• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.3
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• pp.262-267
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• 2006

The term temporomandibular disorders is used to describe a group of conditions that involve the temporomandibular joint, masticatory muscles, and associated structures. Many modalities have been proposed for treating temporomandibular disorders, including medication, physical therapy, occlusal stabilization splints with or without manual repositioning, surgery, and arthrocentesis. Temporomandibular disorders are treated in a step-wise manner. Initially, conservative treatment is used. Depending on the response, more aggressive interventions may be necessary. This usually takes the form of arthrocentesis. Arthrocentesis is used in the treatment of not only acute, closed, and locked TMJs but also various other temporomandibular disorders. Recently, the intra-articular injection of sodium hyaluronate after arthrocentesis was shown to have long-term palliative effects on TMJ symptoms. Synovial fluid consists of plasma and glycosaminoglycan, including hyaluronic acid derived from synovial cells. Sodium hyaluronate, the sodium salt of hyaluronic acid, is a high-molecular-weight polysaccharide and a major component of synovial fluid. This highly viscous substance has analgesic properties, lubricant effects, and anti-inflammatory actions; it causes cartilage formation and plays a role in the nutrition of avascular parts of the disc and condylar cartilage. We conclude that the intra-articular injection of sodium hyaluronate is effective for treating temporomandibular disorders.

• Journal of Acupuncture Research
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• v.36 no.4
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• pp.197-203
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• 2019

The purpose of this study was to investigate useful manual therapy techniques for peripheral facial nerve palsy and to propose guidelines to be applied for current manual therapy techniques. Several databases were searched to find manual therapies for facial palsy. These therapies included cervical, and temporomandibular joint chuna manual therapy, proprioceptive neuromuscular facilitation, neuromuscular re-education, facial exercise, and mime therapy. Both cervical, and temporomandibular joint chuna manual therapy release nerve compression, helping blood circulation and nerve conduction. Proprioceptive neuromuscular facilitation uses irradiation, bilateral activation, and eccentric facilitation to improve muscle power and symmetry. Neuromuscular re-education, as a retraining tool for facial movement patterns, enhances neuromuscular feedback. Facial exercise helps the patient continuously move and massage facial muscle themselves. Mime therapy aims to develop a conscious connection between the use of certain muscles and facial expressions. The use of facial chuna manual therapy for peripheral facial nerve palsy can stimulate the proprioceptive neuromuscular receptors in the face. Peripheral facial nerve palsy has 4 phases; progress phase, plateau phase, recovery phase, and sequelae phase. Each phase needs different treatments which include relaxation, assistance, resistance, origin-insertion extension, and nerve pathway expansion.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.4
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• pp.1-11
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• 2019

Purpose : This study was aimed at investgating the effect of McKenzie exercise on temporomandibular joint disorder (TMJD) and body balance. Methods : Thirty subjects with TMJD were selected. They were randomly assigned to one of two groups (15 in each group) : namely the conservative treatment group and McKenzie exercise group. The conservative treatment group were treated physical therapy for 6 weeks (3 times a week). The McKenzie exercise group performed McKenzie exercise for 6 weeks (3 times a week). We measured mouth opening, pain, muscle activation and body balance before and after exercise by using the maximum mouth opening MMO), visual analog scale (VAS), electromyography and Biodex Balance System, respectively. Results : We found statistically significant differences in pain and mouth opening in the conservative treatment group and McKenzie exercise group before and after (p<.05). Conclusion : We confirmed the effect of McKenzie exercise on TMJD. Thus we thought these results could be used as basic data and reference for TMJD. But we need more study effect of McKenzie exercise on TMJD and body balance.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.6
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• pp.301-307
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• 2014

Coronoid process hyperplasia is a rare condition that causes mouth opening limitation, otherwise known as trismus. The elongated coronoid processes impinge on the medial surfaces of the zygomatic arches when opening the mouth, which limits movement of the mandible and leads to trismus. Patients with trismus due to coronoid process hyperplasia do not have any definite symptoms such as temporomandibular joint pain or sounds upon clinical examination, and no significant abnormal signs are observed on panoramic radiographs or magnetic resonance images of the temporomandibular joint. Thus, the diagnosis of trismus is usually very difficult. However, computed tomography can help with the diagnosis, and the condition can be treated by surgery and postoperative physical therapy. This paper describes four cases of patients who visited our clinic for trismus and were subsequently diagnosed with coronoid process hyperplasia. Three were successfully treated with a coronoidectomy and postoperative physical therapy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.1
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• pp.1-2
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• 2024

• Physical Therapy Korea
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• v.23 no.3
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• pp.29-39
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• 2016

Background: In the treatment of temporomandibular joint (TMJ) disorder, the goals of traditional physical therapy are not only to reduce the inflammatory process leading to pain, but also to decrease joint overload and muscle hyperactivity. To achieve those goals, physical therapists generally use a photo-therapy, joint mobilization, and massage. Objects: To examine the impact of an unloading technique using non-elastic taping on the pain, opening mouth, functional level, and quality of life in patients with TMJ disorder. Method: Twenty patients with TMJ disorder were included in this study and randomly divided into the experimental ($n_1$=10), and control ($n_2$=10) groups. Traditional physical therapy including massage and stretching for 30 min was performed in both groups. Non-elastic taping was performed in the experimental group after traditional physical therapy, and they were recommended to keep the tape attached for 12 hours. Outcomes for pain, functional level, and quality of life were measured using a survey. The opening mouth was measured using a general ruler. Result: Significant differences were observed in the pain level, opening mouth, functional level, and quality of life after the intervention and on follow-up in both groups. However, we found that while the levels of all parameters were maintained throughout the follow-up period in the experimental group, the functional status level was not maintained throughout the follow-up period in the control group. Conclusion: Our unloading technique using non-elastic tape results comparable to those achieved by traditional physical therapy in the treatment of TMJ. However, the unloading taping method using non-elastic tape is more effective than traditional physical therapy in maintaining the impact of intervention.

• Journal of Oral Medicine and Pain
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• v.41 no.4
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• pp.169-179
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• 2016

Purpose: This study is designed to analyse etiology and bone pattern at the first visit using cone-beam computed tomography (CBCT) and to evaluate the treatment outcome of conservative treatment in temporomandibular disorder (TMD) patients with rheumatoid arthritis (RA). Methods: One hundred condyles in 50 subjects with RA were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Dental Hospital, diagnosed as TMD. Condylar bone changes were classified by normal, erosive bony change, proliferative bony change and combined group (erosive bony change+proliferative bony change). They were treated conservatively with physical therapy, medication, behavioral therapy and/or occlusal stabilizing splint therapy. After 3 months on average, patients were re-evaluated with regards to subjective symptoms and the clinical findings were investigated. Results: TMD patients with RA have behavioral contributing factors such as parafunctional habit. The results that analyse bone pattern at the first visit using CBCT proliferative bony changes group (32.6%) were more common than erosive bony changes group (15.2%). In comparison between unilateral and bilateral bony change in temporomandibular joint, the ratio showed no significant differences. After 3 months of conservative treatments, pain, noise, limitation of motion (LOM) were markedly improved regardless of occlusal splint therapy. However only LOM was significantly improved through occlusal splint therapy during 3 months. Conclusions: TMD patients with RA had similar behavioral contributing factors and characteristics of CBCT images shown in general TMD patients and also similar response to conservative treatment so it is difficult to differentiate. Therefore when TMD patients show symptoms corresponding to clinical diagnostic criteria of RA at the first visit, serological testing should be conducted and through this, early diagnosis and treatment of RA should be initiated.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.6
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• pp.520-527
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• 2010

Introduction: This study examined the treatment patterns of temporomandibular disorders (TMD) including conservative and surgical procedures. Materials and Methods: Patients with TMD who visited Gangnam Severance Hospital from June 2007 to May 2008 were enrolled in this study. All patients were examined from the orthopantomogram, temporomandibular joint (TMJ) tomography, and a clinical examination. The patients who required a further evaluation were examined by magnetic resonance imaging and/or computed tomography. The treatment patterns were divided into counseling, medication, splint therapy, botulinum toxin injection (BTI) and surgical treatment. Results: Among the 2,464 patients, the average age was 31.8 years (ranging from 6 to 93); 764 (31.0%) were male and 1,700 (69.0%) were female. 2,355 (95.6%) patients were treated with conservative therapy; 1,460 (62.0%) patients were treated with medication, 931 (39.5%) patients were treated with splint, and 46 (2.0%) were treated with BTI. There were 109 (4.4%) patients treated surgically. Eight (0.3%) patients were treated with total temporomandibular joint replacement surgery. Conclusion: Almost all patients with TMD were treated using conservative methods. Those patients who received surgical treatment because of an ineffective response to conservative treatment had definite problems with the internal derangement and/or osteoarthritis or had severe clinical symptoms.

• Journal of Oral Medicine and Pain
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• v.47 no.4
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• pp.174-182
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• 2022

In chronic temporomandibular disorders (TMDs), constituent tissues such as muscles are sensitive to pain and psychological stress, which negatively affect the quality of life. In addition, since chronic TMDs is often accompanied by diseases such as psychological disorders and other chronic pain disorders, the diagnosis of those diseases and patient referrals are mandatory. The management of chronic pain in TMDs requires a multidisciplinary and holistic approach. Pharmacological therapy using cyclobenzaprine, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, progressive relaxation, and psychological approaches using cognitive behavioral therapy such as shifting negative thoughts about pain are all valid treatment options.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.3
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• pp.174-182
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• 2020

Objectives: Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage. Materials and Methods: Twenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test. Results: Patient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 post-trauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, P<0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, P<0.001); however, concomitant conservative therapy showed no difference in treatment outcome. Conclusion: The results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.