Pain was induced in the upper trapezius muscle by an injection of hypertonic saline. The intensity of pain and limited mouth opening were studied.
The subjects were 8 males between 26 and 34 years old who had complete dentition and no dysfunction of their neck, shoulder, or mandibles. A bolus of 0.5 ml hypertonic (6%, EX) and isotonic saline (0.9%, CT) was injected at the superior border of the upper trapezius muscle using a 25 G needle in a single blind, randomized crossover study. Pain intensity caused by the injection was evaluated by 100 mm visual analog scale (VAS), and the maximum mouth opening was measured using slide calipers to measure right inter-incisal distance every 30 seconds from immediately after injection to 600 seconds post-injection.
The VAS of the EX score was significantly higher than that of CT, from immediately after injection to 270 seconds (p<0.01), and the highest score was recorded at 30 seconds after injection (64.1±16.8 mm). The maximum mouth opening at baseline was approximately 54 mm in both series, and was significantly reduced in EX compared with CT from immediately after injection to 60 seconds after (p<0.05), and the lowest value in EX was 47.4±4.8 mm.
On the basis of these findings, we considered that the cause of limited mouth opening might originate in the shoulder and neck area. The result also confirmed the importance of examining of the shoulder and neck of TMD patients.

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This investigation by questionnaire was done to study the functional outcomes of ten patients (aged under 15) with condylar fractures at an average of 9 years after the treatment, who had been conservatively treated. All fractures were classified according to the Spiessl & Schroll classification (1972). Three fractures were classified as nondisplaced fracture; four fractures as low neck fracture with displacement; and three fractures as high neck fracture with displacement. No patient described trismus or pain at rest. One patient complained of mild occasional pain with mandibular motion in the fractured side. Joint sounds occurred in two joints. One patient with mental retardation had a slight reduced chewing capacity. The criteria for assessment of the postoperative jaw function are classified into four groups: excellent, fair, poor, and no good (Nakatomi, 1964). Eight patients were evaluated as excellent and two were assessed as fair. One patient assessed as fair showed a deformed condyle (cortical irregularity, bifid condyle, neoarthrosis, shortened ramus height), a flattening of glenoid fossa and a severe disc deformation. Conservative treatment is still justified in children (aged under 15) with condylar fractures, promising a good functional recovery, but a long-term subsequent study of jaw function will be necessary in cases with deformed condyle after conservative treatment.

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This study investigated the short-term effect of intra-articular injection of prednisolone in patients with chronic closed lock of the temporomandibular joint. Pumping manipulation was performed in 30 TMD patients who had unilateral closed lock of at least three months duration. These patients were randomly divided into two groups, consisting of those who were injected with a normal saline and a steroid (prednisolone 10 mg) after pumping manipulation. Maximal mouth opening (MMO), the improvement rate of joint pain and the effective rate of treatment were assessed. A 10 mg prednisolone injection significantly improved joint pain. There was no statistically significant difference between groups in regard to MMO. However, in each group MMO was significantly increased immediately after pumping manipulation. These results indicate that an injection of 10 mg prednisolone could be useful for patients who have painful closed lock.

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