Aim <p>The purpose of the present study was to compare the clinical outcomes between two different types of open joint procedures in Wilkes Grade III TMJ internal derangement patients after failure of conservative (nonsurgical) treatment and arthrocentesis.</p> Methods <p>Patients were retrospectively reviewed from an institutional database. Subjects were divided into two groups and were followed up at four different time points. The primary outcome variable was change in TMJ pain. A 10&#xa0;cm standard visual analogue scale (VAS) assessment was used to evaluate outcomes. Individual time points were compared to baseline pain scores using a student <i>t</i> test. Significance was determined at an alpha level of 0.05.</p> Results <p>Sample included 18 patients in group 1 for discectomy and 15 in group 2 for disc repositioning. Improved postoperative pain score was noted at all recorded time points for both groups 1 and 2 (<i>p</i> &lt; 0.001). Most significant pain improvement was noted after subsequent intervention at T4. Mild decrease in MIO was noted in both groups; however, no significant difference was noted between groups (<i>p</i> = 0.66).</p> Conclusion <p>Both disc repositioning and discectomy lead to improved postoperative pain control in this select cohort of patients. More than a third of these patients required a subsequent surgical intervention for more optimal pain control.</p>