الفهرس 
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Abstract
In this study we evaluated arthroscopic diagnosis of patients with clinically proved temporomandibular joint-internal derangement that weren’t responding to conservative management protocol versus magnetic resonance imaging findings. This study was carried out on ten healthy adult patients who are proved clinically to have TMJ/ ID causing functional disability and pain and who had not responded to conservative management protocol. All patients were selected from the out-patient clinic of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University. Conservative modalities were first done for twenty patients for three months and those who didn’t respond were recommended for this study after clinical examination and imaging had been held out. Ten patients with eleven TMJs were included in this study for evaluation of accuracy of diagnostic arthroscopy versus MRI done pre-operatively. The findings were then evaluated and compared regarding disc position and disc recapture (mobility) and statistical analysis was held out on the collected data. The results of this study showed no significant statistical difference between arthroscopy and MRI regarding the diagnosis of disc position and disc recapture (mobility), however arthroscopy was more sensitive in diagnosis. Arthroscopy had the ability to diagnose synovitis, fibrocartilage fibrillation and disc perforation which couldn’t be diagnosed by MRI. The diagnostic arthroscopy is also useful in some cases like in those cases when MRI is strictly contraindicated, as in patients is with permanent cardiac pacemakers, implantable cardioverter-defibrillators, retained transvenous pacemaker, defibrillator leads implantable pediatric sternum device, metallic foreign body in the eye,” trigger fish ” contact lens, insulin pumps, temporary trans-venous pacing leads, gastric reflux devices, ferromagnetic vascular clips, or hemodynamic support devices. Also whenever patient will undergo therapeutic arthroscopy in the same time, it’s better to diagnose and treat at the same time arthroscopically. The diagnostic arthroscopy MRI are both considered the gold standards but MRI have some limitations. Like that an MRI machine is expensive and not always available, except in large cities. Also it has its limitations for the diagnosis of TMJ’s bone abnormalities, synovitis, fibrillation and disc perforation. Moreover, disc displacement was found by MRI in a substantial number of asymptomatic volunteers. Furthermore, several authors have noted a lack of correlation between MRI findings of DD and the extent of pain and dysfunction of the TMJ in patients with painful limitation of mandibular opening. Accordingly, we can use arthroscopy as a more sensitive diagnostic tool. Diagnostic arthroscopy showed a dynamic view of intra articular structures. It also showed synovitis which couldn’t appear in MRI. Arthroscopy, being used for diagnosis, resulted in removal of inflammatory mediators and also lysis and lavage that were beneficial to patients. While MRI is only a diagnostic tool.