• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권4호
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• pp.227-230
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• 2016

Septic arthritis of the temporomandibular joint (TMJ) is a rare disease. The most common symptoms of this disease are acute malocclusion, limited mouth opening, swelling, and tenderness of affected TMJ. These symptoms are often confused with internal derangement of the articular disc, rheumatoid arthritis, retrodiscitis, or osteoarthritis. Therefore, differential diagnosis by image examination is required. Usually, antimicrobial treatment and surgical drainage by needle aspiration, arthroscopy, or arthrotomy are effective treatment approaches. In this study, a patient who was diagnosed with septic arthritis was treated with arthrocentesis and antibiotics without significant complications. We present a case report with a review of the literature.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권3호
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• pp.178-181
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• 2022

Williams-Beuren syndrome (WS) is a rare genetic disorder that results from microdeletion at chromosome 7, which harbors the elastin gene. Clinical findings include arteriopathy, aortic stenosis, hypertension, and laxities and contractures in different joints throughout the body. While many components of the temporomandibular joint (TMJ) normally contain elastin, there are few reports on TMJ manifestations of WS. This study reports a TMJ ankylosis case in a WS patient and shares insight on a possible link between development of TMJ ankylosis and elastin deficiency in WS patients. A WS patient presented with bilateral TMJ ankylosis and was successfully treated with TMJ gap arthroplasty. Hypermobility of TMJ and lack of elastin in retrodiscal tissue can induce anterior disc displacement without reduction. Due to lack of elastin, which has a significant role in the compensatory and reparatory mechanism of TMJ, WS patients might be prone to TMJ ankylosis.

• 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.

• Imaging Science in Dentistry
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• 제33권2호
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• pp.63-70
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• 2003

Purpose: To describe the MRI findings of the retrodiskal tissue in patients presenting with TMJ internal derangement and to correlate these findings with clinical and other MRI manifestations. Materials and Methods: One hundred eighteen joints of 63 patients with TMJ internal derangement were examined by MRI. Tl-weighted sagittal MR images taken in both closed- and open-mouth were evaluated for the presence of demarcation between disk and retrodiskal tissue, the presence of low signal intensity, and the depiction of the temporal part of the posterior attachment. The results were correlated with the duration of TMJ internal derangement, the presence of pain, and other MRI findings, including the type of internal derangement, the extent of disk displacement, the degree of disc deformation, and the presence of osteoarthrosis. Results: A significant relationship between the presence of low signal intensity in the retrodiskal tissue and other MRI findings was determined. Low signal intensity on the open-mouth view was observed more frequently in patients with disc displacement without reduction, severe disc displacement and deformation, and osteoarthrosis (p<0.05). The demarcation between disk and retrodiskal tissue, and the depiction of the temporal part of the posterior attachment(TPA) were correlated neither with clinical, nor with other MRI findings. Conclusion: This study suggests that low signal intensity in the retrodiskal tissue on open-mouth MR image can be indicative of advanced stages of disk displacement.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권1호
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• pp.78-86
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• 1996

This is a retrospective study of 31 patients, who were diagnosed as bilateral TMJ internal derangement in consequence of magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) at Department of Dentistry, Ajou University Hospital, and who were compared clinical findings with radiological findings. The results obtained were as follows. 1. The average of the patients of bilateral TMJ internal derangement was 27.3 years with a range from 12 to 74 years, and 93.6% of the patients were yonger than 40 years of age. The male-female ratio was 1 : 6.8, and the females of $20{\sim}29$ years were most common in 35.5%. 2. In the patients of bilateral TMJ internal derangement, the patients who complained clinical symptoms bilaterally were 38.7% and the patients who complained clinical symptoms untilaterally were 61.3%. 3. The most common disc position of bilateral TMJ internal derangement was anterior disc displacement without reduction on both sides in 38.7%. The most common disc configuration of bilateral TMJ internal derangement was biconcave on both sides and amorphous on both sides in closed mouth, and was amorphous on both sides in open mouth. 4. In the patients of bilateral TMJ internal derangement, the joints which really showed clinical symptoms were most common in anterior displacement without reduction of 48.9%.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권6호
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• pp.354-359
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• 2023

The temporomandibular joint is a unique structure composed of the joint capsule, articular disc, mandibular condyles, glenoid fossa of the temporal bone, surrounding ligaments, and associated muscles. The condyle is one of the major components of a functional temporomandibular joint. Reconstruction of large mandibular defects involving the condyle is a surgical challenge for oral and maxillofacial surgeons. To restore large mandibular defects, there are different options for free flap method such as fibula, scapula, and iliac crest. Currently, the vascularized fibula free flap is the gold standard for reconstruction of complex mandibular defects involving the condyle. In the present report, neocondyle regeneration after mandible reconstruction including the condyle head with fibula free flap was evaluated. In this report, two patients were evaluated periodically, and remodeling of the distal end of the free fibula was observed in both cases after condylectomy or mandibulectomy. With preservation of the articular disc, trapezoidal shaping of the neocondyle, and elastic guidance of occlusion, neocondyle bone regeneration occured without ankylosis. Preservation of the articular disc and maintenance of proper occlusion are critical factors in regeneration of the neocondyle after mandible reconstruction.

• Journal of Oral Medicine and Pain
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• 제30권2호
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• pp.239-246
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• 2005

본 연구는 측두하악장애환자와 정상인 간 그리고 측두하악장애환자의 분류에 따른 하악과두와 하악지 비대칭지수를 파노라마 방사선사진에서 비교하여 측두하악장애환자의 진단 및 치료계획 수립에 도움이 되고자 본 연구를 시행하였다. 측두하악장애환자 120명과 정상인 30명의 파노라마 방사선사진을 촬영후, 투사도를 작성하였다. 그리고 파노라마 방사선사진 계측항목 계측치의 평균값과 표준편차를 측두하악장애환자와 정상인으로 구분하여 산출한 다음 비대칭지수식을 이용하여 비대칭지수를 산출하여 양군 간의 비교분석을 시행하여 다음과 같은 결과를 얻었다. 1. 측두하악장애군과 대조군 간 하악과두 수직비대칭지수는 유의한 차이를 보였으나, 하악지 수직비대칭지수에서는 유의한 차이를 보이지 않았다. 2. 관절장애군과 근육장애군의 하악과두 수직비대칭지수는 대조군에 비해 더 크게 나타났지만, 관절장애군과 근육장애군 간의 하악과두 수직비대칭지수는 유의한 차이를 보이지 않았다. 3. 관절장애군, 근육장애군, 그리고 대조군 간의 하악지 수직비대칭지수 비교에서는 군간 유의한 차이를 보이지 않았다. 4. 관절원판변위군, 정복성관절원판전위군, 그리고 비정복성관절원판전위군 간의 하악과두 그리고 하악지 수직비대칭지수 비교에서는 유의한 차이를 보이지 않았다. 5. 하악과두와 하악지 수직비대칭지수 모두 연령증가와 관련이 없었다. 이상의 결과는 측두하악장애군이 정상인에 비해 하악과두 수직비대칭지수가 높게 나타나, 이러한 차이가 측두하악장애와 관련이 있음을 시사하였다. 따라서 파노라마 방사선사진을 이용한 하악과두 수직비대칭지수 측정은 측두하악장애 진단과 치료시 고려해야 할 중요한 부분으로 사료된다.

• 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.

• Journal of Oral Medicine and Pain
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• 제25권2호
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• pp.173-189
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• 2000

The purpose of this study was to evaluate the effect of specific head positions on the mandibular rotational torque movements in maximum mouth opening, protrusion and lateral excursion. Thirty dental students without any sign or symptom of temporomandibular disorders(TMDs) were included as a control group and 90 patients with TMDs were selected and examined by routine diagnostic procedure for TMDs including radiographs and were classified into 3 subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Mandibular rotational torque movements were observed in four head postures: upright head posture(NHP), upward head posture(UHP), downward head posture(DHP), and forward head posture(FHP). For UHP, the head was inclined 30 degrees upward: for DHP, the head was inclined 30 degrees downward: for FHP, the head was positioned 4cm forward. These positions were adjusted with the use of cervical range-of-motion instrumentation(CROM, Performance Attainment Inc., St. Paul, U.S.A.). Mandibular rotational torque movements were monitored with the Rotate program of BioPAK system (Bioresearch Inc., WI, U.S.A.). The rotational torque movements in frontal and horizontal plane during mandibular border movement were recorded with two parameters: frontal rotational torque angle and horizontal rotational torque angle. The data obtained was analyzed by the SAS/Stat program. The obtained results were as follows : 1. The control group showed significantly larger mandibular rotational angles in UHP than those in DHP and FHP during maximum mouth opening in both frontal and horizontal planes. Disc displacement with reduction group showed significantly larger mandibular rotational angles in DHP and FHP than those in NHP during lateral excursion to the affected and non-affected sides in both frontal and horizontal planes(p<0.05). 2. Disc displacement without reduction group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening as well as lateral excursion to the affected and non-affected sides in both frontal and horizontal planes. Degenerative joint disease group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening, protrusion and lateral excursion in both frontal and horizontal planes(p<0.05). 3. In NHP, mandibular rotational angle of the control group was significantly larger than that of any other patient subgroups. Mandibular rotational angle of disc displacement with reduction group was significantly larger than that of disc displacement without reduction group during maximum mouth opening in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group or degenerative joint disease group during maximum mouth opening in the horizontal plane(p<0.05). 4. In NHP, mandibular rotational angles of disc displacement without reduction group were significantly larger than those of the control group or disc displacement with reduction group during lateral excursion to the affected side in both frontal and horizontal planes. Mandibular rotational angle of disc displacement without reduction group was significantly smaller than that of the control group during lateral excursion to the non-affected side in frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group during lateral excursion to the non-affected side in the horizontal plane(p<0.05). 5. In NHP, mandibular rotational angle of the control group was significantly smaller than that of disc displacement with reduction group or disc displacement without reduction group during protrusion in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of the disc displacement with reduction group or degenerative joint disease group during protrusion in the horizontal plane. Mandibular rotational angle of the control group was significantly smaller than that of disc displacement without reduction group or degenerative joint disease group during protrusion in the horizontal plane(p<0.05). 6. In NHP, disc displacement without reduction group and degenerative joint disease group showed significantly larger mandibular rotational angles during lateral excursion to the affected side than during lateral excursion to the non-affected side in both frontal and horizontal planes(p<0.05). The findings indicate that changes in head posture can influence mandibular rotational torque movements. The more advanced state is a progressive stage of TMDs, the more influenced by FHP are mandibular rotational torque movements of the patients with TMDs.

• 대한치과교정학회지
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• 제22권2호
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• pp.345-372
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• 1992

The purpose of this experiment was to study the effects of changes of mandibular position on temporomandibular joint in internal derangement patients Twenty-four female New Zealand White Rabbits, weighing over 3.5kg, were utilized in this study . Bilateral temporomandibular joint surgery was performed in twenty-one of the rabbits to displace disc anteriorly through incising the retrodiscal tissue 1-2mm posterior to the disc, thus inducing internal derangement. They were divided into three groups nine were left untreated after surgery, six were fitted with functional protrusive appliances 4 weeks after surgery, and six wore collar appliances to apply 4 ounces of mandibular refractive force per side 4 weeks after surgery. The remaining three served as the control group. Histologic examinations were performed after sacrificing them by threes at 4-week intervals. The results were as follows. 1. Histologic findings similar to internal derangement were observed in the rabbits whose retrodiscal tissues had been incised. 2. In the rabbits untreated after surgery, articular surface on condylar process and articular eminence showed severe erosion and deformation, and displaced disc manifested changes in both shape and internal architecture. 3. Functional protrusion after surgery resulted in progressive remodeling on postero-superior portion of condyle and glenoid fossa, while it also brought about erosion on articular eminence and anterior portion of condyle. 4. Mandibular retraction after surgery resulted in compression of retrodiscal tissue and regressive remodeling of posterior portion of condyle.