• Journal of Oral Medicine and Pain
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• 제37권3호
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• pp.183-188
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• 2012

노인층에서의 턱관절장애의 증상과 징후에 관한 이전 연구에서 일관된 결론을 제시하지 못하고 있다. 본 연구의 목적은 연령에 따른 턱관절의 증상과 징후의 유병률을 분석하는 것이다. 젊은층을 대조군으로 평가하였다. 40명의 노인층 환자 (28명 여자, 12명 남자, 평균연령: $65.2{\pm}2.5$)와 40명의 젊은층 환자 (30명 여자, 10명 남자, 평균연령: $23.3{\pm}2.6$)로서 턱관절장애(temporomandibular disorders, TMD)로 진단받은 질환자를 대상으로 하였다. 실험 대상자는 다음과 같은 평가기준을 적용하였다. 주관적 평가인 주소에서 구강안면 통증의 정도(VAS), 객관적인 평가에서 하악 개구 시 운동량, TMJ 관절잡음 (관절음, 염발음), TMJ 촉진 시 통증, 저작과 관련된 근육(교근, 측두근)과 목 근육, 견부근의 촉진 시 통증에 관한 것을 포함한다. 두 그룹 간 차이점 분석은 t 검정과 카이제곱 검정 방법을 사용하였다. (SPSS v. 17) P 값이 0.05 이하인 것을 통계적으로 유의성 있게 보았다. 주관적인 평가에서 주소에 나타난 구강안면 통증 정도에서는 두 그룹 간 유의한 차이는 발견되지 않았다. 객관적인 평가에서 노인층 환자에서 개구 시 염발음이 25%에서 관찰되었고 저작근 촉진 시 통증은 82.5%에서 관찰되었으며 측두근 촉진시에 60%에서 통증을 보였다. 반대로, 젊은층에서 62.5%에서 관절잡음이 관찰되었고 개구 시 좀 더 큰 운동량을 보였다. (p=0.043) 관절잡음과 촉진 시 근육 통증, 하악 운동량에서 두 그룹 간 차이는 현저했다. 노인층에서 TMD에 대한 개구 시염발음, 근육 촉진 시 통증이 자주 관찰되는 반면 젊은 층에서는 하악 운동 시 관절잡음, 운동 시 개구량의 증가가 보다 많이 관찰되었다.

• 구강회복응용과학지
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• 제26권2호
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• pp.157-168
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• 2010

현재 스포츠 치의학은 두가지 방면으로 연구가 진행되고 있는데, 하나는 부드러운 재질로 만든 마우스 가드로 스포츠 외상의 예에 관한 연구이고, 또 하나는 딱딱한 재질로 만든 교합안정장치로, 구강 기능과 전신의 운동능력과 의 상관성에 관한 연구이다. 현재 많은 프로선수들이 운동능력향상을 위해 교합안정장치를 사용해 오고 있다. 그러나 국내에서는 스포츠 치의학에 대한 관심이 적어 위와 같은 연구가 이루어져 있지 않을 뿐만 아니라 그러한 연구를 위한 기초 자료조차도 준비되어 있지 않은 실정이다. 또한 소수의 연구에서 실험 대상자의 정확한 분석과 교합 안정장치 장착 전과 후의 변화를 보여주지 못하고 있다. 이에 저자는 골프선수들의 교합분석과 턱관절분석을 시행하고, 피검자의 상태에 따른 정확한 교합안정장치를 제작하여 장치 장착 전과 후의 저작근의 근활성량의 변화와 드라이버 비거리의 변화를 측정하여 분석하였다. 그 결과 교합안정장치를 장착함으로써 저작근의 근안정이 유도되고, 드라이버 비거리가 증가되었다. 특히 측두하악장애를 지닌 골프선수일수록 교합균형장치를 사용함으로 드라이버 비거리의 향상에 도움이 될 것이라고 기대된다.

• 대한소아치과학회지
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• 제28권4호
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• pp.593-599
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• 2001

최근에 측두하악장애 (Temporomandibular Disorder, TMD)는 해마다 증가하는 경향을 보이고 있다. 측두하악장애는 저작근, 측두하악관절 및 그와 관련된 구조물의 많은 임상증상을 포함하는 포괄적인 용어이다. 측두하악장애로 치과에 내원하는 환자는 여정이 많으며, 각 연령별 분포에서 보면 10대 후반에서 20대 후반에 호발한다. 그러나 최근에는 호발연령이 낮아지는 경향을 보이고 있다. 이에 측두하악장애의 조기진단의 필요성이 요구되어지며, 본 논문에서는 진단의 한 방법으로 간편하면서 쉽게 시행할 수 있는 최대개구량을 측정하였다. 최대개구량에 관한 여러 보고가 있지만, 소아기의 전 연령을 대상으로 광범위하게 조사된 보고는 희귀하다. 이에 저자는 4세부터 13세까지 1775명의 어린이를 대상으로 최대개구량을 측정하였으며, 최대개구량과 연령, 신장, 체중에 관한 상관관계를 조사하여 악관절장애 진단의 기초적인 참고자료로 이용하고자한다. 본 연구에서는 4세에서 13세까지의 1775명(남자943명, 여자832명)을 대상으로 최대개구량과 연령, 신장, 체중의 상관관계에 관한 비교분석을 시행하여 다음의 결론을 얻었다. 1. 4세에서 12세까지의 연령군중 4세, 8세, 12세의 평균 최대개구량을 보면 남자의 경우 각각 40.16mm, 47.32mm, 50.54mm였고, 여자의 경우 각각 39.79mm, 44.85mm, 48.09mm였다. 2. 연령 이 증가함에 따라 최대개구량은 증가하는 경향을 보였고, 남자가 여자보다 큰 측정치를 보였다. 3. 신장이 증가함에 따라 최대개구량은 증가하는 경향을 보였으며, 105cm 이상 115cm 미만을 제외하고는 남자가 여자보다 큰 측정치를 보였다. 4. 체중이 증가함에 따라 최대개구량은 증가되는 경향을 보였으며, 모든 군에서 남자가 여자보다 큰 측정치를 보였다. 5. 최대개구량과 연령, 신장, 체중간의 관계에서 유의한 순상관 관계를 보였으며, 신장이 가장 높은 상관성을 보였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권1호
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• pp.11-20
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• 1993

Bony ankylosis is an intraarticular condition where there is fusion of the bony surfaces of the joint : The condyle and the glenoid fossa. It occurs in both children and adults, unfortunately more frequently in the former, in whom early recognition and correction is particularly critical. Trauma is well proven to be the predominant cause of TMJ ankylosis. Infection, rheumatoid arthritis and neoplasm are another, significant cases of TMJ ankylosis. The necessity for using an interpositional material to prevent TMJ reankylosis has been widely discussed and many interpositional materials have been used, including temporal muscle and fascia, dermis, auricular cartilage, fascia lata, fat, Lyo-dura, Silastic and various metals. The temporal muscle and fascia have been widely used pedicled flap for head and neck reconstruction. The use of a temporal muscle and fascia for reconstruction of the TMJ, particularly in cases of ankylosis is a very reasonable option. Its principle advantages are its autogenous nature, resilience, and proximity to the joint, allowing for a pedicled transfer of vascularized tissue into the joint area. However, the viability of temporal muscle and fascia is a critical question. We treated 2 cases of TMJ ankylosis with temporal muscle and fascia transfer and one case with temporal fascia. We obtained satisfactory results as to functional aspects.

• 대한치과보철학회지
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• 제26권1호
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• pp.99-111
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• 1988

The purpose of this study was to investigate the influence of the occlusal interference on the activity of anterior temporal and masseter muscles during maximal biting. In seven subjects, cast hard gold cap providing new occlusal surface approximately 0.5mm above its occlusal level was cemented on the mandibular right first molar during aquired experimental period. EMG recordings were taken bilaterally during one second hardest possible clenching four times. This procedure was done not only before, immediately after, 48 hours after and one week after cementation of interfering crown but also immediately after and one week after removal of occlusal interfering crown. The results were as follows : 1. Immediately after cementation of interfering crown, the activity was significantly decreased in all muscles studied. 2. One week after cementaion of interfering crown, the lowest muscle activity was recorded. But clinical sign and symptoms were significantly subsided. 3. Immediately after removal of interfering crown, the activity was increased in all muscles studied. 4. One week after removal of interfering crown, the activity of masseter muscles was increased to the level of before cementation of interfering crown. 5. There was no significant activity difference between right and left in the muscle studied. 6. Masseter muscle activity showed significant change than anterior temporalis with the unilateral mandibular posterior tooth interference.

• Journal of Oral Medicine and Pain
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• 제15권1호
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• pp.37-44
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• 1991

The author has synchronously recorded average electromyographic activities of temporalis anteriors and masseter muscles and the maximum bite force on the mandibular first molar on the prferred chewing side. These activities were recorded in order to study the EMG activity pattern of the working side and the balancing side to maximum bete force and functioning state of muscle in 30 patients with TMD and in 30 healthy subjects as controls. The results were as follows : 1. The maximum bite force on the mandibular first molar on the preferred chewing side was 20.63kg in TMD patients and 53.30kg in the healthy subjects(p<0.01). The maximum bite force in TMD patients was 38.7% of the healthy subjects. 2. The average electromyographic activities of temporalis anterioris and masseter muscles on the working side and the balancing side during maximum bite force were lower in TMD patients than in the healthy subjects(p<0.01). The average electromyographic activities of each muscle in TMD patients were 61.0%-62.8% of the healthy subjects. 3. The proportionalities of average electromyographic activities of temporalis anteriors and masseter muscles on the working side and the balancing side to maximum bite force were greater in TMD patients than in the healthy subjects(p<0.01). 4. Between the working side and the balancing side, the proportionality of average electromyographic activity of temporalis anterior to maximum bite force on the working healthy subjects (p<0.01). The proportionality of average electromyographic activity of working side and the balancing side in both groups (p<0.05).

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.143-153
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• 2006

Temporomandibular joint(TMJ) ankylosis is characterized by the formation of bony or fibrous mass, which replaces the normal articulation. Ankylotic block formation causes reduction of mandibular mobility, particularly hindering mouth opening, due to a mechanical block of the condylar head in its roto-transfatory motion. Surgery in TMJ ankylosis treatment entails complete ankylotic block removal and subsequent arthroplasty, possibly with autologous tissue between articular surfaces or heterologous material to restore the anatomic structure and normal function. Temporalis myofascial flap holds great promise for the reconstruction of various maxillofacial defects. In more recent years, a pedicled temporalis myofascial flap has been advocated in TMJ ankylosis surgery. Advantages of the temporalis myofascial flap in TMJ reconstruction include close proximity to the TMJ, adequate blood supply from the internal maxillary artery, and its attachment to the coronoid process, which provides movement of the flap during function, simulating physiologic action of the disc. This study evaluated 8 patients(11 TMJs) affected by TMJ ankylosis. All patients underwent surgical treatment of the removal of the ankylotic block and subsequent interpositional arthroplasty with temporalis myofascial flap. Bilateral TMJ ankylosis was observed in 3 patients(6 TMJs), right-sides in 3 patients, left-sided in 2 patients. Epipathogenesis was traumatic in 6 patients(8 TMJs), ankylosing spondylitis in 2 patients(3 TMJs). In 3 patients coronoidotomy was underwent. Average follow-up was 16.8 months after surgery, with a range of 7 to 28 months. No patients underwent additional TMJ procedures after the temporalis myofascial flap. All patients showed a distinctive improvement both in articular functionality and symptoms. We found that temporalis myofascial flap is very valuable in reconstruction of TMJ ankylosis.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.325-329
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• 2007

Purpose: Mobius syndrome is a rare congenital disorder characterized by facial diplegia and bilateral abducens palsy, which occasionally combines with other cranial nerve dysfunction. The inability to show happiness, sadness or anger by facial expression frequently results in social dysfunction. The classic concept of cross facial nerve grafting and free muscle transplantation, which is standard in unilateral developmental facial palsy, cannot be used in these patients without special consideration. Our experience in the treatment of three patients with this syndrome using transfer of muscles innervated by trigeminal nerve showed rewarding results. Methods: We used bilateral temporalis muscle elevated from the bony temporal fossa. Muscles and their attached fascia were folded down over the anterior surface of the zygomatic arch. The divided strips from the attached fascia were passed subcutaneously and anchored to the medial canthus and the nasolabial crease for smiling and competence of mouth and eyelids. For the recent 13 years the authors applied this method in 3 Mobius syndrome cases- 45 year-old man and 13 year-old boy, 8 year-old girl. Results: One month after the surgery the patients had good support and already showed voluntary movement at the corner of their mouth. They showed full closure of both eyelids. There was no scleral showing during eyelid closure. Also full closure of the mouth was achieved. After six months, the reconstructed movements of face were maintained. Conclusion: Temporalis muscle transfer for Mobius syndrome is an excellent method for bilateral reconstruction at one stage, is easy to perform, and has a wide range of reconstruction and reproducibility.

• 대한치과보철학회지
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• 제29권1호
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• pp.53-71
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• 1991

This study was performed to investigate the muscular activity of the complete denture wearers compare with subjects with natural teeth. For the study, 10 subjects with natural dentition and 18 upper and lower complete denture wearers selected and the Bio-electric Processor EM2(Myo-tronics Reaserch, Inc., U.S.A.) with the surface electrodes was used to record electromyographic activity from the right and left middle of masseter and anterior temporal muscles of each subject during mandibular postural rest position, tapping of teeth from postural rest position, maximal clench, and right and left gum and raw carrow chewing. This results of this study were as follows : 1. In mandibular postural rest position, the denture wearers produces high muscular activity in contrast to natural objects(P<0.05) but, there was no difference between the state of denture removal and insertion, and the muscle activity of the anterior temporal muscle was high than the middle of masseter muscle in natural objects and denture wearers. 2. In tapping of teeth, there was no difference in muscle activity between natural objects and the state of denture removal of denture wearers. 3. In maximal clench, there was markedly lower denture wearers than natural objects in muscle activity, and the ratio of mean voltages was about 36 percentages. 4. In gum and raw carrow chewing, the activity was lower than natural object, the ratio was about 59 percentages. 5. In chewing, the mean voltages of the middle of masster muscle on the chewing side was highest, followed by the anterior temporal on the chewing side, the anterior temporal and masster muscles on the non-chewing side.

• 대한심미치과학회지
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• 제32권1호
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• pp.23-32
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• 2023

비기능적 습관을 가진 환자는 턱관절 장애, 저작 근육의 근막통증증후군 등과 함께 치아의 광범위한 마모를 유발한다. 지속되는 교모는 수직교합고경의 감소를 동반하게 되며 이는 안모의 변화, 저작 효율 저하, 측두하악 관절 장애 등의 문제가 발생할 수 있다. 이런 수직교합고경 감소 환자의 3차원적인 교합 회복과 재구성을 위해서는 정확한 진단 및 분석과 예지성 있는 치료계획 수립이 필요하며, 생리적인 수직교합고경의 회복 및 정상적인 교합평면 재설정을 동반한 보철치료가 필요하다. 본 증례는 구강 악습관에 의한 전반적인 치아의 마모와 저작근의 불편감, 그리고 수직교합고경 감소로 인한 심미적 불만족을 호소하는 환자의 수직교합고경 증가를 동반한 완전 구강 회복 증례이다. 교합안정장치를 통한 측두하악관절의 안정과 고딕아치 기록장치를 이용한 악간관계 재설정 및 임시 수복물을 통한 경과 관찰을 통해 기능적, 심미적으로 좋은 결과를 보였기에 이를 보고하고자 한다.