• Imaging Science in Dentistry
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• v.35 no.2
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• pp.69-75
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• 2005

Purpose : To determine the clinical correlation of magnetic resonance imaging (MRI) findings of temporomandibular joint internal derangements. Materials and Methods : The MR images of 150 TMJs in 75 patients were analyzed. The clinical symptoms were pain in the preauricular area and masticatory muscles and TMJ sounds. Results : There was a statistically significant relationship between the MRI diagnoses of different types of disc displacements and clinical findings of pain, clicking, and crepitus. The risk of TMJ pain was increased when the disc displacement without reduction occurred at the same time in combination with the osteoarthrosis and effusion. Conclusion : Regardless of the results, the data indicate that each of these MR imaging variables may not be regarded as the unique and dominant factor in defining TMJ pain occurrence.

• Journal of Oral Medicine and Pain
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• v.21 no.1
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• pp.67-78
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• 1996

This study was performed to compare the TMJ sounds by means of vibration-related items by Sonopak such as integral, high integral, above 300/(0-300) ratio, peak amplitude, peak frequency and median frequency before and after occlusa1 splint therapy as well as counselling, physical modalities. For this study 22 patients with craniomandibular disorders (CMDs) were selected and examined by routine diagnostic procedure for CMDs including Transcranial and Panoramic radiographs and were classified into 3 CMDs subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Visual analogue scale (VAS) about joint sound was recorded during treatment period and VAS treatment index (VAS Ti) was calculated from the VAS data and treatment duration. The author evaluated and compared treatment results by several parmeters such as symptom duration, timing of joint sound, parafunctional habits, trauma, and diagnostic classification. The obtained results were as follows : 1. Before the treatment, the highest value of peak amplitude was observed in disc displacement with reduction group and value of median frequency was highest in degenerative joint disease group. In addition the highest values of peak frequency and ratio ware observed in degenerative joint disease group, though they were not significant. Furthermore the lowest value of high integral was observed in disc displacement without reduction group and though it was not significant, value of integral was lowest in that group. 2. Among 3CMDs subgroups disc displacement with reduction group showed the significantly decreased value of high integral and degenerative joint disease group had the significantly decreased value of integral after conservative treatment including occlusal splint therapy. Conclusively conservative treatment including occlusal splint therapy vay be effective in the treatment of CMDs including TMJ sound. 3. Fair prognosis for conservative treatment was observed in acute group under 6 months than chronic group, 6 months over in symptom duration but there was no statistical difference. The result for conservative treatment was observed slightly poor in subjects with bruxism, clenching, unilateral chewing habit and trauma history but there were no statistical differences.

• Journal of Oral Medicine and Pain
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• v.36 no.3
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• pp.177-185
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• 2011

Aims: The purpose of this study was to evaluate the relationship between temporomandibular joint pain and the relative signal intensity (RSI) of retrodiscal tissue on T1-, and T2-weighted MRI images. Materials and Methods: This study was based on 122 TMJs of 61 patients who complain of TMJ pain in only one side but were revealed to have disc displacement in both TMJs according to MRI findings. The signal intensities of regions of interest (ROIs) in retrodiscal tissues were measured using T1-, and T2-weighted MRI images. The RSIs of retrodiscal tissues were referenced to the signal intensities of the ROIs of brain gray matter. The relationships between the RSI of retrodiscal tissue and joint pain, joint effusion, condylar degenerative change, and degree of disc displacement were examined. In addition, the relationships between joint pain and joint effusion, condylar degenerative change, and degree of disc displacement were examined. Results: On T1-weighted MR images, the painful TMJs showed significantly higher retrodiscal tissue RSI than non-painful TMJs. In addition, there is an association between joint pain and the degree of disc displacement. However, on T2-weighted MR images, the RSIs of retrodiscal tissues didn't show any significant differences with regard to joint pain, joint effusion, condylar degenerative change, and degree of disc displacement. Conclusions: The signal intensity of retrodiscal tissue can be used as a diagnostic marker for painful TMJ. However, the overall results suggest the signal intensity of retrodiscal tissue has a limited diagnostic significance in determining the pathologic status of TMJ.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.5
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• pp.417-422
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• 2001

Objective: In many TMD cases, deformed and reduced condyle heads were frequently observed. This study was prepared to compare the dimensions between normal and symptomatic condyles, using MR images. Materials: One hundred and twenty one patients with clinical signs and MRI-confirmed diagnosis of disc displacement were selected for this study. Thirty eight TMJs from nineteen asymptomatic volunteers who had no clinical symptoms and no disc displacement on sagittal and coronal view of MRI, were served as normal. Methods: Symptomatic condyles were classified according to the severity of the anterior disc displacement. The amount of anterior disc displacement was evaluated at sagittal section, and they were classified into 4 groups as normal(N), little(G0), mild(G1), moderate(G2) and severe displacement(G3). The dimentions of condyle were measured at the 200% magnified view, by digitizing program. All dimensions were compared among each groups on the central section of sagittal and coronal views, and the statistical analysis was performed. Results: The mean value of anteroposterior length of normal condyle was $0.79{\pm}0.13cm$ at sagittal section and mediolateral length was $2.12{\pm}0.22cm$ on coronal section. The mean value of anteroposterior length of symptomatic condyle was $0.67{\pm}0.16cm$ at sagittal section and mediolateral length was $1.97{\pm}0.28cm$ on coronal section. Conclusions: The size of symptomatic condyle was smaller than normal TMJ. The size of condyle was decreased as the amount of the disc displacement was increased. The dimensional change was found on the anterior articular surface of condyle at the mild or moderate disc displacement. And at the case of severe disc displacement, dimensional change was found on the superior articular surface.

• Journal of Oral Medicine and Pain
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• v.33 no.4
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• pp.387-394
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• 2008

Purpose : The purpose of this study was to verify the usefulness and feasibility of ultrasonographic imaging for the detection of the disorders of the surrounding supporting structure such as articular capsule, retrodiscal tissue and related ligaments, osteoarthritic evidence and associated disc displacement at the temporomandibular joint(TMJ) Materials and Methods : 20 patients(40 joints) with periodic lock and crepitations were investigated prospectively using 12 MHz array transducer. Ultrasonographic Imagings were assessed for osteoarthritic surface changes of condyle, extent of disc displacement and disorders of surrounding structures. Ultrasonographic images were compared with clinical investigations, conventional radiography and Dental Computed Tomographic scans. Results : In clinical and conventional radiography, osteoarthritic changes were diagnosed in 8 joints. Ultrasonographically 7 of the 8 osteoarthritic changes were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 87.5%, 62.5%, and 67.5% respectively. About the detection of disc displacement, disc displacement were diagnosed in 21 joints clinically. Ultrasonographically 19 of the 21 disc displacements were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 95%, 90%, and 92.5% respectively. when the disorders of supportive structure were figured out, the disorders of supportive structure were diagnosed in 18 joints clinically. Ultrasonographically 1 of the 18 the disorders of supportive structure were diagnosed correctly. Sensitivity, specificity, and accuracy of ultrasonography in the osteoarthritic detections were 5.5%, 4.5%, and 55% respectively. Conclusion : Ultrasonography is an relatively reliable diagnostic tool for the detection of disc displacement and some of osteoarthritic changes. But it's not an insufficient imaging technique for the detection of the disorders of the surrounding structure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.2
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• pp.191-199
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• 1997

Mandibular trauma is developed due to traffic accident, fall down, industrial injury, and others. TMJ disorder is usually also developed after facial traumatic injury. Many authors suggested that disc displacement or tearing, acute synovitis, TMJ ankylosis, traumatic arthritis, or effusion are developed after facial trauma. It is still very controversible what is the best treatment of TMJ injury such as condylar fracture and meniscal injury. In TMJ injury, synovial inflammation is developed and pain mediators such as prostaglandin E2 or leukotriene B4 are released from the synovial membrane. This can be a cause of TMJ disorder. I present a variety of experimental study about the condylar fracture and meniscal injury and enzyme-immunoassay of synovial fluid after mandibular trauma that have been studied since 1992 and establish the treatment criteria of traumatic TMJ injury. I think that the treatment option of condylar fracture depends upon the surgeon's criteria exclusively. There are no significant differences between conservative and surgical treatment. If the aggressive functional physical therapy and long-term followup be performed, the favorable functional recovery of TMJ can be obtained. And I think that the initial surgical management of meniscus of TMJ is unnecessary in condylar fracture. And also arthrocentesis can be available to release the patient's subjective symptoms and improve the healing of injured TMJ.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.14.1-14.11
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• 2020

Background: The purpose of this study is to introduce our modified disc plication technique using MITEK mini anchors and to evaluate the clinical outcome for patients with internal derangement (ID) of the temporomandibular joint (TMJ). Patients and methods: We evaluated 65 joints in 46 patients, comprised 32 women and 14 men, who first visited the Asan Medical Center from December 2012 to December 2016. The age of the patients ranged from 14 to 79 years, with a mean age of 36.6 years. The patients presented with joint problems including pain, joint noise, and mouth opening limitation (MOL). Patients who met our inclusion criteria underwent unilateral or bilateral disc repositioning surgery with our minimally invasive disc plication technique using MITEK mini anchors and No. 2-0 Ethibond^® braided polyester sutures. The variables taken into account in this study were the range of maximum mouth opening (MMO), painful symptoms (evaluated with the visual analog scale, VAS), and the type of noise (click, popping, crepitus) in the TMJ. Results: Preoperative examination revealed painful symptoms in 50.7% (n = 35) of the operated joints (n = 69) and the presence of clicks in 56.5% (n = 39). Postoperative examination revealed that 4.3% (n = 3) of the operated joints had painful symptoms with lower intensity than that in the preoperative condition. Additionally, 17.4% (n = 12) had residual noise in the TMJ, among which two were clicking and the other 10 had mild crepitus. The intensity of the postoperative residual noise was significantly decreased in all cases compared to that in the preoperative condition. Among patients with MOL below 38 mm (n = 18), the mean MMO was 31.4 mm preoperatively and 44.2 mm at 6 months postoperatively, with a mean increase of 13.8 mm. A barely visible scar at the operation site was noted during the postoperative observation period, with no significant complications such as facial palsy or permanent occlusal disharmony. Conclusion: Subjective symptoms in all patients improved following the surgery. TMJ disc plication using MITEK mini anchors with our minimally invasive approach may be a feasible and effective surgical option for treating TMJ ID patients who are not responsive to conservative treatment.

• Journal of Oral Medicine and Pain
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• v.21 no.1
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• pp.103-113
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• 1996

The author examined the clinical signs and symptoms , routine radiographs, laboratory test and bone scan in 73 subjects with TMJ disorders and studied the responses of clinical test on patients, the distribution of signs and symptoms of joints, the simple uptake rate(SUR) of affected joints , the SUR of subclassified groups of TMJ disorders, active joints of subclassified groups of TMJ disorders and the SUR of joints with noises. The obtained results were as follows : 1. The percentage of joint pain on palpation, joint noises joint pain on function, mandibular dysfunction and active finding of bone scan in aptients with TMJ disorders were higher 2. The SUR was higher in joints affected by joint pain on function, joint pain on palpation, mandibular dysfunction and creptius. 3. The SUR of osteoarthrosis was the lowest. 4. The percentage of active joints were the highest in joints with discdisplacement without reduction, and followed by osteoarthritis, and disc displacement with reduction. 5. The SUR of TMJ showing joint noises only was lower.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.25 no.4
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• pp.337-349
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• 1999

The extracellular matrix(ECM) is a complex network of different combination of collagens, glycosaminoglycans, laminin, fibronectin, and many other glycoproteins including proteolytic enzymes. The composition and organization of the ECM contributes to the uniques physical or biomechanical properties of a tissue. Fibronectins(FN) are dimeric glycoproteins located on cell surfaces, in the matrix of connective tissue, and in blood. Fibronectins mediate cell attachment to collagen substratum and have been implicated in a variety of important biological processes, including embryogenesis and cell differentiation. The purpose of this study was to determine the effects of surgical induction of anterior disk displacement(ADD) on distribution of fibronectin in the rabbit temporomandibular joint(TMJ) tissues included the articular cartilage, disc, retrodiscal tissue, articular eminence using an immunohistochemical technique. The left TMJ was exposed surgically, and all discal attachments were severed except for the posterior attachment. The disk was then repositioned anteriorly and sutured to the zygomatic arch. The right TMJ served as a shamoperated control. Normal joints were used as a nonoperated control. Fourty-five rabbits were used for experiments in total. For fibronectin immunohistochemical study, eighteen rabbits (one normal group and 5 experimental groups, each group consists of 3 rabbits) were used. The experimental rabbits were sacrified after operation period of 2, 3, 4, 6 and 8 weeks on fibronectin. The obtained results were as follows ; 1. Fibronectin immunoreaction on all TMJ tissues(mandibular condyle, articular disc, retrodiscal tissue, articular eminence) in the normal rabbit was observed. Especially the reverse cell layer and proliferation zone of articular cartilage of condyle show strong positive reaction. 2. Depletion of fibronectin in the all TMJ tissues except hypertrophic zone of articular cartilage occurred at 2 weeks following induction of ADD. 3. The restoration of immunoreaction at 4 weeks was observed and a progressive increasing reaction at 6 weeks, 8 weeks also was found. Our study generally showed degenerative changes in TMJ tissues after ADD although TMJ tissues adapted or degenerated to abnormal loads and stress distribution according to the remodeling capacity of TMJ tissues.