الفهرس 
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Abstract
Among various types of temporomandibular disorders (TMD) pain is the most irritating symptom that drives patients to seek treatment.likewise, ID represents the most frequent problem among the abundant categories and classifications of TMD. Several therapeutic modalities have been proposed for treatment of ID ranging from simple conservative therapy up to invasive open arthrotomies. However, since the invention of minimal invasive procedures as, arthrocentesis and arthroscopic lysis and lavage ALL, they gained wide popularity. These procedures are considered generally effective with lesser complications when compared to open surgical procedures. Moreover, the hyperactivity of LPM resulting from myalgic pain can displace the articular disc causing ID. Thus, it is presumed that inhibiting the effect of SHLP on the disc and/or disc-capsule complex in patients suffering ID will promote the effect of disc release that is created by ALL procedure. Since BTX-A injection represents a very effective method in treating LPM dysfunction with tolerable side effects and it has also shown higher specificity in ID treatment.
The aim of this study was to evaluate the clinical effect of arthroscopic guided BTX type A injection in lateral pterygoid muscle in patients suffering internal derangement.
This Prospective study was conducted on 20 Patient’s suffering ID selected from the TMJ clinic in the department of oral and maxillofacial surgery, Minia University Dental Hospital (MUDH). They were randomly divided into two groups. Control group A underwent ALL for the superior joint space whereas, experimental group B underwent the same ALL procedure in addition to office based immediate arthroscopic guided injection (AGI) of Botox -A (BTX-A) to the SHLP. Maximum painless Mouth opening (MO), pain scores using visual analogue score (VAS), behavioral rating score (BRS) and MRI findings were assessed as clinical parameters preoperatively, two weeks, three and six months postoperatively.
Results of the current study revealed that, Both groups showed significant improvement in MO and pain scores at two weeks, one and six months postoperatively. group B showed superior significant results over control group regarding both MO and pain scores at all postoperative assessments. Regarding BRS group B showed significant change at 2nd week records.
In conclusion, Simultaneous office based ALL and AGI of BTX-A to SHLP proved the validity of office based AGI of SLPM by BTX-A in the treatment of ID enhances the clinical outcome of ID treatment.