The Vulcan Electro Thermal Arthroscopy System^® (Smith ＆ Nephew Inc., USA) has been used mainly in the fields of orthopaedic surgery. The present system is based on high-frequency energy, and tissue vaporization, hemostasis, and incision are performed by applying a high-frequency electric current to the body. Molecular vibration occurs in the body, and the tissue resistance and friction caused by this vibration generate heat. The present system is considered suitable for temporomandibular joint (TMJ) arthroscopic surgery because the temperature increase in the perfusion liquid is small, and the probe is easier to handle. The purpose of this study was to examine the application and efficacy of this instrument to arthroscopic surgery of the TMJ. Arthroscopic surgery was performed in patients with TMJ intracapsular disorder who did not respond to conservative therapy and arthrocentesis. We clinically applied the Vulcan Electro Thermal Arthroscopy System^® and a monopolar probe handpiece with a micro-chisel probe. This system was used in 11 joints of 10 patients, 1 male and 9 females, with a mean age of 39 years. The range of mouth opening improved from 24.5 mm before surgery to 44.6 mm after surgery, and the visual analog scale of pain during jaw movements decreased from 58.5 to 2.0. The surgical success rate was considered excellent in all cases using the criteria of the American Association of Oral and Maxillofacial Surgeons (AAOMS) -Parameters of Care-95. This system, which improves the effectiveness and efficiency of surgery, is expected to be applicable also to arthroscopic surgery of the TMJ.

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Acetaminophen and tramadol hydrochloride combination tablets (Tramcet^®) are indicated for the symptomatic treatment of moderate to severe pain. However, it is not clear whether Tramcet^®has clinical usefulness for temporomandibular disorders (TMD). Thus, the present study reports the efficacy of Tramcet^® in patients with persistent TMD, retrospectively. Seven TMD patients who had resistance to self-care and any other standard pharmacotherapy were enrolled. Patients took a half tablet of Tramcet^® at bedtime for the first two days and a whole tablet at bedtime for the next three days. If the patient could not get enough analgesic effect at that point, one tablet was taken after breakfast and one after the evening meal for the next four days. Ten days after the first administration, patients who still had pain were allowed to take one tablet three or four times a day. The main assessment included the improvement rate of pain and side effects. Improvement rate was calculated by Visual Analogue Scale (VAS) which was recorded before and after the pharmacotherapy with Tramcet^®. Two patients showed an improvement of over 80%on the VAS score. Although three patients had an improvement of 41-79%, the other two patients had an improvement of less than 40%. Only two of them felt stomach discomfort as a side effect in the early days. Although Tramcet^® might have good clinical usefulness for persistent masticatory myofascial pain, further studies are necessary to establish its efficacy in TMD patients.

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Dystonia is a neurological movement disorder, in which sustained muscle contractions cause repetitive movements or abnormal posture. When the disorder occurs in the oromandibular cavity, uncomfortable jaw function, pain and other effects are the main complaints. In this case report, we describe a drug-induced oromandibular dystonia that developed in the masseter and lateral pterygoid muscles, as well as our neurological and pharmacological observations. A 20-year-old woman who arrived at the hospital by ambulance had temporomandibular joint dislocation and pain of the lower jaw. Computed tomography of the jaw demonstrated dislocation of the right-temporomandibular joint. The joint was manipulated under propofol sedation by emergency medical doctors. However, we and oral and maxillofacial surgeons were called to apply medical treatment when the jaw dislocated again. When we examined the patient, the mandible was in the closed position and shifted to the right side. The position was obviously different from the first examination by the emergency medical doctors. Palpation of the masticatory muscle showed hypertonia in the left-masseter and left-lateral pterygoid muscles. She could not open her mouth owing to hypertonia, and we observed apraxia of eye-opening and sursumvergence. Because dystonia was suspected based on these symptoms, we asked her about her medication, and she revealed that she was currently taking two antipsychotic drugs. Thus, we diagnosed drug-induced oromandibular dystonia and performed an intramuscular injection of 5 mg biperiden lactate, which has anticholinergic effects, under the consultation of a psychiatrist. Five minutes after the injection, she could open her mouth easily and symptoms including apraxia of eye-opening, sursumvergence, muscle hypertonia and abnormal mandibular position were improved. Therefore, when faced with a patient with oromandibular dystonia, an appropriate diagnosis should be performed quickly. It is important to understand the characteristics of dystonia and manage it in cooperation with other medical specialists.

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