Temporomandibular disorders (TMDs) comprise a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joints, masticatory muscles, and associated structures. They represent an important cause of non-odontogenic orofacial pain and may manifest clinically as preauricular pain, restricted mandibular movement, joint sounds, deviation during mouth opening, and intermittent or persistent locking. Intra-articular disorders constitute an important subgroup of TMDs, with displacement or dysfunction of the articular disc being among the most frequently encountered structural abnormalities [1,2].

Internal derangement of the temporomandibular joint refers to an abnormal positional or functional relationship between the articular disc and the articulating components of the joint. Disc displacement may occur with reduction, in which the displaced disc returns to an approximately normal relationship with the condyle during mandibular movement, or without reduction, in which the displaced disc fails to reduce during opening. The latter condition may be associated with restricted mouth opening or a clinical closed-lock presentation [1,3]. Nevertheless, structural disc abnormalities and clinical symptoms do not always correspond directly, making careful clinical assessment essential when treatment is being considered.

The pathogenesis of symptomatic TMJ internal derangement is multifactorial. Mechanical alterations within the joint may be accompanied by increased intra-articular pressure, impaired lubrication, synovial inflammation, adhesion formation, and accumulation of inflammatory mediators. These changes may contribute to pain and restriction of normal translatory movement of the mandibular condyle [3,4]. Consequently, treatment should not be directed exclusively toward restoring the anatomical position of the articular disc. Reduction of pain and restoration of satisfactory mandibular function are generally more clinically meaningful therapeutic objectives.

Initial treatment of TMJ internal derangement is usually conservative. Patient education, modification of parafunctional habits, a soft diet, pharmacotherapy, physiotherapy, jaw exercises, and occlusal appliances may be used according to the clinical presentation. A substantial proportion of patients improve with conservative treatment; therefore, invasive procedures are generally reserved for persistent or functionally significant symptoms [2,5]. However, some patients continue to experience joint pain, restricted mouth opening, or recurrent locking despite an adequate period of nonsurgical management. Minimally invasive intra-articular interventions provide an intermediate therapeutic option for these patients before more invasive surgical procedures are considered.

Temporomandibular joint arthrocentesis is one of the simplest minimally invasive surgical techniques used for the management of intra-articular TMDs. The technique evolved from the observation that arthroscopic lavage and lysis could provide symptomatic improvement in patients with persistent closed lock. Nitzan and colleagues subsequently described arthrocentesis as a simplified procedure for treating severe limitation of mouth opening [6]. Unlike arthroscopy, arthrocentesis does not require direct visualization of the intra-articular structures and can generally be performed using relatively simple equipment under local anesthesia.

Conventional arthrocentesis involves placement of needles into the superior joint compartment followed by lavage with an appropriate solution. The therapeutic effect appears to extend beyond simple mechanical washing of the joint. Lavage may dilute or remove inflammatory mediators and degradation products, release minor adhesions, modify intra-articular pressure, improve disc-condyle mobility, and restore a more favorable environment for normal joint lubrication [3,4]. Hydraulic distension during lavage may additionally facilitate mandibular movement in patients in whom adhesions or altered intra-articular mechanics contribute to restricted opening.

The principal advantages of arthrocentesis include its minimally invasive nature, technical simplicity, relatively low morbidity, and potential for rapid functional recovery. It has consequently been used for closed lock, disc displacement without reduction, painful internal derangement, arthralgia, and selected degenerative or inflammatory TMJ disorders [3,7]. Although variations in needle technique, lavage solution, lavage volume, adjunctive intra-articular medication, and number of treatment sessions have been reported, pain intensity and maximum mouth opening remain the most consistently evaluated clinical outcomes.

Evidence accumulated over the past several decades generally supports improvement in pain and mandibular function following TMJ arthrocentesis. A systematic review by Guarda-Nardini et al. evaluating randomized clinical evidence concluded that arthrocentesis can reduce pain and improve jaw function, although substantial heterogeneity in diagnostic criteria and treatment protocols limits the strength of comparisons between individual approaches [7]. Similarly, systematic evaluation of conventional and ultrasonography-guided arthrocentesis has demonstrated improvement in pain and maximum mouth opening with both techniques, without convincing evidence that image-guided treatment provides superior clinical outcomes [8].

Comparative studies have also examined whether additional intra-articular agents improve the results obtained from lavage alone. These include sodium hyaluronate, corticosteroids, platelet-rich plasma, and other biologically active substances. However, the additional benefit of such agents has not been demonstrated consistently. In a randomized clinical study, arthrocentesis alone and arthrocentesis followed by platelet-rich plasma both resulted in significant improvement in pain, mouth opening, and joint sounds, without a significant difference between the treatment groups [9]. This suggests that the mechanical and biochemical effects of lavage itself account for an important proportion of the therapeutic response.

The place of arthrocentesis within the overall management pathway for internal derangement nevertheless remains an area of continued clinical interest. Arthroscopy provides direct visualization and permits operative manipulation within the joint but requires specialized equipment and greater technical expertise. Earlier meta-analytic evidence suggested some superiority of arthroscopy over arthrocentesis for pain reduction and improvement in mandibular movement, although the authors emphasized the limited quantity and quality of comparative evidence [10]. More recent randomized evidence has shown substantial clinical improvement following both procedures, supporting arthrocentesis as a less invasive alternative in appropriately selected patients.

Clinical outcome assessment following arthrocentesis should therefore focus on patient-centered endpoints such as reduction in pain, restoration of mouth opening, improvement in mandibular function, and resolution or reduction of disabling joint symptoms. Establishing the magnitude and persistence of these changes is particularly relevant in patients who remain symptomatic despite initial conservative management.

Aim

The present study was undertaken to evaluate the clinical effectiveness of temporomandibular joint arthrocentesis in patients with symptomatic internal derangement.

Objectives

The primary objectives were to assess the change in pain intensity measured using a visual analogue scale and maximum mouth opening following arthrocentesis. Secondary objectives were to evaluate changes in joint sounds, mandibular functional limitation, and overall clinical response during follow-up.

Study Design and Setting This prospective clinical study was conducted in the Department of Oral and Maxillofacial Surgery among patients presenting with signs and symptoms suggestive of temporomandibular joint (TMJ) internal derangement. Patients who remained symptomatic despite an initial course of conservative management were screened for eligibility. The study was conducted after obtaining approval from the Institutional Ethics Committee. All participants were informed about the nature of the procedure, anticipated benefits, possible complications, and follow-up requirements. Written informed consent was obtained before enrolment. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Study Population Patients presenting with TMJ pain, restricted mandibular movements, joint sounds, intermittent locking, or a combination of these symptoms were clinically evaluated. Diagnosis of internal derangement was established on the basis of history, standardized clinical examination, and radiological assessment where indicated. Patients were included only when symptoms persisted despite conservative treatment. Conservative management consisted of patient education, dietary modification, avoidance of excessive mandibular movements and parafunctional habits, pharmacotherapy when indicated, physiotherapy/jaw exercises, and/or occlusal splint therapy. Inclusion Criteria Patients were eligible for inclusion when they fulfilled the following criteria: 1. Age ≥18 years. 2. Clinical diagnosis of symptomatic TMJ internal derangement. 3. TMJ pain associated with mandibular movement and/or functional limitation. 4. Restricted mouth opening, joint sounds, intermittent locking, or other clinical evidence of internal derangement. 5. Persistence of clinically significant symptoms despite conservative management. 6. Willingness to undergo arthrocentesis and attend the scheduled follow-up visits. 7. Provision of written informed consent. Exclusion Criteria Patients were excluded in the presence of: 1. Previous open surgery involving the affected TMJ. 2. TMJ ankylosis. 3. Acute local infection at or near the proposed needle-insertion site. 4. Neoplastic disease involving the TMJ. 5. Recent major maxillofacial trauma involving the joint. 6. Systemic inflammatory arthropathy likely to substantially influence TMJ symptoms. 7. Uncontrolled systemic disease that contraindicated an elective invasive procedure. 8. Bleeding disorders or ongoing anticoagulant therapy that could not be appropriately managed. 9. Pregnancy when the required diagnostic or therapeutic procedures were considered inappropriate. 10. Inability or unwillingness to complete follow-up. Preoperative Clinical Assessment A detailed history was recorded for each participant, including age, sex, duration of symptoms, affected side, pain, joint sounds, episodes of locking, difficulty in mastication, previous treatment, and relevant medical and dental history. A standardized TMJ examination was performed. The principal clinical parameters were pain intensity, maximum mouth opening, joint sounds, and functional limitation. Assessment of Pain Pain intensity was recorded using a 10-point visual analogue/numerical rating scale, with 0 representing no pain and 10 representing the worst imaginable pain. Patients were asked to indicate the severity of TMJ pain associated with mandibular function. Maximum Mouth Opening Maximum mouth opening was measured as the maximum interincisal distance between the incisal edges of the maxillary and mandibular central incisors during maximum voluntary opening. Measurements were recorded in millimetres. Where an anterior open bite or missing central incisors prevented conventional measurement, reproducible reference points were selected and documented for subsequent follow-up. Joint Sounds The affected TMJ was examined during repeated opening and closing movements for the presence or absence of clicking, popping, or crepitation. Joint sounds were assessed by palpation and clinical examination. Functional Limitation Patients were questioned regarding difficulty during chewing, wide mouth opening, yawning, and other routine mandibular functions. The presence of intermittent locking and restriction of mandibular movement was also documented. Arthrocentesis Procedure All arthrocentesis procedures were performed under strict aseptic precautions using a standardized conventional two-needle technique. The patient was positioned comfortably with the head turned to expose the affected preauricular region. The skin over the TMJ and surrounding area was disinfected, and sterile draping was performed. A line was drawn from the midpoint of the tragus to the lateral canthus of the eye to identify the anatomical landmarks for access to the superior joint compartment. Local anaesthetic was infiltrated into the preauricular skin and subcutaneous tissues while avoiding unnecessary deposition within the joint space. The patient was asked to open the mouth maximally to facilitate translation of the condyle and improve access to the superior joint compartment. The first needle was introduced into the posterior aspect of the superior joint space. A second needle was subsequently inserted anteriorly to provide an outlet for irrigation fluid. After confirmation of appropriate needle placement, the superior joint compartment was gently distended. Lavage was then performed using sterile normal saline/Ringer's lactate solution. Fluid was introduced through one needle and allowed to exit through the second needle, thereby establishing continuous irrigation of the upper joint compartment. During lavage, the mandible was gently manipulated through opening, closing, protrusive, and lateral movements where required. This manoeuvre was intended to facilitate lavage throughout the superior compartment and assist in releasing minor intra-articular adhesions. Following completion of lavage, the needles were withdrawn and gentle pressure was applied to the puncture sites. The patient was observed for immediate complications. Postoperative Management Patients were instructed to follow a soft diet during the immediate postoperative period and to avoid excessive loading of the joint. Appropriate analgesic medication was prescribed when required. Patients were encouraged to perform controlled mouth-opening and mandibular range-of-motion exercises after the immediate postoperative period. The importance of adherence to exercises and scheduled follow-up was explained. Any postoperative adverse event, including swelling, transient facial nerve weakness, altered sensation, bleeding, infection, dizziness, occlusal alteration, or persistent increase in pain, was recorded. Follow-up and Outcome Assessment Patients were evaluated at baseline and during subsequent follow-up visits. Follow-up assessments were performed at 1 week, 1 month, 3 months, and 6 months after arthrocentesis. At each visit, pain score, maximum mouth opening, joint sounds, and functional symptoms were reassessed using the same methods employed at baseline. Primary Outcomes The primary outcome measures were: 1. Change in pain intensity: Reduction in VAS pain score from baseline to follow-up. 2. Change in maximum mouth opening: Increase in maximum interincisal opening, measured in millimetres, from baseline to follow-up. Secondary Outcomes Secondary outcomes included: • reduction or disappearance of joint sounds; • improvement in mandibular function; • reduction in episodes of locking; • patient-reported symptomatic improvement; and • occurrence of procedure-related complications. Statistical Analysis Data were entered into a spreadsheet and analyzed using an appropriate statistical software package. Continuous variables were summarized as mean ± standard deviation when approximately normally distributed and as median with interquartile range when distributional assumptions were not satisfied. Categorical variables were expressed as frequencies and percentages. Normality of continuous variables was assessed before inferential analysis. Changes in pain scores and maximum mouth opening across multiple follow-up periods were evaluated using repeated-measures analysis of variance (ANOVA) when parametric assumptions were satisfied. When these assumptions were not met, the Friedman test was used. Where an overall significant difference was detected, appropriate post-hoc pairwise comparisons with adjustment for multiple testing were performed. Changes in categorical outcomes such as the presence of joint sounds or locking were assessed using paired categorical methods, including McNemar's test where appropriate. For the final follow-up analysis, the mean change from baseline was reported with a 95% confidence interval wherever applicable. Effect sizes were also calculated for the principal continuous outcomes to complement statistical significance. A two-sided P value <0.05 was considered statistically significant.

A total of 50 patients with symptomatic temporomandibular joint internal derangement underwent arthrocentesis and were evaluated during the study period. The mean age of the participants was 32.8 ± 8.6 years, with an age range of 19–52 years. There was a female predominance, with 34 (68.0%) females and 16 (32.0%) males. Unilateral involvement was observed in 43 (86.0%) patients, whereas 7 (14.0%) had bilateral symptoms. The mean duration of symptoms before arthrocentesis was 8.7 ± 4.6 months.

Pain, maximum mouth opening, joint symptoms, and functional limitation showed progressive improvement following arthrocentesis.

Table 1. Baseline demographic and clinical characteristics of the study participants (n=50)

The baseline mean VAS pain score was 6.42 ± 1.31. A progressive reduction in pain was observed following arthrocentesis, with mean VAS scores of 3.58 ± 1.24 at 1 week, 2.46 ± 1.13 at 1 month, 1.62 ± 0.96 at 3 months, and 1.18 ± 0.82 at 6 months. Thus, the mean absolute reduction in pain from baseline to 6 months was 5.24 points. Repeated-measures analysis demonstrated a significant change in pain scores over the follow-up period (P<0.001).

Table 2. Change in VAS pain score following TMJ arthrocentesis

Maximum mouth opening also showed progressive improvement. The mean preoperative MMO was 28.76 ± 4.82 mm. This increased to 34.92 ± 4.47 mm at 1 week, 37.64 ± 4.16 mm at 1 month, 39.82 ± 3.91 mm at 3 months, and 40.68 ± 3.76 mm at 6 months. The mean increase from baseline to the final follow-up was 11.92 mm. The improvement across follow-up assessments was statistically significant (P<0.001).

Table 3. Change in maximum mouth opening following arthrocentesis

In addition to improvement in pain and mouth opening, a reduction in TMJ-related symptoms was observed during follow-up. Joint clicking or noise was present in 36 (72.0%) patients at baseline and declined to 19 (38.0%) at 6 months. Intermittent locking decreased from 29 (58.0%) patients at baseline to 5 (10.0%) at the final follow-up. Similarly, difficulty in mastication decreased from 39 (78.0%) to 6 (12.0%), while pain during mouth opening decreased from 44 (88.0%) to 7 (14.0%).

Table 4. Changes in clinical symptoms following TMJ arthrocentesis

At the final follow-up, 39 (78.0%) patients demonstrated a favorable clinical response, characterized by substantial reduction in pain with improvement in mandibular function. Eight (16.0%) patients showed partial improvement, while three (6.0%) showed no meaningful improvement. Two patients (4.0%) required additional therapeutic intervention because of persistent symptoms.

Table 5. Overall clinical outcome at 6-month follow-up

Arthrocentesis was generally well tolerated. Transient preauricular swelling was observed in four (8.0%) patients and mild postoperative discomfort lasting more than 24 hours in six (12.0%). Transient altered sensation was reported by one (2.0%) patient and resolved without additional intervention. No patient developed infection, persistent facial nerve dysfunction, significant bleeding, or another major procedure-related complication.

Table 6. Adverse events following TMJ arthrocentesis

The present study evaluated the clinical effectiveness of arthrocentesis in patients with symptomatic temporomandibular joint internal derangement who had persistent symptoms despite conservative management. The findings demonstrated improvement in both subjective and objective clinical parameters following treatment. Mean VAS pain decreased from 6.42 ± 1.31 at baseline to 1.18 ± 0.82 at 6 months, while maximum mouth opening increased from 28.76 ± 4.82 mm to 40.68 ± 3.76 mm. Improvement was also observed in joint-related symptoms, particularly intermittent locking, difficulty in mastication, pain during mouth opening, and restriction of mandibular function. These findings support arthrocentesis as a minimally invasive therapeutic option for appropriately selected patients with TMJ internal derangement. The reduction in pain was one of the most prominent findings. Mean VAS score decreased from 6.42 at baseline to 3.58 within the first week and continued to decline to 2.46 at 1 month, 1.62 at 3 months, and 1.18 at 6 months. Thus, the overall mean reduction at 6 months was 5.24 points, representing an approximately 82% reduction from the baseline value. The progressive pattern suggests that the benefit of arthrocentesis may not be limited to an immediate mechanical effect but may continue during the subsequent period of functional recovery. These findings are consistent with earlier clinical studies. Vaira et al. reported substantial improvement following arthrocentesis in patients with TMJ internal derangement, while pain and functional outcomes have similarly improved in several prospective investigations [11]. In a study of 30 patients with internal derangement, pain decreased from 4.8 ± 2.65 before arthrocentesis to 0.27 ± 0.45 at one year, with a statistically significant reduction [12]. The magnitude and direction of improvement observed in the present study therefore correspond with established clinical evidence. The therapeutic effect of arthrocentesis is probably multifactorial. Internal derangement may be accompanied by synovial inflammation, altered intra-articular pressure, impaired lubrication, and adhesions within the superior joint compartment. Lavage can remove or dilute inflammatory mediators and degradation products from the joint space. Hydraulic distension may also release minor adhesions and improve movement between the disc and articular surfaces. Restoration of joint lubrication and reduction of intra-articular inflammatory activity may subsequently contribute to sustained pain relief [13]. Improvement in mandibular mobility was the second major finding. Maximum mouth opening increased from 28.76 ± 4.82 mm at baseline to 34.92 ± 4.47 mm at one week. Further improvement occurred during follow-up, reaching 37.64 ± 4.16 mm at one month, 39.82 ± 3.91 mm at three months, and 40.68 ± 3.76 mm at six months. The absolute improvement between baseline and six months was 11.92 mm. This degree of improvement is comparable with previous research. In a prospective study of 30 patients, maximum mouth opening increased from 29.8 ± 2.35 mm before arthrocentesis to 41.9 ± 2.48 mm after one year, corresponding to an increase of approximately 12 mm [12]. Long-term evidence also supports maintenance of functional improvement. Carvajal and Laskin evaluated 26 patients involving 39 joints over a mean follow-up of 48.7 months. Mean maximum vertical opening increased from 25.3 ± 5.5 mm before treatment to 43.8 ± 5.6 mm immediately following arthrocentesis and remained at 37.1 ± 8.8 mm during long-term follow-up. They reported an overall success rate of 88% [14]. The functional improvement observed after arthrocentesis is clinically important because limitation of mouth opening is one of the most disabling manifestations of internal derangement, particularly in disc displacement without reduction. Restricted translation of the condyle may interfere with eating, speaking, yawning, and routine oral hygiene. An increase of nearly 12 mm in mouth opening, as observed in the present study, therefore represents a substantial functional change rather than merely a statistically detectable difference. The present study also demonstrated improvement in symptoms beyond pain and maximum mouth opening. Intermittent locking decreased from 58% at baseline to 10% at six months, while difficulty in mastication decreased from 78% to 12%. Pain during mouth opening declined from 88% to 14%, and restricted mandibular function decreased from 76% to 14%. These findings indicate that improvement following arthrocentesis involves several clinically relevant dimensions of TMJ function. Joint sounds showed a comparatively smaller improvement. Clicking or other joint noises were present in 72% of patients at baseline and remained detectable in 38% at six months. This observation is clinically plausible because elimination of joint noise is not necessarily equivalent to successful treatment of internal derangement. Arthrocentesis is principally intended to reduce pain and restore function rather than to anatomically reposition the displaced articular disc. Persistent clicking in an otherwise pain-free patient with satisfactory mandibular function should therefore not automatically be considered treatment failure. The relationship between structural intra-articular abnormalities and clinical response is complex. Emshoff and Rudisch investigated whether magnetic resonance imaging features of internal derangement, osteoarthrosis, and capsulitis/synovitis were related to changes in clinical outcomes after arthrocentesis [15]. Their work highlights an important principle in TMJ management: imaging findings and clinical symptoms do not necessarily demonstrate a simple one-to-one relationship. Treatment decisions and assessment of success should consequently incorporate pain and functional outcomes rather than being based solely on structural disc position. The overall clinical response in the present study was favorable. At six months, 39 of 50 patients (78%) demonstrated a favorable clinical response, while eight (16%) showed partial improvement. Only three patients (6%) showed no meaningful improvement, and two required additional intervention. These observations are broadly consistent with long-term clinical reports demonstrating high patient satisfaction and clinically meaningful improvement after arthrocentesis [14]. The results should also be considered in relation to conservative treatment. Arthrocentesis is generally not intended to replace appropriate initial nonsurgical management. Instead, it occupies an intermediate position between conservative therapy and more invasive procedures such as arthroscopy or open joint surgery. This treatment sequence is supported by contemporary evidence. A systematic review and meta-analysis comparing arthrocentesis with conservative therapies found greater short- and intermediate-term pain reduction following arthrocentesis. Arthrocentesis also produced greater improvement in maximum mouth opening, although the additional improvement in mouth opening compared with conservative treatment was relatively modest [16]. Thus, patient selection remains important, and arthrocentesis is particularly relevant when clinically significant symptoms persist despite an adequate trial of conservative therapy. Another area of continuing debate concerns the use of intra-articular agents following lavage. Hyaluronic acid, corticosteroids, platelet-rich plasma, and other biological preparations have been investigated as adjuncts to arthrocentesis. The evidence, however, remains heterogeneous. A systematic review and meta-analysis comparing platelet-rich plasma with hyaluronic acid after arthrocentesis found no significant differences between the two approaches in maximum mouth opening at one, three, or six months. Similarly, no significant difference in pain was demonstrated at these follow-up periods, and heterogeneity among studies was substantial [17]. A 2024 systematic review comparing hyaluronic acid with corticosteroids after TMJ arthrocentesis similarly found no significant differences in maximum mouth opening at one week, one month, or three months. Pain outcomes were also generally comparable, although a statistically significant advantage for hyaluronic acid was observed at three months [18]. These findings suggest that the lavage procedure itself remains an important therapeutic component and that the superiority of any single adjunctive medication has not been definitively established. More recent network meta-analytic evidence has attempted to rank different agents administered with arthrocentesis, including platelet-derived preparations, hyaluronic acid and other biological products [19]. Although some agents appear promising at particular follow-up intervals, differences in diagnostic criteria, preparation techniques, injection protocols, and outcome measurement substantially complicate direct comparisons. Consequently, simple arthrocentesis remains a clinically relevant treatment against which newer adjunctive interventions should be evaluated. The safety profile observed in the present study was also favorable. Mild postoperative discomfort occurred in 12% of patients and transient preauricular swelling in 8%. One patient experienced transient altered sensation. No infection, persistent facial nerve dysfunction, significant bleeding, or other major complication was observed. The minimally invasive nature of arthrocentesis represents one of its principal advantages over more invasive TMJ procedures. Appropriate knowledge of preauricular anatomy, correct needle positioning, strict asepsis, and controlled lavage pressure remain essential for minimizing complications. The present findings should nevertheless be interpreted within the broader evidence base. A recent systematic review comparing arthrocentesis with conservative therapy demonstrated clinically relevant superiority for pain reduction but emphasized heterogeneity and limited long-term evidence [16]. Similarly, contemporary systematic reviews of adjunctive intra-articular treatments continue to identify substantial methodological heterogeneity [17-20]. Future studies should therefore use standardized diagnostic criteria, clearly defined arthrocentesis protocols, consistent outcome measures, and longer follow-up periods. Strengths of the Study An important strength of the study was prospective assessment of clinically meaningful outcomes at multiple time points. Both subjective and objective measures were incorporated, including pain intensity, maximum mouth opening, joint symptoms, and functional limitation. Serial follow-up allowed evaluation of the trajectory of improvement rather than relying solely on a single postoperative assessment. The study also evaluated arthrocentesis as a relatively simple intervention without making clinical success dependent on normalization of joint sounds or presumed anatomical repositioning of the disc. This reflects the contemporary clinical objective of TMD treatment, which prioritizes reduction of pain and restoration of satisfactory mandibular function. Limitations Several limitations should be acknowledged. First, the single-arm design did not include a conservative-treatment or sham-control group; therefore, improvement cannot be attributed exclusively to arthrocentesis. Natural disease progression, behavioral modification, postoperative exercises, and regression toward the mean may have contributed to the observed changes. Second, the sample size was relatively modest and the follow-up period was limited to six months. Longer follow-up would be required to determine the durability of clinical improvement and recurrence of symptoms. Third, clinical internal derangement encompasses heterogeneous intra-articular abnormalities. Stratification according to standardized DC/TMD diagnosis and MRI-defined disc displacement would provide a more precise assessment of which subgroups obtain the greatest benefit. Finally, patient-reported outcomes such as pain are inherently subjective. Future randomized controlled studies incorporating validated functional and quality-of-life instruments would provide stronger evidence.

Temporomandibular joint arthrocentesis produced substantial improvement in pain and mandibular function in patients with symptomatic internal derangement. Mean VAS pain decreased from 6.42 ± 1.31 at baseline to 1.18 ± 0.82 at six months, while maximum mouth opening increased from 28.76 ± 4.82 mm to 40.68 ± 3.76 mm. Improvements were also observed in locking, masticatory difficulty, pain during mouth opening, and overall mandibular function.

Arthrocentesis appears to provide a useful minimally invasive treatment option for appropriately selected patients who remain symptomatic despite conservative management. Its technical simplicity, favorable safety profile, and clinically meaningful improvement in pain and jaw mobility support its use before considering more invasive TMJ procedures. Nevertheless, controlled studies with larger samples, standardized diagnostic criteria, and longer follow-up are required to define long-term effectiveness and identify predictors of treatment response.