The role of surgery in the management of disorders of the temporomandibular joint: a critical review of the literature

The literature is unequivocal in its support for surgery in the management of certain disorders of the Temporomandibular joint (TMJ). Unfortunately, the literature on TMJ surgery is based more on observation than science since randomised clinical trials comparing surgical treatment of the TMJ with medical treatment and no treatment (i.e., placebo) do not exist. Because the application of scientific principles in clinical studies which involve surgical intervention are ethically unfeasible, the true benefit of surgical intervention for Temporomandibular Disorders (TMD) may never be conclusively established. Waiting for properly designed, placebo controlled, random clinical trials will only impede the progress of surgical experience and frustrate the decision making for both clinicians and patients. Therefore, the current recommendations for surgery must rely on the best available evidence. The aim of this, the second of two papers, is to scrutinize the role of TMJ surgery in light of the controversies that have appeared in the literature in recent years.