Abstract：
Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a \'one size fits all\' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an \'80% chance of getting 80% better\' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.
摘要：
颞下颌关节紊乱病（TMD）的管理遵循保守管理的逐步方法，微创手术（关节穿刺术和关节镜检查），开放手术和同种异体置换。大多数在初级保健中治疗并最初在二级保健中管理的患者有肌筋膜疼痛，可以在休息的情况下进行保守管理，局部NSAIDs,肌肉按摩,和咬伤矫形器。未能改善并有关节相关疼痛且功能受限的患者应首先进行关节镜检查和关节穿刺术。有效解决80%患者的症状。如果未能改善，关节镜检查可提供最佳的诊断帮助，并且应使外科医生能够适当地计划开放手术。历史上,手术干预是基于“一刀切”的哲学，外科医生执行他们习惯做的手术，而不管病理。在进行关节镜检查之前，无论采用何种方法，都有“80％的机会改善80％”。先前的关节镜检查将成功率降低到50％-60％，并且需要更好的成功率。根据所遇到的病理情况进行手术干预是联合管理的明智方法，如所示，外科医生在关节面或椎间盘上进行手术。在过去的15年里，作者使用了这种方法，从长远来看，成功率达到了80%，理由，和技术将与该领域最新出版物的分析一起讨论。
