• Nuclear Medicine and Molecular Imaging
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• v.43 no.2
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• pp.143-149
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• 2009

Purpose: It is not known whether bone scan is useful for the prediction of the prognosis of patients with temporomandibular disorders(TMD). The aim of the present study was to identify useful prognostic markers on bone scan for the pre-therapeutic assessment of patients with unilateral TMD. Materials and Methods: Between January 2005 and July 2007, 55 patients(M:F=9:46; mean age, $34.7{\pm}14.1$ y) with unilateral TMD that underwent a pre-therapeutic bone scan were enrolled. Uptake of Tc-99m HDP in each temporomandibular joint(TMI) was quantitated using a $13{\times}13$ pixel-square region-of-interest over TMJ and parietal skull area as background. TMJ uptake ratios and asymmetric indices were calculated. TMD patients were classified as improved or not improved and the bone scan findings associated with each group were investigated. Results: Forty-six patients were improved, whereas 9 patients were not improved. There was no significant difference between the two groups of patients regarding the TMJ uptake ratio of the involved joint, the TMJ uptake ratio of the non-involved joint, and the asymmetric index(p>0.05). However, in a subgroup analysis, the patients with an increased uptake of Tc-99m HDP at the disease-involved TMJ, by visual assessment, could be easily identified by the asymmetric index; the patients that improved had a higher asymmetric index than the patients that did not improve($1.32{\pm}0.35$ vs. $1.08{\pm}0.04$, p=0.023), Conclusion: The Tc-99m HDP bone scan may help predict the prognosis of patients with unilateral TMD after splint therapy when the TMD-involved joint reveals increased uptake by visual assessment.

• 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.

• The korean journal of orthodontics
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• v.30 no.2 s.79
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• pp.235-243
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• 2000

Magnetic resonance imaging(MRI) of the temporomandibular joint(TMJ) is very useful method to diagnose internal derangement of the TMJ because of its high specificity foy identification of condyle-disc relationships. The purpose of this study was to evaluate the existence, incidence and severity o』 internal derangement o』 the TMJ by the MRI of Patients who are suspected to have TMJ disorder. MRI sample was composed of 50 subjects(10 males, 40 females) and the mean age was 22.9 years. 43 subjects of the sample were found to have positive findings. $56\%$ of the subjects with positive findings had ADD(anterior disc displacement) without reduction, and $65\%$ had internal derangement of bilateral joints. Distributions in the types of malocclusion in patients with positive findings, the Angle's classification had shown : the largest $41.9\%$ for Cl II ($39.6\%$ for Cl II div 1 and $2.3\%$ for Cl II div 2), $37.2\%$ for Cl I, $18.6\%$ for Cl III, and $2.3\%$ for the unidentified. $8.6\%$ of the subjects with positive findings had facial asymmetry and $55.8\%$ had openbite. We can conclude that the percentage of Cl II is the highest in patients with internal derangement of the TMJ. Openbite or facial asymmetry is considered to be uncompensated or compensated deformity which results from facial skeleton remodeling in the process of degenerative joint disease(DJD) due to TMJ degeneration. Therefore it is recommended to screen the patients with facial asymmetry or openbite by MRI before the beginning of orthodontic treatment. Differential diagnosis is essential because the tendency of relapse is high after the orthodontic treatment and continuous observation of TMJ is needed in patients with TMJ disorder.

• Journal of Oral Medicine and Pain
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• v.30 no.1
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• pp.107-119
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• 2005

Temporomandibular joint arthritides is divided into osteoarthritis, osteoarthrosis and polyarthritis. Because the signs, symptoms and radiographical features of osteoarthritis and osteoarthrosis are similar without arthralgia, diffenential diagnosis is difficult. Also non-radiographically change in early Osteoarthritis leads to misdiagnose. Planar bone scan and SPECT are useful to detect bone change early. This study was carried out in order to make diagnostic criteria of planar bone scan and SPECT. Three hundred and four temporomandibular joints were examined with clinical examination, computerized tomograph, planar bone scan, and SPECT. The obtained results were as follows. 1. If temporomandibular joint simple uptake ratio of patient in twenties is over 1.397%, it's condition may be osteoarthritis. And simple uptake ratio over in thirties-fourties may mean osteoarthritis. 2. It may mean osteoarthritis of temporomandibular joint that the number of coronal and transverse SPECT frame with hot spot is over four. 3. Destructive stage may goes on, if simple uptake ratio is over 1.370% in tweenties and over 1.104% in thirties-fourties. 4. If the number of coronal SPECT frame with hot spot is over four, temporomandibular joint may be on destructive stage in tweenties, thirties-fourties. And if the number of transverse SPECT frame with hot spot is over three, it may be on destructive stage in all ages. 5. When patient complains subjective arthralgia and palpation arthralgia, bone change may be more active than each arthralgia. 6. Osteoarthritis may progress gradually worse in 4.5 anamnesis. And then it may be stable gradually and turn to osteoarthrosis.

• Journal of Oral Medicine and Pain
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• v.35 no.2
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• pp.149-154
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• 2010

In benign exophytic lesion in TMJ such as osteoma, chondroma, osteochondroma, synovial chondromatosis etc, symptom such as pain, mouth opening limitation, Most case of condylar exophytic lesion manifest with facial asymmetry, malocclusion, mandibular midline deviation. An osteochondroma and synovial chondromatosis are most commom benign condylar tumor. However this tumor is most frequently found on long bone and flat bone and is unusual on the skull. We report cases of osteochondroma, synovial chondromatosis of TMJ and review literatures.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.143-147
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• 2013

Mouth opening limitation is generally caused by masticatory muscle or temporomandibular joint pain, disc dislocation without reduction, adhesion or ankylosis of the temporomandibular joint, and muscle contracture. But otorhinolaryngologic disease, neurologic and vascular disease, tumor, inflammation and infection may cause pain and mouth opening limitation which mimics temporomandibular disorders. Re-evaluation for possibilities of inflammation, infection and tumor should be in cases that do not show symptom improvement or appear with continuous aggravation despite of proper treatment. In this case, we report of medial pterygoid muscle pain and mouth opening limitation caused by periapical abscess of third molar spread to the pterygomandibular space.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.149-159
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• 2013

The purpose of this study was to investigate the relationship between horizontal morphology of lateral pterygoid muscle and onset of temporomandibular joint disorders. Randomly selected 150 subjects, assigned with equal number in terms of gender and age group, were included. The axial and sagittal images in their magnetic resonance images of the temporomandibular joints were used to measure the morphologic characteristics of lateral pterygoid muscles and temporomandibular joints. The measurement variables were maximal horizontal width and insertion angle to the condyle, position of the articular disc, condylar deformity, and joint effusion. In addition, presence or absence of the temporomandibular joint pain was examined through history and palpation of the joints. The relationships among measurement variables were analyzed and the results were as follow. The insertion angle of the lateral pterygoid muscle to the condyle was higher in the joint of anterior disc displacement without reduction than that in the joint of normal disc position. In addition, the maximal horizontal width of the lateral pterygoid muscle was significantly increased in joints with pain than those without pain. Also, the insertion angle was significantly higher in younger age group and the maximal width was significantly greater in male than in female. These results suggest that high insertion angle of lateral pterygoid muscle might be an important anatomic predisposing factor for anterior disc displacement in temporomandibular joint and muscular activity of lateral pterygoid muscle might be affected by preauricular pain. In conclusion, there might be a bi-directional interaction between lateral pterygoid muscle and joint in the progression of anterior disc displacement in temporomandibular joint.

• The Journal of the Korea Contents Association
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• v.9 no.7
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• pp.218-224
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• 2009

This study was to investigate the relation between maxillofacial trauma experience and temporomandibular disorder prevalence with a view to helping prevent and cure temporomandibular dysfunctions by conducting a questionnaire survey with 370 students attending C Health Care College located in Ulsan Metropolis. Data collected underwent an analysis using SPSS program, resulting in the following:1. As for TMJ(temporomandibular joint) clicking prevalence rate, with 25.7% of male students and 22.7% of female students answering positively, the former showed higher rate of temporomandibular joint clicking (p<0.01), while no significant difference was identified depending on school years. 2. In terms of temporomandibular pain prevalence rates, females were found to have been more affected than male students. 3. When it comes to trismus prevalence rates, 10.8% of female students and 7.0% of male students responded they had experienced the dysfunction and female students showed slightly higher rate of trismus prevalence. 4. 6.5% of males and 4.3% of female students responded they had got treatment experience resulting from temporomandibular disorders, indicating that more male students had gone through treatment for temporomandibular disorders(p<0.05). 5. Male students showed higher experience rate of maxillofacial trauma(p<0.01), mostly due to falling or tumbling down, followed by exercises and etc. 6. The relation between maxillofacial trauma and temporomandibular disorders showed statistically significant relation between maxillofacial trauma and TMJ(temporomandibular joint) clicking (p<0.01).

• Journal of Dental Rehabilitation and Applied Science
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• v.25 no.4
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• pp.319-328
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• 2009

Temporomandibular disorders(TMD) have been defined as a collective term embracing a number of clinical problems that involve the temporomandibular joint, the masticatory muscles, and associated structures. Since Dr. Costen, an otolaryngologist, published his article in 1934 claiming that pain in and around the jaw and "related ear symptoms" improved with alteration of the bite, diagnosis and treatment of temporomandibular disorders(TMD) have been within the concept of occlusion. However most of the modern descriptions for TMD no longer include occlusal disorders within their domain. Despite this trend toward the exclusion of occlusal disorders from TMD domain, the historical linkages between TMD and occlusal therapy are still strong. Currently the most popular theories regarding TMD etiology are based on the biopsychosocial model. In the future, treatment modalities should be directed at the pathophysiological processes of joint and muscle pain as well as the psychosocial aspects of chronic pain.

• Journal of Oral Medicine and Pain
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• v.37 no.2
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• pp.125-133
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• 2012

TMJ Osteoarthritis is a degenerative disease caused by overload on joint tissue, and often accompany with local tenderness on the joint, crepitus by mandibular movement, restriction of mandibular movement, and anterior openbite. In general, panoramic radiography, TMJ panoramic radiography, and transcranial radiography are conducted to diagnose osteoarthritis after clinical examination, however, these radiographic evaluations are limited in detecting minute bony changes of early pathologic lesion. The aim of this pilot study was to evaluate the limitation and usefulness of several TMJ imaging techniques, so we compare the findings from clinical examination, plain film radiographs, tomograph, and bone scan from 81 patients with temporomandibular joint disorder. The proportion of patients showing same findings in plain film radiographs, TMJ tomograph, and bone scan was high, however, it is desirable that clinician should conduct phased imaging examinations according to the clinical findings due to the possibilities of false negative findings in diagnosis of osteoarthritis.