Surface Electromyographic Characteristics of a Myofascial Trigger Point of the Temporalis Muscle: A Case Report

임영관,백혜성,이금숙,김병국,Im, Yeong-Gwan,Baek, Hey-Sung,Lee, Guem-Sug,Kim, Byung-Gook The Korean Academy of Orofacial Pain and Oral Medi 2013 Journal of Oral Medicine and Pain Vol.38 No.3

근막동통은 국소적인 통증과 촉진시 근 압통을 보이면서 근막 발통점이 존재하는 것이 특징인 근육질환이다. 본 증례에서는 야간 이갈이를 호소하는 환자의 임상검사에서 촉진을 통해 측두근 전방 부위의 잠재성 발통점을 확인하였고, 양측의 측두근과 교근에 대해 표면 근전도 검사를 시행한 결과, 이환된 측두근에서 수축 후 근과민성, 이완 지연 및 근피로 가속과 같은 소견을 얻을 수 있었다. 표면근전도 검사는 저작근의 비정상적인 기능을 확인할 수 있으므로 근육성 측두하악장애의 평가에 도움이 될 수 있다. Myofascial pain is a condition associated with regional pain and muscle tenderness characterized by the presence of myofascial trigger points. In this case report, a subject complaining of nighttime bruxism was clinically assessed, and a latent trigger point of the anterior temporalis muscle was identified with manual palpation. A surface electromyographic (SEMG) exam of the anterior temporalis muscle harboring the latent trigger point demonstrated several SEMG features, including post-contraction irritability, delayed relaxation following contraction and accelerated muscle fatigue. It was concluded that a SEMG exam may detect abnormal masticatory muscle function and, therefore, assist in the evaluation of myogenous temporomandibular disorders.

Correspondence between Temporomandibular Disorder Symptoms and Clinical Examination Findings

임영관,백혜성,김병국,Im, Yeong-Gwan,Baek, Hey-Sung,Kim, Byung-Gook Korean Academy of Orofacial Pain and Oral Medicine 2010 Journal of Oral Medicine and Pain Vol.35 No.1

Objectives: This study aimed to assess the characteristics of temporomandibular disorder (TMD) symptoms and to determine the correspondence between TMD symptoms and clinical examination findings. Material and methods: A total of 218 patients (143 females and 75 males; age=$31.3{\pm}14.0$) were enrolled in this study who completed a questionnaire and underwent a clinical examination and radiographic assessment. Patients were asked about all the symptoms and complaints, including onset or duration, and locations of the symptoms. Clinical examination included amounts of mouth opening, palpable temporomandibular joint (TMJ) sounds, and tenderness to palpation of the TMJ and all masticatory muscles. Tenderness scores obtained from palpation of the masticatory system were summated to define the variables for further analysis. Results: Pain was the most frequently reported symptom (78.9%), followed by joint sounds (45.4%), and limitation in mouth opening (17.0%). Jaw pain comprised 91.9% of pain complaints. The subjective intensity of jaw pain was low to medium in most patients (93.7%), but it was poorly correlated with the sum of tenderness scores of the TMJ and masticatory muscles (Kendall tau = 0.084). In contrast, the side in which pain was reported by patients was well associated with the clinical examination results (pain of the right side, p < 0.001, and left side, p < 0.001). There was moderate agreement in TMJ sounds between the side identified by patients as symptomatic and clinical examination findings (kappa = 0.482). Finally, patients who complained of restricted mouth opening showed about a 10 mm less opening in all three measurements, compared to other patients (p < 0.001). Conclusion: The most frequent symptoms reported by TMD patients were jaw pain, TMJ sounds, and mouth opening limitation. The side of jaw pain, the side of TMJ sounds, and the presence of opening limitation were highly concordant between symptom reports and examination findings.

Management of Lateral Pterygoid Myalgia with Diagnostic Local Anesthetic Injection: A Report of 2 Cases

임영관,김병국,Im, Yeong-Gwan,Kim, Byung-Gook Korean Academy of Orofacial Pain and Oral Medicine 2010 Journal of Oral Medicine and Pain Vol.35 No.4

The lateral pterygoid muscle is one of the masticatory muscles basic to jaw function. Because of its deep location in the masticatory system, digital palpation of the muscle is usually difficult to perform and unreliable. Therefore, diagnosis of the myalgic disorders involving the lateral pterygoid muscle is a perplexing problem for clinicians. Local anesthetic injection can be a more effective method to examine the lateral pterygoid muscle for the purpose of discriminating the source of pain. Furthermore, immediate elimination of muscle pain facilitates stretching of the muscle in the full range. We report two cases of lateral pterygoid myalgia that were diagnosed and managed successfully through the use of intramuscular local anesthetic injection.

The Chewing Efficiency of Occlusal Stabilization Appliances by Anatomy of the Occlusal Surface

임영관,최충호,김재형,이종욱,김병국,Im, Yeong-Gwan,Choi, Choong-Ho,Kim, Jae-Hyeong,Rhee, Chong-Ouk,Kim, Byung-Gook Korean Academy of Orofacial Pain and Oral Medicine 2005 Journal of Oral Medicine and Pain Vol.30 No.3

Occlusal appliance therapy has been proven to be very useful and effective in reducing signs and symptoms of patients with TMD. However, there are no reports about the masticatory efficiency of the occlusal appliance. The purpose of this study was, first, to investigate the masticatory efficiency of the conventional stabilization appliance experimentally in normal healthy subjects, by comparing it with that of their natural dentition; and, second, to develop a modified stabilization appliance as an attempt to increase masticatory efficiency. Eleven subjects (mean age 25.3 years, range from 23 to 33) participated in this study. Six were men and five were women. They were healthy and had complete or near―complete natural dentition, and did not present with signs or symptoms of TMD. Two kinds of occlusal appliances―the conventional flat maxillary stabilization appliance (i.e., FSA) and a modified maxillary stabilization appliance with additional anatomic structures on its occlusal surface (i.e., ASA)―were made for every subject. Subjects chewed peanuts that were selected as a food to test the three masticatory conditions of the natural dentition, the ASA, and the FSA. The number of chewing strokes was counted during each 1-minute chewing period. Chewed peanut boluses were recovered and their hardness was measured by texture analysis. Statistical tests were performed. The following results were obtained. 1. The masticatory efficiency of the FSA was 38.6 percent that of the natural dentition. The efficiency of the ASA was 78.2 percent that of the natural dentition. 2. The number of chewing strokes in the natural dentition condition was measured to be 1.5 strokes per second. It decreased to 90 percent in the ASA and FSA conditions. These results indicate that the ASA could serve an improved masticatory capacity as well as its therapeutic effects in TMD. A clinical application of the ASA should be considered to extend the management of TMD patients.

Association Between Temporomandibular Disorders and Cervical Muscle Pressure Pain

임영관,김재형,김병국,Im, Yeong-Gwan,Kim, Jae-Hyeong,Kim, Byung-Gook Korean Academy of Orofacial Pain and Oral Medicine 2008 Journal of Oral Medicine and Pain Vol.33 No.4

Aims: The aims of this study were to identify the association between cervical muscle pain and TMD by pressure pain response, and to find cervical muscles showing moderate to severe pressure pain that are correlated with masticatory muscle pain. Methods: Patients(n=129, female 65.9%, mean age 28.8 years) answered a TMD questionnaire asking about headache, neck pain, emotional stress, sleep disturbance, parafunction habits, and pain intensity. A clinical examination of the masticatory system was performed. Of the neck muscles, (1) the upper sternocleidomastoid, (2) the middle sternocleidomastoid, (3) the upper trapezius, (4) the splenius capitis, (5) the semispinalis capitis, (6) the scalene medius, and (7) the levator scapulae muscles were examined by palpation. Pressure pain or tenderness of all palpation sites was scored from 0 to 3 according to the pain response. The variables of sum of pressure pain scores were calculated from pressure pain scores and were used for statistical analyses. Results: Eighty patients(62.0%) answered that they suffer from neck pain in the TMD questionnaire. More than 40% of sternocleidomastoid and upper trapezius examination sites showed moderate to severe tenderness in the cervical muscles, and 36% of middle masseter in the masticatory muscles. For the 129 patients, the sum of cervical muscle pain scores(mean=12.88, SD=8.06) and the sum of TMD pain scores(mean=5.36, SD=5.10) were moderately correlated($\rho$ = 0.502, P < 0.001). The sum of TMD pain scores tends to increase as the sum of cervical muscle pain scores increases(Y = 0.395${\cdot}$X, $R^2$ = 0.659, P < 0.001). In the patients with masticatory muscle disorders, the sum of sternocleidomastoid and upper trapezius pain scores(mean = 8.67, SD = 4.95) and the sum of temporalis and masseter pain scores(mean = 3.37, SD = 3.56) showed moderate correlation($\rho$ = 0.375, P < 0.001). Those two variables were in a proportionate relationship(Y = 0.359${\cdot}$X, $R^2$ = 0.538, P < 0.001). In a partial correlation analysis of the sum of unilateral pain scores, the sum of right cervical muscle pain scores and the sum of left cervical muscle pain scores showed the highest correlation(r = 0.802, P < 0.001). The sum of right TMD pain scores and the sum of left TMD pain scores were moderately correlated(r = 0.481, P < 0.001). For the twenty patients with unilateral TMD pain, the partial correlation coefficient between the sum of ipsilateral cervical muscle pain scores and the sum of contralateral cervical muscle pain scores was the largest(r = 0.597, P = 0.009). A partial correlation between the sum of primary TMD side pain scores and the sum of ipsilateral cervical muscle pain scores was 0.564(P = 0.015). Conclusions: TMD is associated with cervical muscle pain on condition of pressure pain response to palpation. Of the cervical muscles, sternocleidomastoid and upper trapezius frequently exhibit moderate to severe pressure pain, and they are closely related to the masticatory muscle pain. The characteristic of symmetric involvement of pain is prominent in cervical muscles; however, TMD can affect the level of cervical muscle pain to modify its symmetric nature.

Micromorphology and Chemical Composition of a Sialolith in the Submandibular Gland Duct

임영관,송호준,김병국,Im, Yeong-Gwan,Song, Ho-Jun,Kim, Byung-Gook Korean Academy of Orofacial Pain and Oral Medicine 2011 Journal of Oral Medicine and Pain Vol.36 No.3

Sialolith is one of the most common pathologic conditions found in the salivary glands. The mechanisms responsible for the formation of sialoliths have not been elucidated so far. In this article, the chemical composition and micromorphology of a sialolith of a 58-year old female patient suffering from chronic sialoadenitis of the submandibular gland was analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). In a SEM evaluation, the highly mineralized amorphous core surrounded by lamellar and concentric structures was revealed, however no foreign body, organic material, or signs of microorganism were observed in the core of the sialolith. EDX analysis showed the central core was composed of only Ca, O and P, and that a high level of C was detected near the central area as well. These results indicated that the inorganic composition of the sialolith was hydroxyapatite crystals, and that inorganic and organic substances existed around the central cores. This study suggests that the sialolith was composed mainly of hydroxyapatite crystals and the formation of the nucleus of the sialolith in the submandibular gland duct was secondary to sialadenitis, which favors the growth of an inorganic crystalline nucleus.

치과 영역에서의 저출력레이저요법

임영관(Yeong-Gwan Im),김지연(Ji-Yeon Kim),김병국(Byung-Gook Kim) 대한치과의사협회 2011 대한치과의사협회지 Vol.49 No.11

Low-level laser therapy (LLLT) is the application of light to pathology to promote tissue regeneration, reduce inflammation, and relieve pain. LLLT has a photochemical effect whereby the light is absorbed and exerts a chemical change. The clinical applications of LLLT include improvement in wound and bone healing processes, control of pain and tooth hypersensitivity, modulation of periodontal inflammation, the prevention and treatment of cancer therapy-induced oral mucositis, management of burning mouth syndrome, and improvement in temporomandibular disorder symptoms. Further research is needed to better elucidate the cellular mechanisms of LLLT and provide a solid scientific basis for the clinical application of LLLT in dentistry.

교합장치용 아크릴레진의 표면경도와 굴곡강도에 대한 침수의 영향

이효언,임영관,김병국,임회순,김재형,Lee, Hoy-Youn,Im, Yeong-Gwan,Kim, Byung-Gook,Lim, Hoi-Soon,Kim, Jae-Hyung 대한안면통증구강내과학회 2010 Journal of Oral Medicine and Pain Vol.35 No.1

By repeating nocturnal bruxism occlusal appliance's wearing condition that is used to cure temporomandibular disorders into the vitro experiment, research aims to find out how moisture infiltrated and drying cycle process affects on the surface microhardness of the resin for occlusal appliance and flexural strength. By utilizing resin for occlusal appliance which is the main component of poly methyl methacrylate, bar shaped sample was produced. For the resin sample utilized as the controlled group 1, the sample was infiltrated in the moisture for 7 days in the temperature of 37C. Then, the resin sample of the controlled group 2 was maintained in a dry condition for 7 days in the normal temperature. After that, each sample's surface microhardness and flexural strength were measured. For the resin sample that is utilized as the experimental sample, the sample was infiltrated in the moisture for 7 days in the temperature of 37C. Then, it was inundated for 8 hours a day and dried in the normal temperature for 16 hours with the continuous process of moisture infiltration and dry cycle process for 30 days. During this cycle process, sample's surface and flexural strength were measured in the 1st day, 7th day, and 30th day. Then, it was statistically analyzed to find out the difference of controlled and experiment group's surface microhardness and flexural strength. Results are 1. For the experimental and controlled group's surface microhardness of the resin for the occlusal appliance, it did not show any significant differences after moisture infiltration and dry cycle process repetition. 2. In case of the flexural strength for resin for the occlusal appliance, experimental group with moisture infiltration and dry cycle for 30 day process had greater effect than the experimental group at the 1st day and controlled group These results can be considered to be utilized from the patients of the temporomandibular disorders towards occlusal appliance used and maintained method.

측두하악관절 주변인대 질환의 초음파영상

홍수민,임영관,김병국,Hong, Soo-Min,Im, Yeong-Gwan,Kim, Byung-Gook 대한안면통증구강내과학회 2008 Journal of Oral Medicine and Pain Vol.33 No.4

Purpose : The purpose of this study was to verify the usefulness and feasibility of ultrasonographic imaging for the detection of the disorders of the surrounding supporting structure such as articular capsule, retrodiscal tissue and related ligaments, osteoarthritic evidence and associated disc displacement at the temporomandibular joint(TMJ) Materials and Methods : 20 patients(40 joints) with periodic lock and crepitations were investigated prospectively using 12 MHz array transducer. Ultrasonographic Imagings were assessed for osteoarthritic surface changes of condyle, extent of disc displacement and disorders of surrounding structures. Ultrasonographic images were compared with clinical investigations, conventional radiography and Dental Computed Tomographic scans. Results : In clinical and conventional radiography, osteoarthritic changes were diagnosed in 8 joints. Ultrasonographically 7 of the 8 osteoarthritic changes were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 87.5%, 62.5%, and 67.5% respectively. About the detection of disc displacement, disc displacement were diagnosed in 21 joints clinically. Ultrasonographically 19 of the 21 disc displacements were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 95%, 90%, and 92.5% respectively. when the disorders of supportive structure were figured out, the disorders of supportive structure were diagnosed in 18 joints clinically. Ultrasonographically 1 of the 18 the disorders of supportive structure were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 5.5%, 4.5%, and 55% respectively. Conclusion : Ultrasonography is an relatively reliable diagnostic tool for the detection of disc displacement and some of osteoarthritic changes. But it's not an insufficient imaging technique for the detection of the disorders of the surrounding structure.

하악골 부분절제술 시행한 환자에서 CAD/CAM Zirconia Framework와 Monolithic Zirconia를 이용한 전악 수복 증례

마보영,박홍주,임영관,박찬,신진호,임현필,Ma, Bo-Young,Park, Hongju,Im, Yeong-Gwan,Park, Chan,Shin, Jin-Ho,Lim, Hyun-Pil 대한치과보철학회 2017 대한치과보철학회지 Vol.55 No.3

구강암에 대한 외과적 처치로 구강 내 광범위한 경조직, 연조직을 제거한 환자는 저작, 연하, 발음 등의 기능적 문제와 치열, 안모의 심미적 문제를 갖게 된다. 악골 재건 후에도 치조골 등 합병증으로 인해 가철성 보철물의 유지 및 지지를 받는데 제한적이다. 임플란트 지지 고정성 보철물은 이러한 환자들에게 적절한 보철수복 방법이 되어 왔다. 본 증례는 하악 재건 후 computer-aided design과 computer-aided manufacturing을 이용하여 지르코니아 프레임워크 상부에 단일 구조 지르코니아 크라운을 제작하여 현재 치열의 기능적, 심미적 회복을 하여 이에 보고하고자 한다. Defects due to mandibulectomy often cause hard and soft tissue loss and result in esthetic problems and functional disorders such as mastication, swallowing, and pronunciation. After the mandibular reconstruction, several complications including loss of alveolar bone can cause limitations in maintenance or supporting of removable prosthesis. For these patients, implant-supported fixed restorations have been an appropriate prosthetic restorative method. In this case report, we report the patient who underwent mandibulectomy and mandibular reconstruction owing to oral cancer, and then restored the current dentition functionally and aesthetically by applying zirconia frameworks and monolithic zirconia crowns by computer-aided design and computer-aided manufacturing.