• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.4
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• pp.373-382
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• 2000

Temporomandibular disorders arised from joint itself was caused by inflammation or mechanical irritation of the retrodiskal tissues. Histologic changes of the retrodiskal tissues of temporomandibular joint(TMJ) internal derangement, such as inflammatory cell infiltration, hyalinization, myxoid change, fatty change, arterial obliteration, and so on, were reported, but relationships between magnetic resonance imaging(MRI) findings and histologic findings of the retrodiskal tissue were few reported. The purpose of this study was to find histologic changes of the retrodiskal tissues for status of joint and joint effusion in MRI of the temporomandibular joint which had surgical treatment. Materials were surgically treated 52 temporomandibular joints with internal derangement or osteoarthritis in TMJ clinic, Yongdong Severance Hospital. All joints were confirmed by magnetic resonance T1- and T2-weighted imagings bofere surgery. Status of joint was categorized by normal position, disc displacement with reduction, disc displacement without reduction, disc displacement without reduction associated with osteoarthrosis using preoperative MR T1-weighted images. Magnetic resonance evidence of joint effusion was observed in T2-weighted images and classified by its amount; degree 0(not observed), degree 1(small amount), degree 2(moderate amount), degree 3(large amount). Histologic features were observed whether the retrodiskal tissue has inflammatory cell infiltration, myxoid change, hyalinization, chondroid metaplasia and arterial obliteration. The distribution of elastic fibers were also observed. The results were as follows; 1. Inflammatory cell infiltration was not observed in any retrodiskal tissues. 2. MRI findings such as status of joint and evidence of joint effusion did not have significant relationship with myxoid change, hyalinization, chondroid metaplasia, arterial obliteration of the retrodiskal tissues. 3. Hyalinization and chondroid metaplasia were found in 8 joints(15.4%) and 5 joints(9.6%). All of them were found in disc displacement without reduction and disc displacement without reduction associated with osteoarthrosis. 4. Arterial obliteration was observed more frequently in disc displacement without reduction(55.6%) than disc displacement without reduction associated with osteoarthrosis(28.6%). Further studies with proper controls and more materials will be necessary.

• Imaging Science in Dentistry
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• v.36 no.1
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• pp.17-24
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• 2006

Purpose : The objective of this study was to investigate the effect of TMJ disc displacement on the TMJ disc configuration and surrounding osseous structure. Materials and Methods : The proton density and 72-weighted MR images of 57 TMJs were retrospectively studied. These TMJs were divided into three groups according to the anterior disc displacement status on MR sagittal images, those were the normal, anterior disc displacement with reduction (ADWR), anterior disc displacement without reduction (ADWOR). The frequency of disc configuration and surrounding bony change, the border status between articular disc and retrodiscal tissue were investigated according to the positional change of articular disc. Results : There were significant statistical differences of chi-square statistics of TMJ disc configurational type between normal and ADWR/ADWOR group, respectively. Surrounding bony change frequently appeared in ADWOR and a statistically significant difference of chi-square statistics of bony change frequency between normal and ADWOR group was observed. Conclusion : These results suggested that the disc configuration and bony change of TMJ are strongly related to TMJ disc displacement.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.6
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• pp.392-396
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• 2003

Purpose : The purpose of this study was to find the predictors for successful arthrocentesis for anterior disc displacement without reduction(ADD without Reduction) of the temporomandibular joint (TMJ). Patients and Methods : Arthrocentesis and lavage was carried out in 25TMJs of 22patients whose MRI findings were all anterior disc displacement without reduction. The effectiveness of the treatment was evaluated in terms of the postoperative range of maximal mouth opening (MMO) and the degree of postoperative pain score. Predectors which was analyzed were age, duration of painful locking, MMO, the degree of pain, perioperative clicking and the amounts of irrigation fluid. Results: 18cases (72%) was included to criteria for success. There were no significant differences in age, duration of locking, MMO and the degree of pain statistically. But In 15cases(83%) of successful cases, amouts of irrigated solution recovered to normal MMO were less than 150ml. And In 8cases (44%) of successful cases, perioperative clicking was appeared. Conclusion : Amounts of irrigated solution recovered to normal MMO and the appeareance of perioperative clkicking may be predictors of the successful results of arthrocenetesis of ADD without reduction of TMJ.

• Journal of Oral Medicine and Pain
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• v.20 no.2
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• pp.477-487
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• 1995

The purpose of this study was to assess the thermographic differences of craniomandibular area between normal individual and patients with craniomandibular disorders and to compare the differences between clinical and thermographical assessment. The author had used 50 subjects as materials for this study, which was divided into 2 groups (first group included 15 healthy subjects and second group included 35 patients) with craiomandibular disorders; 17 subjects had normal disc-condyle relationship, 13 subjects had disc displacement with reduction and 5 subjects had disc displacement without reduction. Agema 870 thermovision(D.I.T.I.) was used to take thermographs with $0.1^{\circ}C$ difference of gradual temperature shift. The results were as follows : 1. Of 34 patients with craniofacial pain, 15(44%) subjects showed hyperthermia on the pain site in the thermography, 8(23.5%)exhibited hyperthermia on the site opposed to the pain site, and 11(32.4%) did not show any significant thermal change. One patient without craniofacial pain showed hyperthermia on the site opposed to the site of disc displacement without reductin. 2. Of 35 patients with craniofacial pain or disc displacement, 24(68.6%) subjects showed a significant thermal difference between symptomatic and asymptomatic sides of the face, but 11(31.4%) did not show any difference. 3. Of 17 patients with pain but with normal disc-condyle relationship, 8(47.1 subjects showed hyperthermia on the pain site, 4(23.5%) showed on the site opposed to the pain site, and 5(29.4%) did not show any significant thermal change. 4. Or 13 patients with pain and disc displacement with reduction, 6(46.2%) subjects showed hyperthermia on the pain site, 3(23.1%) showed on the site opposed to the pain site, and 4(30.8%) did not show any significant thermal change. 5. 15 healthy subjects did not show any thermal differences between the both sides of the face.

• Imaging Science in Dentistry
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• v.43 no.4
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• pp.245-251
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• 2013

Purpose: This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI). Materials and Methods: The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher's exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1- and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side. Conclusion: Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P>0.05).

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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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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• v.36 no.1
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• pp.71-79
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• 2011

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.

• Journal of Oral Medicine and Pain
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• v.25 no.1
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• pp.63-71
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• 2000

The authors assessed if there is a relationship between joint effusion and the presence of pain, and between joint effusion and disc displacement in 446 temporomandibular joints of 223 subjects who visited the Department of Oral Medicine, Kyungpook National University Hospital with the complaints of temporomandibular joint problem. The amount of joint effusion and the position of disc were determined from magnetic resonance images of the temporomandibular joints. The position of disc was classified into normal disc position, disc displacement with reduction (DDWR), and disc displacement without reduction (DDWOR). The amount of joint effusion was graded according to the extent of joint area of high signal intensity on T2-weighted MR images. These findings were correlated with one another and statistically analyzed. The results were as follows; 1. The incidence of temporomandibular joint pain Was higher in the joints with higher amount of joint effusion (P<0.001). 2. The proportion of temporomandibular joints with higher amount of effusion increased in the joints with more advanced articular disc displacement (P<0.001).

• Imaging Science in Dentistry
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• v.32 no.4
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• pp.221-225
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• 2002

Purpose: To evaluate the relationship between internal derangement and osteoarthrosis in the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI). Materials and Methods: One hundred and six MR images of TMJs in 53 patients were evaluated. Disc displacements and osseous changes of the TMJs were assessed. Lateral and rotational disc displacements were also evaluated on coronal images. Results: No significant differences in the frequency of osseous changes of the TMJs between disc displacement with reduction and disc displacement without reduction groups were found. The erosion of the condylar head and the sclerosis of the articular eminence were more frequent in the internal derangement group than in the no disc displacement group. The flattening was the most frequently observed osseous change of both the condylar head and articular eminence. Conclusion : The relationship between internal derangement and osteoarthrosis is obscure, but it is thought that both disorders adversely affect each other.

• Journal of Oral Medicine and Pain
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• v.43 no.4
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• pp.112-117
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• 2018

Purpose: The aim of this study is to compare the short-term effectiveness of hard and soft stabilizing appliances (H-A and S-A) in treating patients with acute temporomandibular joint (TMJ) disc displacement without reduction (DDwoR). Methods: Eighty one patients diagnosed as acute TMJ DDwoR at oral medicine of Chosun University Dental Hospital from November 2016 to September 2017 were included in this study. The subjects were divided into three groups: The control group (34 patients treated without occlusal appliance), the H-A group (31 patients treated with H-A) and the S-A group (16 patients treated with S-A). The pain intensity using Visual Analog Scale and maximum mouth opening (MMO) were evaluated every week for 8 weeks. Results: The improvement of the pain intensity and MMO in the H-A group and the S-A group compared with the control group were noted (p<0.05). Conclusions: This study suggests that hard and S-As may be equally useful in treating patients with TMJ DDwoR. S-A could be recommended to reduce the symptoms of TMJ DDwoR in short period.