Should temporomandibular joint disorders be operated ?

Temporomandibular joint (TMJ) disorders are due to an abnormaladaptation of the manducatory apparatus which causes are occlusalanomalies and dysfunctions amplified by nervous tensions. Clinicalmanifestations involve articular signs (pain, clicking and crepitus)and muscular signs (pain, limitation of the mouth opening). Mainanatomical lesions are anterior displacements of the TMJ disc withmodifications of the articular surfaces of the condyle and sometimesstructural modifications of the mandibular ramus (angle hypertrophy).TMJ disorders treatments consist in normalizing boththe occlusal status and the muscular function. Direct surgical repositionningof the disc is useless because an adequate functionaltreatment can restore a system with a new disc involving a normalTMJ function. Orthognatic procedures can be used to restore anormal dentofacial relationship as well as re-establishing a normalupper airway (nasal) ventilation improves orofacial functions.