Keyhole Surgery for the TMJ: The Endoscopic Breakthrough

Abstract Background: Temporomandibular joint (TMJ) disorders are a major cause of chronic orofacial pain and functional limitation. Conventional open surgeries for TMJ internal derangements, ankylosis, and degenerative pathologies—though effective—carry significant morbidity, cosmetic concerns, and longer rehabilitation. The advent of minimally invasive endoscopic “keyhole” techniques has introduced a paradigm shift by enabling direct intra-articular visualization and intervention through small portals. Objective: To provide a comprehensive overview of keyhole (endoscopic) TMJ surgery, highlighting its evolution, indications, techniques, advantages over traditional methods, clinical outcomes, and future prospects. Methods: This article reviews literature, clinical case series, and technological innovations in TMJ arthroscopy and endoscopy, analyzing both diagnostic and therapeutic roles. Comparative evaluation with open TMJ surgery is included to assess outcome differentials. Results: Endoscopic TMJ surgery reduces operative trauma, enhances precision, improves cosmetic outcomes, and shortens recovery time. It is effective in managing early-to-moderate internal derangements, synovitis, adhesions, and degenerative changes. Limitations include cost, steep learning curve, and reduced efficacy in advanced ankylosis. Conclusion: Endoscopic TMJ surgery is a breakthrough technique that is transforming TMJ management. As instrumentation, imaging, and biologic adjuncts advance, keyhole approaches are expected to become the standard of care worldwide.