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Effect of Auriculotemporal Nerve Block Anesthesia on Manual Reduction of Disc Displacement without Reduction of the Temporomandibular Joint

악관절의 비정복성관절원판변위의 수조작 정복에 대한 이개측두신경 전달마취의 효과

  • Kim, Sook-Young (School of Dentistry, Chonnam National University) ;
  • Kim, Ji-Yeon (Department of Dentistry, Seoul Veterans Hospital) ;
  • Hong, Su-Min (Department of Dental Hygiene, Baekseok University) ;
  • Kim, Byung-Gook (Department of Oral Medicine, School of Dentistry, Chonnam National University) ;
  • Park, Byung-Ju (Department of Oral Biochemistry, School of Dentistry, Chonnam National University) ;
  • Im, Yeong-Gwan (Department of Oral Medicine, Chonnam National University Hospital)
  • 김숙영 (전남대학교 치의학전문대학원) ;
  • 김지연 (서울보훈병원 치과) ;
  • 홍수민 (백석대학교 치위생학과) ;
  • 김병국 (전남대학교 치의학전문대학원 구강내과학교실) ;
  • 박병주 (전남대학교 치의학전문대학원 구강생화학교실) ;
  • 임영관 (전남대학교치과병원 구강내과)
  • Received : 2011.02.05
  • Accepted : 2011.03.03
  • Published : 2011.03.30

Abstract

Aim: Disc displacement without reduction of the temporomandibular joint (TMJ) has been managed by mandibular manipulation to reduce the displaced disc but with a low success rate. The purpose of this study was to determine whether auriculotemporal nerve block anesthesia had an effect on the reduction of the displaced disc and to analyze the factors that influenced the result. Methods: 112 patients were diagnosed with disc displacement without reduction and treated by mandibular manipulation. Disc was recaptured in 35 patients. Among the 77 patients with whom disc recapture had failed, the auriculotemporal nerve was blocked with a local anesthetic in the 49 patients (mean $age \;{\pm}\; SD\; =\; 34.4\;{\pm}\; 15.1$; male 24, female 25) and then mandibular manipulation was performed again. Factors including age, elapsed time from the onset, and opening amount were analyzed in association with disc reduction rate with the auriculotemporal nerve block. Results: Among 49 patients who did not respond to manipulation only, manual reduction with auriculotemporal nerve block anesthesia was successful in 19 patients (38.8%). Maximum unassisted opening amount significantly increased in the 19 patients with successful recapture of the disc ($mean \;{\pm}\; SD\; =\; 46.1 \;{\pm}\; 4.5\; mm$), in contrast to the limited opening amount of the 49 patients before local anesthesia of the auriculotemporal nerve ($mean \;{\pm}\; SD\; =\; 25.7 \;{\pm}\; 6.0\; mm$). Age, elapsed time after the onset, and preoperative opening amount were not associated with the reduction rate. Conclusion: The results of this study suggest that auriculotemporal nerve block anesthesia increases the reduction rate of the disc displacement without reduction of the TMJ when combined with mandibular manipulation, and such anesthesia should be applied at the first stage of manual treatment of disc displacement without reduction.

공률이 낮은 것으로 알려져 있다. 본 연구의 목적은 이개측두신경을 전달마취하여 수조작할 경우 변위된 관절원판의 정복에 영향이 있는지 여부 및 그 결과에 영향을 미치는 인자들을 조사하는 것이다. 비정복성관절원판변위로 진단된 112명의 환자들에 대해 수조작정복술을 시도하였으며, 그 중 35명의 환자들에서 관절원판 변위가 해소되었다. 관절원판 재위치에 실패한 77명의 환자들 가운데 이개측두신경의 전달마취 시술에 동의하는 49명(평균 연령 $34.3\;{\pm}\; 15.1$, 남자 24명, 여자 25명)에 대해 마취시술 후 수조작 정복술을 다시 시행하였다. 연령, 발병후 경과시간, 술전 능동적개구량을 포함한 요인들과 국소마취 후 수조작 정복 성공률과의 관련성을 분석하였다. 수조작만으로 정복이 되지 않았던 49명 환자 중, 이개측두신경 전달마취 후 19명(38.8%)에서 성공적으로 정복이 되었다. 국소마취 전 49명의 최대 능동적 절치간 개구량은 $25.7\;{\pm}\;6.0$ mm로서 개구가 상당히 제한된 상태였으나, 국소마취 및 수조작 후 관절원판이 성공적으로 재위치된 19명의 개구량은 $46.1\;{\pm}\;4.5$ mm로서 정상범위로 회복되었다. 연령, 발병후 경과시간, 술전 능동적개구량 인자들과 국소마취 후 수조작 정복 성공률과는 유의한 관련성이 없었다. 결론적으로 이개측두신경 전달마취는 수조작정복술과 함께 시행할 경우 비정복성관절원판변위의 정복 성공률을 향상시 키므로, 비정복성관절원판변위의 일차적인 치료 단계에서 적극적으로 활용하는 것이 권장된다.

Keywords

References

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