Evaluation Study of Retro Discal Tissue Injection Arthroscopically Versus Ultrasound Guide Injection

Inclusion criteria

• Adults aged 18-60 years with symptomatic TMJ disorder/internal derangement (unilateral or bilateral)
• TMJ pain at rest and/or during function for ≥ 3 months
• Clinical diagnosis consistent with disc displacement with or without reduction (with or without MRI confirmation, if included in the protocol)
• Baseline pain intensity ≥ 4/10 on VAS or NRS
• Limitation of mouth opening or functional impairment (e.g., maximum mouth opening ≤ 35 mm or pain-related limitation)
• Failed or insufficient response to conservative therapy for ≥ 4-6 weeks (e.g., soft diet, NSAIDs, splint therapy, physiotherapy)
• Ability to provide informed consent and comply with scheduled follow-up visits

Exclusion criteria

• Previous TMJ surgery (arthroscopy or arthrotomy) on the study side or TMJ injection within the last 3-6 months
• TMJ ankylosis, fracture, tumor, or active infection
• Primary inflammatory arthropathy (e.g., rheumatoid arthritis, gout, psoriatic arthritis) or systemic connective tissue disease affecting the TMJ
• Significant degenerative joint disease (advanced osteoarthritis) if the study focuses on internal derangement or soft tissue pathology
• Severe skeletal or dentofacial deformity requiring orthognathic surgery during the study period
• Pregnancy or lactation
• Bleeding disorders, platelet disorders, or anticoagulant therapy that cannot be safely managed (particularly relevant for PRP injections)
• Known allergy or contraindication to the planned injectate or local anesthetic
• Severe uncontrolled systemic disease (ASA III-IV) or inability to tolerate anesthesia or sedation (for arthroscopy arm)
• Active psychiatric or neurologic condition that may impair accurate pain reporting or follow-up compliance