• 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).

• Journal of Oral Medicine and Pain
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• v.37 no.4
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• pp.205-211
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• 2012

A 35 year-old female presented with the complaint of sudden occurrence of bite change and concurrent opening limitation, as well as pain in the right temporomandibular joint (TMJ) during mouth opening. From her history it was revealed that she had simple clicking of right TMJ for several years before onset of these symptoms, and that the clicking sound subsided recently after development of opening limitation. On clinical examination, anterior open bite, midline shift of the mandible to right, and premature contacts on left posterior teeth were observed. Maximum mouth opening and lateral movement to left were also restricted. On magnetic resonance images, the right TMJ showed anterior disc displacement without reduction and the posterior joint space is greatly collapsed by retrusion of the condyle. It was thought that the sudden occurrence of occlusal change would be resulted from abrupt displacement of the mandible associated with development of the anterior disc displacement without reduction. The stabilization appliance traction therapy was performed initially for first 3 months along with physical and pharmacologic therapy. However, the anterior open bite and opening limitation didn't resolve and the position of mandible still remained altered. So the stabilization appliance was changed to intermaxillary traction device. Then the mandible returned progressively to normal position and the occlusion became more stable and comfortable. After 5 months of intermaxillary traction therapy, the anterior open bite was dissolved completely and the occlusion became stabilized satisfactorily along with recovery of normal mouth opening range. On post-treatment magnetic resonance image, remodeling of condylar head was observed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.55-65
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• 2005

Most patients with temporomandibular disorder can be treated conservatively. However, open TMJ surgery can be needed in some patients. We analysed the patients with TMD which open surgery has performed since 1998. Open surgery was carried out in 8 patients. Age ranged from 22 to 61 years, with a mean of 42.8years. All patients were male. Final diagnosis was obtained based upon clinical, radiographic and operative finding as follows; habitual luxation, bony ankylosis, traumatic arthritis, disc displacement with destructive change, disc displacement and adhesion. Etiologic factors included trauma(4), infection(2), and unknown(2). Open surgery included arthroplasty with either of condylectomy, eminectomy, meniscoplasty, capsurrohaphy. All patients were recovered uneventfully without severe complications. Some mouth opening limitation and mouth opening deviation remained. Postoperative aggressive physical therapy and careful follow up were performed. In conclusion, open TMJ surgery must be considered in organic disease such as ankylosis, tumor and TMD without favorable recovery after long-term conservative therapy.

• Journal of Yeungnam Medical Science
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• v.12 no.1
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• pp.141-148
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• 1995

The Magnetic resonance imaging has been used widely to evaluate the disk position without any interruption of the TMJ structures, and the dynamic MRI presenting computed serial imaging or the video-recorded simulation images is thought to be very effective to evaluate the disk position under function. This is to study the correlation between the clinical diagnosis and the findings of dynamic MRI for diagnosis of internal derangement of the 7 patients were examined clinically, and the movement of TMJ meniscus was reviewed in the dynamic MRI. MRI was very reliable to diagnose the amount of anterior displacement of articular disc, the structural abnormality of temporomandibular joint, the cause of functional limitation, and to differentiate the muscle related pain & dysfunction.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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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.

• Journal of Oral Medicine and Pain
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• v.31 no.2
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• pp.177-183
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• 2006

The management of refractory pain and limitation of mouth opening in the temporomandibular joint (TMJ) is both challenging and controversial. Arthrocentesis is a simple technique and it can be used instead of more invasive surgical procedures for patients who failed to conventional conservative treatments. The patients in this case report had complained persistent severe pain and restricted mandibular movement of TMJ, although they had been treated with conservative therapy, e.g., stabilization splint therapy, behavioral therapy, physical therapy, pharmacological therapy. Therefore we employed arthrocentesis for these patients, and they showed significant reduction of pain and improvement of mandibular movement after repetitive arthrocentesis. We recommend arthrocentesis as an effective, minimally invasive technique for patients with continuing severe pain and restricted mobility in the TMJ that is unresponsive to conservative management.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.4
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• pp.155-159
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• 2014

Objectives: The purpose of this article is to evaluate factors influencing prognosis of arthrocentesis in patients with temporomandibular joint (TMJ) disorder. Materials and Methods: The subjects included 145 patients treated with arthrocentesis at the Dental Center of Ajou University Hospital from 2011 to 2013 for the purpose of recovering mouth opening limitation (MOL) and pain relief. Prognosis of arthrocentesis was evaluated 1 month after the operation. Improvement on MOL was defined as an increase from below 30 mm (MOL ${\leq}30mm$) to above 40 mm (MOL ${\geq}40mm$), and pain relief was defined as when a group with TMJ pain with a visual analog scale (VAS) score of 4 or more (VAS ${\geq}4$) decreased to a score of 3 or more. The success of arthrocentesis was determined when either mouth opening improved or pain relief was fulfilled. To determine the factors influencing the success of arthrocentesis, the patients were classified by age, gender, diagnosis group (the anterior disc displacement without reduction group, the anterior disc displacement with reduction group, or other TMJ disorders group), time of onset and oral habits (clenching, bruxism) to investigate the correlations between these factors and prognosis. Results: One hundred twenty out of 145 patients who underwent arthrocentesis (83.4%) were found to be successful. Among the influencing factors mentioned above, age, diagnosis and time of onset had no statistically significant correlation with the success of arthrocentesis. However, a group of patients in their fifties showed a lower success rate (ANOVA P=0.053) and the success rate of the group with oral habits was 71% (Pearson's chi-square test P=0.035). Conclusion: From this study, we find that factors influencing the success of arthrocentesis include age and oral habits. We also conclude that arthrocentesis is effective in treating mouth opening symptoms and for pain relief.

• Journal of Oral Medicine and Pain
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• v.41 no.3
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• pp.110-117
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• 2016

Purpose: The purpose of this study is to determine factors influencing the duration of occlusal appliance (OA) treatment for patients with temporomandibular joint (TMJ) internal derangement. Methods: Ninety patients were included for this study, who satisfied the following including criteria: (i) those who were diagnosed as disc displacement of TMJ by taking magnetic resonance imaging (MRI) and (ii) those who were finished OA treatment. The subjects were classified into three groups according to the period of OA treatment: (i) early response group (<6 months), (ii) moderate response group (6 months-1 year), and (iii) delayed response group (>1 year). Demographic data, data from chief complaints and past history of temporomandibular disorder, data from clinical examination and diagnostic imaging including panoramic view and TMJ MRI were compared among groups. One-way ANOVA and chi-square analysis were used to test statistical significance. Results: There were no significant differences in demographic data, data from chief complaints and TMJ imaging. However, only the prevalence of oral parafunctional habits including bruxism, clenching, and unilateral chewing showed significant differences among groups. Conclusions: Oral parafunctional habits could be factors to influence the duration of OA treatment in the patients with TMJ internal derangement.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.370-378
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• 2005

The purpose of this study is that evaluate the distribution and biological roles of TNF-a, interleukin-1${\beta}$(IL-1${\beta}$), interleukin-6(IL-6) and tissue inhibitors of metalloproteinase-1(TIMP-1) in the synovial fliud of patients with non-inflammatory chronic temporomandibular joint(TMJ) disorders in relation to pain during joint movements and magnetic resonance imaging(MRI) findings. TMJ synovial fluids aspirates were obtained from 36 patients (36 joints) with chronic TMJ disorders and from 8 controls(8 joints). Patients were divided to four groups. The control group was from healthy volunteers(8 joints), group I(18 joints) was patients with anterior disc displacement with reduction, group II(5 joints) was patients with disc displacement without reduction and group III (5 joints) was osteoarthritis. The TNF-${\alpha}$, IL-1${\beta}$ and IL-6 levels in the aspirates were determined by using an enzyme-linked immunosorbent assay and the TIMP-1 level was measured by an enzyme immunoassay. Following examinations for pain during joint movements and MRI observations, these cytokines' level and frequencies of detection were compared. The level of IL-1${\beta}$was not significant different in all groups. but the level of TNF-${\alpha}$, IL-6 and TIMP-1 were significant different among groups. The level of IL-6 and TIMP-1 were correlated to pain during movement(p<0.01) and the level of TNF-a(p<0.05). Also, the level of IL-6 was correlated to the level of TIMP-1(p<0.01). Especially, The level of the TIMP-1 level was significantly correlated to the pain during movement and showed very high levle of Pearson's correlation coefficient (r=0.833)(p<0.001). The results indicated that the TNF-${\alpha}$, IL-6 and TIMP-1 levels in the TMJ aspirates of patients with chronic TMJ disorders have been raised. Especially, IL-6 and TIMP-1 were very high levels in the patients who were degraded in the TMJ. Also, TNF-${\alpha}$, IL-6 and TIMP-1 showed the significant correlation in the chronic temporomandibular joint disorders. Therefore I suggest that these cytokines were also correlated to the pain during movement in the chronic temporomandibular joint disorders.

• 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.