Temporomandibular joint internal derangement (TMJ ID) is the most frequent type of temporomandibular disorder (TMDs)which is managed by different therapeutic modalities. it begins with conservative methods like medical treatment, physiotherapy, thermotherapy, and bites appliance therapy. Surgical intervention is a controversial issue in cases not responding to conservative methods. A novel minimally invasive surgical technique which is extracapsular trans oral (Pterygomaxillary disjunction) has been advocated as a minimally invasive extracapsular technique that preserves TMJ integrity.

Inclusion Criteria:

• Patients without relevant disease
• Patients refractory to conservative treatment > 6 months.
• Patients are diagnosed, with unilateral/bilateral anterior disc displacement without reduction, clinically and by MRI recently.
• No previous TMJ surgery.
• No previous maxillofacial trauma.

Exclusion Criteria:

• Patients with systemic joint disease (rheumatoid, osteoarthritis, gouts).
• Medically compromised patients contraindicating operation.
• Patients to whom general anesthesia is contraindicated.
• Patient with neuromuscular disorders.
• Patients with any gross pathology of the ear.
• Patient with psychoneurotic disorders.