• 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 Oral Medicine and Pain
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• 제38권1호
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• pp.87-95
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• 2013

측두하악관절 골관절염은 측두하악장애의 한 형태로 관절조직의 생리적 내성을 초과하는 기능적 부하가 지속적으로 관절에 가해졌을 때 관절연골 및 연골하 골조직의 점진적 파괴와 이차적 염증을 특징으로 하는 질환이다. 관절면에 가해지는 물리적 하중은 관절내에서 기질파괴 단백효소나 염증성 cytokine, 유리기의 활성을 증가시키고, 그에 따라 골조직의 퇴행과 재형성 사이의 균형을 깨뜨려 골조직의 흡수를 야기한다. 최근에는 물리적 하중 이 외에 비만세포에서 유래하는 adipokine이 골흡수를 증가시킨다는 보고들이 있으나 측두하악관절에 적용하기에는 아직 추가적인 연구가 필요하므로 현재로서 골관절염의 치료는 관절의 기능적 부하를 줄이고 환자의 생리적 내성을 증가시키는 방향으로 이루어져야 한다. 임상증상은 충분한 기간 정확한 술식대로 시행한 물리치료, 약물치료, 교합안정 장치치료 등의 보존적 처치와 관절강내 주사요법이나 관절세척술 및 관절경 수술과 같은 추가적인 외과적 처치에 의해 성공적으로 조절될 수 있으나, 임상증상의 개선이 골파괴의 중지와 재형성을 담보하는 것은 아니므로 임상증상의 개선 이 후에도 지속적인 골변화의 추적관찰이 필요하다. 또한, 골변화 활성 자체를 직접적으로 조절할 수 있는 활용 가능한 치료법이 없는 한, 지속적인 동기유발과 행동조절을 통해 관절에 가해지는 기능적 부하를 환자 스스로 조절할 수 있도록 끊임없이 교육하는 것이 골변화를 겪는 측두하악관절로 하여금 보다 이른 시기에 보다 유리한 정형적 안정에 도달하게 함으로써 골관절염을 보다 성공적으로 조절할 수 있는 길이라고 할 수 있다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권3호
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• pp.173-179
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• 2012

Purpose: This study was to determine the effects of surgical induction of anterior disc displacement (ADD) on the distribution of glycosaminoglycan (GAG) and collagen fiber arrangement in the rabbit temporomandibular joint (TMJ) tissues including articular cartilage of condyle, disc, retrodiscal tissue, and articular eminence. Methods: We used van Gieson staining and Alcian blue critical electrolyte concentration (CEC) method to observe change of collagen fibers on disc and to measure GAG up to 10 weeks in TMJ tissues after surgical induction of ADD on 25 rabbits. Results: CEC measurements for GAG showed 0.3 M, 0.4 M, 0.6 M, and 0.8 M at 1 week, 2 weeks, 3, 4, and 8 weeks, 10 weeks, respectively. This result indicated that GAGs shifted to highly sulphated ones as time passed. Disruption of collagen fiber arrangement in the disk occurred at 10 days and aggravated at 3 weeks. Conclusion: Our study showed degenerative osteoarthritis changes in rabbit TMJ following surgical induction of ADD up to 10-week period.

• 대한치과의사협회지
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• 제50권5호
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• pp.256-261
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• 2012

Temporomandibular joint (TMJ) prosthesis have been hesitated to use because of bitter memories about Proplast-Teflon interpositional TMJ implants. Many clinicians, however, are trying to use total TMJ prosthesis with getting continuous long-term follow-up results. Alloplastic total TMJ replacement have been applied to much more patients who have failed previous TMJ prostheses or TMJ implants, fibrous/bony ankylosis, severe osteoarthritis, degenerative joint disease, idiopathic condylar resorption, condyle loss by trauma or tumor resection, and other bony destructive diseases. Nowadays three types of total TMJ prosthesis are widely used. In this article, indications, types of prosthesis, safety and stability would be demonstrated with a case report.

• Journal of Oral Medicine and Pain
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• 제30권1호
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• pp.107-119
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• 2005

측두하악관절 관절염은 골관절염, 골관절증, 다발성 관절염으로 나뉜다 골관절염과 골관절증은 관절통을 제외하면 그 증상, 징후, 방사선적 특징이 비슷하기 때문에 감별진단이 어렵다. 또한 초기 골관절염의 경우 방사선적 변화가 나타나지 않아서 오진을 할 수가 있다. 골스캔과 단광자방출 전산화 단층촬영은 골의 변화를 초기에 감지하는데 유용하다. 이 연구는 골스캔과 단광자방출 전산화 단층촬영을 이용하여 진단학적인 기준을 제시하기 위하여 시도되었다. 임상검사, 전산화단층 촬영, 골스캔, 단광자방출전산화 단층촬영을 실시한 304개의 측두하악관절을 대상으로 연구하였다. 연구결과 다음과 같은 결론이 도출되었다. 1. 골스캔을 이용하여 측두하악관절을 진단하는데 있어서 20대 환자의 단순섭취율이 1.397% 이상인 경우, 30$\sim$40대 환자의 단순섭취율이 1.332% 이상인 경우에는 골관절염으로 추정해 볼 필요가 있다. 2. 단광자방출 전산화단층 촬영을 이용하여 측두하악관절을 진단하는데 있어서 온점이 관찰되는 관상단면, 횡단면이 4개 이상일 경우에는 골관절염으로 추정해 볼 필요가 있다. 3. 골스캔을 이용하여 측두하악관절을 진단하는데 있어서 20대 환자의 단순섭취율이 1.370% 이상인 경우, 30-40환자의 단순 섭취율이 1.104% 이상인 경우에는 골파괴 과정이 진행중인 것으로 생각해 볼 필요가 있다. 4. 단광자방출 전산화단층 촬영을 이용하여 측두하악관절을 진단하는데 있어서 20대와 30-40대에서 온점이 관찰되는 관상단면이 4개 이상일 경우에는 골파괴 과정이 진행중인 것으로, 모든 연령에서 온점이 관찰되는 횡단면이 3개 이상일 경우에는 골파괴 과정이 진행 중인 것으로 생각해 볼 필요가 있다. 5. 임상적으로 주관적 관절통과 촉진통이 모두 나타난 경우에 골변화가 더욱 활발할 가능성이 높다. 6. 관절음, 관절통, 개구제한의 병력이 4.5개월까지 점차 길어질 수록 측두하악관절은 골관절염으로 점차 악화되고, 그 이후에는 골관절증으로 점차 안정화되는 경향을 보였다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권2호
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• pp.65-66
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• 2016

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권2호
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• pp.308-315
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• 1996

Osteoarthritis is a noninflammatory degenerative disease affecting the articular surfaces and is accompanied by remodeling of the underlying bone. The sympotms of osteoarthritis of the temporomandibular joint are pain in the joint and muscles of mastication, limitation. Osteoarthritis is generally accepted that several factors can contribute to the trauma, aging process, internal derangement and MPDS. Radiographic features of the osteoarthritis are seen flattening of joint, sclerosis on flattened area and osteophyte or anterior lipping. In the past, osteoarthritis was considered to self-limiting disease. Currently, synovial chondromembrane is part of the process of osteoarthritis secondary to trauma. Synovial chondromatosis is an uncommon disease of cartilaginous transformation of synovial membrane with formation of loose bodies within the joint space. The pathogenesis is more an active metaplastic than a neoplastic process. The cause of synovial chondromatosis is unknown. Although trauma and inflammation have all been cited as possible factors in tis pathogenesis. The clinical sign and symptoms are unilateral swelling of the joint region, pain in the joint area and crepitus seem to be the most reliable signs and symptoms. Radiographic evidence of loose bodies may or may not be present. This is a case report of 66 year old female with synovial chondromatosis, that is advanced disease of the osteoarthrits. We treated patient with surgical excision of lose bodies, diskectomy and synovectomy. The defected articular fossa area was reconstructed with temporalis fascia flap. The result was satisfactory.

• Journal of Oral Medicine and Pain
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• 제39권1호
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• pp.2-9
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• 2014

Purpose: The purpose of this study was to compare the clinical and radiographic features of temporomandibular joint (TMJ) osteoarthritis (OA) between adolescents and middle-old aged patients. Methods: The subjects were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Hospital and were diagnosed with TMJ OA by clinical exam, X-ray and cone-beam computed tomography (CBCT) from 2010 to 2011. We investigated 93 adolescent patients (12-19 years) and 53 middle-old aged (>45 years) patients who observed the erosive bony changes in TMJ. CBCT scans were retaken at intervals at an average of 8 months. Results: The adolescent patients showed unilateral degenerative changes more often, and the middle-old aged patients showed degenerative changes more frequently on both sides. The transition of bone changes to the improved group occurred most commonly in both the adolescent and middle-old aged patients. The adolescent patients were more likely to improve than middle-old aged patients. In the adolescent patients, loss of erosion and subjective symptoms occurred in shorter periods than in the middle-old aged patients. In the adolescent patients, the transition of erosion was distributed into proliferative, normal, and shortening in order. In the middle-old aged patients, the transition of erosion was distributed into shortening, proliferative, and normal in order. Conclusions: The clinical and radiographic features of TMJ OA are a significantly different between the adolescent and middle-old aged patients. Moreover, the difference by age of the adaptive and regenerative capacity of TMJ affects the prognosis of TMJ OA and adolescent patients have a better prognosis after treatment.

• Journal of Oral Medicine and Pain
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• 제39권1호
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• pp.22-25
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• 2014

Synovial chondromatosis (SC) in temporomandibular joint is a rare benign disorder characterized by cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue. The etiology of the disease is unclear but may be associated with trauma, overuse, local infection, and embryologic disturbance. SC does not spontaneously resolve and respond to nonsurgical treatment. SC should be differentially diagnosed with other temporomandibular joint disorders such as arthralgia or osteoarthritis because surgery should be done for managing it. However, primary diagnosis of SC is not easy because of nonspecific symptoms and signs. For the patients with unsuccessful conservative treatment response, especially accompanied by crepitus, preauricular swelling or posterior open bite, computed tomography/cone-beam computed tomography or magnetic resonance imaging should to be performed to exclude SC. We discussed the importance of the early diagnosis and surgical treatment of SC from this case.

• 대한치과의사협회지
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• 제57권4호
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• pp.204-212
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• 2019

Introduction : Patients with temporomandibular disorder may have various ear-related symptoms. If an excessive load is applied to the ear area due to the skeletal shape of the mandibular condyle or malposition of the disc, an auditory problems may occur. Case report : The patient was referred to our clinic due to the suspicion of temporomandibular disorder from the local otorhinolaryngology clinic. A few days ago, his right ear could not be heard. MRI showed that the left TMJ disc was anterior displacement with reduction, the right TMJ disc was anteromedial displacement without reduction. Also Right mandibular condyle showed sclerotic bone change, subchondral cyst and was compressing the frontal wall of the ear on MRI view. Right TMJ arthroplasty was done under the diagnosis of right TMJ osteoarthritis and osteochondroma. Postoperative intermaxillary fixation was done with SAS screw and elastics for 2 weeks. One month after the operation, hearing and TMJ discomfort were recovered without any complications. Conclusions As seen in this case, hearing loss due to benign tumor-like lesions of the temporomandibular joint should be treated surgically to restore the TMJ function and hearing.