The goal of this clinical trial is to compare two methods of arthrocentesis in treating temporomandibular joint (TMJ) disorders. The main questions it aims to answer are:

Is surgery-guided arthrocentesis more efficient in terms of operation time compared to traditional two-needle arthrocentesis? Does the use of surgical guides lead to less postoperative pain and better patient comfort?

Participants will:

Undergo either the traditional two-needle arthrocentesis or the surgery-guided arthrocentesis.

Be monitored for operation time, postoperative pain, and overall patient comfort.

Researchers will compare the outcomes of patients who underwent traditional two-needle arthrocentesis with those who had surgery-guided arthrocentesis to see if the latter can shorten operation time and improve patient comfort.

Inclusion Criteria:

• Patients diagnosed with Wilkes stage II, III, or IV Temporomandibular Joint (TMJ) internal derangement.
• Presence of pain, sound, or both in the TMJ.
• Limitation or locking in mouth opening, or both.
• Patients who have not responded to symptoms after a minimum of three months of splint therapy.

Exclusion Criteria:

• Presence of infection in the puncture area.
• Presence of osteomyelitis in the neighboring region.
• Patients with uncontrolled coagulopathies.
• Patients experiencing limitation in maximum mouth opening without disk disorder.
• Patients with severe degenerative joint disease (e.g., deformed condylar contour, osteophyte findings in MRI).
• History of TMJ surgery.
• History of muscle-originated mandibular hypomobility.