• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제48권1호
• /
• pp.50-58
• /
• 2022

Objectives: Osteoarthritis (OA) is the most prevalent and disabling joint disease in the world. Temporomandibular joint (TMJ) exercise is a widely used treatment and could be a beneficial and long-term tool for treating TMJ OA. The present study aims to evaluate the effects of therapeutic exercise in the conservative treatment of TMJ OA. Materials and Methods: A single-group experimental pre-post test was performed. We included patients who met the diagnostic criteria for TMJ OA. Outcome variables were pain intensity (visual analogue scale), functionality (Helkimo index), and structural changes (ultrasound). Follow-up periods were at months 1, 3, and 6. The intervention included a home-based program with thermotherapy, manual therapy, and therapeutic exercise during the entire follow-up period. Results: We included 15 patients and 26 joints, all women with a median age of 57 years (range, 49-62 years). Median change in pain intensity on joint palpation, mouth opening, and at rest at the first month was 47.5 mm, 51 mm, and 60 mm, respectively, and 48 mm, 49.5 mm, and 42.5 mm, at six months (P=0.001). The Helkimo index showed significant improvement in medians from baseline severe dysfunction (17 points) to minimal dysfunction at three and six months (2 points) (P=0.001). Ultrasound showed improved disc position. Conclusion: This study demonstrated significant improvements in pain, function, and joint disc position and represents a valuable tool for the long-term treatment of patients with TMJ OA.

• Imaging Science in Dentistry
• /
• 제37권1호
• /
• pp.15-18
• /
• 2007

Purpose : Disc and condylar position were observed on MRIs of temporomandibular joint disorder patients and condylar position agreement between MRI and tranascranal radiography was evaluated. Materials and Methods MRI and transcranial radiographs of both TM joints from 67 patients with temporemandibular disorder were used. On MRI, the position and shape of disc and condylar position as anterior, middle, posterior was evaluated at medial, center, and lateral views. On transcranial radiographs, condylar position was evaluated using the shortest distance from condyle to fossa in anterior, superior, and posterior directions. Results. 1. On MRI, 96 joints (71.6%) of 134 had anterior disc dispalcement with reduction and 38 joints (28.4%) without reduction. 2. Fourteen (14.6%) of 96 reducible joints showed anterior condylar position, 19 (19.8%) showed central position, 63 joints (65.6%) showed posterior position. Two joints (5.3%) of 38 non-reducible joints showed anterior condylar position, while 9 (23.7%) showed central position, and 27 (71.1%)-posterior position. 3. In 85 joints (63.4%) of 134, the transcranial condylar position agreed with that of the central MRI view, 10 joints (7.5%) with that of medial, 16 joints (11.9%) with that of lateral, and 23 joints (17.2%) disagreed with that of MRI. Conclusion : On MRT, most oi the reducible and non-reducible joints showed posterior condylar position. Transcranial radiographs taken with machine designed for TMJ had better agreement of condylar position with that of MRI. Extremely narrow joint spaces or very posterior condylar positions observed on transcranial radiographs had a little more than fifty percent agreement with those of MRIs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제31권5호
• /
• pp.370-378
• /
• 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
• /
• 제36권2호
• /
• pp.107-115
• /
• 2011

교합이 완성된 성인에서 비정복성 관절원판전위가 있는 경우에 과두흡수가 없는 상태에서도 갑작스런 교합의 변화 즉 전치부 개교합이 발생한 환자 2명과 측방으로 중심위와 중심교합위 간 활주가 발생한 환자 1명과 그리고 전후방으로 중심위와 중심교합위 간의 차이가 발생한 1명의 환자를 관찰하였기에 증례 보고하는 바이며, 비정복성 관절원판전위와 연관되어 교합의 변화가 발생하는 원인을 분석하고자 한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제38권3호
• /
• pp.139-144
• /
• 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).

• Journal of Oral Medicine and Pain
• /
• 제38권2호
• /
• pp.143-147
• /
• 2013

측두하악장애 중 개구제한은 일반적으로 저작근, 측두하악관절의 통증, 비정복성 관절원판변위, 측두하악관절의 유착이나 강직, 저작근의 근경축 등에 의해 발생한다. 하지만 이비인후과적인 질환, 신경 및 혈관질환, 종양, 염증, 감염 등에 의해 측두하악장애와 유사한 통증 및 개구제한이 유발 될 수 있다. 따라서 병력 조사 및 임상 검사 시 이러한 이차적 질환에 대한 고려가 필요하다. 특히 초진 시 전형적인 측두하악장애의 소견을 보인다고 할지라도 적절한 치료 및 환자의 자기 관리에도 불구하고 증상의 호전이 없거나 지속적인 악화 소견을 보이는 경우에는 염증, 감염, 종양 등의 가능성에 관한 포괄적인 재평가가 필수적이다. 본 증례에서는 제 3 대구치의 치근단 농양이 익돌하악간극(pterygomandibular space)으로 확산되어 발생한 내익돌근(medial pterygoid muscle)의 통증 및 개구제한에 관하여 경험하였기에 이를 보고하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제36권1호
• /
• pp.16-20
• /
• 2014

Mandibular condylar hyperplasia is an uncommon condition of excessive unilateral growth of the condyle causing facial asymmetry and occlusal alterations. The etiology of condylar hyperplasia is unclear, but several factors are suspected, including previous trauma, hormonal disturbances, and abnormal functional loadings. Acute or chronic recurrent dislocation of temporomandibular joint (TMJ) is common, but long-standing dislocation is rare. We present two cases of the exophytic condylar hyperplasia that lasted for over 20 years with TMJ dislocation. In both cases, we performed a condyloplasty to restore normal occlusion and facial symmetry, with satisfactory results.

• Imaging Science in Dentistry
• /
• 제33권2호
• /
• pp.107-112
• /
• 2003

Purpose : To determine the relationship between clinical symptoms and magnetic resoncance (MR) images in patients presenting with temoporomandibular joint (TMJ) disorders. Materials and Methods: This study was based on 172 joints in 86 patients presenting with TMJ disorders. Joint pain and sound during jaw opening and closing movements were recorded, and the possible relationship between disc positions and bony changes of the condylar head and the articular fossa in MR images in the oblique sagittal planes were examined. Data were analyzed by Chi-square test. Results : There was no statistically significant relationship between clinical symptoms and MR images in the patients with TMJ disorders. Conclusion: In the patient with TMJ disorders, joint pain and sound could not be specific clinical symptoms that are related with MR image findings, and asymptomatic joints did not necessarily imply that the joints are normal according to MR image findings.

• Journal of Oral Medicine and Pain
• /
• 제23권4호
• /
• pp.379-385
• /
• 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
• /
• 제23권4호
• /
• pp.369-377
• /
• 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.