턱관절장애 관련 제질환의 임상적 접근

이영준,Young Jun Lee 턱관절균형의학회 2022 턱관절균형의학회지 Vol.12 No.1

위에서 살펴본 바와 같이 나는 급성 턱관절장애의 경우, 첫번째 유형은 주로 턱관절 디스크공간의 문제와 하악의 위치를 바로잡아주는 근육의 문제가 주 원인일 것으로 추정하고 있다. 만약 턱관절 디스크공간이 정상공간이라면 턱의 지그재그 움직임이나 턱관절잡음, 턱통증, 턱탈구, 그리고 개구장애 등이 발생할 수 없기 때문이다. 그리고 근육의 문제 중에서는 턱관절 디스크원판을 양측에서 잡아주는 내외측 익돌근의 문제가 가장 많은 영향을 미치고 있다. 특히 내측 익돌근의 긴장 및 수축이 디스크 원판을 내측으로 빠져나가게 함으로써 하악의 좌우 지그재그 움직임을 야기시키고 턱관절잡음이나 턱통증 및 개구장애를 유발하기 때문이다. 나머지는 저작에 관여하는 근육들이 그 다음으로 영향을 미치는 것으로 예측하고 있다. 그러나 제2형 급성 턱관절장애의 경우는 제1형 급성 턱관절장애가 한단계 더 발전하여 이와 연관된 근육이나 인대의 긴장수축이 오랜 시간 진행되어, 이들이 다시 상부 경추의 아탈구와 두개골의 비정상적 움직임에까지 영향을 미쳐 나타나는 것으로 생각된다. 그렇게 되면 뇌에서 필요 충분한 뇌혈액공급이나 뇌척수액순환의 문제를 일으킬 수 있기 때문이다. 그리고 제1형 만성 턱관절장애의 경우는 제2형 급성 턱관절장애가 좀 더 진행되면서 척추 및 근골격계의 구조변화, 교합 및 턱의 구조변화 그리고 안면구조의 변화에 이르기까지 점점 진행되어 나타나는 것으로 보인다. 따라서 각종 척추 디스크질환, 관절질환을 비롯해서 두개천골계의 순환문제, 부정교합 및 턱 비대칭, 안면 비대칭의 문제를 유발하게 된다고 추정된다. 그러나 두번째 유형의 만성 턱관절장애는, 턱에서 지속적이고 반복적인 그리고 과다한 부정적 자극들이 오랜 기간 누적되면서 턱에 분포된 C 섬유를 비롯한 3차신경의 가소성변화를 유발하면서 결국 중추신경계를 포함하여 전체신경계의 회로망에까지 파급되어 다양한 만성질환 또는 난치성 질환들이 양산되는 것으로 추정하고 있다. 아마도 지금까지 서양의학에서 아직 밝혀내지 못한 대부분의 질병들이 여기에 포함되지 않을까 하는 것이 나의 생각이다.

FCST의 구강내 균형장치를 이용한 경추부 근긴장 이상증 증례보고

이영준,인창식,Lee, Young Jun,Yin, Chang Shik 턱관절균형의학회 2016 턱관절균형의학회지 Vol.6 No.1

경추부 근긴장 이상증에 대해 턱관절 자세균형 개념에 따라 구강내 균형장치를 활용한 자세훈련법 등의 치료로 긍정적인 호전을 관찰했다. 증례 보고이기는 하지만 턱관절 자세균형을 활용한 치료법에서 긍정적인 치료효과가 이어지고 있어서 앞으로 더욱 체계적인 관찰과 연구가 필요할 것으로 사료된다. To investigate the effects of the postural balance of TMJ using intraoral balancing appliance of functional cerebrospinal technique (FCST) combined acupuncture and manual medicine therapeutics in the treatment of congenital muscular torticollis. An idiopathic cervical dystonia case was managed with postural training with intraoral balancing appliance, combined with acupuncture and manual medicine therapeutics. Clinical assessment included radiography, Toronto Western Spasmodic Torticollis Rating Scale, and global clinical impression. Clinical improvement was observed over 5 months of treatment period. Clinical observational data on spasmodic torticollis provide an positive prospective for further investigation on the effect of FCST.

FCST의 음양균형장치를 이용한 연축성 사경증 증례보고

최근욱,이영준,Choe, Geun-Wook,Lee, Young-Jun 턱관절균형의학회 2012 턱관절균형의학회지 Vol.2 No.1

본 증례에서는 원인불명의 전신 연축성 사경증과 강박장애를 동반한 경부 연축성 사경증의 두 증례에 대해 음양균형장치를 포함한 표준형 구강내 균형장치, 침구치료, 한약처방, 골반교정 등 복합치료를 통해 뚜렷한 치유효과를 관찰했다. 음양균형장치와 표준형구강내 균형장치 등 턱관절의 균형조절을 통한 기능적뇌척주요법의 치료가 경추와 흉추의 구조변화는 물론 전신자세에도 긍정적인 변화를 주고 있음을 관찰했다. Objectives: Therapeutic effect of Yinyang Balancing Appliance of functional cerebrospinal therapy (FCST) for meridian and neurologic yinyang balance was observed in cervical dystonia cases. Methods: Two cervical dystonia cases were managed with the Yinyang Balancing Appliance on temporomandibular joint (TMJ), combined with acupuncture. Clinical outcome measurement was based on subjective measures and clinical observations. Results: The patients showed positive changes even after the initial treatment and this effect maintained over the follow-up period. Conclusions: Although it is not clear the effect is a sustaining or temporary in its nature, a positive effect was observed and further clinical and biological research on FCST is expected.

턱관절자세음양교정술(FCST)의 음양균형장치를 활용한 구안와사 증례보고

김윤상,Kim, Yun Sang 턱관절균형의학회 2016 턱관절균형의학회지 Vol.6 No.1

본 증례에서는 구안와사환자에게 음양균형장치를 포함한 표준형 구강내 균형장치, 침구치료, 골반교정 등 복합치료를 통해 유효한 임상경과를 보인 결론은 다음과 같다. 1. 안면신경은 주행이 길고 측두골내에서 좁은 골관을 지나기 때문에, 좌상(bruised) 등 여러 가지 이유에 의하여 골도속의 신경 부종과 혈액순환 장애로 지연성 마비를 일으킨다. 2. 음양균형장치와 표준형구강내 균형장치 등 턱관절의 균형조절을 통한 기능적뇌척주요법의 치료가 안면신경마비의 치료에 효과적인 방법인 것을 관찰하였다. 기존의 구안와사의 경우 대부분 뚜렷한 치료방법을 선택하기가 어려웠으나, 이 증례를 통해 볼 때 수술 등의 대증요법을 하지 않고 기능적뇌척주요법 치료의 접근을 시도해 볼 수 있는 가능성이 있다고 사료된다. Therapeutic effect of temporomandibular joint postural training by functional cerebrospinal therapy (FCST) for the balance of the meridian and neurologic system was observed in a facial palsy case. An idiopathic facial palsy case of House-Brackmann grade V was managed with FCST, combined with acupuncture and postural training of the cervical and pelvic structures. Clinical outcome measurement was performed by House-Brackmann grade and Yanagihara's scale. The patient showed positive changes in the degree of palsy and subjective symptoms within one month. Further research on the effect of FCST is expected.

수면중 이갈이에 의해 발생한 턱관절 통증 환자에 대한 FCST 활용 1예 보고

엄태민,김윤식,설인찬,유호룡,Eom, Tae-Min,Kim, Yoon-Sik,Seol, In-Chan,Yoo, Ho-Ryong 턱관절균형의학회 2014 턱관절균형의학회지 Vol.4 No.1

본 증례에서는 수면 중 이갈이에 의해 발생한 턱관절 통증에 대하여 FCST를 포함한 침치료를 통해 양호한 치료효과가 있는 것을 관찰하였다. 상기 환자는 FCST의 균형측정지 검사상 TMJ의 경미한 불균형 외에 방사선 소견상 구조적인 큰 이상이 없었음에도 이갈이에 따른 심한 근육긴장으로 통증이 발생한 경우였다. 이것을 통해 FCST가 턱관절의 구조적인 문제에만 국한되어 적용되는 것이 아니라 턱관절 주위 근육 긴장의 빠른 회복에도 상당한 효과가 있음을 볼 수 있었다. 또한 야간에 TBA를 착용한 상태로 잠을 자게 되면 그 자체로 이갈이에 대한 예방효과가 있어 현재 턱관절통증 등의 증상이 없는 이갈이 환자에게도 예방적인 목적으로 TBA의 처방이 가능할 것으로 사료된다. A 27 year-old male patient with sleep bruxism-induced temporomandibular pain was managed by appliance of FCST with 3 weeks of duration, combined with acupuncture. After being treats for 3 weeks, the patient's pain was improved. Assessment was made by self assessment (Numerical Rating Scale, NRS; Korean Oral Health Impact Profile, KOHIP) and clinical observation. An impressive effect was observed and further clinical and biological research on FCST is expected.

TBA착용 전후의 뇌파 변화 관찰

조현석(Hyunseok Cho) 턱관절균형의학회 2015 턱관절균형의학회지 Vol.5 No.1

Objectives: The aim of this study was to examine the effect of TMJ Balancing Appliance (TBA) on healthy humans by using power spectral analysis of Electroencephalogram (EEG). Methods: 50 healthy volunteers participated in this study. A thirty-two channel EEG device was used for this study on 50 subjects (28 males, 22 females; mean age=25.3 years old). Results: 19 channel was measured and analysed. The relative power values in α, β, γ, Senorimotor rhythm (SMR), mid-β, high-β band and concentration index ((SMR wave+Mid-β wave)/θ) increased insignificantly. Relaxation index(α/High-β wave) increased significantly (p<0.05) comparing to the before the TBA application. After the TBA application, the relative power values in α, β, γ, SMR (Senorimotor rhythm), mid-β, high-β band and concentration index((SMR wave+Mid-β wave)/θ) increased insignificantly. Relaxation index (α/High-β wave) increased significantly (p <0.01) comparing to the before the TBA application. Conclusions: These results suggest that TBA application causes significant changes on relaxation index. Application of TBA shall regulate the function of the cerebral cortex increase parasympathetic nervous activity.

턱관절균형의학에서 편차발생현상의 신경과학 및 재료역학적 해석과 일반화

지규용,Gyoo-yong Chi 턱관절균형의학회 2022 턱관절균형의학회지 Vol.12 No.1

Objectives: For the deviation phenomenon occurring during the treatment process in temporo-mandibular balancing medicine (TBM), hypotheses were established regarding the cause and mechanism of formation from the perspective of neuro-science and material mechanics, and a verification method was proposed. Methods: The deviation phenomenon was theoretically analyzed based on the structure theories of material mechanics of the joint and the neurological pain mechanism. Results: Deviation occurs due to temporary yield by the accumulation of heterogeneous stress in the temporo-mandibular joint and the affected joint. Because the joint structures are corresponding with material mechanics showing compressive and tensile properties. The size of the deviation is expressed in terms of strain. The occlusal surface of the teeth is level with the axial joint. Since the magnitude of the deviation has a proportional relationship with the degree of abnormality of the temporo-mandibular joint, the magnitude of the deviation calculated by the balance measurement can be replaced by the strain. The major variables involved in the occurrence of deviations are the strength of joint structures and neurological conditions. Therefore plastic deformation and adaptation occur as a long-term depression of neural circuits is strengthened in different ways at different locations each time in various clinical situations. This is the reason why the sequence of the restoration process while correcting deviations is following reverse order of the accumulation in many layers in the muscular nervous system. Conclusions: From the above results, it can be inferred that the occurrence and correction of the deviations are corresponding with the plastic deformation and neuro-plasticity.

12~19세기 한의학 고전문헌에 나타난 턱관절 구강내장치에 대한 고찰

이영준,이상배,최근욱,인창식,Lee, Young-Jun,Lee, Sang-Bae,Choi, Geun-Wook,Yin, Chang Shik 턱관절균형의학회 2014 턱관절균형의학회지 Vol.4 No.1

Objectives: Intraoral appliances (IOA) are applied in the clinical practice of Korean medicine to improve the balance between yin and yang of the body such as temporomandibular joint balancing medicine. Historical examples of IOA were not well known. This study reports prototype IOA's described in medical classics. Methods: Several medical classics of 12th to 19th centuries were narratively reviewed for prototypical descriptions of IOA's in the context of clinical practice. Results: IOA's in the medical classics reviewed adopted such materials as bamboo, chopsticks, and coins that were adjusted in the height and were used as a temporary IOA's with response of the patient being monitored. IOA's were applied integratively with herbal medicine for diverse complaints such as pain, hearing problem, cough, asthma, and rhinorrhea. Conclusions: Prototype IOA's in the medical classics suggest an individualized, integrative, and holistic principle and usage of IOA's in the tradition of Korean medicine.

악관절의 기능과 이상에 관한 역학적(易學的) 해석

지규용,이영준,Chi, Gyoo-yong,Lee, Young Jun 턱관절균형의학회 2017 턱관절균형의학회지 Vol.7 No.1

In order to understand Changeologically on the meaning of FCST's TMJ (temporo-mandibular joint) treatment procedure, Yi, Shike, Bi, Gen trigrams concerning the jaw and change by treatment were analyzed from the viewpoint of semiotic context of hexagon and holistic interpretation on disease. Yi is meant by jaw but actually indicates mouth made by maxilla and mandible, and it's characters are related with nourishing by aliment and words. But when we eat and speak in the daily life, jaw does not nourish properly it's own body by bad habit or postures. For the treatment of this ill state, there needs punishment and correction symbolized with Shike. Shike has fourth nine meaning obstacles between the two strong lines in the upper and lower end, and so it has the function of mastication and get rid of the fourth nine metaphorically indicating subluxation of axis using CBA and auxiliary measures of four movement or laughing methods. Bi expresses the achievement and effects of consecutive mastication process implicating normalized manifestation of jaw and its linked spinal function. Gen symbolizes removing selfish motive or partiality in advance and reaches the best state of the saint righteously self-nourishable human being.

호흡곤란 있는 불안장애 환자 치험 1례

이은주,김태경,신창민,김철홍,Eun Ju Lee,Tae Kyung Kim,Chang Min Shin,Cheol Hong Kim 턱관절균형의학회 2022 턱관절균형의학회지 Vol.12 No.1

Objectives: The purpose of this study is to report the effect of Korean medical treatment with TBT (Temporomandibular Joint Balancing Therapy) on Anxiety disorder patient with dyspnea. Methods: In this study, an Anxiety disorder patient with dyspnea was admitted to △△ Korean medicine Hospital from Nov 1st, 2022 to Nov 23rd, 2022. During the admission period, the patient was treated by Korean medical treatment(acupuncture, pharmacopuncture, herb medicine, etc.), especially using TBT and Western medical treatment (Pharmacotherapy). Beck Anxiety Inventory (BAI) and VAS were used for measuring the Anxiety and Dyspnea. Results: After treatment for 30days, the BAI showed a decrease from 33 to 19, The VAS associated with dyspnea also decreased from 6 to 1 and VAS associated with Neck Pain decreased from 5 to 3. Conclusions: These results showed that Korean medical treatment especially using TBT may have an effect on reducing symptoms of dyspnea due to Panic Attack. But the further researches are needed.