악관절원판의 위치에 관한 연구

김준배(Joon Bae Kim),김형곤(Hyung Gon Kim) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.3

The present study proposes a method delineating the extent of the anterior displacement of the temporomandibular articular disc through the angle formed by the deepest point in the glenoid fossa, the center of the mandibular condyle and the Junction between the end of the posterior band and the retrodiscal tissue. The method was applied to the normal group and TMD group. The TMD group was further divide into 3 groups : Group I(little disc displacement), Group II(anterior disc displacement with reduction) and Group III(anterior disc displacement without reduction). The results were as follows. 1. The normal group showed the location of the articular disc within -10-0° or with a wider allowance, within -10~10° from the reference line GC 2. The TMD group showed the disc located within -21.0~125.8°, with two peaks at 0~10° and 60~80°, suggesting that the group may be composed of more than two different subgroups. 3 The threshold point delineating the normal and TMD states was 0°, because 82.5% of normal group appeared below 0° and 94.8% of TMD group appeared above 0°. 4. Since the angular disc displacement tends to increase from Group I to Group III, the angular displacement increases as the overall severiety of the disease increases, and the chance for a reduction of the disc decreases. 5 The normal group, Group I, Group II, and Group III can be categorized into statistically different groups. The normal group and TMD group can be distinguished in reference to 0°, while the presence-absence of the anterior disc displacement is judged in reference to 10°, and the probability of the disc reduction can be estimated in reference to 50°. The present study assesses the location of the articular disc from the sagittal central section offering a supplementary clinical classification. This system provides an additional information concerning the location of the disc, thereby offering an objective mean to evaluate the progress of the disease. Further studies may be needed on the clinical changes according to location of the disc, as well as the relationship between the morphological changes and the anterior or sideways displacement of the disc.

자기공명영상의 관상면상에서 악관절원판의 내외측 위치에 관한 연구

김준배(Joon Bae Kim) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.4

MRI and arthrograms were used to diagnose the disc displacement of temporomandibular joint, but most of these trials focused on the anterior disc displacement. The discs could be displaced laterally or medially and in some case this sideway displacement may play a role as a main problem of temporomandibular disorder. In this study, 45 patients(31 unaffected sites, 59 affected sites) and 20 asymptomatic volunteers sagittal and coronal MRI views were reviewed, then some results were found as follows 1. In sagittal plan, anterior disc displacements were found 15% in normal sites, 45% in unaffected sites and 69% in affected sites. 2. In coronal plan, sideways disc displacements were found 15% as medial in normal, 6% as medial and 13% as lateral in unaffected, 8% as medial and 14% as lateral diaplacement in affected sites. 3. In asymptomatic sites involving unaffected sites, medial disc displacements(11.3%) but in symptomatic joints, lateral disc displacements(13.8%) were prevalent. 4. The sideways disc displacement were observed 10.1% as medial and 2.9% as lateral dispalcement without and 9.8% as medial and 16.4% lateral dispalcements with anterior disc displacement. And, the coronal views of MRI were beneficial to evaluate the sideways disc displacement. Further studies may be needed on evaluation of the relations between sideways displacements and clinical symptoms or the treatment results.

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.

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.

Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report

임지훈,이혜진,이상헌 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.5

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6—7/10 to 1—2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3—4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

악관절 자기공명영상 소견상 Joint Effusion에 관한 연구

김준배(Joon Bae Kim) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.1

The purpose of this study was to correlate MR evidence of joint effusion in the temporomandibular joint with disc displacement, disc reducibility, bony change of articular surface, joint pain, muscular tenderness and headache. The temporomandibular joints of 70 TMD patients (94 affected sites and 46 unaffected sites) and 20 asymptomatic volunteers were imaged bilaterally. Sagittal and coronal T1, proton density, and T2-weighted images were obtained. Image findings of joint effusion were correlated with the patholosic changes of articular structures and pain-related symptoms. The results were as follows 1. MR showed effusion in 5.0% of asymptomatic joints, 28.3% of unaffected joints and 54.3% of affected joints. Joint effusion was more prevalent in symptomatic joints than symptom-free joints. 2. Disc displacement was observed 2.8% in asymptomatic joints, 37.0% in unaffected joints and 79.8% in affected joints. Joint effusion was more prevalent in disc-displaced joints and the rate of joint effusion increased according to the severity of disc displacement. 3. Nonreduced disc displacement was observed 2.5% in asymptomatic joints, 15.2% in unaffected joints and 53.2% in affected joints. Joint effusion was more prevalent in the disc-displaced joints without reduction. 4. The bony change of articular surface was observed 6.5% in unaffected joints and 12.8% in affected joints. Joint effusion was more prevalent in articular surface-damaged joints but the rate of joint effusion was high in the affected joints with mild damaged articular surface. 5. Joint effusion was seen in 56.9% of mild painful joints and in 85.7% of moderate to severe painful joint A strong association was seen between joint effusion and moderate to severe joint pain. 6. Joint effusion was seen in 51.2% of the joints with mild muscular tenderness and in 56.6% of the moderate to severe painful joint. There was little difference between the presence and the absence of the muscular tenderness. 7. Joint effusion was seen in 51.7% of the joints without headache and in 58.8% of the joint with headache. There was little difference between the presence and the absence of headache, but joint effusion was seen as a high rate(72.7%) in the joints having moderate to severe headache.

Morphometric Study of the Lumbar Posterior Longitudinal Ligament

Lee, Sang Beom,Chang, Jae Chil,Lee, Gwang Soo,Hwang, Jae Chan,Bae, Hack Gun,Doh, Jae Won The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.1

Objective : Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement. Methods : In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle. Results : Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8-36.9% of the disc width and the fan-like portion of the PLL covered 63.9-76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1-74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5-29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons. Conclusion : This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

Acute Malocclusion Caused by Articular Disc Perforation: A Case Report

남현,심영주,강진규 대한안면통증∙구강내과학회 2018 Journal of Oral Medicine and Pain Vol.43 No.4

Patients with temporomandibular disorder often present with acute occlusal change and properly managed with conservative treatment. If such change is caused by unusual etiology, differential diagnosis may be challenged. This article describes the diagnosis of a patient exhibiting pain and acute posterior open bite on the ipsilateral side after chewing hard food. After initial conservative treatment failed to resolve the complaint, magnetic resonance imaging was ordered and confirmed partial perforation of articular disc. Disc perforation itself is usually chronic in nature, but sudden macrotrauma may also cause the disorder. However, occlusal discrepancy caused by disc perforation is rare and seldom reported. We present a case of acute malocclusion caused by disc perforation with a review of related literature.

Difficulty in Closing Mouth in Patient with Disc Displacement: A Case Report

문요선,임현대,이유미,강진규,심영주 대한안면통증∙구강내과학회 2017 Journal of Oral Medicine and Pain Vol.42 No.1

Clinicians are familiar with limitation of opening mouth caused by temporomandibular disorders. Sometimes, patients also complain of difficulty in closing mouth. Difficulty in closingmouth can be caused by anterior, posterior disc displacement, and subluxation of temporomandibularjoint (TMJ). In this report, we presented a patient who had a difficulty in bothopening and closing mouth. The patient complained of TMJ noises and intermittent limitationof opening mouth, and inability to get teeth back into maximal intercuspal position. Magneticresonance images revealed that the left TMJ had an anterior disc displacement with relativeposterior disc displacement. We reviewed the possible causes, signs and symptoms, and treatmentfor difficulty in closing mouth with related literatures.

Acute Malocclusion Caused by Articular Disc Perforation: A Case Report

Nam, Hyun,Shim, Young-Joo,Kang, Jin-Kyu Korean Academy of Orofacial Pain and Oral Medicine 2018 Journal of Oral Medicine and Pain Vol.43 No.4

Patients with temporomandibular disorder often present with acute occlusal change and properly managed with conservative treatment. If such change is caused by unusual etiology, differential diagnosis may be challenged. This article describes the diagnosis of a patient exhibiting pain and acute posterior open bite on the ipsilateral side after chewing hard food. After initial conservative treatment failed to resolve the complaint, magnetic resonance imaging was ordered and confirmed partial perforation of articular disc. Disc perforation itself is usually chronic in nature, but sudden macrotrauma may also cause the disorder. However, occlusal discrepancy caused by disc perforation is rare and seldom reported. We present a case of acute malocclusion caused by disc perforation with a review of related literature.