• Journal of Oral Medicine and Pain
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• v.25 no.3
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• pp.305-313
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• 2000

이 연구의 목적은 악관절 내장증 환자에서 관절원판의 형태를 자기공명영상사진으로 평가하고 임상적 증상과의 관계를 알아보고자 하는 것이다. 악관절 내장증의 증상을 가진 90명의 환자에서 169개의 관절을 자기공명영상사진으로 관절원판과 하악과두의 관계를 기준으로 정상군, 정복성 관절원판 변위군, 비정복성 관절원판 변위군으로 분류하고 관절원판의 형태를 5가지로 나누었다. 임상검사는 측두하악관절통과 관절음의 유무를 확인하여 그 상관관계를 알아보았다. 실험 결과에서 측두하악관절통은 각 군에서 관절원판의 형태와는 정상군을 제외하고는 통계적인 유의성이 없었으며, 염증성 삼출액과 유의한 관계를 보였다. 관절음은 정복성 관절원판 변위환자에서 관절원판형태와 통계적으로 유의성을 보였으며, 비정복성 관절원판 변위환자에서도 상당수 관절음이 발생하였음을 알 수 있었다. 이 결과는 측두하악관절의 통증은 관절원판의 형태가 많이 변형될수록 통증이 심해지는 경우가 많았지만, 다른 여러 가지 원인들이 존재할 수 있으며, 관절음은 정복성 관절원판 변위환자에서 관절원판의 변형이 심할수록 관절원판이 정복할 때 발생될 수 있다는 것을 의미한다. 따라서, 임상적인 검사와 더불어 자기공명영상사진으로 정확한 진단을 함으로써 관절원판 변위의 적절한 치료가 행해질수 있으리라 생각된다.

• Journal of Oral Medicine and Pain
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• v.23 no.1
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• pp.37-44
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• 1998

본연구는 서울대학교 치과병원 구강진단과 악안면 동통진료실에 내원한 환자 중 임상적 검사에 의해 악관절 내장증으로 진단된 총 32명 53개의 측두하악 관절을 대상으로 악관절 조영술이나 자기공명영상을 실시하여 임상적 진단의 정확도를 알아보고 향후 이 결과를 적절히 활용하여 정확한 적응증의 설정에 도움을 주고자 시행되었다. 각 악관절을 임상적 검사, 조영술 및 자기공명영상 검사를 기준으로 정상, 정복성 관절원판 변위, 비정복성 관절원판 변위, 퇴행성 관절 질환을 동반한 정복성 관절원판 변위, 퇴행성 관절 질환을 동반한 비정복성 관절원판 변위로 구분하였다. 이상의 연구를 통하여 다음과 같은 결론을 얻었다. 1. 악관절 내장증으로 내원한 환자 32명, 총 53개 관절중, 정상인 경우가 5예, 정복성 관절원판 변위인 경우가 33예, 비정복성 관절원판 변위인 경우가 14예, 퇴행성 관절 질환을 동반한 정복성 관절원판변위인 경우가 1예이었고, 퇴행성 관절 질환을 동반한 비정복성 관절원판 변위인 경우는 없었다. 2. 악관절 조영술 검사를 시행한 35개의 관절중 임상적 검사와 일치하는 경우는 32개로 그 일치율은 91.1%이었으며, 자기공명영상 검사를 시행한 28개의 관절중 임상적 검사와 일치하는 경우는 20개로 그 일치율은 71.4%이었다. 3. 악관절 조영술 및 자기공명영상 검사를 동시에 시행한 10개 관절중 악관절 조영술 및 자기공명영상검사가 일치하는 경우는 9개이었으며 이중 8개 결과는 임상적 진단과 일치되는 소견을 보였다. 임상적 검사는 악관절 내장증의 진단에 유용한 방법임이 확인되었다. 그러나 임상적으로는 정상으로 진단되었지만 주관적인 증상을 가진 환자에게는 자기공명영상 검사와 악관절조영술 검사 등의 영상진단술식이 필요할 것으로 사료된다.

• Journal of Oral Medicine and Pain
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• v.32 no.3
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• pp.305-318
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• 2007

To evaluate the treatment outcome after conservative treatment in patients with TMJ disc displacement which is the most common temporomandibular joint arthropathy, the subjects were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Hospital, diagnosed as TMDs and treated with conservative methods from 1994 to 2006 for 13 years. 88 patients with diagnosis of DD/cR and 60 patients with diagnosis of DD/sR were selected as the experimental group and 74 patients with diagnosis of masticatory muscle disorder (MMD) were selected as the control group. Subjective symptoms and clinical findings were investigated to evaluate and compare the subjects' status at the first visit and the last visit. The results were as follows; 1. Pain, noise, LOM and MCO measurements of DD/cR, DD/sR and MMD groups were markedly improved after conservative treatments including behavior therapy, physical therapy, medication and splint therapy. 2. At the first visit, high score of pain in MMD group, high score of noise and large MCO measurement in DD/cR group and high LOM score in DD/sR group were observed. At the last visit, high score of noise and increased MCO measurement in DD/cR group and high score of pain and LOM in DD/sR group were observed. 3. Among the patients who complained joint sound at their first visit, about 60% showed complete loss of joint sound after conservative treatment 4. DD/cR and DD/sR groups showed satisfactory outcomes after conservative treatments such as behavior therapy, physical therapy, medication and splint therapy while MMD group showed similar treatment outcome irrespective of the treatment modality used. 5. There was no difference in treatment outcomes after conservative treatments when the subjects were classified and compared according to gender, age group and chronicity. 6. MMD showed satisfactory prognosis in 10 treatments in less than 6 months while DD showed favorable prognosis in 10-20 treatments for 6 months to 2 years.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.29-34
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• 2013

Objective: All patients who have the disc displacement with reduction (DDwR) are always not progressive but some of them with significant catching or locking progress to disc displacement without reduction (DDw/oR). In this study, we suggest opening exercise therapy using Locking-free Appliance (LA) to be helpful to prevent progressive derangement. Methods: Retrospectively, a total 37 patients who received exercise treatment using LA was analyzed from January 2010 to December 2011. Patients had been instructed in proper exercise technique to practise for opening and closing of mouth wearing the appliance 30 times a day in locking-free position. Results: None of the patients took a turn for worse to DDw/oR (37 patients). The 16 patients (43.2%, locking-free group) of them could open their mouth without intermittent condylar locking. Measurement of data was analyzed using and Mann-Whitney test. There was no statistically significant difference for age, gender, presence of palpational pain, locking period, VAS quantitative pain score between locking-free group and locking group. Conclusions: In this study, some patients could open their mouth without intermittent locking and did not take a turn for worse to DDw/oR after opening exercise therapy with LA. Furthermore, LA had advantages which were short wearing time, low costs and minimizing patients' uncomfortable compared to conventional treatment method. This therapy can be more appropriate new treatment to prevent progress to DDw/oR.

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.511-517
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• 1995

Bone scan is a very sensitive diagnostic imaging test for detecting bone and joint disorders. So it might be useful in the diagnosis of temporomandibular disorders of the joint origin. Thus, the effectiveness of bone scan for detecting temporomandibular joint(TMJ) diseases and differentiating the TMJ disc displacement from the TMJ arthritis was evaluated. Bone scan was done in 21 patients with TMJ disc displacement(13 unilaterally affected, 8 bilaterally affected), 25 patients with TMJ arthritis(23 unilateral, 3 bilateral), and 39 volunteers with no signs, symtoms, or history of TMJ disease. TMJ simple uptake rate(SUR) and difference of both TMJ SUR were calculated from the 100,000 count lateral image of head and neck region in 99mTc MDP bone scan. Transcranial and panorama X-ray examination was also done in all patients. TMJ SUR(%) were $1.673{\pm}0.606$ in TMJs affected with arthritis, $1350{\pm}0.351$ in TMJs affected with disc displacement, and $1.084{\pm}0.172$ in TMJs of controls. Significant differences were demonstrated among them(p<0.01) Difference of bith TMJ SUR was highest in patients with unilateral TMJ arthritis($0.608{\pm}$0.533, p<001), and there is no significant difference between that of controls and that of unilateral TMJ dist displacement patients($0.062{\pm}0.063$ vs $0.122{\pm}0.100$). TMJ SUR of Joint with bone change on X-ray finding was not significantly different from that of joint with normal X-ray finding. Those in patients with unilateral TMJ disc displacement(696% and 87% vs 23.1% and 23%). The proportions of patients with increased TMJ SUR and difference of both TMJ SUR(>mean+2SD of controls) in unilateral TMJ arthritis patients were significantly higher than those in patients with unilateral TMJ disc displacement(69.6% and 87% vs 23.1% and 23%). Conclusively, bone scan nay help to detect TMJ disease and differentiate TMJ disc displacement from TMJ arthritis.

• The korean journal of orthodontics
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• v.36 no.2 s.115
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• pp.136-144
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• 2006

The purpose of this study was to determine whether association exists between temporomandibular joint (TMJ) characteristics in transcranial radiographs and TMJ internal derangement and to evaluate the validity of transcranial radiographs in diagnosis of internal derangement. Transcranial radiographs and magnetic resonance imaging (MRI) of 113 TMJs from 76 subjects were used for this study and all TMJs were classified into 3 groups according to the results of MRI: normal disk position, disk displacement with reduction, and disk displacement without reduction. Transcranial analysis included linear measurement of joint spaces and condylar head angle measurement. To determine any relationship between transcranial measurements according to disk displacement, one-way ANOVA was used. The results showed that condyle-fossa relationship in standard transcranial radiographs had no relationships with disk displacement. And, as disk displacement progressed, condylar angle between head and neck increased significantly. This result can be interpreted that condylar head angle reflects structural hard tissue change according to internal derangement progress. But this is insufficient in the determination of internal derangement. Therefore, although still clinically helpful, the validity of standard transcranial radiographs to diagnose TMJ internal derangement was questioned.

• Journal of Oral Medicine and Pain
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• v.31 no.2
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• pp.177-183
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• 2006

The management of refractory pain and limitation of mouth opening in the temporomandibular joint (TMJ) is both challenging and controversial. Arthrocentesis is a simple technique and it can be used instead of more invasive surgical procedures for patients who failed to conventional conservative treatments. The patients in this case report had complained persistent severe pain and restricted mandibular movement of TMJ, although they had been treated with conservative therapy, e.g., stabilization splint therapy, behavioral therapy, physical therapy, pharmacological therapy. Therefore we employed arthrocentesis for these patients, and they showed significant reduction of pain and improvement of mandibular movement after repetitive arthrocentesis. We recommend arthrocentesis as an effective, minimally invasive technique for patients with continuing severe pain and restricted mobility in the TMJ that is unresponsive to conservative management.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.441-447
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• 2007

Internal derangement of the temporomandibular joint(TMJ) is defined as an abnormal relationship of the articular disc to the condyle. Mandibular manipulation is one of the conservative treatments to be considered first to manage the patients with anterior disc displacement without reduction. Mandibular manipulation is used to increase articular mobility and to restore the displaced disc into an anatomically normal position. While Farrar's technique has been popularly used, Minagi et al., Mongini and Suarez introduced the manipulation technique conducted by the patients themselves. But there is no study on the efficacy of self-manipulation technique, comparing with conventional one. The aim of this study was to investigate the efficacy of the conventional and self-manipulation technique, which was modified to complement the previously described technique by Minagi et al., in the treatment of patients with anterior disc displacement without reduction. TMD patients, who visited Department of Oral Medicine of Seoul National University Dental Hospital from December, 2002 to November, 2004 and were diagnosed as anterior disc displacement without reduction by TMJ magnetic resonance imaging (MRI) were enrolled. Conservative treatments including physical therapy, exercise, behavioral therapy, stabilization splint therapy, and manipulation therapy were done to every single patient until the symptomsimproved enough to discharge the patient. The charts were reviewed retrospectively according to the type of manipulation. In the results, patients whose maximum mouth opening was more than 40 mm was higher in the self-manipulation group(69.9%) than in the conventional manipulation group(42.9%). But difference between two groups was not significant. According to the fact that we decided to discharge the patients whentheir mouth opening increased to more than 40 mm and subjective symptoms such as pain and discomfort were improved as well, treatment period of discharged patients was significantly shorter in the self-manipulation group($29.2{\pm}12.3$ weeks) than in the conventional manipulation group ($61.0{\pm}38.0$ weeks) (p<0.01). In conclusion, in the treatment of TMD patients with anterior disc displacement without reduction, the self-manipulation technique which is performed by patients themselves is an effective treatment modality for increasing the range of mouth opening and shortening the total treatment period.

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.205-211
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• 2012

A 35 year-old female presented with the complaint of sudden occurrence of bite change and concurrent opening limitation, as well as pain in the right temporomandibular joint (TMJ) during mouth opening. From her history it was revealed that she had simple clicking of right TMJ for several years before onset of these symptoms, and that the clicking sound subsided recently after development of opening limitation. On clinical examination, anterior open bite, midline shift of the mandible to right, and premature contacts on left posterior teeth were observed. Maximum mouth opening and lateral movement to left were also restricted. On magnetic resonance images, the right TMJ showed anterior disc displacement without reduction and the posterior joint space is greatly collapsed by retrusion of the condyle. It was thought that the sudden occurrence of occlusal change would be resulted from abrupt displacement of the mandible associated with development of the anterior disc displacement without reduction. The stabilization appliance traction therapy was performed initially for first 3 months along with physical and pharmacologic therapy. However, the anterior open bite and opening limitation didn't resolve and the position of mandible still remained altered. So the stabilization appliance was changed to intermaxillary traction device. Then the mandible returned progressively to normal position and the occlusion became more stable and comfortable. After 5 months of intermaxillary traction therapy, the anterior open bite was dissolved completely and the occlusion became stabilized satisfactorily along with recovery of normal mouth opening range. On post-treatment magnetic resonance image, remodeling of condylar head was observed.

• The Journal of the Korean dental association
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• v.40 no.6 s.397
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• pp.424-429
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• 2002