In the treatment of diseases, there are usually various methods, from conservative treatment, minimally invasive treatment, to surgical treatment. Surgical treatment is sometimes called the “cry of failure”. When all else fails, removal, repair or repositioning of the lesion becomes the last chance to solve the problem. Today, although there are many options for treating the disease, and pharmaceutical interventions are available to prevent and treat these diseases, surgery is still a critical approach. As with other parts of the body, this is also true for the TMJ. However, a review of the national and international literature suggests that surgery on the TMJ has a variable and unpredictable outcome. Because of the unpredictable nature of this surgical outcome, understanding this uncertainty is critical for a TMJ specialist; a few cases can indeed be treated surgically, but most patients may be better treated with conservative or minimally invasive treatment options. The most common reason for unsuccessful TMJ surgery is the failure to either eliminate the cause of the apparent pathogenic problem or to effectively improve the patient’s clinical symptoms. In many cases, in the course of daily practice, the surgeon only pays attention to the immediate situation without considering what caused it in the first place. As medical practitioners, we all know that unless the latter is addressed, there is still an extremely high risk of recurrence due to the same cause. Another reason why TMJ surgery may not be successful is preoperative misdiagnosis. Because of the similarity in symptoms and signs between masticatory muscle pain and disorders and certain TMJ disorders, and also because joint disorders and muscle disorders are often etiologically related to each other. On the other hand, a correct diagnosis and treatment plan is developed, but the patient is not operated on correctly during the procedure. Of course sometimes the surgery is done well, but the lack of proper postoperative care and rehabilitation can also lead to an unsatisfactory outcome. Surgical procedures are not the primary treatment for TMJ disorders. This concept has been accepted by most TMD specialists internationally. The current indications for surgery are limited only to patients who have had poor results with sequential conservative treatment, patients with significant organic damage and severe dysfunction of the TMJ, or even patients who have developed the disease and are unable to live a normal working life, and patients who urgently require surgery and strongly request it despite being told that it may not be effective. Therefore, according to our statistics of more than 10,000 patients, the chance of actually having open surgery is only about 5%. When the attending physician chooses any treatment, he or she always hopes that it will lead to improvement, improvement, cure or even a cure. Therefore, a good surgeon must choose a treatment that gives the patient the least possible cost and the greatest possible result. The greater the ratio, the better the choice. The principle of maximizing efficacy is the golden rule of any treatment choice, including TMJ treatment.