Clinical Application of a High Frequency Electric Knife With Coblation Technology For Temporomandibular Joint Arthroscopic Surgery

Purpose: ArthroCare Multi-electrode System^TM with Coblation technology (bipolar) and Vulcan Electro Thermal Arthroscopy System^TM (monopolar) has been used in the fields of neurosurgery and orthopaedic surgery.  Coblation, derived from cooler, controlled ablation, is a patented process employing bipolar radiofrequency technology to achieve precise and rapid tissue removal with minimal thermal damage to collateral tissue.  Radiofrequency power setting and heat loss through lavage solution play a significant role in heat distribution and morphologic alterations in joint capsule after arthroscopic application of monopolar radiofrequency energy.  This study examined the efficacy and safety of these instruments to temporomandibular joint arthroscopic surgery.

Materials and Methods: We clinically applied ArthroCare Multi-electrode System^TM (bipolar) and Vulcan Electro Thermal Arthroscopy System^TM (monopolar) to temporomandibular joint arthroscopic surgery.  These Systems were used in 82 joints of 68 patients, 14 males and 54 females with a mean age of 49 years.

Results:The range of mouth opening improved from 27 mm before surgery to 43 mm after surgery, the visual analogue scale score of pain during jaw movements decreased from 65 to 4. There was no obstruction of the surgical field with bleeding during detachment or separation of intraarticular tissues, and the operation time was shortened. These factors improved the efficiency of temporomandibular joint arthroscopic surgery. More efficient and less invasive arthroscopic surgery could be performed with this system than with methods used previously. Patients report significantly less pain following Coblation and electrothermal surgery compared with previous surgical approaches, and findings from our series indicate that recovery and rehabilitation are considerably accelerated.

Conclusions: These systems, which improves the safety and efficiency of surgery, are expected to be applicable also to temporomandibular joint arthroscopic surgery.

Reference

1. Chen MJ, Yang C, Zhang SY, et al. Use of coblation in arthroscopic surgery of the temporomandibular joint. J Oral Maxillofac Surg. 2010 68:2085-2091.
2. Gonzalez-Garcia R. Arthroscopic myotomy of the lateral pterygoid muscle with coblation for the treatment of temporomandibular joint anterior disc displacement without reduction. J Oral Maxillofac Surg. 2009;67:2699-2701.