• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권3호
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• pp.189-197
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• 1993

Tempormandibular Joint pain and dysfunction is a common and important clinical problem. With the recent advances in imaging technology, radiologists have made major contribution to the understanding of TMJ disease. The MRI has several advantages over the conventional imaging methods. It is possible to obtain surprisingly precise images of internal hard and soft tissues with MRI. It is not invasive without ionizing radiation. The abnormal disk position has been thought as the cause of TMJ internal derangement. But there are few methods to relate disk position to TMJ internal derangement quantatively. The object of our study is to determine the amount of anterior displacement fo articular disk in symptomatic patients related each symptoms. Using the method of Dr. Drace, we studied the 38 joints of 22 persons with susceptable TMJ internal derangement. 1. In determining the anterior displacement of TMJ articular disk, the junction between the posterior band and bilaminar zone was useful. 2. The mean anterior displacement of disk in reduction group and without reduction group were $51.0^{\circ}C$ and $81.1^{\circ}C$ respectively. The difference was significant. 3. In the mean anterior displacement of disk, the pain without clicking group showed $84.8^{\circ}C$ and the clicking and pain group $70.8^{\circ}C$, the clicking group respectively.

• Imaging Science in Dentistry
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• 제31권1호
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• pp.9-16
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• 2001

Purpose: To investigate bone and disc configuration on MR images in internal derangement related to age. Materials and methods: MR images of 150 TMJs in 107 patients were analyzed to determine the morphologic changes. Two groups were distinguished to be correlated with age. Group I consisted of TMJs that were diagnosed as having anterior disc displacement with reduction (ADDwR), and Group 2 consisted of TMJs that were diagnosed as having anterior disc displacement without reduction (ADDwoR). We assessed the configuration of the articular disc, degree of anterior disc displacement, and osseous changes of TMJs. Results: The third decade (83 of 150 joints) was most frequent in this study. In the ADDwR group biconcave discs was most frequent at all ages except fifth decade, but in the ADDwoR group deformed discs was most frequent at third and forth decades. In the ADDwR group slightly displaced discs was most frequent at all ages, but in the ADDwoR group severely displaced discs was most frequent at second decade, and the degree of disc displacement was increased with aging over 30 years of age. TM joints showed osseous changes in 17% of the ADDwR group, and in 30% of the ADDwoR group. MR findings of osseous changes of the TMJ were not found to be significantly correlated with age. Conclusion: The prevalence of deformation of disc, displacement of disc, and osseous changes of TMJ was higher in the ADDwoR group than in the ADDwR group. MR findings of disc configuration and degree of disc displacement were found to be correlated with age.

• 구강회복응용과학지
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• 제31권3호
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• pp.273-282
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• 2015

중심위에서 벗어나 있는 최대교두감합위는 상하악 치아의 조기접촉 및 사면활주의 직접적인 원인이며, 악관절 내장증, 치아마모, 치주질환 등을 일으킬 수 있다. 그러므로 광범위한 보철수복이 필요한 환자에서 중심위와 최대교두감합위의 불일치가 존재하는 경우 반드시 이를 제거하여 생리적인 교합양식을 회복해야 한다. 본 증례의 환자는 초진 시 약 3.5 mm의 사면활주와 다수의 우식 및 중등도의 치주질환을 앓고 있었다. 보철수복을 통해 기능 및 심미성을 회복하는 동시에 중심위와 최대교두감합위를 일치시켜 사면활주를 제거하였으며, ARCUSdigma II와 경두개 방사선 사진을 이용하여 생리적인 위치로 수정된 하악위와 변화된 개폐구 경로를 관찰하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권1호
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• pp.48-53
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• 1999

Purpose: The aim of this study was to investigate the improvement of referred symptoms of TMJ internal derangement after open surgery of TMJ. Materials and Methods: The present study focused referred symptoms such as headache, neck pain, shoulder pain and evaluated the incidences and changes in their improvement at 1, 3, 6, 12 months after surgery in 118 patients who had TMJ internal derangement and received meniscoplasty(or meniscorrhaphy) and eminectomy at TMJ clinic of Yonsei University, Yongdong Severance Hospital, between 1992 and 1997. Results: One hundred eighteen patients(102 females, 16 males) with mean age of 29.6 years(range, 14 to 74) were included in this study and the mean follow-up period was 19.5 months(range, 12 to 60). The incidences of headache, neck pain, shoulder pain among the surgically treated TMJ internal derangement patients were 66.9%, 28.8%, 28.0% before surgery. Thirty-two preoperative severe(+++) headache patients were all improved their headache at 1, 3, 6 months after surgery, but slight relapse(9.4%) was found at 12 months after surgery. The clearance rate of preoperative neck and shoulder pain were 91.2% and 90.9% at 1 month after surgery and all of these groups had no pain at 12 months after surgery. Conclusions: Referred symptoms of TMJ internal derangement such as headache, neck pain, shoulder pain were dramatically improved after surgical treatment of TMJ.

• 치과방사선
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• 제21권2호
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• pp.225-234
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• 1991

This study was designed to investigate the effects of the posterior slope of the articular eminence and the condylar angulation to the posterior slope of the articular eminence on internal derangement of TMJ. The materials consisted of 78 transcranial oblique lateral projections of 31 normal subjects and 47 internal derangement patients. The results were as follows: 1. The posterior slope of the articular eminences in normal group were larger than that in abnormal group, but there were not significant differences between each group about the condylar angulation to the posterior slope of the articular eminences. 2. The differences between in the right and left sides in patients who were affected unilaterally and bilaterally were larger than that in normal groups. 3, In patients affected unilaterally, there were not significant differences between affected joints and unaffected joints about the posterior slope of the articular eminence and the condylar angulation to the posterior slope of the articular eminence. 4. In abnormal group, there were significant differences between each group about condylar angulation to the post, slope of the articular eminence (ant. disk displacement without reduction > fibrous adhesion > ant. disk displacement with reduction), but not about the post, slope of the articular eminence.

• Journal of Oral Medicine and Pain
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• 제38권2호
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• pp.137-142
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• 2013

구강내과는 측두하악관절장애 및 신경병성통증 등과 같은 구강안면 통증, 연조직 질환, 구취, 레이저 치료, 코골이와 수면 무호흡증, 법치의학적인 감정 분야 등을 포함하고 있다. 이상의 질환은 비교적 흔하게 발생되며 환자에게 큰 불편과 고통을 안겨주며 때로는 건강에 치명적인 위협을 초래하기도 한다. 구강내과학적인 측면에서 볼 때, 현대 사회로 갈수록 생활 패턴의 변화와 스트레스 증가 등의 원인으로 턱관절 장애를 포함한 구강 안면 통증 환자가 늘어나고 있으며 또한 연조직 질환, 코골이와 수면 무호흡증, 법치의학적인 감정 등과 같은 구강내과적인 전문성을 요구하는 분야의 수요가 가파르게 증가되고 있다. 따라서 치과학 중에서 구강내과의 역할과 전문성에 대한 요구가 갈수록 증가되고 있다. 연간 구강내과에 내원한 신환의 질병명에 따른 분포도와 증상의 이환 기간, 내원 경로 등을 분석하는 것은 향후 구강내과의 역할과 비중에 대한 정보를 제공해주며 환자를 위한 원활한 진단과 치료를 가능하게 한다. 따라서 본 연구에서 1년간 치과대학병원 구강내과에 내원한 신환을 분석하여 향후 구강내과의 역할과 전문성에 대하여 고찰해 보았을 때 다음과 같은 결과를 얻었다. 1. 구강내과에 내원하는 신환은 주로 측두하악장애, 연조직 질환, 신경병성 통증 환자로 나타났다. 2. 측두하악장애 환자는 신환중 가장 높은 비율을 보였으며 세부 진단순은 복합 장애 환자, 근육통 환 자, 관절원판 내장증 환자 순이었다. 3. 연조직 질환 환자 중 구강건조증 환자가 가장 높은 비율을 보였으며 그다음 편평태선 환자, 재발성 아프타성 궤양 순이었다. 4. 신경병성 통증 환자에서 구강 작열감 증후군이 가장 높은 비율을 보였다.

• 치과방사선
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• 제22권2호
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• pp.351-364
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• 1992

Internal derangement of the temporomandibular joint can be defined an abnormal relationships of the meniscus relative to the mandibular condyle, articuar fossa and eminence. This may cause variable mandibular dysfunctions and pain. For diagnosis, arthrography, computed tomography and magnetic resonance imaging are used. In this study, the author reviewed 98 TMJs of 88 patients who were diagnosed as internal derangement througth inferior joint space arthrography at the department of Oral & Maxillofacial Radiology, Dental Hospita, Dankook university through 1986 to 1992. 98 TMJs consisting of 30 disc displcement with reduction, 48 disc displcement without reduction and 20 perforation were studied about clinical and radiological findings. The results were as follows: 1. Internal derangement was found most frequently in the 2nd 3rd decades and the average age of perforation was higher than that of disc displcement with higher than that of disc displcement with reduction. The sexual predilection was 2 times hiher in females. 2. The most frequent chief complaints were TMJ sound in disc displcement with reduction, pain and limitation of mouth opening in disc displcement without reduction and pain in perforation. The duration of the chief complaints was longer in disc displcement with reduction with than in preforation and disc displcement without reduction. 3. Reciprocal click was the most frequently TMJ sound in disc displcement with reduction. History of joint sound in disc displcement without reduction an crepitus in perforation was the most frequent one. 4. The average maximum opening was 45.4㎜ in disc displcement with reduction, 31.4㎜ in disc displcement without reduction and 33.8㎜ in perforation. 5. In the centric occlusion, posterior condylar position was the most frequent in disc displcement with reduction. posterior and concentric condylar position was frequent in disc displcement without reduction, concentric and anterior condylar position in perforation. At 1 inch opening, the same position to articular eminence was most frequently found in disc displcement with reduction, posterior position in disc disp1cement without reduction, posterior and nterior position in perforation was frequently found. 6. Bony changes, especially sclerosis and flattening, was most frequently found in perforation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권4호
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• pp.330-335
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• 2002

The study was performed to investigate the comparison of relative signal intensity of normal- and abnormal-side retrodiscal tissue, and relationship between clinical examination, joint effusion and relative signal intensity of retrodiscal tissue in patients with unilateral TMJ internal derangement. The study group comprised 19 females and 9 males, with a mean age of 29 years. After measurements of the signal intensity were made on the MR imager for the T2 weighted images on retrodiscal tissue and brain gray matter, we calculated relative value and tried to find relationship between clinical examination, joint effusion and relative signal intensity on normal- and abnormal-side. The results are as follows. 1. The gray matter is an appropriate reference point. 2. The relative signal intensity is high significantly in abnormal-side retrodiscal tissue compared with normal-side retrodiscal tissue. 3. The relative signal intensity is high significantly in painful joints compared with nonpainful joints and in joints with joint effusion compared with joints without joint effusion. 4. The relative signal intensity in normal joints, joints with reduction and joints without reduction is increased in order significantly.

• 치과방사선
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• 제28권1호
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• pp.205-213
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• 1998

This study was designed to reveal the correlationship between the internal derangement state of TMJ and clinical characteristics including pain and mandibular dysfunction. One hundred and twenty five subjects with TMJ signs and symptoms were chosen for two years. The level of pain and madibular dysfunction were evaluated by Visual Analog Scale(VAS) and Craniomandibular Index(CMI). The diagnostic categories of TMJ internal derangement were determined by arthrography and they included normal disc position, anterior disc displacement with reduction(ADDR), rotational disc displacement with reduction (RDDR), anterior disc displacement without reduction(ADDNR), and rotational disc displacement without reduction(RDDNR). Also disc perforation was used as a criteria to divide the diagnostic subgroups. The obtained results were as follows; 1. The patient distribution of each group was 5 in normal disc position(4％), 40 in ADDR(32％), 30 in RDDR(24％), 34 in ADDNR(27％), and 16 in RDDNR(13％). 2. Perforation was observed in 8％ of ADDR, 10％ of RDDR, 32％ of ADDNR, and 19％ of RDDNR. 3. CMI of non-reduction group was higher than that of reduction or normal group(p<0.05), but V AS showed no significant difference.4. CMI of perforation group was higher than that of non-perforation group in reduction group (p<0.05). 5. There were no significant differences of CMI and VAS between anterior disc displacement group and rotational disc displacement group in both reduction and non-reduction group. 6. CMI of RDDNR group was higher than that of RDDR group(p<0.05). 7. There were no significant difference of CMI and VAS between bilateral involvement group and unilateral involvement group(p<0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권4호
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• pp.373-382
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• 2000

Temporomandibular disorders arised from joint itself was caused by inflammation or mechanical irritation of the retrodiskal tissues. Histologic changes of the retrodiskal tissues of temporomandibular joint(TMJ) internal derangement, such as inflammatory cell infiltration, hyalinization, myxoid change, fatty change, arterial obliteration, and so on, were reported, but relationships between magnetic resonance imaging(MRI) findings and histologic findings of the retrodiskal tissue were few reported. The purpose of this study was to find histologic changes of the retrodiskal tissues for status of joint and joint effusion in MRI of the temporomandibular joint which had surgical treatment. Materials were surgically treated 52 temporomandibular joints with internal derangement or osteoarthritis in TMJ clinic, Yongdong Severance Hospital. All joints were confirmed by magnetic resonance T1- and T2-weighted imagings bofere surgery. Status of joint was categorized by normal position, disc displacement with reduction, disc displacement without reduction, disc displacement without reduction associated with osteoarthrosis using preoperative MR T1-weighted images. Magnetic resonance evidence of joint effusion was observed in T2-weighted images and classified by its amount; degree 0(not observed), degree 1(small amount), degree 2(moderate amount), degree 3(large amount). Histologic features were observed whether the retrodiskal tissue has inflammatory cell infiltration, myxoid change, hyalinization, chondroid metaplasia and arterial obliteration. The distribution of elastic fibers were also observed. The results were as follows; 1. Inflammatory cell infiltration was not observed in any retrodiskal tissues. 2. MRI findings such as status of joint and evidence of joint effusion did not have significant relationship with myxoid change, hyalinization, chondroid metaplasia, arterial obliteration of the retrodiskal tissues. 3. Hyalinization and chondroid metaplasia were found in 8 joints(15.4%) and 5 joints(9.6%). All of them were found in disc displacement without reduction and disc displacement without reduction associated with osteoarthrosis. 4. Arterial obliteration was observed more frequently in disc displacement without reduction(55.6%) than disc displacement without reduction associated with osteoarthrosis(28.6%). Further studies with proper controls and more materials will be necessary.