COMPARATIVE EFFICACY OF ARTHROSCOPY VERSUS ARTHROCENTESIS FOR ADVANCED TEMPOROMANDIBULAR JOINT INTERNAL DERANGEMENT: A RANDOMIZED CONTROLLED TRIAL

Background:Temporomandibular joint internal derangement (TMJID) often leads to orofacial pain and dysfunction,
frequently due to abnormal disc-condyle relationships. When conservative treatments fail for advanced TMJID,
minimally invasive procedures like arthrocentesis and arthroscopy are considered, but comparative data on their
effectiveness remain limited.
Materials and methods: This randomized controlled trial enrolled 26 female patients (18-45 years) with advanced
TMJID. Patients were randomly assigned to Group A (n=13, arthroscopy) or Group B (n=13, arthrocentesis). Both
groups received intra-articular platelet-rich plasma and hyaluronic acid. Baseline and 6-month follow-up assessments
included Visual Analog Scale (VAS) for pain, Maximum Voluntary Mouth Opening (MVMO), Maximum Assisted
Mouth Opening (MAMO), joint sounds, and MRI findings (disc position, morphology, osteoarthritic changes).
Operative duration was recorded. Statistical analysis used SPSS 26.0.
Results:Both groups showed significant pain reduction over 6 months, with no significant inter-group difference in
VAS scores (p > 0.05). Group A exhibited significantly greater improvements in both MVMO and MAMO compared
to Group B at all postoperative time points (p < 0.001). Preoperative clicking (46.2% in both groups) resolved in both
groups by 3 months, with no significant inter-group difference at 1 month (p = 0.141). MRI showed improved disc
position (transition from DDWOR to DDWR) in both groups by 6 months, with no significant inter-group difference
(p = 0.680). Arthroscopy had a significantly longer operative duration (72.08 ± 6.37 min vs. 27.15 ± 2.88 min; p <
0.001).
Conclusion: Both arthrocentesis and arthroscopy effectively reduce pain and improve disc position in advanced
TMJID. However, arthroscopy demonstrates superior outcomes in improving maximum mouth opening, likely due to
its direct ability to address complex intra-articular pathologies.