Ultrasound Guided Versus Conventional Arthrocentesis in Treatment of Temporomandibular Joint Internal Derangement.

• Scrubbing and draping of the patient will be carried out in a standard fashion using betadine surgical scrub.
• Head turned to the affected side. • External auditory meatus will be blocked with a cotton plug.
• Transducer is placed over TMJ, parallel to the long axis of mandibular ramus. • Transducer is tilted until the optimal visualization is obtained.
• Disc is visualized as a thin homogenous, hypo-to-iso-echoic band lying adjacent to the inferior relation. The bony landmarks of the mandibular condyle and the articular eminence are visualized as hyperdense lines.
• Superior joint space located between the disc and articular eminence is the targeted point of the needle.

Intra-operative procedures - continued in both groups:

• Lavage is performed with 100 ml of saline solution.
• 1 ml of Hyaluronic acid is injected into the superior joint space.
• Puncture point is covered with sterile dressing for 24 hours

• Scrubbing and draping of the patient will be carried out in a standard fashion using betadine surgical scrub.
• Head turned to the affected side. • External auditory meatus will be blocked with a cotton plug.
• A line will be drawn from tragus of the ear to the outer canthus of the eye with ink.
• Double needled canula is inserted into superior compartment of the joint space 2mm below and 10 mm ahead of mid-tragal end of Holmund Hellsing's line.

Intra-operative procedures - continued in both groups:

• Lavage is performed with 100 ml of saline solution.
• 1 ml of Hyaluronic acid is injected into the superior joint space.
• Puncture point is covered with sterile dressing for 24 hours