Scientific evidence in surgery for the treatment of temporomandibular joint internal derangement

Temporomandibular joint (TMJ) internal derangement (ID) is the most prevalent indication for surgery among TMJ pathology. Generally considered the literature lacks studies with the highest evidence -which is mainly supported by systematic reviews and randomized controlled trials- regarding the usefulness of surgery in the management of TMJ ID. The objective of the present manuscript is to report the actual knowledge in terms of surgical treatment of TMJ ID considering scientific evidence criteria. A non-systematic review in the literature in relation to the degree of the existing scientific evidence regarding the uselfuness of surgery for the treatment of ID of the TMJ is performed. A bibliography search on MEDLINE, EMBASE and the Cochrane library databases for studies published from March 2000 to March 2019 was conducted. The author only included studies published in the English language and those dealing with “surgical treatment of temporomandibular internal derangement”; The following technical bibliographic exclusion criteria were applied: (1) case reports; (2) technical report; (3) animal or in vitro studies; (4) review articles; (5) uncontrolled clinical studies; and (6) publications in which the same data were published by the same group of researchers. The abstracts of yielded results were reviewed and the full text of those with apparent relevance was obtained. Several results must be highlighted from the evaluation of the literature with the highest degree of evidence: (1) high-degree evidence is insufficient in relation to the effect of surgery; (2) surgery is useful in patients refractory to conservative treatment; (3) there are not differences among surgical techniques; (4) arthroscopy and arthrocentesis are effective in the treatment of chronic closed lock of the TMJ. Surgical treatment of the TMJ based on evidence is present in a moderate degree, as studies with the highest evidence are scarce. Specially for patients with TMJ ID, surgical treatment must be highly supported by the results of large series by experienced surgeons and recommendations from societies of experts in TMJ surgery