• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권1호
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• pp.32-36
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• 2010

The purpose of this study was to evaluate the clinical outcomes of patients with temporomandibular joint disorder before and after performance of arthrocentesis and stabilization splint therapy. The subjects of this study were 33 patients with limited mouth opening or pain or joint effusion who visited the Department of Oral and Maxillofacial Surgery, St Mary's Hospital, Catholic University of Korea. The arthrocentesis was performed and the stabilization splint was worn immediately after the arthrocentesis. Comparing the clinical outcomes of treatment at the times of first medical examination, 3 months and 6 months later on treatment. The results are as follows; 1. Statistically significant increase in the amount of maximum mouth opening occurred 3 months and 6 months later on treatment. 2. Statistically significant decrease in the average value of pain on test measured by VAS during maximum mouth opening, protrusive movement, right lateral movement, left lateral movement occured 3 months and 6 months later on treatment. The results suggested that arthrocentesis and stabilization splint therapy provide a improvement on patients with temporomandibular joint disorder when the exact diagnosis were provided.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권4호
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• pp.322-328
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• 1993

The trauma has been known as a major etiologic factor in temporomadibular joint disorders. The endotracheal intubation is suspected as one of the traumatic factor to temporomandibular disorder. But there are few reports about the amount of mouth opening during endotracheal intubation and temporomandibular joint disorder after endotracheal intubation. The authors studied the effects of endotracheal intubation to temporomandibular joint with 70 patients given surgical operation through general anesthesia. The results were as follows. 1. The mean amount of mouth opening for entire patients during endotracheal intubation was 26.3mm (s, d : 2.6), for oral intubation group 25.9mm(s, d : 3.2), for nasal intubation group 26.6mm(s, d : 1.9). There was no difference between two group stastically. (p<0.05) 2. 1 week later endotracheal intubation, the maximum mouth opening increased 1.5mm for entire patients, 1.5mm for oral intubation group, 1.6mm for nasal intubation group than behare endotracheal intubation. 3. Five patients complained the discomforts around temporomandibular joint after endotracheal intubation. The amount of mouth opening during endotracheal intubation was within physiologic range. It seemed that $45^{\circ}$ upward endoscopic lifting for exposure of glottis gave trauma to temporomandibular joint.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.18.1-18.10
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• 2019

Background: Temporomandibular joint (TMJ) ankylosis during early childhood may lead to disturbances in growth and facial asymmetry and to serious difficulties in eating as well as in breathing during sleep. The purpose of this study is to describe the effectiveness of an interocclusal splint (IOS) for active mouth opening exercises in the treatment of TMJ ankylosis. Methods: A total of nine patients with 13 instances of TMJ ankylosis from 2008 to 2010 were included in this study, of which five patients were male and four patients were female. Five patients demonstrated unilateral ankylosis, while five patients showed bilateral symptoms. Ankylosed mass resection with coronoidectomy, fibrotic scar release, and resection of stylohyoid ligament calcification was performed with gap arthroplasty without an interpositional graft, and all patients were assessed for maximum mouth opening (MMO) during a mean 6.6-year follow-up period. Results: All patients were subjected to postoperative mouth opening exercises from the day of the operation with the help of an IOS, which was based on an impression taken during surgery. All patients were sufficiently comfortable moving their mandible according to the IOS's guiding plane and impingement, and satisfactory results were achieved, in which MMO was improved by 35 mm more than 6 years after surgery. Conclusions: Complete and adequate resection of the ankylosed mass and postoperative active mouth opening exercises are essential in the treatment of TMJ ankylosis. Moreover, a more comfortable mouth opening guide and interdigitation can be achieved using an IOS, and newly organized fibrosis in the gap space between the newly made resected condylar head and temporal fossa can be suggested.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.270-274
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• 2010

Introduction: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. Material and Methods: A total of 14 patients (female 12, male 2, average age: $29.1{\pm}14.4$), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range <35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. Results: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was $30.2{\pm}3.5mm$ and the average MMO after treatment and follow up was $47.1{\pm}4.7mm$. The mean amount of mouth opening increment was $16.9{\pm}5.4mm$ (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) Conclusion: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.

• 대한치과보철학회지
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• 제27권1호
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• pp.55-81
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• 1989

Recently the instantaneous center concept has been to understand the biomechanics by which a tissue derangement causes a mechanical derangement in human joint. Therefore, to understand the biomechanics of temporomandibular joint (T.M.J.) as a part of human joint, it is necessary to clarify the instantaneous center of rotation (I.C.R.) in the mandibular movement. Twenty male subjects without T.M.J. disorder and mandibular deviation during the mandibular movement were selected for this study. The habitual opening and closing paths were recorded on the paper of the sagittal metal plate by two pencil markers connected to the resin open clutch attached on the lower teeth, which was designed for this study. The coordinates of the 33-target points and the 109-anatomical landmarks were obtained using a Summagraphic digitizer connected to a 18AT computer. The original raw data of the opening and closing paths were smoothed by B-spline curve fitting technique and then the I.C.R. pathways were determined mathematically by the computer using algorithm for finding the I.C.R. of a planer rigid body model. Also the opening and closing movements of the mandible were simulated according to the determined I.C.R. The results obtained from this study were as follows. 1. At the early opening and the last closing, I.C.R's were almost distributed around the mastoid process outside the mandibular body without the presence in the region of the mandibular condyle. 2. The I.C.R. pathway showed variable patterns to each subject at the opening and closing movements. 3. The K constant with uniform pattern was obtained by the rotation angle times the radius, which was assumed to the index of the mandibular movement. 4. The opening and closing movements of the mandible were simulated by the I.C.R. pathways at the habitual opening and closing movements. 5. The mandibular condyle was rotated or translated accordng to the relative rotation angle and radius of the determinant factors of K contant.

• 한국전문물리치료학회지
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• 제23권3호
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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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• 제9권1호
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• pp.77-92
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• 1984

The purpose of this study was to investigate the relationship between the mandibular positions and the habitual mandibular opening and closing movements in normal subject using the newly developed electric mandibular movement analyzing device(Saphon Visi-Trainer C-II.Tokyo Shizaisha Inc. Tokyo, Japan) One of the cause of the temporomandibular joint dysfunction has been considered abnormal mandibular positions especially the abnormal deviation between intercuspal position from retruded contact position. The subjects in this study were consisted of 55 young adults in 20 decade who had normal occlusion, no prosthodontic restorations and no history of disturbance or pain on temporomandibular joint and masticatory muscles. The results were as follows : 1. The deviations of intercuspal position from retruded contact position were 0.23mm in frontal view and 1.02mm in sagirral view. 2. The larger the deviation of intercuspal position from the retruded contact position, the higher the proportion of uncoincidence of the habitual nandibular closing and opening trajectories was, and the proportion was higher in sagittal view than frontal view, 10mm opening than 5mm opening. 3. Correlation between the deviation of intercuspal position from retruded contact position and uncoincidence rate of the habitual mandibular closing and opening trajectories was higher in frontal view than sagittal view.

• Journal of Oral Medicine and Pain
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• 제20권1호
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• pp.141-158
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• 1995

This study was performed to invetigate the relationship between clinical manifestations related to temporomandibular joint sounds and temporomandibular joint vibrations that occurred synchronously with sounds. There have been reported in many articles that joint sounds indicate internal joint pathology. Therefore, it is necessary to evaluate type and patterns of joint sounds, and radiographic changes of temporomandibular joint(TMJ) in order to diagnose and deal with the Temporomandibular Disorders(TMD). For this study 142 patients with TMDs were collected and they were examined by routine diagnostic procedure for TMDs. The author classified TMJ sounds clinically into 3 types : click, popping, and crepitus. Transcranial and panoramic radiographs were taken for observein bony changes of TMJ, and for observing vibrations of TMJ Sonopak of Biopak system was used. The obtained results were as follows : 1. Female subjects with crepitus were older than those with click or popping and their mean ages were about 45 years old. But in male subjects, there was no age difference. 2. For all subjects, mean value of maximal mouth opening were above 40mm, which are lower limit of normal vertical opening. But in subjects with L-type opening deviation, mouth opening capacity were about 36mm of range. 3. Symptom duration stated when patient presented first were slightly longer in subjects with crepitus but there were no statistical differences. And there were also no radiographic differences among 3 types of joint sounds in regard to symptom duration. 4. In subjects wih click, it might have been interpreted that 12% had closed lock, 12% had degenerative joint disease, and about 17% of he subjects had normal joints by Sonopak. 5. There were no significant relationships between subjective loudness of joint sounds and magnitude of joint vibrations. 6. The highest value of Integral and peak amplitude were observed in popping sounds and though it was not significant, value of peak frequency was highest in crepitus. 7. Amount of mandibular positional change were differed between click and crepitus on frontal plane, between click, crepitus and popping on horizontal plane in rotational movement, respectively. However, there no difference among them in translational movements.

• 대한치과의사협회지
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• 제37권6호통권361호
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• pp.445-455
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• 1999

Arthrocentesis is a simple, less invasive, inexpensive, and highly efficient procedure for closed lock of the temporomandibular joint with regard to the lack of recurrence of symptoms during extended periods of follow-up and significiant improvement in pain and jaw function. It can be performed under local anesthesia. Arthrocentesis closed lock provide sustained normal joint function and marked pain relief. This study is the clinical outcome of arthrocentesis for closed lock of the temporomandibular joint. 160 patients(169 joints) who had experienced sudden-onset, persistent limited mouth opening were the subjects of this study. Arthrocentesis of the upper compartment of the affected TMJ was performed using normal saline. As results, at 3-60 months postarthrocentesis maximum mouth opening(MMO) had increased from mean of 27.7mm to 43.5mm, contralateral movements(CLM) from mean 5.74mm to 9.55mm, midline deviation during mouth opening from mean 3.04mm to 0.69mm. In 130 cases there was a history of joint noises, in 52 cases all noise had ceased after procedures.

• Journal of Oral Medicine and Pain
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• 제42권2호
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• pp.35-43
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• 2017

Purpose: This study aims to evaluate the correlation between joint sounds and radiographic bone change patterns along with clinical symptoms of temporomandibular joint osteoarthritis (TMJ OA) patients. Methods: The patients for this study were over 19 years of age, diagnosed tentatively with TMJ OA. The patients were examined with temporomandibular disorders analysis test and all three radiographs, including panoramic radiography, transcranial radiography, and cone beam computed tomography (CBCT). Information of the patients' age, pain status, joint sound and mouth opening range were collected. And bone change pattern was examined by reviewing panoramic radiography, transcranial radiography and CBCT images. Results: The patients with crepitus had a higher average active mouth opening (AMO) range than patients without crepitus, and the group with bilateral crepitus had a higher average AMO range than the group with unilateral crepitus (p<0.001). And the patient with pain during mastication was increased in the group with clicking than the group without clicking, and the group with bilateral clicking showed a statistically significant increase in the patient with pain during mastication than the group with unilateral clicking (p<0.05). The analytical results of the relevance of crepitus showed a high correlation with bone change observed from each of the three radiographs. And the agreement in bone change findings from 3 groups of paired radiographs showed high agreement (p<0.001). Meanwhile, 77.2% of CBCT findings showed bone change of condyle without crepitus (p<0.001). Conclusions: This study presented significant results in the evaluation of the correlation with crepitus and bone change of TMJ OA patients from panoramic radiography or transcranial projection. However, the accurate assessment is required through CBCT for the patient with complains of persistent pain, limitation of mouth opening, and occlusal change even if the crepitus does not exist.