Stepwise management of temporomandibular joint internal derangement: from conservative therapy to arthrocentesis with intra-articular hyaluronic acid and 12.5% dextrose.

Temporomandibular joint (TMJ) internal derangement frequently leads to orofacial pain, joint dysfunction, and limited mandibular movement. Conservative treatment is first, but arthrocentesis may help refractory cases. This case report describes one year of conservative therapy and arthrocentesis with intra-articular hyaluronic acid (HA) and 12.5% dextrose. A 21-year-old woman had right-sided preauricular pain, joint clicking, and intermittent locking for one year. Clinical and magnetic resonance imaging findings confirmed anterior disc displacement with reduction and intermittent locking with osteoarthritis of the right TMJ. After 8 months of physiotherapy, pharmacotherapy, occlusal splint, and diet modification, maximum mouth opening improved from 13 to 36 mm, but symptoms persisted. Two arthrocentesis sessions with prolotherapy were performed: one with HA alone, followed by HA and 12.5% dextrose. At 4-month follow-up, function was restored, symptoms resolved, and joint clicking disappeared. Arthrocentesis with intra-articular HA and 12.5% dextrose relieved pain, improved mouth opening, and restored function in refractory TMJ internal derangement. This case highlights the value of a staged, minimally invasive strategy, though larger controlled studies are needed to validate its efficacy and to standardize treatment protocols. A stepwise approach, from conservative therapy to arthrocentesis with intra-articular HA and 12.5% dextrose, can effectively manage TMJ internal derangement.