• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.23.1-23.8
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• 2015

Background: The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). Methods: A total of 15 joints from 11 elderly patients (71-78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. Results: No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. Conclusion: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.300-304
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• 1991

This is case report of open reduction of condylar fractures with or without discal injury. Many articles described open reduction and internal fixation of condylar fractures emphasize the method of bony reduction and fixation without mention of the position of the disc. So we like to present our cases of open reduction of condylar fractures in conjunction with reconstruction of the disc and associated structures. The pupose of this presentation is to emphasize several well - established principles of trauma management and management of temporomandibular joint injuries, such as 1) in situations of traumatic injury, anatomic restoration is the goal of treatment and, 2) anatomic alignment of the TMJ disc over the condyle is preferable to disc subluxation because the latter may lead to chronic pain, limitation of opening and degenerative arthritis. Although our case is small with short term follow up, we believe that open reduction and internal fixation of condylar fractures in conjunction with disc repair is a biologically sound approach to those fractures indicated for open surgery. Long term follow up will allow better judge the validity of this treatment approach to us.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.453-457
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• 2006

This study was designed to investigate the effect of intra-articular injection of hyaluronic acid for the treatment of internal derangements of the temporomandibular joint(TMJ). Sixteen patients with internal derangements of TMJ in 1 male and 15 females aged 68 to 18 years comprised the study material. The patients' complaint was limited mouth opening and pain during function. Patients were divided into 3 groups(articular disc displacement with reduction, articular disc displacement without reduction, osteoarthritis group). The preauricular area was disinfected anesthetized locally with 2% lidocaine hydrochloride. Arthrocentesis was performed. Hyaluronic acid(1.5 ㏄) was then injected into the superior compartment of the TMJ. Active range of motion exercises were instituted at approximately 24 hours postoperatively. Antibiotics and NSAID, three times daily by mouth, was prescribed for 3 days. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, final follow-up visit postoperatively. Pain during function was assessed using visual analog scales(VAS). Maximal mouth opening was recorded as a distance between upper incisal edge and lower incisal edge. Intra-articular injection of hyaluronic acid caused significant reduction of pain during function, significant increase of maximal opening range. These findings suggest that intra-articular injection of hyaluronic acid is useful for decreasing patient reports of pain while increasing functional mobility of the mandible in internal derangements of the TMJ.

• Journal of Oral Medicine and Pain
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• v.31 no.3
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• pp.265-274
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• 2006

Temporomandibular joint (TMJ) internal derangement, especially disc displacement with reduction (DDwR) is the most common TMJ arthropathy and has been thought to do some effects on masticatory performance. Measuring of maximal bite force has been widely used as objective and quantitative method of evaluating masticatory performance, but previous studies showed various results due to various characteristics of subjects and different measuring devices and techniques. In a few studies about the correlation of bite force and temporomandibular disorders (TMD), some authors reported that bite force and masticatory performance would be reduced in patients with TMD because of pain. But the correlation of changes in structure of articular disc and masticatory performance has not been well investigated yet. In this study, to investigate the influences of non-painful disc change on the masticatory performance, we measured the value of maximal bite force, occlusal contact area and occlusal pressure of 39 patients with non-painful DDwR of the TMJ using pressure sensitive film, and compared it with that of 59 controls. The results are summarized as follows: 1. The maximal bite force (P<0.01) and the occlusal contact area (P < 0.05) of the DDwR patients were greater than the controls. 2. There was no significant difference in occlusal pressure between the DDwR patients and the controls (P > 0.05). 3. The maximal bite force of the male group was greater than that of the female group (P < 0.05). However, the occlusal contact area and the occlusal pressure between the male and the female group didn't show significant difference (P > 0.05). From the results above, we can suggest that DDwR could be a factor of changing bite force, but more controlled, large scaled and EMG related further study is needed.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.19 no.1
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• pp.7-18
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• 1989

The authors analyzed the clinical findings, radiological findings and their correlations in the temporomandibular joint disorders. The results were as follows: 1. The most prevalent age group was in the first decade, then the second decade and the third decade. Female were more common with a ratio of 3.4:1. 2. The most common clinical findings was the pain on open mouth position (42.3%), then came the clicking and limitation of mouth opening. 3. The most common bone change on the condyle side was the erosion, then came the flattening, the osteopyte and the sclerosis in that orders. 4. In the case of the crepitus, the coarse crepitus showed more radiological change than the fine crepitus. The 27% of the patients with crepitus showed the bone change and the patients with crepitus showed more bone change than any other clinical symptoms. 5. In the case of the mouth opening limitation, the evaluation of the translatory movement by transcranial projection was in accordance with the clinical evaluation. 6. The correlation between the clinical symptom and the condylar position within the mandibular fossa was not present and in the case of diagnosis of disc displacement, the transcranial projection seemed not to be able to substitute for the arthrography. Radiographically, the most prevalent age group which showed the bone change was in the first, the second and the third decade. And the bone change seemed to have no relationship with aging.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.2
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• pp.141-146
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• 2002

Purpose: Various treatment methods have been utilized for recurrent dislocation of the TMJ (temporomandibular joint). The purpose of this study is to define the effect of the eminectomy with discoplasty that had been performed in patients with TMJ luxation. Materials and Methods: Twenty patients (22 joints), whose diagnosis were TMJ dislocation were selected in 772 patients (871 joints) who had been underwent TMJ surgery between 1988 and 2000. The selected patients were divided into two groups. Group I (12 joints) was the habitual-luxation group which involves the recurrent TMJ dislocation patients. Group II (10 joints) was the open lock-history group which involves the patients who had more than two episodes of TMJ luxation and TMJ disorders. The history of TMJ luxation, maximum mouth opening and other TMJ signs and symptoms before and after surgery were reviewed. Results: In group I, one patient who had been underwent both TMJ operation had a intermittent locking, but it disappeared after post-operative 32 months. In group II, intermittent pain was present in one patient who had bruxism, but it was disappeared by splint therapy. No more TMJ dislocations and other pains were checked in other patients of group I and II. Conclusion: Eminectomy with discoplasty may be used to successfully treat the TMJ habitual luxation accompanied with abnormal condition of the disc-condyle complex.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.2
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• pp.120-130
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• 1999

This investigation studied the effect of ovariectomy on the temporomandibular joint (TMJ) of rat. Forty female Sprauge-Dawley strain white rats, each weighing about 200grams were used and divided into two groups. The one group was performed ovariectomy, and the other was performed sham operation. Both group were killed at the intervals of 3 days, 1, 2, 4, and 8 weeks postoperatively, paraffin section were stained with H&E, MT and histomorphometric study of the TMJ was performed in a synchronous manner with an sham operated control group The result were as follows: 1. At 4 weeks after ovariectomy, an adhesion between the inferior surface of the articular disc and the condyle was observed in the central portion. At 8 weeks after ovariectomy, a focal thickening of the bone (osteophyte) was observed in anterior portion and there was a marked decrease in the trabecular bone in the posterior region. 2. The thickness of cartilage zone was increased at 2 weeks postopratively in the central portion, and decreased at 4 weeks postopratively in the posterior portion. The thickness of transitional zone was decreased at 1 week postoperatively in the anterior and proliferating zone was decreased postoperatively. The thickness of articular zone was decreased at 3 days postopratively in the anterior portion, and decreased at 1 week postoperatively in the central portion. From the above finding, we could conclue that estrogen deficiency in rats causes alteration of TMJ in marked early stage.

• Imaging Science in Dentistry
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• v.45 no.1
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• pp.1-5
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• 2015

Purpose: Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. Materials and Methods: Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fisher's exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. Results: Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. Conclusion: In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable.

• Journal of Oral Medicine and Pain
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• v.40 no.1
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• pp.28-34
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• 2015

Purpose: The aim of this study is to assess the relationship between possible occlusal change after stabilization splint therapy and the research diagnostic criteria for temporomandibular disorders (RDC/TMD) Axis I diagnoses and lateral cephalometric variables. Methods: Clinical and radiographic records of 47 TMD patients wearing stablization splint were reviewed. The number of occluding teeth was recorded and lateral cephalogram was taken at pre-treatment and 6-month post-treatment. They were divided into two groups. The control group consists of patients with the unchanged number of occluding teeth throughout 6-month splint therapy (19 females and 4 males), and occlusal-loss group with the number of occluding teeth decreased (19 females and 5 males). The difference of RDC/TMD diagnoses and cephalometric variables were compared between two groups. Results: In the control group, RDC group I, muscle disorders, was 39.1% (9/23), group II, disc displacements, was 17.4% (4/23), group III OA, osteoarthritis/osteoarthrosis, was 73.9% (17/23), and group III pain, arthralgia, was 82.6% (19/23). In the occlusal-loss group, group I was 41.7% (10/24), group II was 41.7% (10/24), group III OA was 70.8% (17/24), and group III pain was 83.3% (20/24). The frequency of RDC groups was not different between two groups, analyzed by binomial logistic regression. Pre-treatment cephalometric variables were not different between two groups. However, articular angle, AB to mandibular plane and ODI decreased and gonial angle increased significantly in the occlusal-loss group, implying clockwise rotation of the mandible, between pre-treatment and 6-month post-treatment, while none of cephalometric variables showed any statistical difference in the control group. Conclusions: Change in the number of occluding teeth was not related to the RDC/TMD diagnoses. Cephalometric values changed only in the occlusal-loss group as a result of mandibular clockwise rotation. None of cephalometric variables before the stabilization splint therapy was statistically different between the control and occlusal loss group.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.5
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• pp.544-549
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• 2000

The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and high incidence of recurrence. TMJ ankylosis has been treated by excision and total joint reconstruction with alloplastic, allogeneic, autogenous materials as interpositional materials. The temporalis myofascial flap had been considered to be a successful interpositional material, due to its anatomical, topographical, and functional properties. This study evaluated the efficacy of the temporalis myofascial flap for nine TMJs (five patients) through the preauricular approach and coronoidectomy. Radiographic and physiologic long term result was investigated in this study. The result reveals that the temporalis myofascial flap is a good autogenous tissue satisfying the criteria of an ideal interpositional material, which offers a material that fulfills the physiological function of the disc. In spite of favorable functional outcome, mild postoperative openbite tendency remains another challenge.