ABSTRACT
The role for open surgery of the temporomandibular joint (TMJ) is diminishing. The realisation that many patients with temporomandibular disorders improve with or without conservative therapy and the success of minimally invasive techniques for those with articular disease has led to a conceptual shift. Early arthroscopy coupled with early TMJ replacement for end-stage disease appears to provide better patient-reported outcomes. These techniques and conditions are discussed elsewhere, and this chapter will focus on open surgery for those patients with failed conservative and closed treatment, diagnosed articular disease but not requiring formal TMJ reconstruction. Surgery is performed under general anaesthesia, ideally using a nasal endotracheal tube to permit manipulation of the mandible and hence condyle. The patient is positioned in the reverse Trendelenburg slant with the head raised above the rest of the body to reduce venous flow.
