• Journal of Oral Medicine and Pain
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• v.48 no.3
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• pp.112-117
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• 2023

Coronoid process hyperplasia (CPH) of the mandible is a rare condition in which abnormal elongation of the coronoid process leads to chronic mandibular hypomobility. CPH causes impingement or impedance of the coronoid process on the inner surface of the frontal part of the zygomatic bone during mouth opening. The lack of significant symptoms makes the diagnosis difficult. Its etiology remains inconclusive despite several theories being suggested. In this report, three reviewed cases are presented. All three patients visited our clinic with limited mouth opening as the chief complaint. Standard clinical and radiographic examinations were conducted under the initial impression of temporomandibular disorders (TMDs), and restricted jaw movements were confirmed in all cases. The absence of improved signs and symptoms following conservative treatment for TMDs or the indeterminate plain radiographs required the attending clinicians to consider three-dimensional imagery. Computed tomography revealed bilateral coronoid hyperplasia in all cases and impingement on the zygomatic bone in two of the three cases. After concluding that this condition caused the patients' limited mouth opening, the patients were referred to the Department of Oral and Maxillofacial Surgery for possible bilateral coronoidectomy or coronoidotomy. CPH usually presents no symptoms apart from a progressive reduction of mouth opening over time. Diagnosis is often delayed, and patients may undergo unnecessary treatment procedures. Clinicians should be aware of this condition and exercise caution in the differential diagnosis of patients with chronic mandibular hypomobility.

• Journal of Oral Medicine and Pain
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• v.20 no.2
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• pp.257-267
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• 1995

An Epidemiologic study was carried out on 77 TMD patients with degenerative joint disease who had visited the Orofacial Pain Clinic in Pusan National University Hospital. Al subjects were interviewed and examined clinically and radiologically using a standardized examination form. As related to gender and duration, subjective and objective sysmptoms in DJD patients were studied. The obtained results were as follows : 1. There were much more patients in the twenties or thirties, women and histories such as chronic duration and microtrauma. 2. Most patients responded positively more often to the questions of jaw function, unilateral chewing in habits, poot appetite and depression in behavioral response and shoulder pain in worsening prognosis 3. While the most common reasons for treatment were pain, noise, and limitation of opening, the associated symptoms such as headache, neckache, earache, jaw dysfunction, neck dysfunction, acute bite change and dizziness, ringing or fullness in the ears as secondary CNS excitatory effects were complained. 4. Opening the mouth in 25 to 40mm, soft end feel and deflective incisal pathway were seen and more tenderness to lateral or dorsal capsule of joint than intra or extra oral muscles were complained. 5. While there appeared no click, crepitus and single click in acute group, in chronic group, crepitus, single click and no click appeared in order of sequence. 6. Tomogram or bone scan revealed more bony changes than panorama and transcranial view.

• The Journal of the Korean dental association
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• v.38 no.6 s.373
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• pp.549-557
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• 2000

ㆍPurpose: This study was performed to investigate the initial conservative treatment for TMD patients using careful counselling and medication prospectively. ㆍMaterials and Methods: Careful counselling and medication were performed in 51 TMD patients and 27 patients had follow-up check 2 months or more. Diagnosis of TMD was based on medical history and, physical and radiographic examination. TMD included masticatory disorder, internal derangement, degenerative joint disease, inflammatory joint disorder. and problems resulting from extrinsic trauma. All patients had chief complaints of TMJ pain, mouth-opening limitation. joint noise, and/or referred pain. We counselled and explained to the patient about the pathogenesis, etiologic factors, diagnosis and treatment plan for abut 10 minutes. We prescribed nonsteroidal anti-inflammatorv analgesic(Somalgen) and amitriptyline 10mg per day for 2 weeks. We informed the patient of the attention sheet and taught self-exercise of jaw. The patient were assessed by answering the questionnaire of subjective evaluation of TMD & maxillofacial pain. Questionnaire of an activity limitation. Questionnaire of a jaw function, and Questionnaire for the evaluation of TMD. ㆍResults: In questionnaire for the evaluation of TMD, 88.5% of 26 patients answered that the treatment was efficacious. 71.4% of 21 patients answered no problem in everyday life. There were significant differences between pretreatment and final follow-up in the evaluation of the subjective pain in the following sections: opening widely, chewing, resting, morning, masticatory muscle, and temporal portion(SAS program, paired T-test, P = 0.05). ㆍConclusions: Considerate counselling and proper medication could be significantly effectve in the initial treatment of TMD.

• Journal of Dental Rehabilitation and Applied Science
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• v.36 no.2
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• pp.80-87
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• 2020

Purpose: This study aims to measure the mandibular movement using JT-3D system and provide a range of mandibular movement that can serve as a good reference for diagnosing the temporomandibular disorder. Materials and Methods: This study was conducted in 60 young male and female adults. The maximum opening and closing movement was recorded using JT-3D system, and by regarding 5 times of repetitive movement as 1 cycle of movement, total 3 cycles of movement were recorded. During the maximum opening, vertical position of lower jaw, antero-posterior position, lateral deflection position, and maximum opening distance were recorded. To evaluate the reproducibility of JT-3D system, statistical analysis were conducted (α = 0.05). Results: During the maximum opening, the average value appeared at 31.56 mm vertically and 24.42 mm rearwardly, lateral deflection position 0.72 mm, and maximum opening distance 40.32 mm. There was no statistical significance in all measured values for three cycles of movement recorded with JT-3D system (P > 0.05). Conclusion: During the maximum opening, the average value appeared at 0.72 mm in lateral deflection position and the maximum opening distance at 40.32 mm, and the analysis on the maximum opening of lower jaw using JT-3D system showed sufficiently reproducible results.

• Journal of the korean academy of Pediatric Dentistry
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• v.23 no.3
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• pp.717-728
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• 1996

The effects of electro-acupuncture on the pain threshold and the amplitude of dEMG(di-gastric EMG) evoked by the noxious electric stimulation on teeth and gingiva in dogs were studied. Experiments were carried out with 10 dogs weighing 5-8kg. Each animal was anestheticed with Entobar given intraperitoneally in an initial dose of 30mg/kg. Maintenance dose of 5mg/kg/hr was given through a cannula, in the femoral vein, as required to keep up light anesthesia. Bipolar stimulating wire electrodes, 0.1mm in diameter, insulated except for tips, were inserted into the upper canine and palatal gingiva. Rectangular aluminium plate electrodes (15$\times$5mm) were placed on acupuncture points, called Yin-Hsiang, located at both sides of the upper jaw. Rectangular biphasic current pulses of 2Hz, with a $250{\mu}sec$ duration, were delivered for 15 minutes. The dEMG activities were recorded from the anterior belly of the digastric muscle(one of the jaw opening muscles) using bipolar wire electrodes. The magnitude of the jaw opening reflex at different intensties of electro-acupuncture(1volt 4volt and 10volt) was estimated by averaging the 30 superimposed dEMGs recorded on an oscilloscope and audiomonitor. Data were analysed statistically with ANOV A and paired t-test. The obtained results were as follows: 1. Pain thresholds were increased 7.7 %, 15.4 %, 17.3 % in the teeth and 11.1 %, 19.0 %, 25.4 % in the gingiva as the intensities of electro-acupuncture increased incrementally. 2. Amplitudes of dEMG were decreaed 8.3%, 22.4%, 27.4% in the teeth and 9.8%, 36.5%, 42.2 % in the gingiva as the intensities of electro-acupuncture increased incrementally. 3. Inhibition of pain responses by the electroacupuncture was more effective in the gingiva than in the teeth.

• Physical Therapy Korea
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• v.26 no.1
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• pp.28-36
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• 2019

Background: Temporomandibular disorder (TMD) is characterized by pain and limited range of motion in the jaw. TMD patients generally prefer to chew on the unaffected or less-affected side, and this tendency often results in asymmetries in masseter muscle thickness and range of mandibular motion. Objects: The purpose of this study was to compare the asymmetries in masseter muscle thickness and range of mandibular motion in subjects with and without temporomandibular disorders. Methods: Thirty-nine subjects were divided into two groups: A TMD group ($n_1=19$) and a control group ($n_2=20$). The jaw opening range and laterotrusion were measured using a digital vernier caliper. The masseter muscle thickness was examined in both the resting state and the maximal clenching state using ultrasonography. The absolute asymmetry indices calculated based on the laterotrusion and masseter muscle thickness of the respective right and left sides. A two-way ANOVA and a Mann-Whitney U test were used for statistical analysis. Results: No significant different was found in the masseter muscle thickness between the TMD and control group. A significant difference was found in the absolute asymmetry indices of mandibular laterotrusion between the TMD and control groups (p<.05). Furthermore, the ranges of jaw opening were significantly different between males and females (p<.05). The absolute asymmetry index values of masseter muscle thickness at rest and during maximal clenching were also significantly different between males and females (p<.05). Conclusion: These results demonstrated that the subjects with TMD had a larger degree of asymmetry in laterotrusion than those without TMD. Therefore, a physiotherapy program needs to be designed to restore normal laterotrusion capacities for TMD subjects. These results also showed that female subjects had greater absolute asymmetry indices in masseter muscle thickness than male subjects. Therefore, more training is needed to promote bilaterally balanced chewing among women.

• Journal of Oral Medicine and Pain
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• v.41 no.3
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• pp.133-136
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• 2016

Facial abscess is a suppurative condition that is caused by infection and that its infected materials built up within the loose connective tissues or a fascial space of the head and neck. Facial abscess should be treated with a caution since it can make threat to patient's life. When pus collects near masticatory muscles, it may lead to masticatory muscle disorder reducing the range of mouth opening and the mobility of jaw. The authors review an uncommon case of facial abscess which occurred in temporal muscle and induced mouth opening limitation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.3
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• pp.139-144
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• 2012

This study was performed in order to evaluate the occurrence of temporomandibular joint disorder after surgical correction of skeletal class II malocclusion. Materials and Methods: This study included 21 patients who underwent orthognathic surgery for the correction of dentofacial deformities by a single surgeon at Mokdong Hospital, Ewha Womans University from 2000 to 2010. They underwent bilateral sagittal split ramus osteotomy for the treatment of undesirable mandibular advancement. The temporomandibular disorder (TMD) symptoms prior to surgery were recorded and the radiographic evaluation (panorama, bone scan, and magnetic resonance imaging [MRI]) of the post-surgery temporomandibular joint (TMJ) were assessed in order to evaluate condylar resorption, remodeling and disc displacement. The minimum follow-up period, including orthodontic treatment, was 12 months. Orthognathic procedures included 1-jaw surgery (n=8 patients) and 2-jaw surgery (n=13 patients). The monocortical plate was used for bilateral sagittal split ramus osteotomy fixation. Results: Among class II malocclusion patients with TMD symptom, clicking improved in 29.1%, and maximum mouth opening increased from $34.5{\pm}2.1$ mm to $37.2{\pm}3.5$ mm. The differences were not statistically significant, however. Radiographic changes in bone scan improved slightly based on the report by radiologist but not in TMJ dynamic MRI. Conclusion: No particular improvements were found in patients with joint sound only. Patients with limitation of mouth opening showed an increase in the degree of opening, but the difference was not statistically significant (P>0.05).

• The Journal of Advanced Prosthodontics
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• v.6 no.6
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• pp.483-490
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• 2014

PURPOSE. The purpose of this study was to determine the average facial proportions and mandibular movement capacity of 316 first-year dental students who carefully recorded them on each other. MATERIALS AND METHODS. This early exacting clinical experience was closely supervised by the authors in Columbus, Ohio during 1969-70. Five vertical and six horizontal distances were measured on each subject's face. An ala-tragus line and an occlusal line were drawn on the left side of the face to determine if these two lines were parallel. Measurements of mandibular movements involved maximum normal and hinge opening at the incisors and maximum amounts of right, left lateral and protrusive excursions of the mandible. RESULTS. The ala width and distance between the tips of upper right and left canine cusps averaged (35.2 mm and 34.8 mm) but with very large individual variations. The distance between ala to occlusal plane lines was 29.9 mm at the tragus and 31.3 mm near the ala. The angle between orbitale and ala-tragus averaged 13.6 degrees. CONCLUSION. The upper lip length was the most variable and the distance between the pupils was the most stable of the eleven facial measurements. The ala-tragus line and the occlusal plane lines were for all practical purposes parallel. Maximum jaw opening averaged 51.2 mm which was 3.0 times larger than maximal hinge opening of 17.2 mm. The maximum right plus left side jaw excursions (9.2 and 9.4 mm) totaled 18.6 mm, 2.3 times more than the 8.0 mm mean maximum forward protrusion.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.83-91
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• 2010

Objectives: This study aimed to assess the characteristics of temporomandibular disorder (TMD) symptoms and to determine the correspondence between TMD symptoms and clinical examination findings. Material and methods: A total of 218 patients (143 females and 75 males; age=$31.3{\pm}14.0$) were enrolled in this study who completed a questionnaire and underwent a clinical examination and radiographic assessment. Patients were asked about all the symptoms and complaints, including onset or duration, and locations of the symptoms. Clinical examination included amounts of mouth opening, palpable temporomandibular joint (TMJ) sounds, and tenderness to palpation of the TMJ and all masticatory muscles. Tenderness scores obtained from palpation of the masticatory system were summated to define the variables for further analysis. Results: Pain was the most frequently reported symptom (78.9%), followed by joint sounds (45.4%), and limitation in mouth opening (17.0%). Jaw pain comprised 91.9% of pain complaints. The subjective intensity of jaw pain was low to medium in most patients (93.7%), but it was poorly correlated with the sum of tenderness scores of the TMJ and masticatory muscles (Kendall tau = 0.084). In contrast, the side in which pain was reported by patients was well associated with the clinical examination results (pain of the right side, p < 0.001, and left side, p < 0.001). There was moderate agreement in TMJ sounds between the side identified by patients as symptomatic and clinical examination findings (kappa = 0.482). Finally, patients who complained of restricted mouth opening showed about a 10 mm less opening in all three measurements, compared to other patients (p < 0.001). Conclusion: The most frequent symptoms reported by TMD patients were jaw pain, TMJ sounds, and mouth opening limitation. The side of jaw pain, the side of TMJ sounds, and the presence of opening limitation were highly concordant between symptom reports and examination findings.