J Oral Maxillofac Surg 68:782-789, 2010 Discectomy as the Primary Surgical Option for Internal Derangement of the Temporomandibular Joint Michael Miloro, DMD, MD,* and Brent Henriksen, DDS, MD† Purpose: The goal of this study was to evaluate outcomes of patients who underwent temporoman- dibular joint (TMJ) discectomy without replacement as the primary treatment for internal derangement after failure of nonsurgical therapy. Patients and Methods: Thirty consecutive patients with TMJ internal derangement were treated with discectomy from 2001 to 2007. Four patients were lost to follow-up, and 2 were excluded because of prior joint surgery. Using the standardized Helkimo Anamnestic and Clinical Dysfunction Indexes, 24 patients, or 32 joint surgeries, were evaluated postoperatively, with an average follow-up of 30.8 months (range, 2 to 60 months). Results: All 24 patients showed improvement in mandibular mobility and joint function, as well as reduction in TMJ and muscular facial pain, represented by a clinical dysfunction index of DiO, DiI, or DiII. Preoperatively, all patients had an anamnestic index of AiII, which represented moderate to severe pain in the TMJ and masticatory muscles, and/or locking of the joint before surgery. Postsurgically, 20 of the 24 patients scored an index of DiO or DiI, which correlated with a clinically symptom-free state or only a small, minor dysfunction. TMJ pain, muscle pain, and pain with mobility scored the lowest point index, indicating a subjectively successful outcome. Conclusions: Discectomy of the TMJ as a primary surgical option significantly reduces pain and improves function. © 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:782-789, 2010 Signs and symptoms of temporomandibular joint (TMJ) dysfunction are reported frequently, and ac- cording to various demographic analyses of its prev- alence, TMJ dysfunction may exist in 10% to 30% of the general population. Most patients can be managed successfully with nonsurgical methods such as phys- ical therapy, bite splints, moist heat, arthrocentesis or intra-articular injections, or pharmacotherapy. 1 How- ever, about 5% of patients whose nonsurgical therapy fails require open joint surgery. 2 Over the past 2 decades, the approach to the patient with TMJ has changed significantly, and a “less is more” philosophy governs the practice of most oral and maxillofacial surgeons. In fact, the indications for open joint sur- gery have narrowed significantly over the years, as have the specific procedures that are performed. In fact, arthroscopy of the TMJ is performed successfully by only a limited number of surgeons who are expe- rienced in performing arthroscopic surgical proce- dures, rather than simple lysis and lavage, which can be accomplished with simple arthrocentesis and jaw manipulation. Considering that disc repositioning and disc replacement surgery have not been shown to be effective long term, and that the eventual fate of most operated joints is discectomy, then the selection of the surgical procedure with the highest probability of success and the least morbidity should be considered primarily. Discectomy is the most common surgery performed for the painful TMJ 3 ; it is also the one procedure for which there are the best long-term data outcomes available. 4-8 Bjornland and Larheim 9 found that a 3-year follow-up examination proved to be a reliable predictor of the 10-year results for patients treated with a discectomy of the TMJ. The present study evaluated the short-term outcome of patients treated with discectomy as the first surgical proce- dure for TMJ internal derangement. In fact, McKenna 10 *Professor, Department Head, Program Director, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL. †Private Practice, Sioux Falls, SD. Address correspondence and reprint requests to Dr Miloro: Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, 801 South Paulina St M/C 835, Chicago, IL 60612-7211; e-mail: mmiloro@uic.edu © 2010 American Association of Oral and Maxillofacial Surgeons 0278-2391/10/6804-0012$36.00/0 doi:10.1016/j.joms.2009.09.091 782