측두하악 관절원판 후조직의 MMP(matrix metalloproteinase)-1과 MMP-2 mRNA의 발현

허종기(Jong-Ki Huh),박광균(Kwang-Kyun Park),최민아(Min-Ah Choi),김형곤(Hyung-Gon Kim) 대한구강악안면외과학회 2003 대한구강악안면외과학회지 Vol.29 No.4

Matrix metalloproteinases (MMPs) play an important role in the normal morphogenesis, maintenance, and repair of matrix and also have important functions in pathologic conditions characterized by excessive degradation of extracellular matrix, such as rheumatoid arthritis, osteoarthritis, periodontitis and in tumor invasion and metastasis. In this study, expression of MMP-1 and -2 mRNA in retrodiscal tissue of the temporomandibular joint (TMJ) was examined and compared with magnetic resonance imaging (MRI) and surgical findings. MMP mRNAs in the retrodiscal tissue samples were detected by reverse transcription - polymerase chain reaction. TMJ internal derangement (ID) was categorized as normal disc position, disc displacement with reduction, early stage of disc displacement without reduction (DDsR) and late stage of DDsR. TMJ osteoarthrosis (OA) was classified with normal, mild and advanced OA. The amount of synovial fluid collection was divided into not detected, small, large and extremely large amount on MR T2-weighted imaging. Perforation and adhesion were examined during open surgery of the TMJ. Six out of 37 samples were excluded because of little amount of extracted total mRNA. MMP-2 mRNA was detected whole joints, and so the MMP-2 mRNA seems to be expressed normally in retrodiscal tissue. However, MMP-1 mRNA was expressed in 8 of 31 joints. Frequencies of MMP-1 mRNA expression according to the TMJ IDs, amount of synovial fluid and surgical findings made no significant difference. MMP-1 mRNA was detected more frequently in OA groups (7/16 joints, 43.8%) than in normal bony structure group (1/15 joints, 6.7%). Expression of MMP-1 mRNA in retrodiscal tissue might be related with OA of the TMJ.

인공 턱관절 전치환술

허종기(Jong-Ki Huh) 대한치과의사협회 2012 대한치과의사협회지 Vol.50 No.5

Temporomandibular joint (TMJ) prosthesis have been hesitated to use because of bitter memories about Proplast-Teflon interpositional TMJ implants. Many clinicians, however, are trying to use total TMJ prosthesis with getting continuous long-term follow-up results. Alloplastic total TMJ replacement have been applied to much more patients who have failed previous TMJ prostheses or TMJ implants, fibrous/bony ankylosis, severe osteoarthritis, degenerative joint disease, idiopathic condylar resorption, condyle loss by trauma or tumor resection, and other bony destructive diseases. Nowadays three types of total TMJ prosthesis are widely used. In this article, indications, types of prosthesis, safety and stability would be demonstrated with a case report.

악관절 내장증 환자에서 자기공명영상 소견과 관절원판 후조직의 조직학적 소견과의 연관성

허종기(Jong Ki Huh),김형곤(Hyung Gon Kim) 대한구강악안면외과학회 2000 대한구강악안면외과학회지 Vol.26 No.4

Temporomandibular disorders arised from joint itself was caused by inflammation or mechanical irritation of the retrodiskal tissues. Histologic changes of the retrodiskal tissues of temporomandibular joint(TMJ) internal derangement, such as inflammatory cell infiltration, hyalinization, myxoid change, fatty change, arterial obliteration, and so on, were reported, but relationships between magnetic resonance imaging(MRI) findings and histologic findings of the retrodiskal tissue were few reported. The purpose of this study was to find histologic changes of the retrodiskal tissues for status of joint and joint effusion in MRI of the temporomandibular joint which had surgical treatment. Materials were surgically treated 52 temporomandibular joints with internal derangement or osteoarthritis in TMJ clinic, Yongdong Severance Hospital. All joints were confirmed by magnetic resonance T1- and T2-weighted imagings bofere surgery. Status of joint was categorized by normal position, disc displacement with reduction, disc displacement without reduction, disc displacement without reduction associated with osteoarthrosis using preoperative MR T1-weighted images. Magnetic resonance evidence of joint effusion was observed in T2-weighted images and classified by its amount; degree 0(not observed), degree 1(small amount), degree 2(moderate amount), degree 3(large amount). Histologic features were observed whether the retrodiskal tissue has inflammatory cell infiltration, myxoid change, hyalinization, chondroid metaplasia and arterial obliteration. The distribution of elastic fibers were also observed. The results were as follows; 1. Inflammatory cell infiltration was not observed in any retrodiskal tissues. 2. MRI findings such as status of joint and evidence of joint effusion did not have significant relationship with myxoid change, hyalinization, chondroid metaplasia, arterial obliteration of the retrodiskal tissues. 3. Hyalinization and chondroid metaplasia were found in 8 joints(15.4%) and 5 joints(9.6%). All of them were found in disc displacement without reduction and disc displacement without reduction associated with osteoarthrosis. 4. Arterial obliteration was observed more frequently in disc displacement without reduction(55.6%) than disc displacement without reduction associated with osteoarthrosis(28.6%). Further studies with proper controls and more materials will be necessary.

측두하악관절에 발생한 염증성 활액낭

조명철,허종기,홍순원,김진태,전국진,김형곤,Cho, Myung-Chul,Huh, Jong-Ki,Hong, Soon-Won,Kim, Jin-Tae,Jeon, Kug-Jin,Kim, Hyung-Gon 대한악안면성형재건외과학회 2008 Maxillofacial Plastic Reconstructive Surgery Vol.30 No.3

활액낭은 측두하악관절에 매우 드물게 나타나는 질환으로 본 증례는 개구제한을 주소로 내원하여 측두하악관절장애로 의심하고 자기공명 영상검사를 시행하였다. T2강조영상에서 좌측 측두하악관절강내에 다량의 활액이 관찰되었으나 전형적인 활액막 연골종증과 달리 상하관절강내의 활액이 격벽에 의해 분리되어 있었으며 수술시 낭성 병변이 관찰되었다. 조직학적으로 낭주위가 활액세포로 이장되어 있는 진성낭이었으며 낭벽내에 신생혈관 및 염증세포의 침윤이 관찰되어 염증성 활액낭으로 최종 진단하였다. 이 증례는 특징적인 자기공명영상소견을 나타내었지만 타 질환과 감별에 많은 어려움이 있었다. 치료는 병소의 적출을 시행하였으며 추적관찰기간 동안 재발은 보이지 않았다. Temporomandibular joint cysts usually occur between the second and fourth decade of life. There is a female predominance to male of approximately 3 to 1. The patients complain of swelling, pain and sometimes decreased mouth opening. Synovial cysts of the temporomandibular joint seem to develop by an increase of intraarticular pressure due to trauma or inflammation which causes capsular herniation. However, if inflammatory synovial cysts develop by an increase of synovial fluid into inflammation tissue in the capsule without capsular herniation, a differential diagnosis should include synovial chondromatosis and synovitis. This is a case report of a synovial cyst developed in a capsule of the temporomandibular joint.

폐쇄성 수면무호흡증 진단을 위한 한국인 성인 부정교합자의 두부방사선 사진 계측 분석에 의한 연구

박광호,허종기,안제영,김지용,임재형,Park, Kwang-Ho,Huh, Jong-Ki,Ahn, Je-Young,Kim, Ji-Yong,Lim, Jae-Hyung 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.3

Obstructive sleep apnea syndrome (OSAS) is characterized by sleep-induced obstruction of the upper airway that results in cessation of airflow. Obstruction can occur at a number of points in the airway, but frequently in the oropharynx. A diagnostic evaluation includes cephalometry, computed tomography, magnetic resonance imaging, acoustic reflection technique, polysomnography and fibroptic endoscopy. Cephalometric measurements of the patients with obstructive sleep apnea have revealed that posterior airway anatomy has strong relations with the symptoms of them. A lateral cephalogram is routinely obtained in the radiologic evaluation of sleep apnea patients. The purpose of this study is to provide a the lateral cephalometric korean norms for the diagnosis and treatment of the patients with obstructive sleep apnea by analyzing the abnormal occlusion of Korean adults.

측두하악관절 장애 환자에서 관절원판후조직의 에스트로겐 수용체(ER)의 단백 발현

김종윤(Jong-Yun Kim),임재형(Jae-Hyung Lim),박광호(Kwang-Ho Park),김형곤(Hyung-Gon Kim),허종기(Jong-Ki Huh) 대한구강악안면외과학회 2009 대한구강악안면외과학회지 Vol.35 No.6

Those composing temporomandibular joint (TMJ) complex such as the temporal bone, the disc and the mandibular condyle perform their own functions with organic relation. The retrodiscal tissue is the main area of pain induction and contributes to compositional change of synovial fluid. If displacement of the disc lasts long time, not only adaptive changes, but also destructive or degenerative changes may happen. It was reported that these changes and symptoms appear mostly to female rather than male and especially, in the case of patients suffering from TMJ disorder, a large quantity of female sex hormone is found in the joint synovium. And that may play a role in bone resorption and inflammation. Also, the frequency and the intensity of pain perception for female is reported to be much more than for male. In this study, we investigated the expression extents of estrogen receptors (ER) and progesteron receptors (PR) in retrodiscal tissue with immunohistochemistry among the patients received TMJ surgery and compared with MRI findings and surgical findings. We report the relations between the expression of ER in retrodiscal tissue and the pathological change in TMJ, such as inflammation, internal derangement and osteoarthritis.

악관절 내장증의 증상 중 연관통의 악관절 수술 후 변화

김형곤,박광호,허종기,윤현중,김기영,남광현,Kim, Hyung-Gon,Park, Kwang-Ho,Huh, Jong-Ki,Yoon, Hyun-Joong,Kim, Ki-Young,Nam, Kwang-Hyun 대한악안면성형재건외과학회 1999 Maxillofacial Plastic Reconstructive Surgery Vol.21 No.1

Purpose: The aim of this study was to investigate the improvement of referred symptoms of TMJ internal derangement after open surgery of TMJ. Materials and Methods: The present study focused referred symptoms such as headache, neck pain, shoulder pain and evaluated the incidences and changes in their improvement at 1, 3, 6, 12 months after surgery in 118 patients who had TMJ internal derangement and received meniscoplasty(or meniscorrhaphy) and eminectomy at TMJ clinic of Yonsei University, Yongdong Severance Hospital, between 1992 and 1997. Results: One hundred eighteen patients(102 females, 16 males) with mean age of 29.6 years(range, 14 to 74) were included in this study and the mean follow-up period was 19.5 months(range, 12 to 60). The incidences of headache, neck pain, shoulder pain among the surgically treated TMJ internal derangement patients were 66.9%, 28.8%, 28.0% before surgery. Thirty-two preoperative severe(+++) headache patients were all improved their headache at 1, 3, 6 months after surgery, but slight relapse(9.4%) was found at 12 months after surgery. The clearance rate of preoperative neck and shoulder pain were 91.2% and 90.9% at 1 month after surgery and all of these groups had no pain at 12 months after surgery. Conclusions: Referred symptoms of TMJ internal derangement such as headache, neck pain, shoulder pain were dramatically improved after surgical treatment of TMJ.

자기공명영상에서의 temporomandibular joint effusion과 증상 및 수술소견과의 연관성에 대한 후향적 연구

김형곤(Hyung Gon Kim),허종기(Jong Ki Huh),박광호(Kwang Ho Park),윤현중(Hyun Joong Yoon),김일수(Il Soo Kim),남광현(Kwng Hyun Nam),최희수(Hee Soo Choi) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.2

Purpose: Although joint effusion caused by the inflammatory changes of synovium has been known to be associated with joint pain, it is still controversial. This study is to clarify the relationship between the evidence of joint effusion seen high signal intensity in T2-weighted magnetic resonance imaging and clinico-surgical findings. Materials and Methods: All of the patients were diagnosed as temporomandibular joint internal derangement and received unilateral open surgery. The authors classified the joint effusion as four categories by size and shape: degree O-no evidence; degree 1a-a line of high signal along articular surface in unfolded disc; degree 1b-high signal spot in the folded disc; degree 2-pooling in the anterior recess and folded disc; degree 3-pooling in the glenoid fossa and along articular eminence. The authors evaluated clinical and surgical findings. Results: Two-hundred eighty-nine patients(242 females) with mean age of 30.2 years(range: 14 to 74) were included. High signal intensity was seen in 166 joints(57.4%): degree 1 in 82 joints, degree 2 in 69 joints(23.9%), degree 3 in 15 joints(5.2%). Maximal mouth opening of degree 0 group was 38.07㎜, degree 1: 36.34㎜, degree 3: 33.47㎜. Mean TMJ pain score of the joint effusion groups was 1.58 no evidence group was 1.41. Click of degree 0 group was 44.7%, degree 3 was 43.4%. Crepitus of degree 0 group was 17.1%, degree 3 was 26.7%. Mean pain score of headache of degree 0 group was 1.80, degree 2 was 1.22. Neck and shoulder pain of degree 0 group was 50.4%, degree 1 was 39.0%. Perforation, adhesion, hyperemia of degree 0 was 27.6%, 35.8%, 18.7%, degree 2: 23.2%, 29.0%, 29.3%(degree 1). Conclusions: TMJ pain, TMJ sound and surgical findings did not relate significantly to the joint effusion of TMJ, but referred symptoms such as headache, neck and shoulder pain were less severe in the joint effusion groups.

골격성 3급 부정교합자의 악교정 수술 후 설골 위치와 상기도 크기의 변화

김지용,안제영,임재형,허종기,박광호,Kim, Ji-Yong,Ahn, Je-Young,Lim, Jae-Hyung,Huh, Jong-Ki,Park, Kwang-Ho 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.2

After orthognathic surgery in skeletal class III patients, the hyoid bone position and the upper airway dimension could be changed due to mandibular setback. There has been many studies about airway dimension of the patients with skeletal class II malocclusion or obstructive sleep apnea. but not with skeletal class III. The purpose of this study was to examine the change of position of the hyoid bone and the consequent change of airway space as the result of retrusion of mandible after orthognathic surgery in skeletal Cl III malocclusion patients. It is also to apply this results in predicting, diagnosing and treating the subsequent obstructive sleep apnea. Forty patients who were diagnosed as skeletal Cl III maloccusion, received orthoganthic surgery of both jaws including mandibular setback, and were followed up post-operatively for more than 6 months were selected. There were 10 male patients 30 female patients. The preoperative and postoperative lateral cephalograms were traced and the distances and angles were measured. The nasopharyngeal space increased postoperatively while the oropharyngeal space decreased. Except for the change of oroparyngeal space, the changes in male patients were greater than female patients. The hyoid bone moved in the posterior-inferior direction, and the change was greater in males than in females. If the postoperative mandibular setback is great, then a significant decrease of airway space and posterior and inferior movement of the hyoid bone were observed. This can result in symptoms related to obstructive sleep apnea. This result should be considered in the diagnosis and treatment planning of orthognathic surgery patients.

골격성 제3급 부정교합자의 양악 수술 후 중안면부 연조직 변화에 관한 두부 계측 방사선학적 연구

안제영,김지용,주범기,김민철,허종기,김형곤,박광호,Ahn, Je-Young,Kim, Ji-Yong,Joo, Bum-Ki,Kim, Min-Chul,Huh, Jong-Ki,Kim, Hyung-Gon,Park, Kwang-Ho 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.2

Considering the skeletal class III malocclusion that complains of mandibular prognathism, there have been some studies of the mandibular change for comparing the changes of pre operative with post operative state. Nowadays it is common to do the orthognathic 2-jaw surgery for the correction of the maxillary deficiency, the post operative stability and the esthetics. We compare and analyze the changes of soft tissue around the nose and the lip with the changes in the direction and the amount of maxilla. Patients who were diagnosed as maxillofacial deformity and received orthognathic surgery of both jaws at Yongdong Severance hospital from 2001 through 2003 were included in this study. Their lateral cephalograms were analyzed, and the post operative change of hard tissue and soft tissue were studied. Upon analyzing the preoperative cephalograms and 6 month post operative cephalograms, there were significant in the vertical change of Labialis superius(Ls) and Stomion(Stm) in soft tissue in relation to the vertical change of skeletal landmarks (Anterior Nasal Spine, Subspinale, Prosthion, Incision Superious). In addition, there were no significance in horizontal movement of the skeletal landmarks among groups. In terms of hard tissue landmarks, group 3(maxillary posterior impaction and advancement surgery group) showed significantly greater change in the vertical movement of Anterior Nasal Spine(ANS), Subspinale(A), Prosthion(Pr), and Incision Superious(Is) compared with other groups. In terms of soft tissue change, group 3 showed more significant change in the vertical movement of Ls and Stm. This study calculated the changes of the skeletal and soft tissue landmarks in order to act as a guide in planning and performing the surgery and as a reference in predicting the postoperative change of facial appearance.