Aim: The aim was to Compare the clinical outcome (pain score and mouth opening) of dexamethasone phonophoresis in a (continuous versus pulsed maneuver) for management of TMD. Materials and participants: Eighty patients were diagnosed with temporomandibular disorder( internal derangement ) then were equally divided into either of the 4 groups according to the gel and type of phonophoresis to be applied each patient was treated with 10 sessions over a total of 30 days as following: Group DCP (n=20 patients), who received dexamethasone and continuous phonophoresis, Group DPP (n= 20 patients), who received dexamethasone and pulsed phonophoresis, Group ACP (n=20 patients) who received acoustic gel and continuous phonophoresis and Group APP (20 patients) who received acoustic gel and pulsed phonophoresis. Pain and inter-incisal distance both before and after treatment were recorded and statistically analyzed. RESULTS: intergroup and intragroup comparisons were performed; a significantly lower pain score for all four study groups following treatment was observed however; DCP group showed significantly lower pain score than ACP and APP. Mouth opening showed no statistical significance in between all four groups after treatment while a significant higher mouth opening was shown before and after treatment indicating that all interventions resulted in significant increases in mouth opening, but no method was statistically superior to the others. CONCLUSION: Both treatment modalities (continuous or pulsed) ultrasound therapy with and without dexamethasone gel application were effective in pain alleviation and improving inter-incisal distance however; Continuous dexamethasone phonophoresis was superior in pain relief.