EVALUATION OF TMJ ARTHROSCOPY WITH HYALURONIC ACID INJECTION VERSUS STANDARD TMJ ARTHROSCOPY FOR PATIENTS WITH INTERNAL DERANGEMENTS: A RANDOMIZED CLINICAL TRIAL

Background: Initial Temporomandibular joint (TMJ) arthroscopy aims to reduce inflammation and mechanical ob- struction in TMJ internal derangement. Supplemental hyaluronic acid (HA) deposition is frequently employed to improve joint lubrication and protect articular surfaces, yet its long-term therapeutic impact as an adjunct is not well-defined. Objective: While TMJ arthroscopy is a standard treatment for TMJ internal derangements(ID), the added therapeu- tic value of HA as an adjunct remains unclear. Study Design: Randomized controlled trial with 1:1 allocation. Setting: Patients with TMJ ID was selected from those attending the Outpatient Clinic of Oral and Maxillofacial Surgery Departement at Sayed Galal University Hospital, Al Azhar University and Faculty of Dental Medicine ,Boys, Cairo Al Azhar University Participants: twelve patients over 18 years of both sexes, suffer from TMJ ID which not respond to conservative treatments, were randomized into two groups, study group(n= 6) patients and control group (n=6)patients. Interventions: Participants receive either standard TMJ arthroscopic lysis and lavage (ALL) alone (Control Group) or the same ALL supplemented with an intra-articular injection of HA (study Group). Both protocols were per- formed under general anesthesia for patients diagnosed with TMJID. Main Outcome Measures:, including pain levels according visual analog scale (VAS) and maximal interincisal opening (MIO), laterality excursion, protrusion, chewing efficacy and disc position change in MRI, were assessed between groups at standard follow-up intervals Results: Both groups showed significant pain reduction, but HA group reported significantly lower pain at 3 months (2.00 vs. 4.33, p = 0.016) and 6 months (1.33 vs. 4.33, p = 0.005), No statistically significant differences were ob- served between the groups for any additional parameters throughout the follow-up period (p>0.05), with both co- horts demonstrating comparable improvements in maximal incisal opening (MIO). Conclusions: TMJ arthroscopy effectively treats ID, with adjunctive HA providing superior early pain relief and functional recovery. However, long-term functional outcomes are comparable to standard arthroscopy alone. While HA accelerates initial healing, standard arthroscopy remains a highly reliable definitive treatment.