• 대한치과교정학회지
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• 제23권4호
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• pp.503-527
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• 1993

This paper describes a new method to create an animal model for TMJ internal derangement in the New Zealand white rabbits and the light and electron microscopical changes of posterior attachment of them. Twenty six rabbits(2.5-3.0kg), four normal and twenty two experimental, were used. The right disc of experimental animal was displaced anteriorly without sectioning the posterior attachment and tied to the zygomatic arch with nylon not to be reduced to the original position. The left TMJ was sham-operated to be compared with its right experimental one. Normal animals were sacrificed one day and eight weeks after experiment. Experimental animals were sacrificed one day, ten days, three weeks, five weeks and eight weeks after surgery respectively. They were fixed intravenously with $2\%$ glutaldehyde under general anesthesia and the samples of them were processed for light and electron microscopic examination. The purpose of this experiment is to make a suitable animal model of disc displacement without reduction for studying and understanding the cellular and morphologic events in posterior attachment of TMJ including early changes which were difficult to be observed in human TMJs. The results of this investigation suggest the following conclusions : 1. Authors induced anterior disc displacement surgically in rabbits with new method to examine histologic changes of posterior attachment. Tissue reactions of this model seem to be similar to those observed in human disc displacement. We think this animal model for anterior disc displacement may be used to explore and evaluate objectively the effects of many treatment modalities in disc displacements. 2. The animal disease model showed inflammation at early stage(one and ten days). At this stage there were mild-to-severe mononuclear inflammatory cell infiltration, numerous newly formed vessels, vessel dilatation and engormement and many fibroblasts. 3. At middle stage(three weeks), fibrosis occurred, where fibroblasts decreased in number, but their cytoplasm was profuse indicating high activity. Collagen fibers increased in number and the tissue looked more dense. 4. At late stage(five weeks and eight weeks) showed degenerative changes including perforation of posterior attachment, disintegration of collagen fiber bundles, degeneration of fibroblasts, metastatic ossification, and dystrophic calcification.

• 치과방사선
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• 제24권2호
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• pp.337-345
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• 1994

Arthrography of the temporomandibular joint is a useful method of demonstrating the soft tissue abnormalities related to disc dysfunction. In this study, 19 asymptomatic joints, 31 joints with anterior disc displacement with reduction, 31 joints with anterior disc displacement without reduction which were classified by arthrotomography under fluoroscopy were evaluated to determine the linear measurement of anterior recess of inferior joint space and the relationship between the condylar anterior translation and the severity of the internal derangements. Their fluoroscopic images were also evaluated to describe the characteristics of condylar paths in internal derangements of the temporomandibular joints. The results were as follows; 1. The mean lengths of the anterior recess in asymptomaic group. reduction group. and non-reduction group were 8.7±1.6㎜. 11.2±1.7㎜, 12.8±1.7㎜ respectively. The length of the anterior recess was increased according to the severity of the internal derangements(P<0.05). 2. Linear measurements of anterior movement of condyle on maximum mouth opening were 13.1 ±4.2㎜, 15.9±4.1㎜, 5.0±3.7㎜ in asymptomatic group. reduction group, and non-reduction group respectively. Compared with asymptomatic group, reduction group showed hypermobolity of the condyle and non-reduction group showed hypomobility. 3. Condyles moved beyond the crest of articular eminence in 80% of reduction group and did not reach it in 70% of non-reduction group. 4. The condyle moved mainly superiorly in reduction group(66%) and horizontally in asymptomatic group(47%). There were no cases to move superiorly in non-reduction group.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권5호
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• pp.457-462
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• 2005

The aim of this study is to evaluate the relative signal intensity of TMJ retrodiscal tissue in T2-weighted MRI as diagnostic marker of temporomandibular disorder(TMD). 58 temporomandibular joints from 29 TMD patients (14 men & 15 women) were evaluated. The relative signal intensity of retrodiscal tissue in T2-weighted MRI was referenced to brain gray matter same size of the region of interest(ROI). The collected data was compared to disc positions (normal, anterior disc displacement with reduction, anterior disc displacement without reduction), the presence of joint effusion. The relative signal intensity of retrodiscal tissue was significantly increased when the disc was displaced without reduction. And the relative signal intensity of retrodiscal tissue was significantly increased when joint effusion was present. The results suggest that evaluating the relative signal intensity of TMJ retrodiscal tissue using a T2-weighted MRI is valuable as a non-invasive tool for diagnosing the procession of TMD.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권1호
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• pp.97-104
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• 2000

The temporomandibular joint arthrocentesis is indicated the 'closed lock' due to anterior disc displacement without reduction. It can be easily carried out under local anesthesia with little complications. We performed arthrocentesis to the 24 patients, 9 patients who suffered from acute or chronic closed lock with anterior disc displacement, 2 patients from temporomandibular joint dysfunction related to systemic disease and 13 patients from joint dysfunction with pain. We present the common clinical aspect of arthrocentesis that operator can be easily faced with and possible modifications of this method.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.23.1-23.8
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• 2015

Background: The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). Methods: A total of 15 joints from 11 elderly patients (71-78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. Results: No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. Conclusion: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.

• Journal of Oral Medicine and Pain
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• 제38권2호
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• pp.149-159
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• 2013

이 연구의 목적은 측두하악관절장애와 외측 익돌근의 수평적 형태 간의 연관성을 조사하는 것이다. 이를 위해 10대에서 50대까지 연령군별로 각 남녀 15명씩 임의로 선정한 총 150명의 측두하악관절장애 환자에서 자기공명영상의 수평면 및 시상면상에서 나타난 외측 익돌근 및 측두하악관절의 형태적 특성을 조사하였다. 조사한 해부학적 특성은 외측 익돌근의 최대폭경, 수평 부착각도, 관절원판의 위치, 과두의 변형여부, 관절 삼출액 여부 등이며, 또한 전이부의 통증여부, 과두 주변의 압통 유무와 같은 임상적 소견이 포함되었다. 이들 해부학적 특성 및 임상적 소견의 상호 간 관련성을 분석한 결과, 비정복성 관절원판 변위를 가진 경우 외측 익돌근의 부착각도가 유의하게 높았으며 전이부에 통증이 있는 경우에는 최대 폭경이 유의하게 큰 것으로 나타났다. 뿐만 아니라 연령이 낮을수록 부착각도가 유의하게 높았으며 남성에서 최대 폭경이 더 큰 것으로 나타났다. 위의 결과를 통해 외측 익돌근 수평 부착각도가 관절원판 변위와 유의한 관련성이 있으며 전이부의 통증이 최대 폭경을 증가시키는 것으로 생각된다. 결론적으로 외측 익돌근의 높은 수평 부착각도가 관절원판 변위 발생의 중요한 해부학적 기여요인이 될 수 있으며, 측두하악관절의 통증은 외측 익돌근의 활성에 영향을 줄 수 있을 것으로 추정된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권1호
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• pp.78-86
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• 1996

This is a retrospective study of 31 patients, who were diagnosed as bilateral TMJ internal derangement in consequence of magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) at Department of Dentistry, Ajou University Hospital, and who were compared clinical findings with radiological findings. The results obtained were as follows. 1. The average of the patients of bilateral TMJ internal derangement was 27.3 years with a range from 12 to 74 years, and 93.6% of the patients were yonger than 40 years of age. The male-female ratio was 1 : 6.8, and the females of $20{\sim}29$ years were most common in 35.5%. 2. In the patients of bilateral TMJ internal derangement, the patients who complained clinical symptoms bilaterally were 38.7% and the patients who complained clinical symptoms untilaterally were 61.3%. 3. The most common disc position of bilateral TMJ internal derangement was anterior disc displacement without reduction on both sides in 38.7%. The most common disc configuration of bilateral TMJ internal derangement was biconcave on both sides and amorphous on both sides in closed mouth, and was amorphous on both sides in open mouth. 4. In the patients of bilateral TMJ internal derangement, the joints which really showed clinical symptoms were most common in anterior displacement without reduction of 48.9%.

• The Journal of Korean Physical Therapy
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• 제12권3호
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• pp.455-467
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• 2000

The purpose of this study was to analyse the effects of disc degeneration on the biomechanical behaviors of the intervertebral disc in term of axial displacement, intradiscal pressure. disc bulge at the 1.4-1.5 functional spinal unit(FSU). The degeneration is divided 4 grade by initial intradiscal pressure: normal: 135kPa. mild: 107kPa. moderate: 47kPa, severe: 15kPa, The predicted results were follows: 1. The magnitude of the bulge is found to be maximum at the anterior, minimum at the postero-lateral portion. The bulge of lateral, postero-lateral is found to be maximum in severe grade. followed by moderate. mild, normal grade. 2. Tho displacement was increased with increasing compressive load in all four grades.'rho stiffness of disc was found to be reduced by progressing from normal to severe grade. 3. The intradiscal pressure was increased nearly linearly with increasing compressive load in normal and mild grade. But the increasing rate in moderate and severe grade was showed apparently different from nomal and mild grade. Specially, it was increased very slightly in severe grade. In conclusion, decreased intradiscal pressure resulted in increase of axial displacement and disc bulge with compressive load increasing. these may compromise the nerve root impingement or irritation. Therefore posture and activities must be focus to reduce compressive load applied on the back or disc.

• The Journal of Korean Physical Therapy
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• 제23권6호
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• pp.9-14
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• 2011

Purpose: The pelvic tilting exercise is a well recognized rehabilitation maneuver. However, little information is available on the changes of lumbar segmental motion during pelvic tilting. This study was conducted to measure the kinematics of the pelvic tilting exercise on the supine and prone positions via fluoroscopy. Methods: A total of 10 female subjects were enrolled. During anterior, neutral, and posterior pelvic tilting, radiographs were taken in each exercise via fluoroscopy (ARCADIS Orbic, Siemens, USA). Images were sent to the picture archiving communication system (PACS), and the digitized images were analyzed using LabVIEW software (National Instruments, USA). Lumbosacral lordosis and the intervertebral body angle, intervertebral disc angle, and intervertebral displacement were analyzed. Results: The results of lumbar kinematic analysis during three tilting postures in the supine and prone positions demonstrated that lumbosacral lordosis and the intervertebral body angle and intervertebral disc angle were significantly higher when the pelvis was tilted anteriorly (p>0.05). However, there was no significant difference between anterior and neutral tilting in the intervertebral disc angle at the L3/4 level in the prone position (p>0.05), and there was no significant difference among tilting positions in intervertebral body displacement in the prone position (p>0.05). Conclusion: This study provides scientific evidence about the pelvic tilting exercise in lumbosacral segmental motion. Depending on the pelvic tilting exercise, kinematic changes were demonstrated in both positions, especially in the supine position. It is suggested that the supine position is effective for mobility, but it should be used carefully for the LBP (Low back pain) patient with hypermobility.

• Journal of Oral Medicine and Pain
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• 제23권4호
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• pp.379-385
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• 1998

A patient with TMJ osteoarthritis and anterior open bite was treated with an intermaxillary traction device. Pretreatment examination revelaed a pain in both TMJ during mouth opening, moderate tendernesso f left sternocleidomastoid and right trapezius muscles. Anterior open Bite was aobserved with interincisal distance of 2mm. Tomograms and MRI showed anterior disc displacement withouit reductoin of both temporomandibular joints, and the condyles were flattened and slightly eroded. A pair of full-coverage occlusal appliances was made on both maxillary and mandibular dentition, with pivoting fulcrum on the site of the second moalr. Traction force was gained by the intermaxillary orthodontic elastics which were hooked by orthodontic brackets on the labial surfaces of the upper and lower anterior and premolar teeth. After 8 weeks of traction treatment, the joint pain was subsided completely and the anterior open bite was closed to get an edge to edge relationship of anterior teeth.