Anteriolateral disc w/o reduction both tmj joints. tried meds, arthrocentesis. splint on order. how long to try splint for before surgery?

Not too long: If you've already had an mri, and you know that both discs are completely displaced without reduction, you're a good candidate for TMJ arthroscopy with lavage and lysis of adhesions. I wouldn't wait several months for a splint to have an effect. Arthroscopy is more effective than arthrocentesis for closed locks. If arthroscopy fails to solve the problem, an open arthroplasty would be next step.

Well...: I would be very cautious about about jumping into surgery. Bite splint would be the first therapy i would try. I usually do an anterior bite plate for 2weeks 24x7 coupled with a steroid for the first week. After that, splint therapy goes to night-time wear only. Sometimes a permanent splint is required to re-open the bite in cases w/o reduction, but surgery is always an absolute last resort.

TMJ disc: If you can open normaly, then surgery should noot be a consideration. Most patients begin to see improvement in their symptoms within 4-6 weeks after initiating oral appliance therapy. It is best if the appliance is only worn during sleep. During the day, the teeth should remain apart except for eating, swallowing and speaking. Connservative therapy work 96-98% of the time with tmds.

Physical Therapy: Passive stretching exercises using your thumb and index finger of the same hand pushing the teeth apart to stretch the joints works well muscle pain even in a joint that has disc displacement. The key is to stretch the joint to a point where muscles actually hurt and keep the position for about 10 secs or so a few times a day. I have also been very successful with nti type splints.

Few weeks: A few weeks should be enough. If no better, will not likely improve with more time. If you are somewhat better after a few weeks, wait til you stop improving and then assess your status. Make sure your TMJ surgoen is VERY experienced.