Louis G Mercuri1. 1. Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA. Electronic address: lgm@tmjconcepts.com.
Abstract
PURPOSE: This article discusses why the management of temporomandibular joint disorder (TMD) cases leads to some oral and maxillofacial surgeons to actively avoid attracting such patients to their practices, offers some evidence-based explanations, and provides recommendations for resolution that will benefit not only the specialty, but more importantly the patients it serves. MATERIALS AND METHODS: A review of the reasons some surgeons state they do not wish to manage TMD cases is presented, followed by an updated review of the TMD and orthopedic literature discussing not only the importance of a proper diagnosis but also the impact of comorbid conditions, genetics, clinical experience, and patient expectations important to achieving good TMD management outcomes. RESULTS: The literature shows that the frustration clinicians and TMD and orthopedic patients have had in the past are related to initial misdiagnosis leading to multiple failed procedures, failed materials and devices, failure to understand the impact of comorbid conditions and genetic features on outcomes, clinicians' experience in complex cases, and unrealistic outcomes expectations by the clinician and the patient. CONCLUSION: Although it is not reasonable to believe that every graduate of an oral and maxillofacial surgery residency will have an interest in management of TMD cases in their future practices, those who will must understand the importance of the issues of proper diagnosis, the relation of TMD patient comorbidities and prior management to final outcomes, honest awareness of their experience and ancillary support to manage complex cases, and how essential a realistic prognosis is to a successful outcome for the clinician and the patient.
PURPOSE: This article discusses why the management of temporomandibular joint disorder (TMD) cases leads to some oral and maxillofacial surgeons to actively avoid attracting such patients to their practices, offers some evidence-based explanations, and provides recommendations for resolution that will benefit not only the specialty, but more importantly the patients it serves. MATERIALS AND METHODS: A review of the reasons some surgeons state they do not wish to manage TMD cases is presented, followed by an updated review of the TMD and orthopedic literature discussing not only the importance of a proper diagnosis but also the impact of comorbid conditions, genetics, clinical experience, and patient expectations important to achieving good TMD management outcomes. RESULTS: The literature shows that the frustration clinicians and TMD and orthopedic patients have had in the past are related to initial misdiagnosis leading to multiple failed procedures, failed materials and devices, failure to understand the impact of comorbid conditions and genetic features on outcomes, clinicians' experience in complex cases, and unrealistic outcomes expectations by the clinician and the patient. CONCLUSION: Although it is not reasonable to believe that every graduate of an oral and maxillofacial surgery residency will have an interest in management of TMD cases in their future practices, those who will must understand the importance of the issues of proper diagnosis, the relation of TMDpatient comorbidities and prior management to final outcomes, honest awareness of their experience and ancillary support to manage complex cases, and how essential a realistic prognosis is to a successful outcome for the clinician and the patient.