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Numerous factors have been indicated as possible causes of alterations in the articular disc of the temporomandibular joint (TMJ). The main aim of the present study was to demonstrate the effectiveness of arthroscopic osteoplasty of the medial TMJ wall associated with myotomy of the superior head of the lateral pterygoid muscle for treating TMJ internal derangement.A retrospective and comparative study was performed analyzing patients diagnosed with TMJ internal derangement and underwent TMJ arthroscopic surgery in our Hospital. These patients presented signs and symptoms of TMJ internal derangement along with pathological magnetic resonance imaging images, and underwent either arthroscopic osteoplasty of the medial TMJ and myotomy of lateral pterygoid muscle (group 1) or arthroscopic eminoplasty (group 2) in our center.The sample consisted of 109 patients (21 male, 88 females) who agreed to voluntarily participate in our study. The results revealed that the patients who had undergone arthroscopic osteoplasty of the medial TMJ and myotomy of lateral pterygoid muscle showed better outcomes in terms of pain reduction when compared with patients who had undergone arthroscopic eminoplasty. No statistically significant differences were found between the 2 groups in terms of postoperative mouth opening.Arthroscopic osteoplasty of the medial and anterior medial wall of TMJ associated with arthroscopic myotomy of the SLEM represent an effective treatment option for TMJ internal derangement even in advanced stages (Wilkes IV and V).