외상과 턱관절 장애 연관성에 관한 연구

  • Kim, Young-Kyun (Dept. of Oral & Maxillofalcial Surgery, Section of Dentistry, Seoul National University Bundang Hospital) ;
  • Yun, Pil-Young (Dept. of Oral & Maxillofalcial Surgery, Section of Dentistry, Seoul National University Bundang Hospital) ;
  • Ahn, Min-Seok (Dept. of Oral & Maxillofalcial Surgery, Section of Dentistry, Seoul National University Bundang Hospital) ;
  • Kim, Jae-Seun (Dept. of Oral & Maxillofacial Surgery, Konkuk University Medical Center)
  • 김영균 (분당서울대학교병원 치과 구강악안면외과) ;
  • 윤필영 (분당서울대학교병원 치과 구강악안면외과) ;
  • 안민석 (분당서울대학교병원 치과 구강악안면외과) ;
  • 김재승 (건국대학교병원 치과 구강악안면외과)
  • Published : 2009.09.30


Objective : Trauma has been a controversial issue although it has been considered to be a major factor for the temporomandibular disorder(TMD). We evaluated the relationship between macrotrauma or microtrauma and TMD. Methods : This study was performed in patients with TMD undergoing treatment at SNUBH from October 2006 to January 2007. Sixty one male patients and 166 female patients(total 227) were included and the average age was 34 years(ranging from 14 to 85 years). We investigated the possible etiologic factors, diagnosis and treatment with the review of medical records and radiography. Chronic pain, depression, somatic score(including pain item), somatic score(excluding pain item) were evaluated on the basis of diagnostic index from the Research Diagnostic Criteria on TMD. Results : Eighteen patients(7.9%) out of 227 patients suffered from TMD as a result of macrotrauma. Ninety four(41.4%) patients had microtrauma and six patients(2.6%) had both macro- and microtrauma(etiologic factor). The main symptoms included pain. joint noise and mouth opening limitation while the other symptoms were headache and tinnitus. The patients had suffered from TMD for average 41 weeks (ranging from 1 to 480 weeks). 116 patients took splint as a major treatment. As a prognosis, 19 patients(8.4%) recovered completely. 26(11.0%) had improvement and 181(80%) had persistent symptoms. 1 patient(0.4%) underwent an arthroplasty. Diagnostic index from RDC chart showed that macrotrauma was the highest score(except depression score) among the other etiologic factors. Conclusion : This study showed that macro- and microtrauma can be considered to be the major etiologic factors of TMD, which also affect the chronic, depression and somatic discomfort.


  1. Kim YK : Traumatic TMJ injury. J Kor Asso Maxillofac Plast Reconstr Surg. 19 :191, 1997
  2. Kim JW, Yeo HH : Diagnosis and Treatment of TMJ Injury. Narae Pub Co. 1996 : 53
  3. Okeson JP : Management of temporomandibular disorders and occlusion. 4th ed. St. Louis, Mosby Co. 1999
  4. Pullinger AG, Monteiro AA : History factors associated with symptoms of temporomandibular disorders. J Oral Rehabilation.15 : 117, 1988
  5. Yun PY, Kim YK : The role of facial trauma as a possible etiologic factor in temporomandibular joint disorder. J Oral Maxillofac Surg. 63 : 1576, 2005
  6. Truelove EL, Sommers EE, LeResche L et al : New classification permits multiple diagnoses. J Am Dent Assoc. 123 : 47, 1992
  7. Dworkin SF, Sherman J, Manol L et al : Reliability, validity, and clinical utility of the research diagnostic criteria for temporomandibular disorders axis II scales depression, non-specific physical symptom, and graded chronic pain. J Orofac Pain. 16 : 207, 2002
  8. Spitzer WO, Skovron ML, Salmi LR et al : Scientific monograph of the Quebec Task Force on whiplash-associated disorders : redefining "whiplash"and its management. Spine. 20 : 73, 1995
  9. Grushka M, Ching VW, Epstein JB et al : Radiographic and clinical features of temporomandibular dysfunction in patients following indirect trauma : A retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 104 : 772, 2007
  10. Romanelli GG, Mock D, Tenenbaum HC : Characteristics and response to treatment of posttraumatic temporomandibular disorder : a retrospective study. Clin J Pain. 8 : 6, 1992
  11. Brooke RI, Stenn PG : Postinjury myofascial pain dysfunction syndrome : its etiology and prognosis. Oral Surg Oral Med Oral Pathol. 45 : 846, 1978
  12. Klobas T, Tegelberg A, Axelsson S : Symptoms and signs of temporomandibular disorders in individuals with chronic whiplash-associated disorders. Swed Dent J. 28 : 29, 2004
  13. Harkins SJ, Marteney JL : Extrinsic trauma: a significant precipitating factor in temporomandibular dysfunction. J Prosthet Dent. 54 : 271, 1985
  14. Burgess JA, Dworkin SF : Litigation and post-traumatic TMD : how patients report treatment outcome. J Am Dent Assoc. 124 : 105, 1993
  15. Daview SJ, Al-ani Z : Treatment of temporomandibular disorder in a viola player-a case report. Dental Update. 34 : 181, 2007
  16. Ward MR : Myofascial pain in young violin player: a case report. NZ Dent J. 86 : 92, 1990
  17. Kovero O, Kononen M : Signs and symptoms of temporomandibular disorders and radiologically observed abnormalities in the condyles of the temporomandibular joints of professional violin and viola players. Acta Odontol Scand. 81 : 53, 1995
  18. Zhang ZK, Ma XC, Gao S et al : Studies on contributing factors in temporomandibular disorders. Chin J Dent Res. 2 : 7, 1999
  19. Kim YK, Kim HT, Lee DH et al : Analysis of tmj status in the patients with mandibular fractures: preliminary study. arthroscopic examination, histomorphology and joint fluid analysis. J Kor Oral Maxillofac Surg. 27 : 308, 2001
  20. Tanaka E, Kawai N, van Eijden T et al : Impulsive compression influences the viscous behavior of procine temporomandibular joint disc. Eur J Oral Sciences. 111 : 353, 2003
  21. Greco CM, Rudy TE, Turk DC et al : Traumatic onset of temporomandibular disorders : Positive effects of a standardized conservative treatment program. Clin J Pain. 13 : 337, 1997
  22. Israel HA, Diamond B, Saed-Nejad F et al : The relationship between parafunctional masticatory activity and arthroscopically diagnosed temporomandibular joint pathology. J Oral Maxillofac Surg. 57 : 1034, 1999
  23. Nitzan DW, Dolwick F, Heft MW : Arthroscopic lavage and lysis of the temporomandibular joint : A change in perspective. J Oral Maxillofac Surg. 48 : 798, 1990
  24. Goss AN, Bosanquet AG : The arthroscopic appearance of acute temporomandibular joint trauma. J Oral Maxillofac Surg. 48 : 780, 1990
  25. Kim YK, Yeo HH, Cho SI et al : Enzymeimmuno-assay of PGE2 in the synovial fluid from TMJ of the patients with mandibular condylar fracture and internal derangement. J Korean Assoc Oral Maxillofac Surg. 22 : 65, 1996
  26. Holmlund A, Hellsing G : Arthroscopy of the temporomandibular joint : occurrence and location of osteoarthrosis and synovitis in a patient material. Int J Oral Maxillofac Surg. 17 : 36, 1988
  27. Merill RG, Yie WY, Langan M : A histologic evaluation of the accuracy of TMJ diagnostic arthroscopy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 70 : 393, 1990
  28. Sandler NA, Buckley MJ, Cillo JE et al : Correlation of inflammatory cytokines with arthroscopic findings in patients with temporomandibular joint internal derangements. J Oral Maxillofac Surg. 56 : 534, 1998
  29. Murakami K, Segami N, Fujimura K et al : Correlation between pain and synovitis in patients with internal derangement of the temporomandibular joint. J Oral Maxillofac Surg. 49 : 1159, 1991
  30. Quinn JG, Bazan NG : Identification of prostaglandin E2 and leukotriene B4 in the synovial fluid of painful, dysfunctional temporomandibular joints. J Oral Maxillofac Surg. 48 : 968, 1990
  31. Alstergren P, Kopp S : Pain and synovial fluid concentration of serotonin, in arthritic temporomandibular joint. Pain. 72 : 137, 1997
  32. Appelgren A, Appelgren B, Kopp S et al : Substance Passociated increase of intra-articular temperature and pain threshold in the arthritic TMJ. J Orofac Pain. 12 : 101, 1998
  33. Murakami EI, Segami N, Moriya Y et al : Correlation between pain and dysfunction and intra-articular adhesions in patients with internal derangement of the temporomandibular joint. J Oral Maxillofac Surg. 50 : 705, 1992
  34. Im JH, Kim YK, Yun PY : The epidemiologic study of the patients with temporomandibular joint disorders, using research diagnostic criteria for TMD(RDC/TMD) : Preliminary report. J Kor Oral Maxillofac Surg. 34 : 187, 2008