistent closed lock of the TMJ. J
Oral Maxillofac Surg 1997: 55: 797
802.
88. Nitzan DW. The process of lubrication
impairment and its involvement in tem-
poromandibular joint disc displacement:
a theoretical concept. J Oral Maxillofac
Surg 2001: 59: 3645.
89. Nitzan DW, Etsion I. Adhesive force:
the underlying cause of the disk ancho-
rage to the fossa and/or eminence in the
temporomandibular jointa new con-
cept. Int J Oral Maxillofac Surg 2002:
31: 9499.
90. NORMAN J, BRAMELY P (eds). Textbook
and Color Atlas of the Temporomandib-
ular Joint. London: Wolfe Medical Pub-
lications Ltd. 1990.
91. Ogus H. The mandibular joint: internal
rearrangement. Br J Oral Maxillofac
Surg 1987: 25: 218.
91a. OGUS H, TOLLER PA. Common Disorders
of the Temporomandibular Joint. 2nd
edn. Bristol: John Wright 1986.
92. Ohnishi M. Arthroscopy of the tempor-
omandibular joint. J Jpn Stomat 1975:
42: 207212 [in Japanese].
93. Ohnishi M. Arthroscopic laser surgery
and suturing for temporomandibular dis-
orders. Techniques and clinical results.
Arthroscopy 1991: 7: 212.
93a. OKERSON JP. Management of Temporo-
mandibular Disorders and Occlusion.
2nd ed. St. Louis: CV Mosby Co. 1989.
94. Quinn JH. Identication of prostaglan-
din E2 and leukotrine B4 in the synovial
uid of painful, dysfunctional temporo-
mandibular joints. J Oral Maxillofac
Surg 1990: 48: 968971.
95. Quinn PD. Alloplastic reconstruction of
the temporomandibular joint. Select
Readings Oral Maxillofac Surg 2000:
7: 1.
96. Revington PJD. The Dautrey proce-
durea case for reassessment. Br J Oral
Maxillofac Surg 1986: 24: 217220.
97. Risdon F. Ankylosis of the temporo-
mandibular joint. J Am Dent Assoc
1934: 21: 19331937.
98. ROWE NL. Ankylosis of the temporo-
mandibular joint. J R Coll Surg Edinb
1982: 27 (Part 1): 6779, 27 (Part 2):
167173, 27 (Part 3): 209218.
99. Rugh JD, Harlan J. Nocturnal bruxism
and temporomandibular disorders. Adv
Neurol 1988: 49: 329341.
100. Ryan DE. Alloplastic implants in the
temporomandibular joint. Oral Maxillo-
fac Surg Clin North Am 1989: 1: 427
441.
101. Sanders B. Arthroscopic surgery of the
temporomandibular joint: treatment of
internal derangement with persistent
closed lock. Oral Surg Oral Med Oral
Pathol 1986: 62: 361364.
102. Sanders B, Newman R. Surgical treat-
ment for recurrent dislocation or chronic
subluxation of the temporomandibular
joint. Int J Oral Surg 1975: 4: 179183.
103. Schellhas KP, Wilkes CH, El Beeb
M. Permanent Proplast temporomandib-
ular joint implants: MR imaging of
destructive complications. Am J Roent-
genol 1988: 151: 731735.
104. Schwartz LJ. Pain associated with
the TMJ. J Am Dent Assoc 1955: 51:
394.
105. Stegenga B, DeBont LGM, Boering
G, Van Willigen JD. Tissue responses
to degenerative changes in the tempor-
omandibular joint: a review. J Oral Max-
illofac Surg 1991: 48: 10791088.
106. Stevenson TR, Evaskus DS, Laskin
DM. Role of the meniscus in TMJ anky-
losis; a histological study. J Dent Res
1979: 58(Special issue A): 269.
107. Topazian RG. Etiology of ankylosis
of the TMJ analysis of 44 cases. J Oral
Surg Anesth Hosp Dent Serv 1964: 22:
227.
108. Topazian RG. Comparison of gap and
interpositional arthroplasty. J Oral Surg
1966: 24: 405.
109. Vereuil A. De la creation dune Fausse
articulation por section ou resection
partielle de lmaxillaire inferier. Arch
Generale de Med V Serie 1860: 15:
174.
110. Wagner JD, Mosby EL. Assessment of
Proplast-Teon disc replacements. J
Oral Maxillofac Surg 1990: 48: 1140.
111. Ward TG, Smith DG, Sommar M.
Condylotomy for mandibular joints. Br
Dent J 1957: 103: 147148.

112. Ward TG. Surgery of the mandibular
joint. Ann R Coll Surg Engl 1961: 28:
139145.
113. Westesson P-L. Arthrography of the
temporomandibular joint. J Prosthet
Dent 1984: 51: 535.
114. Wilkes CH. Arthrography of the tem-
poromandibular joint in patients with
TMJ pain dysfunction syndrome. Minn
Med 1978: 61: 645652.
115. Wilkes CH. Internal derangements of
the temporomandibular joint: pathologi-
cal variations. Arch Otolaryngol Head
Neck Surg 1989: 115: 469.
Role of surgery in management of disorders of TMJ 113
116. Wolford LM, Dingworth DJ, Tal- Address:
war RM, Pitta MC. Comparison of 2 George Dimitroulis
temporomandibular joint total joint pros- St. Vincents Hospital Melbourne
thesis systems. J Oral Maxillofac Surg Suite 5
2003: 61: 685690. 10th Floor
117. Yih W-Y. Pathology of arthroscopic 20 Collins Street
tissue of the temporomandibular joint. Melbourne
Oral Maxillofac Surg Clin North Am Vic. 3000
1989: 1: 93102. Australia.
118. Yih W-Y, Merrill RG. Pathology of Tel.: 61 3 9654 3799
alloplastic interpositional implants in Fax: 61 3 9650 3845
the temporomandibular joint. Oral E-mail : geodim@netspace.net.au
Maxillofac Surg Clin North Am 1989:
1: 415.