• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.37 no.6
• /
• pp.448-456
• /
• 2011

Introduction: Condylar fractures are common in the maxillofacial region, comprising 29-40 percent of all mandibular fractures, accounting for about 20-62 percent). Previous studies reported that pediatric condylar fractures can cause disorders in facial growth and function, and the treatment methods have been controversial. Recently, conservative treatment has shown good results in skeletal growth and functional recovery but the conservative treatment of pediatric condylar fractures has shown unpredictable and undesirable results in some cases, such as facial asymmetry and temporomandibular joint disorder. This study examined the specific age groups and specific mandibular condylar fracture type in growing children treated conservatively in the past. Materials and Methods: Eighteen patients (10 men and 8 women) who received conservative treatment for unilateral condylar fractures in Dankook University Dental Hospital between 2000 to 2007 were followed up for a mean period of 7.2 years. Results: In the survey of 18 pediatric patients who received conservative treatment for condylar fractures, the incidence of temporomandibular dysfunction and growth disturbance was 45% and 35%, respectively. Conclusion: In all complications, the symptoms observed most frequently was mouth opening displacement of the mandible exceeding 2 mm. The other complications of functional and growth disturbance included facial asymmetry concentrated along specific condylar types. Complications including facial asymmetry and functional and growth disturbances showed an increasing tendency according to the specific fracture types. Functional and growth disturbances in the undisplaced condylar fracture type showed a lower incidence(P <0.05). Functional and growth disturbances differed according to the fracture type, which has poor relationship with articular fossa and condyle(P <0.05). Functional and growth disturbance in the cases of the high-level condylar fracture type showed a higher incidence(P <0.05). The functional and growth disturbances of the fracture types were similar in the fragment-contact and non-contact groups(P >0.05).

• The Journal of Korean Academy of Prosthodontics
• /
• v.35 no.3
• /
• pp.517-534
• /
• 1997

It has been held that excessive mechanical forces to the osseous and soft tissues of the TMJ result in joint dysfunction. Understanding the stress pattern on TMJ is very important in TMJ research. But, it is very difficult to measure directly the biomechanical stress distribution in the TMJ when the mandible is loaded. Therefore, stress distribution in the TMJ during functional movement was studied through animal experiment or mathematical model. It was observed and compared the stress distribution occuring in the working and balancing condyle when lower right canine, lower right first molar and lower right second molar were clenched by the three dimensional finite element analysis. Also, stress distribution in the working and balancing condyles were observed and compared when $20^{\circ}$ forward and buccal bite forces were applied to the first molar. The results were as follows : 1. Stress distribution in the condyles during unilateral clenching of the first molar, second molar, canine showed no difference. In the working condyle, tensile force was concentrated on the lateral aspect of the condylar articular surface and condylar neck. And compressive force was concentrated on the anteromedial and lateral aspect of condyle. In the balancing condyle, tensile and compressive forces were concentrated on the lateral aspect of the condylar articular surface and stress transmission to the temporal bone was not observed. 2. When lateral forces were applied to the first molar, tensile forces were concentrated on the medial aspect of the condylar neck and condylar posterior surface in working and balancing condyle. Compressive force was concentrated on the anteromedial and lateral surface of the condyle and stress transmission to the temporal bone was not observed. 3. During unilateral clenching, stress in the working condyle decreased as the occlusal load moved posteriorly while the stress in the balancing condyle increased. when lateral force was applied to first molar, the incremental amount of stress was greater than vertical load. 4. During unilateral clenching, the average balancing/working condyle stress ratio was 2.52. There was a greater concentration of stress in the balancing condyle. The ratio increased as the occlusal load moved posteriorly and decreased considerably when lateral forces were applied to the first molar.

• Imaging Science in Dentistry
• /
• v.54 no.1
• /
• pp.71-80
• /
• 2024

Purpose: This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography. Materials and Methods: In total, 210 joints from 183 patients(144 females, 39 males, ranging from 12 to 88 years old with a mean age of 44.75±19.97 years) diagnosed with temporomandibular joint osteoarthritis were stratified by age. Mandibular condyle position and bony changes (flattening, erosion, osteophytes, subchondral sclerosis, and subchondral pseudocysts in both the condyle and articular eminence, thickening of the glenoid fossa, joint space narrowing, and joint loose bodies) were evaluated through cone-beam computed tomography. After adjusting for sex, the association between age groups and radiographic findings was analyzed using both a multiple regression model and a multinomial logistic regression model(α=0.05). Results: The prevalence of joint space narrowing and protruded condyle position in the glenoid fossa significantly increased with age (P<0.05). The risks of bony changes, including osteophytes and subchondral pseudocysts in the condyle; flattening, erosion, osteophyte, and subchondral sclerosis in the articular eminence; joint loose bodies; and thickening of the glenoid fossa, also significantly rose with increasing age (P<0.05). The number of radiographic findings increased with age; in particular, the increase was more pronounced in the temporal bone than in the mandibular condyle (P<0.05). Conclusion: Increasing age was associated with a higher frequency and greater diversity of bony changes in the temporal bone, as well as a protruded condyle position in the glenoid fossa, resulting in noticeable joint space narrowing in temporomandibular joint osteoarthritis.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.27 no.3
• /
• pp.283-287
• /
• 2005

Osteochondroma is one of the most common benign tumors of the axial skeleton, but is rarely found in the facial bones. Osteochondroma shows an irregular radiopaque lesion and chondromatic area surrounded by osteoma. It may appear different findings as calcification levels. When it develops in the long bone, it has a marked tendency in the ages from 10 to 20 years and ceases with the end of pubertal growth. However, when it develops in the condyle, it is prevalent in the third decades (average 39.2 years) and continues to develop. Lesions developed in the long bone have a predilection for men (M:F = 2:1), but for women in the mandible. Osteochondroma is differentiated from chondroma, osteochondromatosis and osteoma. Mandibular condyle osteochondroma presents asymptomatic facial swelling, rarely posterior openbite, pain during mouth opening and internal derangement of the temporomandibular joint disc due to condylar lengthening and condylar hyperplasia. The first choice of treatment of the massive osteochondroma is the surgical removal. We report osteochondroma of the mandibular condyle showing good result to treat the lesion.

• Imaging Science in Dentistry
• /
• v.30 no.1
• /
• pp.23-32
• /
• 2000

Purpose : The purpose of this study is to compare radiographic techniques for the diagnostic accuracy in the detection of osteophytes of the mandibular condyle. Material and Methods : A series of bone chips were placed at four locations on the condylar head of a dried human skull. Eight radiographic techniques such as panoramic, transcranial, infracranial, transorbital, reverse-Towne's, submentovertex, multidirectional tomographic and computed tomographic techniques were compared. Three oral radiologists were asked to rate the lesions by four stage score. The statistical analysis was performed by ANOVA test. Results: For the detection of lateral osteophyte, transcranial, infracranial, transorbital and reverse-Towne' s views showed superiority. Also, transcranial and infracranial views showed superiority for medial osteophyte. While for the detection of superior and anterior osteophyte, panoramic, transcranial, infracranial, transorbital views showed superiority. Lateral tomograph showed superiority for the detection of superior and anterior osteophyte, but it showed inferiority for lateral and medial osteophyte. And antero-posterior tomograph showed superiority for the detection of all osteophytes. Axial computed tomograph showed superiority for the detection of all osteophytes, and coronal computed tomograph showed superiority for lateral, medial and superior osteophytes. While reconstructed sagittal computed tomograph showed relatively superiority for the detection of anterior and superior osteophytes. Conclusion : The conventional radiographs can be used for the detection of bony changes of the mandibular condyle, and tomograph or computed tomograph can be used additionally when it is difficult to detect bony changes on conventional radiographs.

• Archives of Plastic Surgery
• /
• v.33 no.6
• /
• pp.792-796
• /
• 2006

Purpose: After exposure of fracture site, the proximal segment must be reduced to their preinjury position for open reduction of fractured mandibular condyle. We examined the use of inter-maxillary fixation screws or titanium screws tied with stainless steel wire to assist in positioning of proximal segment. Since it enables to make a relatively small preauricular incision by not disturbing the operative field like Moule pin, we can reduce the danger of injury to the facial nerve. Methods: A preauricular approach was used for exposure, reduction, and rigid fixation in 4 cases of mandibular condylar fractures. Inter-maxillary fixation screws or titanium screws tied with stainless steel wire were used to assist in aligning proximal segment. The joints were submitted to functional exercises and postoperative radiologic and clinical follow-ups were performed. Results: No facial nerve lesions were found in all 4 cases. Radiologic follow-up showed correct reduction and fixation in all 4 cases. Clinical follow-up showed an initial limitation, but normal morbility of the condyle was achieved within 4 months after the operation, with a maximum mouth opening of $34.1{\pm}5.2mm$ after 12 months. There found no occlusal disturbances, no trismus, no lateral deviations of the mandible. Conclusion: By using Inter-maxillary fixation screws tied with stainless steel wire, it was shown that reducing the proximal segment to their preinjury position is easy to perform and it enables us to make a minimal dissection below preauricular skin incision to avoid facial nerve injury.

• Imaging Science in Dentistry
• /
• v.34 no.2
• /
• pp.81-89
• /
• 2004

Purpose: To investigate the histopathological changes in the temporomandibular joint in streptozotocin-induced diabetic rat following irradiation. Materials and Methods : Sprague-Dawley rats weighing about 250 gm were divided into three groups: control, diabetic, and diabetic-irradiated groups. Diabetes mellitus was induced in the rats by injecting streptozotocin. Rats in the control group were injected with citrate buffer only. After 5 days, the head and neck region of the rats in diabetic-irradiated group were irradiated with single absorbed dose of 10 Gy. The rats were killed at 1, 3, 7, 14, 21, and 28 days after irradiation. The specimen including the temporomandibular joint were sectioned and observed using a histopathological method. Results : In the diabetic group, severe bone resorption in the mandibular condyle was observed throughout the period of experiment. Necrosis of bone marrow and trabeculae was observed at 28 days after diabetic state. Atrophy and fibrosis in the retrodisca] tissue was gradually progressed during the time of the experiment. In the diabetic-irradiated group, severe bone resorption in the mandibular condyle was observed during the early experimental phases, but regeneration of bone marrow was initiated at ]4 days after diabetic state and irradiation. A]so, calcification of abnormal trabeculae was observed at 28 days after diabetic state and irradiation. The retrodisca] tissue was degenerated in the early experimental phases, but it had been gradually regenerated during the experimental time. Conclusion: This experiment suggests that bone resorption and degeneration in the mandibular condyle are caused by the induction of diabetes, and abnormal bone formation is induced after irradiation in diabetic state.

• Journal of Technologic Dentistry
• /
• v.25 no.1
• /
• pp.111-118
• /
• 2003

I measured the movement range on the hinge articulator and the movement range in an oral. And then I studied to analyze the gap. I got wax records by the movement on the hinge articulator, the movement in an oral and the movement on the hand articulating. I measured the distance of the cusp tips that are close to the mesial direction and the distal direction, the buccal direction and the lingual direction then I compared gaps. As I saw results on data, I knew that the hinge articulator represented the range of mandibular movement restrictively. I could find the decisive contradiction that the sliding movement finished on the hinge articulator although it did not finish in an oral. If the sliding movement does not reappear exactly, it brings a fatal failure to the dental prosthesis. In addition it is impossible that the hinge articulator restores the movement in an oral because the lateral condyle inclination and the horizontal condyle inclination are fixed previously. Therefore dental prosthesisses were made by the hinge articulator, they will interfere with a mastication. I have obtained the following results; 1. The distance of sliding movement on the hinge articulator showed shorter than the distance of sliding movement in oral. This means the increase of cusp inclination of the dental prosthesis that was made on the hinge articulator. Therefore, when the lateral movement occurs in oral, there is a possibility to become the premature as the increase of cusp inclination. 2. The results that were impressed records in oral and impressed records on the hand articulating have many congruities. I think that the simple crown etc. that were made by the hand articulating method except the long span bridge and the free end case that can not measure the vertical dimension exactly can represent similarly the mandibular movement. 3. If we want to represent the mandibular movement similarly, we have to use the articulator that can adjust the horizontal condyle inclination and the lateral condyle inclination at least.

• The korean journal of orthodontics
• /
• v.50 no.3
• /
• pp.206-215
• /
• 2020

Osteochondroma is a common benign tumor of bones, but it is rare in the mandibular condyle. With its outgrowth it manifests clinically as deviation of the mandible limitation of mouth opening, and facial asymmetry. After the tumor is diagnosed on the basis of clinical symptoms and radiographic examination including cone-beam computed tomography (CBCT) analysis, an appropriate surgery and treatment plan should be formulated. Herein, we present the case of a 44-year-old female patient who visited our dental hospital because her chin point had been deviating to the left side slowly but progressively over the last 3 years and she had difficulty masticating. Based on CBCT, she was diagnosed with skeletal Class III malocclusion accompanied by osteochondroma of the right mandibular condyle. Maxillary occlusal cant with the right side down was observed, but it was confirmed to be an extrusion of the molars associated with dental compensation. Therefore, after intrusion of the right molars with the use of temporary anchorage devices, sagittal split ramus osteotomy was used to remove the tumor and perform orthognathic surgery simultaneously. During 6 months after the surgery, continuous bone resorption and remodeling were observed in the condyle of the affected side, which led to a change in occlusion. During the postoperative orthodontic treatment, intrusive force and buccal torque were applied to the molars on the affected side, and a proper buccal overjet was created. After 18 months, CBCT revealed that the rate of bone absorption was continuously reduced, bone corticalization appeared, and good occlusion and a satisfying facial profile were achieved.

• Imaging Science in Dentistry
• /
• v.43 no.1
• /
• pp.25-30
• /
• 2013

Purpose: This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. Materials and Methods: A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Results: Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). Conclusion: BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.