• Imaging Science in Dentistry
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• 제51권3호
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• pp.313-321
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• 2021

Ankylosis of the temporomandibular joint (TMJ) is a disabling disease resulting from fibrous or bony fusion of the mandibular condyle and the glenoid fossa. Early diagnosis and surgical treatment are essential to prevent facial deformity and other complications. Conventional radiography has limitations in demonstrating the true extent of ankylosis. It is important for surgeons to be aware of the size and degree of bony ankylosis in order to perform complete resection of the ankylotic mass. In addition, a detailed evaluation of the relationship with adjacent vital structures such as the internal maxillary artery, inferior alveolar nerve canal, external auditory canal, and skull base are crucial to avoid iatrogenic injury. Multidetector computed tomography (MDCT) is the current imaging modality of choice for preoperative assessments. Herein, the authors propose a structured CT reporting template for TMJ ankylosis to strengthen the value of the preoperative imaging report and to reduce the rates of intraoperative complications and recurrence.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권6호
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• pp.354-359
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• 2023

The temporomandibular joint is a unique structure composed of the joint capsule, articular disc, mandibular condyles, glenoid fossa of the temporal bone, surrounding ligaments, and associated muscles. The condyle is one of the major components of a functional temporomandibular joint. Reconstruction of large mandibular defects involving the condyle is a surgical challenge for oral and maxillofacial surgeons. To restore large mandibular defects, there are different options for free flap method such as fibula, scapula, and iliac crest. Currently, the vascularized fibula free flap is the gold standard for reconstruction of complex mandibular defects involving the condyle. In the present report, neocondyle regeneration after mandible reconstruction including the condyle head with fibula free flap was evaluated. In this report, two patients were evaluated periodically, and remodeling of the distal end of the free fibula was observed in both cases after condylectomy or mandibulectomy. With preservation of the articular disc, trapezoidal shaping of the neocondyle, and elastic guidance of occlusion, neocondyle bone regeneration occured without ankylosis. Preservation of the articular disc and maintenance of proper occlusion are critical factors in regeneration of the neocondyle after mandible reconstruction.

• 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.

• 치과방사선
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• 제22권1호
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• pp.29-37
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• 1992

The temporomandibular joint was evaluated using magnetic resonance imaging using a urface coil in 11 patients having reciprocal clicking or locking and compared with the normal joint in five subjects. Serial multisection 3㎜-thick parasagittal, paracoronal, and axial image on both closing and opening mouth were obtained with a 1.5 Tesla MR system and surface coil using CSMEMP, GRASS, MPGR, powerful extensions of fast imaging that is currently under clinical evaluation. MR images obtained were analized correlating with the theory of internal derangement. The obtained results were as follows: 1. The serial findings of structures in joint were determined on the serially sectioned images of joint with reciprocal clicking or locking by CSMEMP and MPGR on closing mouth. 2. The delta shaped white images of synovial fluid in the glenoid fossa and on the posterior surface of condyle were revealed on the parasagittal images by MPGR on opening mouth as in the normal joints. 3. The white image of joint fluid surrounding meniscus was recognized on the paracoronal image by GRASS on opening mouth as in the normal joints. 4. In joints having temporomandibular dysfunction the smooth image of displaced meniscus was recognized, but otherwise in the normal joints the image of muscle was noted on the paracoronal image sectioned at the anterior portion of condyle by GRASS. 5. The more thickened fascial plane between superior and inferior belly of lateral pterygoid muscle was not recognizable in joints having temporomandibular dysfunction than in the normal joints.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권1호
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• pp.11-20
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• 1993

Bony ankylosis is an intraarticular condition where there is fusion of the bony surfaces of the joint : The condyle and the glenoid fossa. It occurs in both children and adults, unfortunately more frequently in the former, in whom early recognition and correction is particularly critical. Trauma is well proven to be the predominant cause of TMJ ankylosis. Infection, rheumatoid arthritis and neoplasm are another, significant cases of TMJ ankylosis. The necessity for using an interpositional material to prevent TMJ reankylosis has been widely discussed and many interpositional materials have been used, including temporal muscle and fascia, dermis, auricular cartilage, fascia lata, fat, Lyo-dura, Silastic and various metals. The temporal muscle and fascia have been widely used pedicled flap for head and neck reconstruction. The use of a temporal muscle and fascia for reconstruction of the TMJ, particularly in cases of ankylosis is a very reasonable option. Its principle advantages are its autogenous nature, resilience, and proximity to the joint, allowing for a pedicled transfer of vascularized tissue into the joint area. However, the viability of temporal muscle and fascia is a critical question. We treated 2 cases of TMJ ankylosis with temporal muscle and fascia transfer and one case with temporal fascia. We obtained satisfactory results as to functional aspects.

• 대한치과교정학회지
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• 제22권2호
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• pp.345-372
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• 1992

The purpose of this experiment was to study the effects of changes of mandibular position on temporomandibular joint in internal derangement patients Twenty-four female New Zealand White Rabbits, weighing over 3.5kg, were utilized in this study . Bilateral temporomandibular joint surgery was performed in twenty-one of the rabbits to displace disc anteriorly through incising the retrodiscal tissue 1-2mm posterior to the disc, thus inducing internal derangement. They were divided into three groups nine were left untreated after surgery, six were fitted with functional protrusive appliances 4 weeks after surgery, and six wore collar appliances to apply 4 ounces of mandibular refractive force per side 4 weeks after surgery. The remaining three served as the control group. Histologic examinations were performed after sacrificing them by threes at 4-week intervals. The results were as follows. 1. Histologic findings similar to internal derangement were observed in the rabbits whose retrodiscal tissues had been incised. 2. In the rabbits untreated after surgery, articular surface on condylar process and articular eminence showed severe erosion and deformation, and displaced disc manifested changes in both shape and internal architecture. 3. Functional protrusion after surgery resulted in progressive remodeling on postero-superior portion of condyle and glenoid fossa, while it also brought about erosion on articular eminence and anterior portion of condyle. 4. Mandibular retraction after surgery resulted in compression of retrodiscal tissue and regressive remodeling of posterior portion of condyle.

• 치과방사선
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• 제17권1호
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• pp.89-106
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• 1987

The author obtained individualized lateral cephalometric tomograms from 23 young adults (46 of left and right normal TMJ) with normal occlusion and 20 patients (14 of patient asymptomatic TMJ and 26 of patient symptomatic TMJ) with clicking and painful TMJ after the analysis of submental vertex view. Individualized lateral cephlometric tomogram analysis and TMJ space analysis were performed after tracing each film. All data from these analysis was recorded and statistically processed with CYBER computer system. 1. The results were obtained as follows. In submental vertex view, the mean condylar angulation of Rt. side in normal group was 20.348°±6.358°, Lt. side was 18.870°±7.777° and Rt. side in patient group was 19.350°±7.576° Lt. side was 17.750°±6.146° respectively. The mean condylar angulation of Rt. side was larger than Lt. side in normal and patient group. 2. When the mandible was moved from centric occlusion to centric relation, condylar position relating to the glenoid fossa was placed posteriorly and superiorly in normal TMJ group and patient symptomatic TMJ group. 3. In centric relation position, the proportion of anterior space to posterior space was 1.593 for normal TMJ group, 1.604 for patient asymptomatic TMJ group and 1.671 for patient symptomatic TMJ group. In centric occlusion position, 1.390 for normal TMJ group, 1.539 for patient asymptomatic TMJ group and 1.196 for patient symptomatic group. Normal TMJ group, patient asymptomatic TMJ group and patient symptomatic TMJ group and patient symptomatic TMJ group revealed significant difference in ∠C₂ measurement. (ANOVA-test, p<0.05) 5. Normal group and patient group revealed significant difference in Fh, ∠C₁and ∠C₂ measurement. (T-test, p<0.05) 6. There were strong positive correlation (0.8771) between Fp and Fm, and strong negative correlation (-0.9039) between ∠C₂ and ∠C₁ from the lateral cephalometric tomogram analysis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권5호
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• pp.359-367
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• 2004

Purpose: After the surgical correction with sagittal split ramus osteotomy, the position of the mandibular condyle in the glenoid fossa and the proximal segment of the mandible change because of bony gap between proximal and distal segment, especially in case of mandibular setback asymmetrically. In this study, positional changes in the condyle and proximal segment after BSSRO were estimated in the mandibular asymmetry patient by analyzing the in submentovertex view and P-A cephalogram for identification of ideal condylar position during surgery. Patients and Methods: The 20 patients were selected randomly who visit Dankook Dental Hospital for mandibular asymmetry. Bilateral sagittal split ramus osteotomy with rigid fixation was performed and P-A cephalogram and submentovertex view was taken at the time of preoperative, immediate postoperative, 3 month postoperative period. Results: Intercondylar length and transverse condylar angle was increased due to inward rotation of proximal segment and anteromedial rotation of lateral pole of condyle head. The condylar position had a tendency to return to the preoperative state and after 3 months return up to about half of the immediate post-operative changes, and all the results showed more changes in asymmetry patient and deviated part of the mandible. Conclusion: Based on all these results above, surgeon should make efforts to have a precise preoperative analysis and to have a ideal condylar position during rigid fixation after BSSRO.

• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.41-45
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• 2004

In adhesive capsulitis of the shoulder of no response to nonoperative treatment, an arthroscopic capsular release and manipulation improves range of motion and pain relief. We performed an arthroscopic examination in the stiff shoulder, of which she had no response to nonoperative treatment, after the conservative treatment of a clavicular shaft fracture by motorcycle-driver traffic accident. We found the intra-articular 'rotator interval bridging scar adhesion' between subscapularis tendon and antero-superior glenoid fossa under the rotator interval which was no adhesion and contracture itself. We performed the scar adhesion removal and synovectomy, maintaining the rotator interval. We recommended nonsteroidal anti-inflammatory drug for postoperative pain relief and continuous active and passive range of motion (ROM) exercise to gain motions. Preoperatively, active and passive range of motion were 70° for forward elevation, 60° for abduction and especially 0° for external rotation. After postoperative 2 months, active ROM were 150° for forward elevation, 130° for abduction and 80° for external rotation. After postoperative 6 months, passive and active ROM were full. UCLA score improved from preoperative 9 points to postoperative 29 points.

• Journal of Yeungnam Medical Science
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• 제10권1호
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• pp.218-225
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• 1993

저자들은 악골 변위로 인한 심미적인 문제로 내원한 23세 여자환자에서 안면비대칭, 부정교합을 관찰하였고 두부방사선 계측사진과 전후 방사선사진 및 파노라마사진을 통해 반측안면 왜소증으로 진단하였다. 이에 심미적 개선을 위해 우측하악관절부에 costchodral graft한 후 상악에 Lefort I osteotomy와 하악에 bilateral intraoral sagittal split ramus osteotomy을 시행한 후 양호한 결과를 얻었으며 수술 후 6개월동안 감염이나 골흡수는 보이지 않았다. 부가적으로 하악과두의 비대칭을 보기위한 towns' view와 연조직 분석을 위한 전산단층 촬영술을 첨가하면 진단에 도움이 될것으로 사료되고, 본 증례에서 향후 연조직 재건을 위한 수술이 첨가되면 더 양호한 결과를 얻을것으로 사료된다.