Jung, Hwi-Dong;Kim, Sang Yoon;Park, Hyung-Sik;Jung, Young-Soo
Maxillofacial Plastic and Reconstructive Surgery
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v.37
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pp.14.1-14.11
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2015
The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.
A 9-month-old castrated male Korean Jindo was presented for evaluation of a progressive left forelimb lameness of 4 weeks' duration. On physical examination, the dog showed moderate weight bearing lameness on the left forelimb. Firm and mild swelling was palpated, and range of motion was decreased in the left elbow. Signs of pain were elicited by gentle flection and hyperextension of the left elbow. On radiographs, fragmentation of the medial coronoid process with moderate secondary degenerative joint disease was found. The bone fragments could be seen more clearly on stress radiograph of the left elbow joint which was taken while flexing the elbow and inwardly rotating the antebrachium. A medial elbow arthrotomy was performed, and the loose fragments were removed from the coronoid region. Left forelimb lameness improved markedly after surgery.
Osteoarthritis is caused by joint degeneration, a process that includes progressive loss of articular cartilage accompanied by attempted repair of articular cartilage, remodeling and sclerosis of subchondral bone, and osteophyte formation. The most common causative factor that either causes or contributes to osteoarthritis is overloading of the articular structures of the joint. The diagnosis of temporomandibular joint(TMJ) osteoarthritis is based on the patient's history and clinical findings such as limited mandibular opening, crepitation and tenderness to palpation on TMJ. The diagnosis is usually confirmed by TMJ radiographs, which will reveal evidence of structural changes in the subarticular bone of the condyle or fossa. Plain radiography techniques such as panoramic, transcranial, transpharyngeal views can be used in most dental offices for evaluation of the TMJs. However, plain radiographs are often limited due to overlapping and distortion of anatomical structures. The aim of this study was to compare the clinical examination and panoramic view with computed tomography for diagnosis of temporomandibular degenerative joint disease, and to compare the findings of condylar bony changes through panoramic radiography with that of computed tomography, hence, to confirm the limitations of clinical and panoramic radiography, and the validity of the computed tomography for diagnosis of temporomandibular degenerative joint disease. The pathophysiology of the TMJ osteoarthritis remains poorly understood, and current treatments are based more on speculation than science, and symptomatic treatments often fail to provide satisfactory pain relief. For diagnosis of TMJ osteoarthritis, clinical examination and radiographic examination for confirmation of the bony changes are essential, and computed tomography are clearly superior to plain radiographs for their limitations.
This study was conducted in order to determine the effect of Paraffin Therapy on release of pain, skin temperature and range of motion with joint diseases. This study was performed on 42 patients with general joint diseases and 21 patients with degenerative joint diseases. All the subjects were randomly assigned to three groups with 21 each. The experiment had been done from June, 1. 2002 to September, 30. 2002, in two general hospitals and a social welfare center using Digital Thermometer Kane-May KM330 and VAS(visual analogue scale). Each pint was measured in terms of skin temperature, pain scale and ROM(range of motion). The results of the experiment are as follows : 1. In application of three different heat modalities (Paraffin bath, Infra red, Hydro pack) on the Knee, Ankle, Elbow pints of the subjects for 30 minutes, the elevation of skin temperature and the reduction of pain scale were found to be significantly different. When checked right after the 30 minutes' application, the Infra red resulted in a higher degree elevation of skin temperature than two other modalities, while Paraffin bath resulted in the highest degree of the elevation of skin temperature when it was checked one hour after the application was over. It means that Paraffin bath lasted longer than the other two modalities(F=14.691, p<.000). 2. With Paraffin bath application, pint pain was reduced significantly both in 30 minutes and one hour checks(F=20.675, p<.001). 3. In terms of ROM(range of motion) increase, didn't seem to have any significant differences in 30 minutes and one hour. The results suggest that Paraffin therapy be helpful in maximizing th effects on pint diseases. I strongly suggest that further studies be done on other pints and muscle diseases using Paraffin bath in different methods of applying the therapy.
Objective: This study was conducted to confirm the effect of physiotherapy on the balance and walking in dog with sciatic nerve injury and degenerative arthritis of stifle joints. Design: Single case study Methods: The dog walked abnormally for six months and was administrated in S animal hospital. The dog's right hindlimb was operated for cranial cruciate ligament repair and the dog had been taking a nonsteroidal anti-inflammatory analgesic before being refered. There was severe degenerated osteoarthritis in the right hindlimb. During stance and walking, the right hindlimb was often shown partial weight bearing. The dog's left hindlimb was shown plantigrade stance and walking. The radiograph was shown an intact calcaneal tendon in the left hindlimb. In the neurologic examination, sciatic nerve injury in the left hindlimb was confirmed. The dog was treated using muscle strengthening, proprioceptive exercise, underwater treadmill and Laser therapy two, or three times a week for 3 months. At the 10th and 17th treatment, it was evaluated through stance and gait analyzer system to measure dog's balance and walking. Results: 3 months following physiotherapy, the dog's balance was improved in center of pressure(COP). And peak vertical force(PVF), vertical impulse(VI) was increased in right hindlimb and double stance was decreased. Conclusions: Physiotherapy may have improved the prognosis in this dog with severe osteoarthritis and sciatic nerve injury. This study suggested that animal physiotherapy is a valuable way to improve balance and walking.
ㆍPurpose: This study was performed to investigate the initial conservative treatment for TMD patients using careful counselling and medication prospectively.
ㆍMaterials and Methods: Careful counselling and medication were performed in 51 TMD patients and 27 patients had follow-up check 2 months or more. Diagnosis of TMD was based on medical history and, physical and radiographic examination. TMD included masticatory disorder, internal derangement, degenerative joint disease, inflammatory joint disorder. and problems resulting from extrinsic trauma. All patients had chief complaints of TMJ pain, mouth-opening limitation. joint noise, and/or referred pain. We counselled and explained to the patient about the pathogenesis, etiologic factors, diagnosis and treatment plan for abut 10 minutes. We prescribed nonsteroidal anti-inflammatorv analgesic(Somalgen) and amitriptyline 10mg per day for 2 weeks. We informed the patient of the attention sheet and taught self-exercise of jaw. The patient were assessed by answering the questionnaire of subjective evaluation of TMD & maxillofacial pain. Questionnaire of an activity limitation. Questionnaire of a jaw function, and Questionnaire for the evaluation of TMD.
ㆍResults: In questionnaire for the evaluation of TMD, 88.5% of 26 patients answered that the treatment was efficacious. 71.4% of 21 patients answered no problem in everyday life. There were significant differences between pretreatment and final follow-up in the evaluation of the subjective pain in the following sections: opening widely, chewing, resting, morning, masticatory muscle, and temporal portion(SAS program, paired T-test, P = 0.05).
ㆍConclusions: Considerate counselling and proper medication could be significantly effectve in the initial treatment of TMD.
Objective : Lumbar spinal stenosis is a common degenerative spine disease that requires surgical intervention. Currently, there is interest in minimally invasive surgery and various technical modifications of decompressive lumbar laminectomy without fusion. The purpose of this study was to present the author's surgical technique and results for decompression of spinal stenosis. Methods : The author performed surgery in 57 patients with lumbar spinal stenosis between 2006 and 2010. Data were gathered retrospectively via outpatient interviews and telephone questionnaires. The operation used in this study was named central decompressive laminoplasty (CDL), which allows thorough decompression of the lumbar spinal canal and proximal two foraminal nerve roots by undercutting the lamina and facet joint. Kyphotic prone positioning on elevated curvature of the frame or occasional use of an interlaminar spreader enables sufficient interlaminar working space. Pain was measured with a visual analogue scale (VAS). Surgical outcome was analyzed with the Oswestry Disability Index (ODI). Data were analyzed preoperatively and six months postoperatively. Results : The interlaminar window provided by this technique allowed for unhindered access to the central canal, lateral recess, and upper/lower foraminal zone, with near-total sparing of the facet joint. The VAS scores and ODI were significantly improved at six-month follow-up compared to preoperative levels (p<0.001, respectively). Excellent pain relief (>75% of initial VAS score) of back/buttock and leg was observed in 75.0% and 76.2% of patients, respectively. Conclusion : CDL is easily applied, allows good field visualization and decompression, maintains stability by sparing ligament and bony structures, and shows excellent early surgical results.
Middle age for women is one of the most important stages of the whole normal life span and has unique problems concerning the psychological and physical health, specifically degenerative musculoskeletal diseases. Therefore middle age women should prepare in order to lead a healthy and fruitful life as they enter/begin old age. As the population of middle age women increase, the demands of nurses who care for this age group also continue to glow. Nurses must be interested in this middle age group of women in Korea. This study was designed to identify the extent of family support and self-esteem of the middle age women with degenerative musculoskeletal diseases and the relationship between them and nurse's contribution to middle age women's health promotion that maintain and promote qualify of her life. The population of this study was 112 women aged 40-60, attending the out patient clinic one University Hospital and one Hospital, in Pusan. The data was collected from 1st August to the 30th of September, 1998 by using 36 items questionnaire. The instrument used for measuring family support was of Chai's(1983) FSS which was modified by Kang's(1984) Family Support Scale. And that for self-esteem was Rosenberg's(1965) Self-esteem Scale. The reliability of Chai's FSS and Rosenberg's instruments were tested by Cronbach's alpha and showed that they were 0.93 and 0.89 each respectively. Data was analyzed by descriptive statistics, t-test, ANOVA, and Pearson's Correlation Coefficient using the SPSS computer program. The results of the study were summarized as follows : 1. The mean score of the perceived family support was $39.31{\pm}9.42$. 2. The mean score of the perceived self-esteem was $33.16{\pm}6.75$. 3. Statistically significant factors influencing the family support among sociodemographic variables was satisfaction of marriage(F=-3.069, p<0.003). 4. Statistically significant factors influencing the self-esteem among sociodemographic variables were age(F=3.992, p=0.000), education(F=2.260, P=0.026), housing (F=-1.987, P=0.049) and satisfaction of marriage(F=-2.305, P=0.023). 5. There was a significant correlation between family support and self-esteem (r=.621, p<.000). In conclusion, perceived the family support was important for middle age women to increase their self-esteem. Nurses should be aware of the necessity of family support in the supportive nursing of middle age women and should be able to make a plan to educate the family about supporting the wife/mother. The continuing study of the health promotion of middle age women to find out variables influencing middle age women' health must continue.
Purpose: One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients. as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. Materials and Methods: We reviewed spine SPECT studios obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2. Posterior element: posterior to body (pedicle), posterior to Intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Results: Sixty-nine bone lesions were detected on SFECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis; linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Conclusion: Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients.
The purpose of this report Is to discribe the radiological findings of traumatic elbow luxation and subluxation of carpal joint which were caused by being hit by a wild animal and forced hyperextension of carpus in two hunting dogs. In case 1, carniocaudal and mediolateral radiographic examination of the elbow joint revealed that the radius that the radius and ulna were completely luxated laterally. The lateral projection showed the humeral condyles overlying the radial head with an absent joint space, but displacement is apparent on the craniocaudal projection. Incidence of collateral ligament rupture in conjunction with elbow luxation was not recognized on physical examination of the limb after closed reduction. Radiographic examination of the elbow made 5 months after closed reduction revealed only mild degenerative joint disease. Radiographic examination of the carpus in case 2 demonstrated palmar subluxation of most carpal joints including antebrachiocarpal, mediocarpal carpometacarpal joints, and some intercarpal joints, and avulsion fracture of the palmar surface of the accessory carpal bone. However, the mediocarpal and carpometacarpal joints were most severely affected by tensile forces of hyperextension, and it was concluded that the ligaments of the middle ca,pal joints and carpometacarpal joints as well as the palmar fibrocartilage were ruptured based on clinical and radiographic findings. In elbow luxation and subluxation of carpal Joints of the dog, differentiation of the joint or joints involved, and ligamentous structures damaged is important in determining whether surgery Is necessary and which procedure is most appropriate. And the radiographic findings of these conditions would be of help to practitioners.
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