Going listed indications and contraindications for arthroscopic management of a patient with a temporomandibular joint (TMJ) disorder. The author is from Emory University in Atlanta.


Indications for diagnostic arthroscopy:

(1) diagnosis of significant joint disease which cannot be resolved with noninvasive imaging and which is unresponsive to conservative management

(2) obtain specimens of joint fluid for culture or analysis

(3) biopsy of a mass lesion for histologic examination

(4) allergy to radiopaque dye in a patient with a suspected perforation


Indications for operative arthroscopy:

(1) acute disc displacement without reduction or with frequent intermittent locking

(2) hypomobility secondary to fibrous adhesions in the superior joint space

(3) disc displacement with a small perforation in the retrodiscal tissue or disc

(4) unexplained pain refractors to medical management with

(4a) disc displacement with reduction

(4b) capsulitis

(4c) degenerative joint disease

(5) hypermobility of the joint that is associated with dislocation and/or painful subluxations


Situations where open surgery may be necessary:

(1) large meniscal or retrodiscal perforation

(2) severe ankylosis

(3) removal of a large tumor

(4) removal of alloplastic material



(1) clicking or popping joint unless painful and unresponsive to medical management


Contraindications to arthroscopy:

(1) regional skin infection

(2) possible tumor seeding

(3) septic arthritis of the TMJ

(4) poor operative risk due to severe comorbid condition(s)

(5) severe, uncorrectable coagulopathy

(6) facial pain without a functional intracapsular component


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