• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권5호
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• pp.446-454
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• 2000

Condylar process of mandible is an important and fuctionally versatile part of the mandible. There were quite large amount of investigations on the functional and anatomical adaptation of the temporomandibular joint(TMJ) to the surrounding tissues. But controversies on the mechanism of functional adaptation of the joint still exist. In this research, we investigated changes in the TMJ by the lateral deviation of the maxillary incisor to shift the mandible right, and bone the undecalcified microscopic sections with fluorescent microscope and von Kossa staining with bright field microscope. Results were as follows: 1. Lateral deviation rendered shifting and tilting of the mandible, There were, compressions in the right joint and opening of the left joint space at early stage. At the same time, both condyles shifted slightly to anterior. 2. After $2{\sim}4$ weeks, left condyle showed anterior displacement and compressions in the joint space. Right condyle showed only slight shift to the anterior. 3. Regardless of the direction of the lateral shift, anterior bite plate compressed both condyle heads until 2 weeks. 4. There are bone resorptions in the anterior aspect of the condyle head and apposition of posterior border. Bone remodeling were observed between 3 and 4 weeks. 5. After 8 weeks of the experiment, there were little differences in condylar morphology between experimental and control group, though slight shifting and compression were still present in the experimental group. Lateral deviation of mandible evoked active remodeling of the TMJ until functional and anatomical reconstruction of TMJ position was achieved.

• 치과방사선
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• 제20권2호
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• pp.299-313
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• 1990

The author analysed tomographic and cephalometric radiographs of 82 temporomandibular joints from 41 symptomatic patients and 40 temporomandibular joints from 20 asymptomatic young adults. The results were as follows; 1. The mean condylar angulation in control group and patient group was 21.72±6.48° 20.13±9.14° respectively and there was no significant difference between two groups. 2. The mean depth of cut was 6.63±0.38㎝ in control group and 6.57±0.46㎝ in patient group. 3. Mean height and width of condylar head were 6.66±1.83㎜, 12.42±0.49㎜ in control group and 6.22±1.36㎜, 11.93±l.92㎜ in patient group. 4. The mean height of articular fossa was 10.20±2.04㎜ in control group and 9.89±1.98㎜ in patient group. The mean width of articular fossa was 21.08±2.08㎜ in control group and 21.24±3.03㎜ in patient group. 5. In centric occlusion the superior joint space was largest (4.15±0.93㎜), followed by the posterior joint space (2.99±0.97㎜) and the anterior joint space (2.70±0.73㎜) in control group. The superior joint space (3.47±1.31㎜) and posterior joint space (3.47±7.07㎜) were same in patient group. There was significant difference in left superior joint spaces between two groups (p<0.05). 6. The condylar position in articular fossa was displaced anteroinferiorly (0.99±3.65㎜ anteriorly, 1.75±1.01㎜ inferiorly) in control group and posteroinferiorly (3.20±4.69㎜ posteriorly, 1.25±1.87㎜ inferiorly) in patient group with 1 inch opening. In maximum opening, it was displaced anteroinferiorly (6.09±3.55㎜ anteriorly, 1.38±2.47㎜ inferiorly) in control group and anteroinferiorly (1.70±5.96㎜ anteriorly, 1.37±1.85㎜ inferiorly) in patient group. There was significant difference in anteroposterior position of both condyles with 1 inch opening and maximum opening between two groups (p<0.01). 7. The mean inclination of upper central incisor and the posterior inclination of articular eminence in control group was 65.60±6.04° 58.88±9.18° in control group, and 67.14±8.41°, 59.70±9.08° in patient group respectively. There was no significant correlation between two groups.

• 치과방사선
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• 제13권1호
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• pp.151-162
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• 1983

The author analyzed the morphologic changes of bone structure from 848 radiograph is (424 joints) of 212 patients with temporomandibular joint arthrosis, which were obtained by the oblque-Iateral transcranial projection and orthopantomography. The interelation of the bone changes and condylar head positions the results were as follows: 1. In the 212 patients with TMJ arthrosis, 210 patients(99.05%) show the condylar positional changes. Among them, 187 patients 989.05%) show the bone changes. 2. In TMJ arthrosis patients with bone changes, 10% patients(57.75%) show both the condylar positional changes and bone changes. 66 patients( %) show the condylar psoitional changes bilaterally and bone changes unilaterally. On the other hand, 11 patients (5.88%) show the condylar positional changes unilaterally and bone change bilaterally. 3. The bone changes in the TMJ arthrosis patients with the condylar positional changes were as follows: There were the flatlening of articular surface in 103 cases (26.55%) the erosion in 99cases 925.57%), and the erosion in 88 cases (22.68%). There were not much differences among the three types of bone changes. And the deformity in 70 cases (18.04%), the sclerosis in 22 cases(5.67%), the marginal protiferation in 6 cases(1.55%) were seen. 4. The regions of bone changes in TMJ arthrosis patients with condylar positional changes were as follows: They occurred at the condyle head(51.04%), the articular eminence(39.20%) and the articular fossa(9.60%) in that order. The condylar positional changes and bone changes according to the regions were as follows: a) In the bone changes at the condyle head, the flatteming (34.63%) was a most frequent finding and the deformity(27.63%) the erosion(24.32%) in the order. In the condylar positional changes, the downward positioning of condyle(41.44%) was a most frequent finding in the mouth closed state and the restricted movement within the articular fossa(35.46%) in the mouth open state. b) In the bone changes at the articular eminence, the eburnation(33.26%) was a most frequent finding and the flatteming(31.16%), the erosion(28.37%) in that order. In the condylar positional changes, the downward positionirg of condyle(39.81%) was a most frequent finding in the mouth closed state and the restricted movement within the articular fossa(24.77%) in the mouth open state. c) In the bone changes at the articular fossa, the eburnation(72.90%) was amost frequent finding and theerosion(17.76%), the sclerosis(9.35%) in that arder. In the condylar positional changes, the downward positionirg of condyle(41.5%) was a most frequent finding in the mouth closed state and the mormal positionirg of condyle(27.78%) in the mouth open state.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권5호
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• pp.316-323
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• 2009

Purpose: This study was performed to evaluate three-dimensional positional change of the condyle using 3D CT after bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients. Patients and methods: Nine patients who underwent BSSRO for mandibular set-back in skeletal class III malocclusion without facial asymmetry were examined. Miniplates were used for the fixation after BSSRO. 3-D CT was taken before, immediately after, and 6 months after undergoing BSSRO. After creating 3D-CT images using V-works $4.0^{TM}$ program, axial plane, coronal plane, & sagittal plane were configured. Three dimensional positional change, from each plane to the condyle, of the nine patients was measured before, immediately after, and 6 months after undergoing BSSRO. Results: 1. The mean value of mandibular set-back for nine mandibular prognathism patients was 7.36 mm (${\pm}\;2.42\;mm$). 2. In the axial view, condyle is rotated inward immediately after BSSRO (p < 0.05), comparing with preoperative but outward 6 months after BSSRO comparing with postoperative (p < 0.05). 3. In the axial view, condyle is moved laterally immediately after BSSRO (p < 0.05), comparing with preoperative but regressed 6 months after BSSRO comparing with preoperative (p > 0.05). 4. In the frontal & coronal view, there is changed immediately after and 6 months after BSSRO, comparing with preoperative but no statistical difference. Conclusion: These results indicate that three-dimensional positional change of the condyle in skeletal class III patients is observed lateral displacement & inward rotation immediate after BSSRO, but the condyle in 6 months after BSSRO tends to regress to preoperative position.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.758-770
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• 1996

Discectomy is the oldest and most commonly performed operation for the painful temporomandibular joint with internal derangement. It is the one operation for which there are longest follow-up study, with Eriksson, Silver, and Tolvanen et al reporting good results in patients about 30 years after discectomy. About 80% to 90% of patients clinically experience relief from pain and dysfunction after discectomy, and interestingly, the results may improve with time. However such as Myrhaug found headache and Poswillo supposed pain and limitation of movement as postoperative complications, even though this operation had the longest follow-up term, several aspects of discectomy remain unclear. The controversies to discectomy for TMJ with pain and dysfunction have laid emphasis only upon clinical results, and then the histomorphological study was planned to evaluate the morphologic change of TMJ after discectomy. To clarify the nature of the change through an observation on the morphologic changes of articular cartilage and subchondral bone of the condyle resulting from experimental unilateral discectomy in rabbit, the author excised the left articular discs of 12 male rabbits(control 4 rabbits), weighing about 3kg, and at 1, 3, 6, 9 weeks following surgery, harvested both(left surgical site and right nonsurgical sits) TMJ. The specimens were examined with light microscope after H-E and MT stain and the obtained results were as follows. 1. Histopathological features showed thickening of articular zone and active proliferation of fibrocartilaginous zone associated with slight proliferative zone in surgical site than control group. Also replacement of chondrocytes in calcified cartilaginous zone into bone cells was observed. 2. There were thinning of thickness of each zone of articular cartilage except calcified cartilagnous zone was observed in nonsurgical site. 3. In MT stain of condylar trabeculae, there was increased calcification in nonsurgical site than control and surgical site and the degree of calcification was similar in surgical site and control group. 4. In both site of experimental group no features of degenerative changes were observed. From the above results, it is presumed that the morphologic changes of surgical site discectomy are compensatory remodeling process characterized by an hyperplastic reaction of the articular zone and fibrocartilaginous zone filling the void created by removing the disc, and the bone changes are secondary to changes in the cartilage. Increased degree of calcification seen in condylar trabeculae of nonsurgical site results from the excessive use of condyle of that site.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권6호
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• pp.497-504
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• 2011

Purpose: Patients who had a subcondylar fracture with a displaced or deviated condylar segment were treated with a retromandibular approach (RMA) or an endoscope-assisted transoral approach (EATA) in our department of oral and maxillofacial surgery. The clinical results of the approaches were compared. A comparative study of specific approaches for subcondylar fractures has not been published before in Korea. Methods: Twenty-one patients with subcondylar fractures of the mandible were included. Ten patients were treated with the retromandibular approach and 11 were treated with an endoscope-assisted transoral approach. We examined patient age, gender, fracture sites, classifications, period of maxillomandibular fixation, facial nerve (FN) or greater auricular nerve (GAN) injuries, maximal mouth opening, deflection, occlusal changes, number of plates, follow-up period, and other complications. Preoperative computed tomography and pre-operative, post-operative, and follow-up panoramic views were taken of each patient. Results: Mean maximal mouth openings were similar between the two approaches. FN and GAN injuries were more frequent in the RMA group but the deflective rate with mouth opening was higher in the EATA than that in RMA group. Two cases of post-operative infection occurred in the EATA group, and occlusal changes were observed in one case for both approaches. Conclusion: The RMA offers more direct access and visualization of the surgical field but it can cause scars and retractive injuries of the FN and GAN. But, EATA did not result in consequent nerve injuries or scars postoperatively, but unfavorable fractures such as $medial$ $override$ condyles were more difficult to reduce endoscopically. Except cases of an expected difficult reduction, the treatment of choice for a displaced subcondylar fracture may be an EATA.

• 치과방사선
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• 제18권1호
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• pp.81-136
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• 1988

The aim of this study was to determine whether T.M.J. tomographic examination yielded significant differences in condyle positions among asymptomatic, myalgia, derangement, and arthrosis groups of T.M.J. disorders. The author obtained sagittal linear tomograms of right and left T.M.Js. of 36 asymptomatic, 22 myalgia, 54 derangement, and 31 arthrosis patients taken at serial lateral, central, and medial sections in the intercuspal position after submentovertex radiographs analyzed. With the dual linear measurements of the posterior and anterior interarticular space, condyle positions were mathematically expressed as proportion. All data from these analysis was recorded and processed statistically. The results were obtained as follows. 1. In asymptomatic group, radiographically concentric condyle position was found in 50.0% to 65.4% of subjects, with a substantial range of variability. No significant differences existed between men and women and also between right and left T.M.Js. for condyle position. 2. In women, significant difference for mean condyle position of left lateral section of each diagnostic category existed between derangement and myalgia groups (P<.05). Also that of left central section existed between derangement and myalgia groups, and that of left medial section existed between derangement and myalgia groups (P<.05). 3. In main-symptom side, condyle position in myalgia group was more concentric, and condyle position in derangement group was more posterior. This showed significant differences between derangement and myalgia groups in lateral, central, and medial sections of main- symptom sides, and only between derangement and myalgia groups in central section of contra-lateral sides (P<.05). Condyle position in arthrosis group was broadly distributed among all positions. 4. In contra-lateral side, significant difference for mean condyle position of central section of each symptomatic group existed between derangement and myalgia groups (P<.05). Condyle position in derangement group was more posterior. The distribution of the condyle position of contra-lateral side in patients with unilateral symptoms was similar to that of main-symptom side in each symptomatic group. No significant difference existed between main-symptom and contra-lateral sides. 5. For internal derangement subgroups, condyle position in reducible disc displacement group was more posterior than non-reciprocal and locking groups, but there was no significant difference. 6. From 16 to 25 years, significant difference for mean condyle position of medial section of main-symptom side of each symptomatic group existed between myalgia and derangement groups (P<.05).

• 대한소아치과학회지
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• 제39권4호
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• pp.412-417
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• 2012

뮤코다당증(mucopolysaccharidosis : MPS)은 glycosaminoglycans (GAGs)의 분해에 필요한 라이소좀 효소의 결함으로 인해 야기되는 질병으로 GAGs의 대사산물이 세포의 라이소좀 내에 축적되어 점차적으로 세포, 조직 그리고 기관의 기능 이상을 초래해 육체적, 정신적인 퇴행을 보이며, 심한 경우, 조기에 사망하게 되는 다양한 임상양상을 보이는 질환이다. 임상형은 어떠한 효소가 결핍되느냐에 따라 I형에서 IX형으로 분류한다. 치과적인 증상으로는 맹출 지연, 법랑질 저형성증, 왜소치, 부정교합, 하악 과두의 결함, 치은증식, 그리고 함치성낭 같은 여포성낭이 보고되었다. 뮤코다당증 환자는 심혈관계와 호흡계 기능이 취약하므로 치과 치료를 하는 경우, 전신 상태에 대한 주의사항과 뮤코다당증 환자에서 나타날 수 있는 구강 내 증상에 대해 미리 숙지하고, 의학적으로 환아의 전신 상태 변화에 민감하게 대처해가며 치과 진료를 시행해야 한다. 이 증례는 구강 내 다양한 임상증상을 보이는 제2형 뮤코다당증 환아의 치과 진료 후, 다소의 지견을 얻었기에 이를 보고하는 바이다.

• 대한치과교정학회지
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• 제20권2호
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• pp.363-379
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• 1990

The purpose of this study was to evaluate the effects of the mandibular retractive force on the mandibular condyle of growing dog. The experimental animals were six mongrel dogs of two-month old. Their deciduous dentition were completed. Two of them was used as control group, and experimental group was composed of remaining four. Head band and chin cup were made of cotton tape, and hooks are fabricated on the chin cup and had band for closed coil. Mandibular retractive force was 100g/side and chin cap appliance was used for 14 hours/day during night. Experimental group were sacrificed at 2, 4, 6, 8 weeks from beginning of the experiment. Right TMJ was prepared for histologic study and left TMJ was examined grossly for disc, fossa, and condyle. The conclusions are: 1. Two-month old control animal showed active cartilaginous growth on the mandibular condyle, therefore showed thick proliferative and hypertrophic zones. Remodeling process in the condyle head was observed in which there were bone resorption on the anterior surface and bone apposition on the posterior surface. 2. Four-month old control animal showed marked reduction of hypertrophic zone but the condylar bone remodeling was more pronounced. 3. In experimental group, there are marked reduction of hypertrophic zone at 4 weeks from beginning of experiment, and hypertrophic zone disappeared at posterior-superior portion of condyle in 6-week experimental animal. 8 week experimental animal showed slight recovery of hypertrophic zone. 4. In experimental group, bone deposition was increased at anterior surface of condyle, and bone resorption was increased at posterior surface of condyle. 5. In control group, the glenoid fossa and surrounding bone showed mainly bone apposition. But experimental group showed bone resorption at anterior surface of articular eminence and increased bone apposition at posterior surface of postglenoid spine. 6. No marked traumatic change was seen but 4 weeks and 8 weeks experimental animal showed flattening of posterior surperior condylar surface. Bone marrow of condyle showed minute focal bleeding in 2 weeks and 4 weeks experimental animal, and congestion and depression of hematopoietic bone marrow during all experimental period.

• 대한치과교정학회지
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• 제36권3호
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• pp.218-227
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• 2006

안면 비대칭 환자의 진단분석에 이용할 수 있는 이하두정 두부방사선 규격사진과 표면 근전도 검사 자료는 통용화된 진단분석법 부재 등의 이유로 제한적으로 사용되고 있다. 그러나 여타 진단분석법과 비교할 때, 수직 안모 유형의 평가 등 차별적인 정보를 얻을 수 있어 이에 대한 연구가 필요하리라 보인다. 본 연구의 목적은 안면 비대칭을 보이는 60명을 대상으로 이하두정 두부방사선 규격사진 및 저작근의 표면 근전도를 측정하여 수직 안모 유형과의 연관성 및 안면 비대칭과의 연관성을 평가하고자 함이다. 이하두정 두부방사선 규격사진 계측치 중 radiographic corpus length는 비편위측이 큰 값을 보였고 (p<0.001), 유의성은 없었으나 gonion to interspinosum axis는 편위측이 크고, gonion과 하악과두의 위치는 비편위측이 편위측에 비해 전방에 위치하였다 (p=0.07). 안정시 편위측 전측 두근의 근활성은 비편위측보다 높은 것으로 나타났다 (p<0.01). 또한 최대 폐구 시 교근의 활성은 유의성이 없었으나 비편위측에 비해 편위측이 큰 값을 보였다 (p<0.09). Facial index와 intercondylar axes angle은 양의 상관관계를 보였다 (p<0.01). 최대 폐구 시 편위측 및 비편위측의 교근의 활성은 facial index와 양의 상관관계를 보였다 (p<0.05). 이상의 결과를 통해 골격성 안면 비대칭을 보이는 환자에서 이하두정 두부방사선 규격사진과 표면 근전도 검사를 통해 비대칭 양상의 평가와 더불어 수직 안모 유형의 평가 또한 가능한 것으로 생각된다.