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Temporomandibular disorders (TMD) Bioosychosocial model!, internal…

- - - - Arthrocentesis
        
        objective
        
        try to get disc into better functioning position --> pressure on retrodiscal tissue (w the sensory nerves) less --> less pain
        
        note that studies show proportion of pts where disc goes back into anatomic position is very few
      - Arthroscopy
        
        expensive, but improvement in effectiveness of tx is marginal, also machine is expensive to maintain, and the puncture hole is much larger so post-op pain more and damage is more
      - Open TMJ surgery
        
        indications
        
        absolute (eg. underdeveloped condyle, ankylosis, tumour)
        
        relative
        
        extra! usually remove coronoid process also, cos when pt join got problem, try to force open mouth, temporalis keeps pulling up coronoid process, usually get hyperplasia, so remove it else obstruct opening