• Imaging Science in Dentistry
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• 제36권2호
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• pp.73-79
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• 2006

Purpose : To describe the MRI findings of the antero-superior attachment of the disc in patients with internal derangement. Materials and Methods : One hundred fifty-six MR images from 40 normal subjects and 55 abnormal subjects were classified into three study groups of normal, anterior disc displacement with reduction and anterior disc displacement without reduction. On both closed- and open-mouth proton density sagittal images, the depiction of the antero-superior attachment of the disc and its demarcation from the disc were evaluated in three cuts of lateral, central and medial one thirds of the condyle. Results : The depiction of antero-superior attachment was more frequent by the order of normal, anterior disc displacement with reduction and anterior disc displacement without reduction groups, and the significant differences were found on lateral cut of the closed images and lateral and central cuts of the open images. In study for the demarcation between the antero-superior attachment and the disc the lateral cut of the closed images and all three cuts of the open images showed significant differences. Conclusion : Open images are useful to show the difference in depiction of the antero-superior attachment of the disc among the TMJ groups.

• 대한치과교정학회지
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• 제26권4호
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• pp.423-439
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• 1996

본 연구는 측두하악관절장애의 증상을 보이는 환자들의 $SONOPAK^*$을 통한 관절잡음의 분석결과와 자기공명영상 사진의 판독결과를 비교함으로써 SONOPAK의 악관절내장증에 대한 진단적 가치를 평가하기 위해 시행되었다. 연구대상은 측두하악관절장애 증상을 보이는 18명의 성인환자(남자 5명, 여자 13명)로 평균연령은 남,녀 각각 22.1세, 24.3세였다. 소아용 청진기를 사용하여 임상적인 clicking 및 crepitus의 유,무를 기록하였으며 SONOPAK을 사용하여 관절잡음을 기록하고 spectral analysis를 통해서 악관절내장증 단계에 대한 SONOPAK의 분석결과를 얻었다. 또한 모든 환자에서 자기공명영상사진을 촬영하여 그 판독결과를 SONOPAK의 해석결과와 비교하여 아래와 같은 결론을 얻었다. 1. 자기공명영상사진상 관절원판이 정상적인 위치와 형태를 보이는 경우 SONOPAK에 의한 false positive 진단은 없었다. 2. 자기공명영상사진상 관절원판의 전방전위를 보인 경우에는 정복성이나 비정복성 관절원판 전방전위 모두에서 SONOPAK 분석결과와 일치하지 않은 빈도가 높았다. 3. clicking의 유무만으로 관절원판의 정복성 전방전위와 비점복성 전방전위를 감별진단하거나, 관절잡음의 성질로 악관절내장증의 단계를 판정하는 것은 적절하지 못하며 임상증세, 자기공명영상사진등을 포함한 보조적 진단검사의 자료를 종합하여 판단할 때 SONOPAK의 관절잡음 분석결과의 진단적 가치는 증대될 수 있다고 사료된다.

• 대한치과의사협회지
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• 제41권12호통권415호
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• pp.818-824
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• 2003

Visually guided irrigation and lysis(VGIL) using temporomandibular joint(TMJ) arthroscope is useful for decreasing pain and increasing the functional mobility of TMJ. Also it demonstrated similar effectiveness comparing with arthrocentesis. Arthroscopy permits intracapsular inspection that is imperative not only for identification of morphological characteristics of joint space, but also for adequate irrigation and lysis of specific joint space. Conventional 2.3mm diameter arthroscope with 2.7mm catheter was too wide. So it was traumatic and uncomfortable to manipulate on temporomandibular joint space, especially on TMJ internal derangement patient with reduced space. We report our clinical experience on 6 TMJ closed lock patients who were treated with new 1.2mm fiberscope at Chung Hoon Dental Clinic between March 2003 and August 2003. Also we present clinical advantage & disadvantage of new system with literature review.

• 치과방사선
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• 제21권2호
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• pp.225-234
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• 1991

This study was designed to investigate the effects of the posterior slope of the articular eminence and the condylar angulation to the posterior slope of the articular eminence on internal derangement of TMJ. The materials consisted of 78 transcranial oblique lateral projections of 31 normal subjects and 47 internal derangement patients. The results were as follows: 1. The posterior slope of the articular eminences in normal group were larger than that in abnormal group, but there were not significant differences between each group about the condylar angulation to the posterior slope of the articular eminences. 2. The differences between in the right and left sides in patients who were affected unilaterally and bilaterally were larger than that in normal groups. 3, In patients affected unilaterally, there were not significant differences between affected joints and unaffected joints about the posterior slope of the articular eminence and the condylar angulation to the posterior slope of the articular eminence. 4. In abnormal group, there were significant differences between each group about condylar angulation to the post, slope of the articular eminence (ant. disk displacement without reduction > fibrous adhesion > ant. disk displacement with reduction), but not about the post, slope of the articular eminence.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권3호
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• pp.125-132
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• 2015

Objectives: The purpose of this study was to clarify which findings in magnetic resonance imaging (MRI) are good predicators of pain and mouth opening limitation in patients with temporomandibular joint (TMJ) internal derangement (ID). Materials and Methods: Clinical examinations for pain and mouth opening limitation were conducted for suspected TMJ ID. MRI scans were taken within a week of clinical examinations. On the oblique-sagittal plane image, readings were obtained in terms of the functional aspect of disc position, degree of displacement, disc deformity, joint effusion, and osteoarthrosis. Multiple logistic regression analyses were conducted to identify the predictors of pain and mouth opening limitation. Results: A total of 48 patients (96 TMJs) were studied, including 39 female patients and 9 male patients whose ages ranged from 10 to 65 years. The resultant data showed significant correlations between pain and the MR imaging of the degree of disc displacement (P<0.05). The probability of there being pain in moderate to significant cases was 9.69 times higher than in normal cases. No significant correlation was found between mouth opening limitation and MRI findings. Conclusion: We identified a significant correlation between clinical symptoms and MRI findings of ID. The degree of anterior disc displacement may be useful for predicting pain in patients with TMJ ID.

• 대한물리치료과학회지
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• 제5권4호
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• pp.717-728
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• 1998

The Temporomandibural joint(TMJ) is one of the most frequently used joint in the body as $1,500{\sim}2,000$ times per day for the activities of chewing, swallowing, talking, yawing and sneezing. The TMJ are formed by condylar process of mandible and mandible fossa of temporal bone, separated by an articular disc. This articular disc divides into two cavities as upper cavity and lower cavity. The gliding movement occurs in the upper cavity of the joint, whereas hinge movement occurs in the lower cavity. The movements that are allowed at the TMJ are opening, closing, protrusion, retraction and lateral movement. A cause of TMJ dysfunction are capsulitis, internal derangement, osteoarthritis, rheumatoid arthritis, infection and inflammation near the joint, trauma on joint, ankylosis, subluxation or dislocation of joint, injury of articular disc, myositis, muscle contracture or spasm, myofascial pain dysfunction syndrome, dyskinesia of masticatory muscles, developmental abnormality, tumor, connective tissue disease, fibrosis, malocclusion, swallowing abnormality, wrong habits such as bite nail or hair, bruxism, psycological stress and Costen syndrome etc. Assessment of TMJ dysfunction consist of interview, observation, functional examination, palpation, reflex test, joint play test, electromyography and radiologic examination and behavioral and psycological assessment etc.

• 대한치과의사협회지
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• 제51권6호
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• pp.302-312
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• 2013

It has been established that disk displacement of the temporomandibular joint(TMJ) can cause mandibular asymmetry in growing subjects. One of the causes of internal derangement of TMJ seems to be the result of poor positioning of the joint structure in unilateral cross bite, and the subsequent occlusal trauma transferred to the functioning unit of the mandible, the joint and disc. Transverse discrepancy of the maxillary and the mandibular posterior dentoalveolar units was often found in mandibular asymmetric subjects. Most of the asymmetry in growing subjects becomes worse with further growth if left untreated. However once sufficient posterior overjet is gained through orthodontic treatment, many cases have shown improvement in facial asymmetry. Furthermore, the position of condyles in computed tomogram(con-beam CT) changed from anatomically unfavorable position to more concentric position.

• 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.

• 대한치과의사협회지
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• 제46권5호
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• pp.308-314
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• 2008

The risk of temporomandibular joint disorder (TMD) can be increased during dental treatment due to excessive mouth opening and change of occlusion. The aim of this study is to find the relationship between dental treatment and TMD in the patients who developed TMD after dental treatment. The subjects of this study were 21 patients, who developed TMD after dental treatment and were treated with active TMD therapy in Seoul National University Bundang Hospital from June 2003 to February 2007. The subjects were examined with preceding dental treatment, symptom, diagnosis, treatment method of TMD and prognosis of TMD. The obtained results were as follows. 1. Preceding dental treatments were : Implant treatment, 14 cases ; Tooth extraction, 3 cases and others. 2. TMD symptoms were : pain on TMJ, 12cases : Sound on TMJ, 3cases ; Mouth opening limitation, Headache and others. 3. Diagnoses of TMD were : Synovitis and/or capsulitis, 10 cases ; 8 cases of Internal derangement and others. 4. Most TMD were treated by stabilization splint. 5. Prognoses of TMD were : Improvement, 6cases ; sustained 11 cases. In conclusion, the risk of TMD is increased during implant treatment. Prognoses of TMD after dental treatment were bad. It might be that these patients were non-cooperative and have distrust of dental treatment. Because the overloading on TMJ is possible in dental treatment of patients with underlying TMD, prior explanation and knowledge TMJ treatment are very important in these cases.

• Imaging Science in Dentistry
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• 제33권1호
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• pp.1-4
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• 2003

Purpose : The purpose of this study was to investigate the distribution and frequency of temporomandibular joint (TMJ) effusion in magnetic resonance (MR) images of patients with disc displacements. Materials and Methods: On T2 weighted MR images of 148 TMJs taken from 74 patients presenting with TMJ pain and dysfunction, we assessed the cases showing TMJ effusion, defined as an amount of fluid that exceeded the maximum amount seen in a control group of asymptomatic volunteers. The amount of TMJ fluid was graded as: I (none or minimal), II (moderate), III (marked), and IV (extensive), according to a standard set by a reference. Disc displacement categories were also recorded. Results: Of the 148 TMJs examined in this study, 52 joints (35.1%) presented with joint effusion, 24 (16.2%) showing bilateral joint effusion. 38 joints showed upper joint space effusion, 3 showed lower joint space effusion, and 11 showed both upper and lower joint space effusion. 96 joints (64.9%) had grade I joint fluid, 27 (18.2%) grade II, 15 (10.1 %) grade III, and 10 (6.8%) grade IV. 80.0% of the joints presenting with grade IV effusion showed disc displacement without reduction. Conclusion: Joint effusion was found not only in upper, but also in lower joint spaces. The higher the effusion grade, the greater the frequency of disc displacement without reduction.