지도 작성을 통한 악관절원판의 위치에 관한 연구

김준배(Joon Bae Kim),서창호(Chang Ho Seo),배정수(Jung Soo Bae) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.3

According to the autopsy study for the temporomandibular joint disc position, rotation and sideway displacements as well as anterior displacement of TMJ discs are important aspect of internal derangement. There were some trials to suspect anterior and sideway disc displacements through MR images. But the sagittal and the coronal views of MRI could only show the image of cutted slices, these images were not sufficient for showing the entire correlations amomg glenoid fossa, condylar head and articular disc. In this study we combined the images of the each slice of sagittal views like drawing a map, then we could see the interrelations among these three major components of TMJ more precisely. Applying this method to both asymtomatic volunteers and TMD patients, we classified the interrelationships between condylar head and articular disc of TMJ as twelve types. The distributions are as follows; 1. In asymptomatic volunteers cases, normal relations were 65.0%, sideways or rotational displacements without anterior displacement were 20.0%, only anterior displacements were 15.0%, and anterior displacements combined with rotational displacements were 5.0%. 2. In unaffected sides of TMD patients, normal relations were 42.1%, rotational displacements were 11.8% and anterior displacements were 47.0%. 3. In affected sides of TMD patients, normal relations were 10.6%, sideways or rotational displacements were 13.6%, anterior displacements were 75.8%. 4. In asymptomatic volunteers or unaffected sides of TMD patients, pure anterior displacement was more prominent than combined with sideways or rotational displacement, but in affected sides of TMD patients pure anterior displacement was less prominent.

악관절원판의 전방변위에 따른 관절간극의 변화

배정수,김준배,김형순,Bae Jung-Soo,Kim Joon-Bae,Kim Hyung-Soon 대한치과보철학회 2001 대한치과보철학회지 Vol.39 No.4

Objective: Disc displacement may affect the joint space narrowing between condylar head and glenoid fossa. This study was designed to evaluate the correlation between the joint space change and the severity of anterior disc displacement. Materials and Methods: Two hundreds temporomandibular joints MR images of TMD patients(170 joints) and asymptomatic volunteers(30 joints) were evaluated for this purpose. Anterior disc displacement was divided into 3 stages(normal, little to mild, and moderate to severe displacement) based on sagittal images, then joint spaces were measured at medial, central and lateral parts of condyle head on coronal MR images, respectively The joint spaces of 3 groups divided according to the severity of anterior disc displacement were compared. Results: The reduction of joint space was related to the severity of the anterior disc displacement at lateral, medial side and especially at center Conclusion: The temporomandibular joint space was affected by the severity of the anterior disc displacement.

Assessment of functional improvement with temporalis myofascial flap after condylectomy in elderly patients with anterior disc displacement without reduction and an erosive condylar surface

Kang, Young-Hoon,Bok, Jung-Suk,Park, Bong-Wook,Choi, Mun-Jeoung,Kim, Ji-Eun,Byun, June-Ho Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Background: The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). Methods: A total of 15 joints from 11 elderly patients (71-78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. Results: No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. Conclusion: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.

Temporomandibular joint disc plication with MITEK mini anchors: surgical outcome of 65 consecutive joint cases using a minimally invasive approach

Lee, Bu-Kyu,Hong, Jun Hee Korean Association of Maxillofacial Plastic and Re 2020 Maxillofacial Plastic Reconstructive Surgery Vol.42 No.-

Background: The purpose of this study is to introduce our modified disc plication technique using MITEK mini anchors and to evaluate the clinical outcome for patients with internal derangement (ID) of the temporomandibular joint (TMJ). Patients and methods: We evaluated 65 joints in 46 patients, comprised 32 women and 14 men, who first visited the Asan Medical Center from December 2012 to December 2016. The age of the patients ranged from 14 to 79 years, with a mean age of 36.6 years. The patients presented with joint problems including pain, joint noise, and mouth opening limitation (MOL). Patients who met our inclusion criteria underwent unilateral or bilateral disc repositioning surgery with our minimally invasive disc plication technique using MITEK mini anchors and No. 2-0 Ethibond^® braided polyester sutures. The variables taken into account in this study were the range of maximum mouth opening (MMO), painful symptoms (evaluated with the visual analog scale, VAS), and the type of noise (click, popping, crepitus) in the TMJ. Results: Preoperative examination revealed painful symptoms in 50.7% (n = 35) of the operated joints (n = 69) and the presence of clicks in 56.5% (n = 39). Postoperative examination revealed that 4.3% (n = 3) of the operated joints had painful symptoms with lower intensity than that in the preoperative condition. Additionally, 17.4% (n = 12) had residual noise in the TMJ, among which two were clicking and the other 10 had mild crepitus. The intensity of the postoperative residual noise was significantly decreased in all cases compared to that in the preoperative condition. Among patients with MOL below 38 mm (n = 18), the mean MMO was 31.4 mm preoperatively and 44.2 mm at 6 months postoperatively, with a mean increase of 13.8 mm. A barely visible scar at the operation site was noted during the postoperative observation period, with no significant complications such as facial palsy or permanent occlusal disharmony. Conclusion: Subjective symptoms in all patients improved following the surgery. TMJ disc plication using MITEK mini anchors with our minimally invasive approach may be a feasible and effective surgical option for treating TMJ ID patients who are not responsive to conservative treatment.

정상인에서 악관절원판의 전후방 위치에 관한 연구

김준배(Joon Bae Kim),김형곤(Hyung Gon Kim) 대한구강악안면외과학회 1996 대한구강악안면외과학회지 Vol.22 No.4

The present study suggest a new way of expressing the anterior disc displacement through the angle formed by the most concave portion of the glenoid fossa, the center of the mandibular condyle and the junction of the posterior band and retrodiscal tissue. The new method was tested on MRI findings of 40 symptom-free joints. The angle was 0° on 14 joints, and 82.5% of the joints were within -5°~5° range, with one joint having more than 10° displacement. The mean angle was -120+3.79, and this results shows that there are little disc displacemrents in asymptomatic joints. The result suggest that the new method may be used as a meaningful way of expressing the anterior displacement. In this method, the center of the condyle head is esaily recognized regardless of its shape, and no matter where the condyle head is located relative to the fossa, the reference line connccting the center of the condyle head and the concavity of the fossa can be easily obtained. The reference line includes all of the anatomical and functional structures of the joint, can compensate for the anatomical variations in the condyle shape, and can easily be applied with high reproducibility. Instead of using confusing references as 12 o clock direction or immediately superior to the condylar head this method uses anatomical reference points thereby accounting for the individual variations.

성장기 아동에서 상하악 폭경 부조화와 하악과두의 비대칭 성장과의 관계

이지나(Jina Lee) 대한치과의사협회 2013 대한치과의사협회지 Vol.51 No.6

It has been established that disk displacement of the temporomandibular joint(TMJ) can cause mandibular asymmetry in growing subjects. One of the causes of internal derangement of TMJ seems to be the result of poor positioning of the joint structure in unilateral cross bite, and the subsequent occlusal trauma transferred to the functioning unit of the mandible, the joint and disc. Transverse discrepancy of the maxillary and the mandibular posterior dentoalveolar units was often found in mandibular asymmetric subjects. Most of the asymmetry in growing subjects becomes worse with further growth if left untreated. However once sufficient posterior overjet is gained through orthodontic treatment, many cases have shown improvement in facial asymmetry. Furthermore, the position of condyles in computed tomogram(con-beam CT) changed from anatomically unfavorable position to more concentric position.

측두하악장애의 진단에서 Bone Scan의 유용성

김용기(Yong Ki Kim),김인주(In Joo Kim),강양호(Yang Ho Kang),손석만(Seok Man Son),이경석(Kyoung Seog Lee),이재복(Jae Bok Lee),서봉직(Bong Jik Seo),박준상(June Sang Park),고명연(Myung Yun Ko),손성표 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.4

N/A Bone scan is a very sensitive diagnostic imaging test for detecting bone and joint disorders. So it might be useful in the diagnosis of temporomandibular disorders of the joint origin. Thus, the effectiveness of bone scan for detecting temporomandibular joint(TMJ) diseases and differentiating the TMJ disc displacement from the TMJ arthritis was evaluated. Bone scan was done in 21 patients with TMJ disc displacement(l3 unilaterally affected, 8 bilaterally affected), 26 patients with TMJ arthritis(23 unilateral, 3 bilateral), and 39 volunteers with no signs, symtoms, or history of TMJ disease TMJ simple uptake rate(SUR) and difference of both TMJ SUR were calculated from the 100,000 count lateral image of head and neck region in Tc-99m MDP bone scan. Transcranial and panorama X-ray examination was also done in all patients. TMJ SUR(%) were 1.673±0.606 in TMJs affected with arthritis, 1.350±0.351 in TMJs affected with disc displacement, and 1.084±0.172 in TMJs of controls Significant differences were demonstrated among them(p〈001). Difference of bith TMJ SUR was highest in patients with unilateral TMJ arthritis(0.608±0.533, p〈001), and there is no significant difference between that of controls and that of unilateral TMJ disc displacement patients(0.062±0.063 vs 0.122±0.100). TMJ SUR of joint with bone change on X-ray finding was not significantly different from that of joint with normal X-ray finding. Those in patients with unilateral TMJ disc displacement(69.6% and 87% vs 23.1% and 23%). The proportions of patients with increased TMJ SUR and difference of both TMJ SUR(〉mean+2SD of controls) in unilateral TMJ arthritis patients were significantly higher than those in patients with unilateral TMJ disc displacement(69.6% and 87% vs 23.1% and 23%). Conclusively, bone scan may help to detect TMJ disease and differentiate TMJ disc displacement from TMJ arthritis.

악관절잡음 및 동통을 동반한 정복성 관절원판 변위환자에 대한 관절강 Pumping 효과

김현철,최종훈,박혜숙,김종열,Kim, Hyeon-Cheol,Choi, Jong-Hoon,Park, Hye-Suk,Kim, Chong-Youl 대한안면통증구강내과학회 1999 Journal of Oral Medicine and Pain Vol.24 No.1

Pumping into the upper joint cavity of the TMJ was done on patients who had reducible disc displacement with pain. This article discusses the change in TMJ sounds before and after the Pumping treatment. 20subjects(mean age of $32.1{\pm}10.2yr$)were selected among those who visited the department of Oral Medicine of Yonsei University for the treatment of craniomandibular dysfunctions. Through a thorough history taking, clinical exam and X-ray taking these subjects were diagnosed as reducible disc displacement patients, and they were subdivided into two groups as acute and chronic according to the time the TMJ sound was made. Sonopak was used to measure the TMJ sound before, right after and one-week after the Pumping treatment. VAS was used to measure the degree of subjective TMJ complaints(sounds and pain) before and one-week after the Pumping treatment. Vibration related items included total integral, high integral, low integral, ratio of high integral to low integral, peak amplitude, peak frequency and median frquency. 1. It was not statistically significant between the acute and chronic groups before the treatment. However, total integral, high integral, low integral, peak amplitude, peak frequency, median frequency showed to be greater in the chronic group. 2. In all the subjects, just after the Pumping treatment was done, total integral, high and low integral, peak amplitude and peak frequency significantly decreased (p<0.05). Even after one week, low integral, peak frequency and median frequency significantly decreased (p<0,05), and the TMJ sound diminished accordingly. 3. Comparing the two groups(before and right after the Pumping treatment), there was the following difference ; in the acute group, high integral, high amplitude, high frequency and median frequency significantly decreased(p<0.05). In the chronic group, total integral, high integral, low integral, ratio, peak amplitude and peak frequency significantly decreased(p<0,05). It was not statistically significant between the acute and chronic group. 4. Comparing the two groups(right after and one week after the Pumping treatment), there was the following difference : in the acute group, high integral, high amplitude, high frequency and median frequency significantly decreased(p<0.05), In the chronic group, low integral significantly decreased(p<0.05). However, although it was not statistically significant, after one week, there was an increase in total integral, ratio, peak amplitude and peak frequency compared to right after the treatment group. 5. In the VAS of before and one week after the Pumping treatment of the TMJ pain and sound, the TMJ pain significantly decreased(p<0.05) in both the acute and chronic group. However, it was not statistically significant between the two groups. There was a statistically significant decrease(p<0.05) in the TMJ sound in the acute group after one week of Pumping treatment, but no change was notable in the chronic group and it was not statistically significant between the two groups. From the above results, we can conclude that Pumping into the upper joint cavity of patients having reducible disc displacement is effective in reducing clicking and pain. Therefore, it can be applied in diverse clinical fields.

Change of Glycosaminoglycan Distribution and Collagen Fibers Arrangement on Temporomandibular Joint Following Anterior Disc Displacement of the Rabbits

Kim, Uk-Kyu,Chung, In-Kyo,Kim, Kyu-Cheon Korean Association of Maxillofacial Plastic and Re 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.3

Purpose: This study was to determine the effects of surgical induction of anterior disc displacement (ADD) on the distribution of glycosaminoglycan (GAG) and collagen fiber arrangement in the rabbit temporomandibular joint (TMJ) tissues including articular cartilage of condyle, disc, retrodiscal tissue, and articular eminence. Methods: We used van Gieson staining and Alcian blue critical electrolyte concentration (CEC) method to observe change of collagen fibers on disc and to measure GAG up to 10 weeks in TMJ tissues after surgical induction of ADD on 25 rabbits. Results: CEC measurements for GAG showed 0.3 M, 0.4 M, 0.6 M, and 0.8 M at 1 week, 2 weeks, 3, 4, and 8 weeks, 10 weeks, respectively. This result indicated that GAGs shifted to highly sulphated ones as time passed. Disruption of collagen fiber arrangement in the disk occurred at 10 days and aggravated at 3 weeks. Conclusion: Our study showed degenerative osteoarthritis changes in rabbit TMJ following surgical induction of ADD up to 10-week period.

Assessment of anterior positioning splint in conjunction with lateral pterygoid BTX injection to treat TMJ disc displacement with reduction — a preliminary report

Maram Taema,Nouran Abdel Nabi,Samira Ibrahim,Heba Ahmed Kamal,Aala’a Emara 대한악안면성형재건외과학회 2021 Maxillofacial Plastic Reconstructive Surgery Vol.43 No.-

Objective: Treatment of temporomandibular disc displacement with reduction is controversial. This study assessesthe use of an anterior positioning splint with botulinum toxin in the lateral pterygoid muscle (BTX) for such cases. Methods: Twelve joints were included; groups I and II received BTX injection while group II also received ananterior positioning splint. Pain scores and clicking status were recorded at regular intervals then a postoperativeMRI was done after 4 months. Results: Clinical improvement was noted in both groups. Mean pain scores dropped significantly and clicks in thetwelve joints disappeared in 83% of group I and 33% of group II. MRIs showed significant disc positionimprovement with the higher mean change (1.33 ± 0.76) in group I. Group I showed better improvement of discal position and only one joint regained a click. Patients of group IIreported discomfort from the splint which may have caused psychological distress and so worst pain scores. Conclusions: Group I showed slightly better results but the cost of BTX injections and the complications of thesplint should be kept in mind and the decision of treatment selection made according to each condition.