• The Journal of the Korean dental association
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• v.57 no.4
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• pp.204-212
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• 2019

Introduction : Patients with temporomandibular disorder may have various ear-related symptoms. If an excessive load is applied to the ear area due to the skeletal shape of the mandibular condyle or malposition of the disc, an auditory problems may occur. Case report : The patient was referred to our clinic due to the suspicion of temporomandibular disorder from the local otorhinolaryngology clinic. A few days ago, his right ear could not be heard. MRI showed that the left TMJ disc was anterior displacement with reduction, the right TMJ disc was anteromedial displacement without reduction. Also Right mandibular condyle showed sclerotic bone change, subchondral cyst and was compressing the frontal wall of the ear on MRI view. Right TMJ arthroplasty was done under the diagnosis of right TMJ osteoarthritis and osteochondroma. Postoperative intermaxillary fixation was done with SAS screw and elastics for 2 weeks. One month after the operation, hearing and TMJ discomfort were recovered without any complications. Conclusions As seen in this case, hearing loss due to benign tumor-like lesions of the temporomandibular joint should be treated surgically to restore the TMJ function and hearing.

• The korean journal of orthodontics
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• v.23 no.4 s.43
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• pp.503-527
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• 1993

This paper describes a new method to create an animal model for TMJ internal derangement in the New Zealand white rabbits and the light and electron microscopical changes of posterior attachment of them. Twenty six rabbits(2.5-3.0kg), four normal and twenty two experimental, were used. The right disc of experimental animal was displaced anteriorly without sectioning the posterior attachment and tied to the zygomatic arch with nylon not to be reduced to the original position. The left TMJ was sham-operated to be compared with its right experimental one. Normal animals were sacrificed one day and eight weeks after experiment. Experimental animals were sacrificed one day, ten days, three weeks, five weeks and eight weeks after surgery respectively. They were fixed intravenously with $2\%$ glutaldehyde under general anesthesia and the samples of them were processed for light and electron microscopic examination. The purpose of this experiment is to make a suitable animal model of disc displacement without reduction for studying and understanding the cellular and morphologic events in posterior attachment of TMJ including early changes which were difficult to be observed in human TMJs. The results of this investigation suggest the following conclusions : 1. Authors induced anterior disc displacement surgically in rabbits with new method to examine histologic changes of posterior attachment. Tissue reactions of this model seem to be similar to those observed in human disc displacement. We think this animal model for anterior disc displacement may be used to explore and evaluate objectively the effects of many treatment modalities in disc displacements. 2. The animal disease model showed inflammation at early stage(one and ten days). At this stage there were mild-to-severe mononuclear inflammatory cell infiltration, numerous newly formed vessels, vessel dilatation and engormement and many fibroblasts. 3. At middle stage(three weeks), fibrosis occurred, where fibroblasts decreased in number, but their cytoplasm was profuse indicating high activity. Collagen fibers increased in number and the tissue looked more dense. 4. At late stage(five weeks and eight weeks) showed degenerative changes including perforation of posterior attachment, disintegration of collagen fiber bundles, degeneration of fibroblasts, metastatic ossification, and dystrophic calcification.

• The korean journal of orthodontics
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• v.51 no.2
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• pp.105-114
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• 2021

Objective: The purpose of this study was to evaluate the relationship between rotational disk displacement (DD) of the temporomandibular joint (TMJ) and the dentoskeletal morphology. Methods: Women aged > 17 years were included in this study. Each subject had a primary complaint of malocclusion and underwent routine cephalometric examinations. They were divided into five groups according to the findings on sagittal and coronal magnetic resonance images of their TMJs: bilateral normal disk position, bilateral anterior DD with reduction (ADDR), bilateral rotational DD with reduction (RDDR), bilateral anterior DD without reduction (ADDNR), and bilateral rotational DD without reduction (RDDNR). Twenty-three cephalometric variables were analyzed, and the Kruskal-Wallis test was used to evaluate differences in the dentoskeletal morphology among the five groups. Results: Patients with TMJ DD exhibited a hyperdivergent pattern with a retrognathic mandible, unlike those with a normal disk position. These specific skeletal characteristics were more severe in patients exhibiting DD without reduction than in those with reduction, regardless of the presence of rotational DD. Rotational DD significantly influenced horizontal and vertical skeletal patterns only in the stage of DD with reduction, and the mandible exhibited a more backward position and rotation in patients with RDDR than in those with ADDR. However, there were no significant dentoskeletal differences between ADDNR and RDDNR. Conclusions: The results of this study suggest that rotational DD of TMJ plays an important role in the dentoskeletal morphology, particularly in patients showing DD with reduction.

• Journal of Oral Medicine and Pain
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• v.38 no.2
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• pp.149-159
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• 2013

The purpose of this study was to investigate the relationship between horizontal morphology of lateral pterygoid muscle and onset of temporomandibular joint disorders. Randomly selected 150 subjects, assigned with equal number in terms of gender and age group, were included. The axial and sagittal images in their magnetic resonance images of the temporomandibular joints were used to measure the morphologic characteristics of lateral pterygoid muscles and temporomandibular joints. The measurement variables were maximal horizontal width and insertion angle to the condyle, position of the articular disc, condylar deformity, and joint effusion. In addition, presence or absence of the temporomandibular joint pain was examined through history and palpation of the joints. The relationships among measurement variables were analyzed and the results were as follow. The insertion angle of the lateral pterygoid muscle to the condyle was higher in the joint of anterior disc displacement without reduction than that in the joint of normal disc position. In addition, the maximal horizontal width of the lateral pterygoid muscle was significantly increased in joints with pain than those without pain. Also, the insertion angle was significantly higher in younger age group and the maximal width was significantly greater in male than in female. These results suggest that high insertion angle of lateral pterygoid muscle might be an important anatomic predisposing factor for anterior disc displacement in temporomandibular joint and muscular activity of lateral pterygoid muscle might be affected by preauricular pain. In conclusion, there might be a bi-directional interaction between lateral pterygoid muscle and joint in the progression of anterior disc displacement in temporomandibular joint.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.17.1-17.5
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• 2015

Arthroscopy is useful to detect early changes in the temporomandibular joint (TMJ). Despite great advances in arthroscopy, many arthroscopic surgeries have now been replaced by arthrocentesis. We propose a simple diagnostic and therapeutic method having operative rigid ultra-thin arthroscopy with 16 gauge needle size combined with arthrocentesis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.4
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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.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.25 no.2
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• pp.319-330
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• 1995

This study was designed to evaluate the interrelationship between the condylar head position in transcranial view and the articular disc position in the arthrography. The condylar positions were assessed by subjective method and linear measurement method on the transcranial view. The subjects for this study consisted of 24 symptomatic joints with normal disc position, 37 joints with anterior disc displacement with reduction and 44 joints with anterior disc displacement without reduction that were classified by arthrotomography under the fluoroscopic guidance. The interrelationship between the condylar head position in transcranial view and the articular disc position in the arthrography was evaluated by Chi square test. The obtained results were as follows : 1. There was no significant interrelationship between the position of condylar head in closed mouth state on transcraniaJ view and articular disc position in the arthrography (p>0.05). 2. There was no significant interrelationship between the changes of interarticular distance in 1 inch opening state and articular disc position in the arthrography (p>0.05). 3. There was no significant interrelationship between the position of condylar head related to the apex of articular eminence in 1 inch opening state and articular disc position in the arthrography(p>0.05). 4. There was significant interrelationship between the changes of interarticular distance that is assessed by linear measurement method in maximum opening state and articular disc position in the arthrography(p<0.05), but there was no significant interrelationship when the condylar head position was assessed by subjective method(p>0.05). 5. There was significant interrelationship between the degree of condylar translation in maximum opening state and articular disc position in the arthrography(p<0.05). 6. The correlation coefficient between two methods to assess the position of condylar head were 0.7989: the condylar head position in articular fossa in closed state, 0.6847: interarticular space in 1 inch opening state, 0.8965: the degree of condylar translation in 1 inch opening state, 0.5944: the changes of interarticular space in maximum opening state, 0.9215: the degree of condylar translation in maximum opening state.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.4
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• pp.155-159
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• 2014

Objectives: The purpose of this article is to evaluate factors influencing prognosis of arthrocentesis in patients with temporomandibular joint (TMJ) disorder. Materials and Methods: The subjects included 145 patients treated with arthrocentesis at the Dental Center of Ajou University Hospital from 2011 to 2013 for the purpose of recovering mouth opening limitation (MOL) and pain relief. Prognosis of arthrocentesis was evaluated 1 month after the operation. Improvement on MOL was defined as an increase from below 30 mm (MOL ${\leq}30mm$) to above 40 mm (MOL ${\geq}40mm$), and pain relief was defined as when a group with TMJ pain with a visual analog scale (VAS) score of 4 or more (VAS ${\geq}4$) decreased to a score of 3 or more. The success of arthrocentesis was determined when either mouth opening improved or pain relief was fulfilled. To determine the factors influencing the success of arthrocentesis, the patients were classified by age, gender, diagnosis group (the anterior disc displacement without reduction group, the anterior disc displacement with reduction group, or other TMJ disorders group), time of onset and oral habits (clenching, bruxism) to investigate the correlations between these factors and prognosis. Results: One hundred twenty out of 145 patients who underwent arthrocentesis (83.4%) were found to be successful. Among the influencing factors mentioned above, age, diagnosis and time of onset had no statistically significant correlation with the success of arthrocentesis. However, a group of patients in their fifties showed a lower success rate (ANOVA P=0.053) and the success rate of the group with oral habits was 71% (Pearson's chi-square test P=0.035). Conclusion: From this study, we find that factors influencing the success of arthrocentesis include age and oral habits. We also conclude that arthrocentesis is effective in treating mouth opening symptoms and for pain relief.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.44.1-44.7
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• 2019

Background: We evaluated the improvement of pain and the increase in mouth opening after temporomandibular joint arthrocentesis and the possible association with various factors such as previous splint treatment, medication, and diagnosis. Results: We studied 57 temporomandibular joint disorder patients who underwent arthrocentesis at Korea University Anam Hospital. These patients (24 males and 33 females, aged between 15 and 76 years) underwent arthrocentesis that was performed by one surgeon. The degree of mouth opening (assessed using the maximum mouth opening: MMO) and pain (assessed using the visual analog scale: VAS) were assessed pre- and post-arthrocentesis. The study also investigated whether treatment modalities other than arthrocentesis (medication and appliance therapy) were performed. Statistical analysis revealed that there was a significant difference in mouth opening and pain after temporomandibular joint arthrocentesis. Preoperative appliance therapy affected the results of arthrocentesis, but it was not statistically significant. With regard to pain relief, preoperative diagnosis did not show a significant difference. However, with regard to maximum mouth opening, patients with disc displacement without reduction with limited mouth opening (closed lock) showed the highest recovery (11.13 mm). Conclusion: The average of MMO increase after arthrocentesis was 9.10 mm, and patients with disc displacement without reduction with locking (closed lock) showed most recovery in maximum mouth opening and it was statistically significant. The average pain relief of patients after arthrocentesis was 3.03 in the VAS scale, and patients using anterior repositioning splint (ARS) preoperatively showed the most pain relief.

• Journal of Oral Medicine and Pain
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• v.32 no.3
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• pp.293-303
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• 2007

The purpose of this paper is to evaluate if there is a relationship between anterior disc displacement without reduction and development of anterior open bite, and a relation between occurrence of open bite and occlusal appliance therapy. In general, the statistically significant differences were found between the Group 1 and 2 and normal mean group. The variables that represent mandibular size and form, showed a statistical significance in all 3 groups. Also 3 groups patients had a smaller ANB, a larger FMA than normal mean group. When we compared the 3 groups with respect to all cephalometric measurements by One-way analysis of variance (ANOVA), group 1 and 2 patients had a larger FMA, a larger SN to mandibular plane angle, a larger maxillomandibular plane angle, a larger occlusal plane to mandibular plane angle, a smaller total posterior facial height/total anterior facial height(%), and a larger gonial angle than group 3. The statistically significant differences were not found between the Group 1 and 2, and skeletal patterns were similar. Thus, morphologic features of patients with vertical discrepancies may represent a risk factor for the development of anterior open bite with or without occlusal appliance treatment. In case of patients with vertical discrepancy, we may have to be more careful when inducing a change of the vertical dimension.