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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).

The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications.