• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권2호
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• pp.134-137
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• 2017

Giant cell tumor (GCT) of the craniofacial bones has been reported but they are not common. This tumor occurs more often in women than in men and predominantly affects patients around the third to fifth decade of life. GCTs are generally benign but can be locally aggressive as well. We report a case of GCT involving the temporomandibular joint (TMJ), which was initially thought to be temporomandibular disorder (TMD). A 22-year-old female presented with swelling and pain over the right temporal region for 18 months associated with jaw locking and clicking sounds. On examination, her jaw deviated to the right during opening and there was a $2{\times}2$ cm swelling over the right temporal region. Despite routine treatment for TMD, the swelling increased in size. Computed tomography and magnetic resonance imaging of the brain and TMJ revealed an erosive tumor of the temporal bone involving the TMJ which was displacing the temporal lobe. Surgical excision was done and the tumor removed completely. Histopathological examination was consistent with a GCT. No clinical or radiological recurrence was detected 10 months post-surgery.

• Journal of Korean Dental Science
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• 제8권1호
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• pp.1-9
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• 2015

Purpose: To evaluate the effectiveness of temporomandibular joint (TMJ) disorder follow-up and determine the factors that affect the TMJ bone scan hot spot numerical value (bone scan value), and to compare this value to the diagnosis of patients with temporomandibular joint disorders (TMD), their treatment options, and the resolution of their symptoms. Materials and Methods: A retrospective cohort study was performed on 24 patients (four males, 20 females) who received TMD treatment in the Section of Dentistry, Seoul National University Bundang Hospital (Seongnam, Korea) from 2007 to 2014. An analysis of the significance test and correlation between TMD diagnosis, treatment options, a baseline the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire, treatment before and after the clinical examination and subjective progress, and TMJ bone scan value change were completed by using SPSS version 12.0. Result: Although only 14 patients had bony factors that caused TMD, the average pre-treatment bone scan value of the all patients was $4.29{\pm}0.31$, which is higher than the finding for osteoarthritis (3.88), and reduced post-treatment bone scan value was found to be without a statistically significant difference (P=0.056). After the treatments, clinical symptoms in 18 patients disappeared, and six patients did not require additional treatment, although they still displayed subjective symptoms. It was observed that the higher the pre-treatment bone scan value, nonspecific physical symptoms, chronic pain index, characteristic pain intensity, disability score, were, the lower the post-treatment bone scan value was. And this reduced post-treatment bone scan value tendency was not shown with the pre-treatment depression index, but there was not a statistical difference. Conclusion: The post-treatment TMJ bone scan value tended to be insignificantly reduced in the 24 patients whose clinical symptoms were improved (P=0.056). Moreover, the TMJ bone scan value showed no relation to the TMD type or its related symptoms.

• Journal of Oral Medicine and Pain
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• 제39권1호
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• pp.26-28
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• 2014

Nasopharyngeal cancer is malignant tumor of nasopharyngeal area that is characterized of lymphadenopathy, pain, otitis media, hearing loss and cranial nerve palsy and may present symptoms similar to temporomandibular disorder such as facial pain and trismus. In this case, the patient with symptoms similar to temporomandibular disorder after surgery for otitis media presented with facial paresthesia and masticatory muscle weakness. Examinaion of trigemimal nerve was shown sensory and motor abnormaility. The patient was referred to a neurologist. Nasopharyngeal cancer was suspected on computed tomography and magnetic resonance imaging and was confirmed by biopsy. If the patient presenting with paresthesia and muscle weakness the cranial nerve examination should be performed regardless of typical temporomandibular disorder symptom. The neurologic symptom can be caused by neoplasm such as brain tumor and nasopharyngeal cancer. Nasopharyngeal cancer on rosenmuller fossa can develop otitis media. Therefore, the patient with otitis media history should be consulted to otorhinolaryngologist to examin the nasopharyngeal area.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.136-142
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• 2006

Temporomandibular joint(TMJ) disorders have characteristic clinical findings such as pain, joint sound, and abnormal jaw function. With the rapid progress in TMJ imaging techniques, magnetic resonance imaging(MRI) especially provides the clinician and researcher with the ability to evaluate TMJ disorders(effusion, anterior disk displacement) and the hard and soft tissue of the TMJ. In order to manage the internal derangement of TMJ such as anterior disk displacement, the so-called appliance therapy is commonly used. This technique became the treatment of choice before surgical intervention by many practitioners. The purpose of the present study was to evaluate and determine the efficacy of anterior repositioning splint by means of the change of the position of the disk through pre- and post-treatment MRI. MRI and clinical symptom were carefully recorded in TMJ disorder patients. The relationship between TMJ symptoms such as pain, clicking sound, and disk displacement and effusion in MRI were analyzed. Then, splint therapy was applied for 3 months according to our protocol; at day 1, patients should wear 24 hours, in order to accomodate the splint and then, wearing time is reduced to 12 hours per day for one month. During next 2 months, it is tapered to 8 hours per day according to the evaluation of the clinical symptoms. Post-treatment MRI was obtained after 3 month protocol. This treatment strategy improved the clinical symptoms of TMJ disorder, and effusion and articular disk position showed a significant change. In conclusion, a treatment modality using an anterior repositioning splint therapy is an appropriate method for temporomandibular disorder patients.

• Imaging Science in Dentistry
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• 제44권4호
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• pp.293-299
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• 2014

Purpose: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). 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 T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the $X^2$ test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Conclusion: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

• Journal of Oral Medicine and Pain
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• 제44권4호
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• pp.189-194
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• 2019

Perforation of articular disc of temporomandibular joint is a unusual condition and diagnosed through magnetic resonance imaging (MRI), arthrography or arthroscopic surgery. We attempted to investigate the suspicious findings of articular disc perforation through examination commonly used in temporomandibular disorder (TMD) patients. We retrospectively analyzed the clinical and imaging findings of five TMD patients whose articular discs were perforated based on MRI. The most meaningful finding was the abnormal width of the joint space in cone-beam computed tomography. Thus, the clinician should perform a thorough assessment of the joint space in TMD patients and conduct additional investigation to determine what caused the abnormal joint space.

• Journal of Oral Medicine and Pain
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• 제46권3호
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• pp.69-74
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• 2021

As for temporomandibular joint arthritis (TMJ OA), managing the contributing factors at an early stage through accurate diagnosis is necessary to prevent irreversible bone changes. TMJ OA, which is a multi-organ disease caused by various pathophysiological mechanisms, is developed mainly due to mechanical overload. It is a disease characterized by degeneration of articular cartilage and subchondral bone as a low-level inflammatory arthritis condition developed by dysregulation of catabolic and anabolic activity of chondrocytes. Age, mechanical overload sensing of cartilage, chondrocyte apoptosis, catabolic enzymes, inflammatory factors, abnormal remodeling of subchondral bone, and estrogens may be involved in the pathogenesis of arthritis. Therefore, a comprehensive evaluation is needed to diagnose and manage progressive cartilage degeneration, subchondral bone remodeling, and associated symptoms of TMJ OA.

• 한국콘텐츠학회논문지
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• 제9권7호
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• pp.218-224
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• 2009

이 연구는 악안면외상경험과 측두하악장애 유병상태와의 관련성을 조사하여 측두하악장애의 예방과 치료계획에 도움을 주고자 울산광역시에 소재한 C보건대학 학생 370명을 대상으로 설문조사를 실시하였다. 수집된 자료는 SPSS 프로그램을 이용하여 분석하여 다음과 같은 결론을 얻었다. 1. 측두하악관절잡음 유병률은 남학생 25.7%, 여학생 22.7%로 남학생이 측두관절잡음 발생이 높았으나(p<0.01), 학년별로는 유의한 차이를 보이지 않았다. 2. 측두하악동통 유병률은 여학생이 높게 나타났다. 3. 개구장애 유병률은 여학생 10.8%, 남학생 7.0%로 여학생이 개구장애 발생이 약간 높게 나타났다. 4 측두하악장애로 인한 치료 경험은 남학생 6.5%, 여학생 4.3%로 남학생이 측두하악장애 치료경험률이 높게 나타났다(p<0.05). 5. 악 안연외상 경험률은 남학생이 높게 나타났으며(p<0.01), 악안면외상 경험 경로 중 넘어짐이 가장 많았으며, 운동, 기타 순으로 나타났다. 6. 악안면 외상과 측두하악장애와의 관련성은 악악면외상과 측두하악관절잡 음 간에 통계적으로 유의한 관련성을 보였다(p<0.01). 이상의 결과 악안면외상 경험유무와 측두하악장애 간에는 관련성이 존재하며 악안면외상을 측두하악장애 발생의 기여요인으로 볼 수 있겠다. 따라서 향후 측두하악장애를 일으키는 요인이 무엇인지 그 관련요인에 대한 추가연구가 필요하다고 사료된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권3호
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• pp.120-127
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• 2018

Objectives: The aim of this study was to reveal how collagenases (matrix metalloproteinase [MMP]-1, 8, 13) and tissue inhibitor of metalloproteinase 1 (TIMP-1) are expressed in immunohistochemistry of retrodiscal tissue in temporomandibular joint disorder patients. Materials and Methods: This study was conducted on 39 patients who underwent discoplasty or discectomy. Immunohistochemical staining was undertaken and expression levels of MMP-1, 8, 13, and TIMP-1 were evaluated. The status of internal derangement of disc, osteoarthritis, and joint effusion were analyzed using magnetic resonance imaging (MRI). Disc status observed during operation was also categorized. Results: The more severe disc derangement was observed on MRI, the more increased expression of MMPs and TIMP-1 appeared. Regarding MMP-13 expression, 86.7% of late-stage disc displacement patients showed grade II or III. Expression level of MMPs or TIMP was not statistically significant associated with joint effusion level. In perforation and/or adhesion groups, all patients showed grade II or III expression of MMP-13. Once perforation occurred, MMP-13 showed increased expression with statistical significance. Conclusion: MMP-1 and MMP-13 expression seem to be related to progression of osteoarthritis whereas MMP-8 does not seem to have a specific role with regard to temporomandibular joint disorders. TIMP-1 is considered to be partly related to internal derangement rather than osteoarthritis, but it is not significant.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권5호
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• pp.263-269
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• 2020

Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia. This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.