Objectives <p>This study was aimed to investigate the efficacy of comprehensive conservative treatments in patients with temporomandibular joint (TMJ) retrodiscal layer rupture and/or disc perforation.</p> Materials and methods <p>This was a retrospective study of thirty-one consecutive patients with findings of TMJ retrodiscal layer rupture and/or disc perforation using magnetic resonance imaging. Comprehensive stomatognathic system assessments were performed. Comprehensive treatment modalities were applied to each patient and treatment outcomes were analyzed. The changes in patient-reported symptoms and comfortable mouth opening (CMO) and maximum mouth opening (MMO) distances were analyzed between the baseline and after treatment.</p> Results <p>Twenty-eight females and three males were included in this study. Four patients (12.9%) reported a history of facial injury and another four (12.9%) reported having rheumatoid arthritis. Unilateral chewing was the most frequently reported parafunctional habit, followed by clenching. The mean treatment duration was 24.3 ± 11.1 months. Most of the patients received more than one type of treatment. Both CMO and MMO distances increased significantly (<i>P</i> &lt; 0.001) after treatment. Approximately three-quarters of patients reported partial improvement in symptoms, and one-fourth reported complete improvement.</p> Conclusions <p>Comprehensive conservative treatments were effective and should be applied first in patients with TMJ retrodiscal layer rupture and/or disc perforation.</p> Clinical relevance <p>Conservative treatments are recommended for patients with severe damage to the TMJ structures, such as retrodiscal layer rupture and/or disc perforation, before applying surgical approach.</p>