• 대한치과보철학회지
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• 제26권1호
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• pp.171-184
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• 1988

The establishment of an optimal and functional condylar position (centric relation) as the therapeutic and diagnostic reference position during occlusal treatment for patients with temporomandibular joint and muscle pain. dysfunction has long been an important subject in dentistry. The objective of this study was to compare the reproducibility md the changes of condylar position in normal group to those in patient group after use of the occlusal biteplane splint. For this study, 11 normal adults who had no symptoms of masticatory dysfunction and 18 patients who had visited at the department of occlusion in dental infirmary of Yonsei University were selected. For each subject three centric relation records were recorded before treatment, after 2 weeks and after symptoms were improved. And the condylar positions in centric relation were measured using articulators and a Vericheck. On the basis of this study, the following results were obtained. 1. In normal group, there was no significant difference of reproducibility in condylar position before and after the use of the occlusal biteplane splint for 2 weeks. 2. In patient group there was significant improvement in the reproducibility of condylar position after treatment (P<0.01). The reproducibility in patient group, however, was less than normal group. (P<0.01) 3. The mean distance of condylar movements was $0.38{\pm}0.22mm$ after 2 weeks in normal group. 4. In patient group, condylar movements were $1.36{\pm}0.70mm$ (P<0.01), significantly different from normal group. (P<0.01) 5. In patient group, the main direction of condylar movements after treatment was toward anterior and superior, preponderance being at superior direction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권3호
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• pp.189-197
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• 1993

Tempormandibular Joint pain and dysfunction is a common and important clinical problem. With the recent advances in imaging technology, radiologists have made major contribution to the understanding of TMJ disease. The MRI has several advantages over the conventional imaging methods. It is possible to obtain surprisingly precise images of internal hard and soft tissues with MRI. It is not invasive without ionizing radiation. The abnormal disk position has been thought as the cause of TMJ internal derangement. But there are few methods to relate disk position to TMJ internal derangement quantatively. The object of our study is to determine the amount of anterior displacement fo articular disk in symptomatic patients related each symptoms. Using the method of Dr. Drace, we studied the 38 joints of 22 persons with susceptable TMJ internal derangement. 1. In determining the anterior displacement of TMJ articular disk, the junction between the posterior band and bilaminar zone was useful. 2. The mean anterior displacement of disk in reduction group and without reduction group were $51.0^{\circ}C$ and $81.1^{\circ}C$ respectively. The difference was significant. 3. In the mean anterior displacement of disk, the pain without clicking group showed $84.8^{\circ}C$ and the clicking and pain group $70.8^{\circ}C$, the clicking group respectively.

• 대한치과교정학회지
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• 제16권1호
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• pp.85-106
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• 1986

The purpose of this investigation was to know the means of the T.M.J. space and to compare spational differences in centric relation and centric occlusion by the T.M.J. Tomogram and to study the correlation between the articular eminence slope and the lingual surface slope of the maxillary central incisor by the Cephalogram in near normal occlusion subjects. These results could give contribution for the diagnosis of orthodontic treatment and T.M.J. dysfunction and the assessment of orthopedic treatment and orthognathic surgery. 44 young adults (28 men and 16 women, 21 to 27 years of age) were selected from the Dental students in Yonsei Univ. Criteria for selection was normal occlusion, no clinical signs and T.M.J. dysfunction, no history of orthodontic treatment, and no missing tooth. After submental vertex view analysis. each subject was given the T.M.J. Tomogram in centric relation and centric occlusion and the Cephalogram was given with Quint Sectograph. All data was recorded and statistically processed with the CYBER computer system. Results were analyzed: the following findings and conclusions were derived. 1. The mean value for the combined right and left anterior joint space was 2.549mm, the posterior space was 2.260mm, and superior space was 3.31mm in centric relation. The anterior space was 2.316mm, posterior space was 2.474mm, and superior space was 3.435mm in centric occlusion. 2. In the centric relation position, both condyles were placed more posterioly and superioly in their fossae than in the centric occlusion position by the spatial difference. 3. In the centric occlusion position, both condyles were more symmetrically placed in their fossae with equal anterior-posterioly rather than in the centric relation position. 4. The mean articular eminence angle was $48.19^{\circ}$ and the mean fossa height was 7.911mm. A strong positive correlation between the articular eminence angle and fossa height in T.M.J. Tomogram was found. 5. In Cephalometric analysis, there was a strong positive correlation between the articular eminence slope and the lingual surface slope of the upper central incisor to the FH plane, occlusal plane, and S-N plane. 6. There was moderate positive correlation between the S-E measurements and the fossa height, articular eminence angle, and DcGn < F-H.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.131-134
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• 2009

저자들은 보편적으로 보존치료가 불가능 하여 관혈적 정복술이 필요한 하악의 관절돌기골절 증례에서 당뇨, 고혈압의 병력, 고령으로 인한 절개 및 박리, 전신마취 시간증가로 발생할 수 있는 합병증을 줄이기 위해 우선적으로 시행한 형광투시하의 비관혈적 도수정복만으로 정확한 정복에 성공할 수 있었고 이후 골 유합까지 유지하여 만족스런 결과를 얻었기에 보고하는 바이다.

• 대한구순구개열학회지
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• 제7권2호
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• pp.133-139
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• 2004

Congenital bilateral idiopathic hyperplasia of the coronoid processes presents with limited mouth-opening without visible maxillofacial deformity or temporomandibular joint dysfunction / disorder. According to Blanchard et al and McLoughlin et al, it was lnitially described in 1853 by Langenbeck, and the first cases were reported by Holmes in 1956. Since then, there have been regular reports of a certain number of cases. In 1995, McLoughlin et al recorded 79 published cases of bilateral hyperplasia of the coronoid processes. Among them, Fabie et al have found only 3 published cases relating to children younger than 8 years, and have presented the first case of objectively diagnosed restricted mouth opening from birth by pediatricians. Authors have experienced 2 child patients with mouth opening limitation who was diagnosed congenital bilateral idiopathic hyperplasia of the coronoid processes without any other TNJ morphology in Dept of Oral and Maxillofacial surgery, Seoul National University Dental Hospital in 2004. Coronoidectomy was performed and postoperative active mouth opening exercise is indicated. Authors report 2 cases of congenital bilateial idiopathic hypeiplasia of the coronoid processes with literature liview.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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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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• 제35권3호
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• pp.189-194
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• 2013

Osteochondroma is a benign neoplasm, osseous projection surrounded with cartilage, 35.8% of benign osseous tumor, 8.5% of whole osseous tumor and usually arises from the skeletal bone. Osteochondroma is a cartilaginous derivation and relatively uncommon in the craniofacial bone. Osteochondroma of the mandible has slow growth rates which mainly affect women around forty years of age and it can appear through the coronoid process and mandibular condyle, especially in the medial half. Clinical finding associated with osteochondroma of condyle are primarily a palpable, painless temporomandibular area mass with facial asymmetry, malocclusion and midline deviations. Sometimes pain and dysfunction like trismus often accompany the anatomic derangement. Other features include malocclusion with open-bite on the affected side and cross-bite on the contralateral side. In this study, a 45-years old female patient exhibits pain on the left temporo-mandibular joint area and malocclusion due to loss of the molar region with osteochondroma on the top left of her mandibular condyle head. The patient is able to recover gradually from the symptom through treatments on manipulation, stabilization splint, arthroscopic lavage and surgical excision, thus, this is reported as a clinical case.

• 대한소아치과학회지
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• 제23권2호
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• pp.559-574
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• 1996

The purpose of this study was to determine whether there was any correlation between temporomandibular joint dysfunction and structure of the mandibular condyle. Weanling rats had their masseter muscles resected and immunohistochemical findings were observed with a light microscope. The results obtained were as follows : 1. The condylar cartilage region was divided into articular, proliferating, cartilage cell and hypertrophic cell layers according to cell morphology. 2. In light microscopic views, the proliferating and cartilage cell layers of the experimental group decreased gradually and at the 8th week significantly. 3. In immunohistochemical staining for type I and II collagen, a reaction was detected in the lower part of proliferating cell and cartilage cell layers. In the cartilage cell layers, a stronger cellular reaction was present. Immunohistochemical staining for type II collagen reacted more strongly than that of type I collagen. 4. In immunohistochemical staining for proteoglycan, the staining of the experimental group resembled the control group and gradually showed a weak reaction. The proliferating and cartilage cell layers reacted more strongly than the hypertrophic cell layer. 5. In immunohistochemical staining for proliferating cell nuclear antigen(PCNA), the strong reaction was detected in the nucleus of the proliferating cell layer both in control and experimental groups. But the thickness of the proliferating layer decreased in experimental group, consequently the reaction of the experimental group was reduced more than that of the control group.

• 치위생과학회지
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• 제9권4호
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• pp.375-380
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• 2009

본 연구는 노인의 주관적 구강건강상태와 주관적 구강증상의 관련성을 조사하여, 노인의 구강건강 향상을 위한 노인구강보건사업개발의 기초자료를 확보하기 위하여 실시하였다. 2008년 6월부터 9월까지 서울 소재 경로당을 방문하여 편의표본추출법으로 노인 200명을 선정하였으며, 개별 면접조사법으로 자료를 수집하여 통계 처리한 결과 다음과 같은 결론을 얻었다. 1. 주관적인 구강증상에서 저작시 어려움, 구강건조, 구취는 가끔 느낀다는 응답이 각 32.0%, 38.5%, 40.5%로 나타났으며, 구강내 통증, 악관절 이상의 경험, 잇몸질환의 경험 은 겅의 없다라는 응답이 각 44.5%, 69.0%, 46.0%로 높게 나타났다. 2. 구강내 잔존 치아수는 평균 13.71개로 나타났다. 3. 성별에 따른 주관적 구강증상에서 성별과 악관절 이상(p=0.000), 구강건조(p=0.001), 구취 (p=0.006)에서 통계학적으로 유의한 관계를 보았으며, 남자가 여자보다 구강증상을 경험 하고 있는 것으로 나타났다. 4. 저작능력(p=0.000), 구강내 통증(p=0.010), 악관절 이상(p=0.010), 구강건조(p=0.001)와 주관 적 구강 건강상태와는 통계적으로 유의한 차이를 보여 구강이 건강하지 않은 노인이 구강 증상을 경험하고 있는 것으로 나타났다. 잔존 치아 수는 건강하지 않은 노인이 적 었으며, 유의한 차이를 보였다(p=0.000). 5. 치아수가 많을수록 저작능력(p=0.000)과 구강건조의 경험(p=0.000)을 적게 하고 있음을 알 수 있었고, 치아수가 많을수록 잇몸질환의 경험(p=0.007)이 많은 결과를 보였으며, 유의한 차이를 보였다. 또한 구강건강상태가 좋을수록 저작능력(p=0.000), 구강내 통증(p=0.004), 구강건조(p=0.000), 구취의 경험(p=0.008)이 적었으며 통계학적으로 유의한 관계가 있었다. 본 연구결과를 통해 노인이 인지하는 구강건강상태와 구강증상과의 관련이 있으며, 잔존하는 치아의 수와 주관적 구강증상도 관련성이 있음을 알 수 있었다. 따라서 노인의 자연치아를 유지하기 위하여 구강병의 예방적 활동과 구강건강상태 인지 수준을 향상시킬 수 있도록 계속구강건강관리제도와 구강보건교육프로그램이 절실히 필요하다고 사료 된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.758-770
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• 1996

Discectomy is the oldest and most commonly performed operation for the painful temporomandibular joint with internal derangement. It is the one operation for which there are longest follow-up study, with Eriksson, Silver, and Tolvanen et al reporting good results in patients about 30 years after discectomy. About 80% to 90% of patients clinically experience relief from pain and dysfunction after discectomy, and interestingly, the results may improve with time. However such as Myrhaug found headache and Poswillo supposed pain and limitation of movement as postoperative complications, even though this operation had the longest follow-up term, several aspects of discectomy remain unclear. The controversies to discectomy for TMJ with pain and dysfunction have laid emphasis only upon clinical results, and then the histomorphological study was planned to evaluate the morphologic change of TMJ after discectomy. To clarify the nature of the change through an observation on the morphologic changes of articular cartilage and subchondral bone of the condyle resulting from experimental unilateral discectomy in rabbit, the author excised the left articular discs of 12 male rabbits(control 4 rabbits), weighing about 3kg, and at 1, 3, 6, 9 weeks following surgery, harvested both(left surgical site and right nonsurgical sits) TMJ. The specimens were examined with light microscope after H-E and MT stain and the obtained results were as follows. 1. Histopathological features showed thickening of articular zone and active proliferation of fibrocartilaginous zone associated with slight proliferative zone in surgical site than control group. Also replacement of chondrocytes in calcified cartilaginous zone into bone cells was observed. 2. There were thinning of thickness of each zone of articular cartilage except calcified cartilagnous zone was observed in nonsurgical site. 3. In MT stain of condylar trabeculae, there was increased calcification in nonsurgical site than control and surgical site and the degree of calcification was similar in surgical site and control group. 4. In both site of experimental group no features of degenerative changes were observed. From the above results, it is presumed that the morphologic changes of surgical site discectomy are compensatory remodeling process characterized by an hyperplastic reaction of the articular zone and fibrocartilaginous zone filling the void created by removing the disc, and the bone changes are secondary to changes in the cartilage. Increased degree of calcification seen in condylar trabeculae of nonsurgical site results from the excessive use of condyle of that site.