• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.1
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• pp.76-82
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• 2000

In general, treatment of the patients with closed lock divides into a conservative and a surgical treatment. Surgical treatment has been often applied in case that occlusal splint therapy was not effective on the patient with closed lock. In recent, some clinicians reported good results with mandibular manipulation. Three patients complained limitation of month opening-(mean mouth opening was 22.3mm) and TMJ pain. Articular discs were displaced anteriorly on MRI. Two patients didn't improve the symptoms with long term occlusal splint therapy. We applied mandibular manipulation after injection with 2% lidocaine into the upper joint space of the affected TMJ and directly inserted occlusal splint to all patients. At the follow-up check, mean mouth opening was 41.7mm. TMJ pain decreased, condyle and disc relationship was improved functionally on MRI.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.87-92
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• 1989

Transbuccal trocar has been an established method of fixation for the bone plate in the case of mandibular angle fracture. Other than extraoral approaches, this transbuccal approach has many advantages in the treatment of the fracture of mandibular angle. These advantages are as follows ; (1) Damage to the facial nerve branches is minimal. (2) Less postoperative scar is formed. (3) Good vision of occlusion can be easily obtained on the entire operation. (4) Shorter operation time is needed. But, in the clinical procedure of plate fixation, it is has a difficulty in manipulation of the plate and correction of position. To solve these problems, we designed and used a trocar tip which can be easily attached to the trocar, and could make an improvement in the clinical procedures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.297-306
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• 2007

Distraction osteogenesis was pioneered by Ilizarov in the treatment of injured extremities. Its subsequent application to Oral and Maxillofacial Surgery has opened a new chapter in the treatment of facial deformity. Careful monitoring of the period of distraction and consolidation of the callus is important and has been well described. Complications, such as infection, haematoma and premature ossification, are difficult to diagnose and can compromise the outcome after the surgery. Too slow rate of distraction results in premature fusion of cortices and too rapid information of bone 'cyst' within the callus distraction. I experienced 2 patients of congenital unilateral mandibular hypoplasia, so called Hemifacial Microsomia. After distraction surgery, I evaluated callus formation of mandibular distraction with Ultrasound Sonography during distraction and consolidation period. Plain radiography, although it enables accurate measurement of the distraction gap, did not give sufficient detail to allow assessment of early stages of bone formation, But, ultrasound monitoring could enable continuous monitoring of the distraction gap without exposure to ionizing radiation and allow detection of fine detail, which may influence manipulation of the callus.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.5
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• pp.238-241
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• 2013

Lateral and superior-lateral dislocations of the intact condyle are a rare complication, following traumatic insult to the mandible. We report an unusual case of a 54-year-old male patient who experienced both types of dislocations of the intact condyles with symphysis fracture following a road-traffic accident. Under general anesthesia, conventional manipulation was unsuccessful in relocating the condyles into the glenoid fossa. After applying a percutaneous traction force, using a bone traction hook placed at the sigmoid notch, the displaced intact mandibular condyles were repositioned, and the symphyseal fracture was finally reduced and fixed. The mouth opening was within normal limits, and favorable occlusion was confirmed one month postoperatively. To our knowledge, this is the first case of dislocation of both intact condyles--associated with symphysis fracture--being reduced with bone traction hook.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.71-79
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• 2011

Aim: Disc displacement without reduction of the temporomandibular joint (TMJ) has been managed by mandibular manipulation to reduce the displaced disc but with a low success rate. The purpose of this study was to determine whether auriculotemporal nerve block anesthesia had an effect on the reduction of the displaced disc and to analyze the factors that influenced the result. Methods: 112 patients were diagnosed with disc displacement without reduction and treated by mandibular manipulation. Disc was recaptured in 35 patients. Among the 77 patients with whom disc recapture had failed, the auriculotemporal nerve was blocked with a local anesthetic in the 49 patients (mean $age \;{\pm}\; SD\; =\; 34.4\;{\pm}\; 15.1$; male 24, female 25) and then mandibular manipulation was performed again. Factors including age, elapsed time from the onset, and opening amount were analyzed in association with disc reduction rate with the auriculotemporal nerve block. Results: Among 49 patients who did not respond to manipulation only, manual reduction with auriculotemporal nerve block anesthesia was successful in 19 patients (38.8%). Maximum unassisted opening amount significantly increased in the 19 patients with successful recapture of the disc ($mean \;{\pm}\; SD\; =\; 46.1 \;{\pm}\; 4.5\; mm$), in contrast to the limited opening amount of the 49 patients before local anesthesia of the auriculotemporal nerve ($mean \;{\pm}\; SD\; =\; 25.7 \;{\pm}\; 6.0\; mm$). Age, elapsed time after the onset, and preoperative opening amount were not associated with the reduction rate. Conclusion: The results of this study suggest that auriculotemporal nerve block anesthesia increases the reduction rate of the disc displacement without reduction of the TMJ when combined with mandibular manipulation, and such anesthesia should be applied at the first stage of manual treatment of disc displacement without reduction.

• Journal of Oral Medicine and Pain
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• v.20 no.1
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• pp.159-169
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• 1995

The purpose of this study was investigating the effects of pivot splint on width of the temporomandibular joint space in order to get the basic data for clinical applications. Pivot splint could be used for treating the patients with temporomandibular disorders, especially for chronic closed lock which would not be reduced by joint manipulation or with other methods. So it is necessary to have a lot of underlying data for using pivot splint, but there is few available reports related to mechanical principle or clinical results of the splint. Healthy twenty dental students wee collected for this study and pivot splint with 2.5mm high right-side pivot was used. Next, transcanial projection was taken and width of joint space at there mandibular positions were measured : habitual occlusion position, clenching position with splint, and clenching position with splint and mandibular force. The data were processed with SAS statistical program. The obtained results were as follows : 1. Ipsilateral posterior joint space width was increased on clenching the pivot splint, but joint space widths of contralateral side were not significantly changed. 2. Superior and posterior joint space width were increased on clenching the pivot splint with mandibualr force on both ipsilateral and contralateral side. 3. Ipsilateral joint space widths were not significantly changed from habitual occlusion position to clenching the pivot splint with active mandibular force, but in case of with passive mandibular force, posterior joint space width was significantly increased. 4. Correlationships between mandibular positions were more significant at anterior joint space than at superior or posterior joint space. But the correlation between clenching and clenching with mandibular force was significant at all the three joint space.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.441-447
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• 2007

Internal derangement of the temporomandibular joint(TMJ) is defined as an abnormal relationship of the articular disc to the condyle. Mandibular manipulation is one of the conservative treatments to be considered first to manage the patients with anterior disc displacement without reduction. Mandibular manipulation is used to increase articular mobility and to restore the displaced disc into an anatomically normal position. While Farrar's technique has been popularly used, Minagi et al., Mongini and Suarez introduced the manipulation technique conducted by the patients themselves. But there is no study on the efficacy of self-manipulation technique, comparing with conventional one. The aim of this study was to investigate the efficacy of the conventional and self-manipulation technique, which was modified to complement the previously described technique by Minagi et al., in the treatment of patients with anterior disc displacement without reduction. TMD patients, who visited Department of Oral Medicine of Seoul National University Dental Hospital from December, 2002 to November, 2004 and were diagnosed as anterior disc displacement without reduction by TMJ magnetic resonance imaging (MRI) were enrolled. Conservative treatments including physical therapy, exercise, behavioral therapy, stabilization splint therapy, and manipulation therapy were done to every single patient until the symptomsimproved enough to discharge the patient. The charts were reviewed retrospectively according to the type of manipulation. In the results, patients whose maximum mouth opening was more than 40 mm was higher in the self-manipulation group(69.9%) than in the conventional manipulation group(42.9%). But difference between two groups was not significant. According to the fact that we decided to discharge the patients whentheir mouth opening increased to more than 40 mm and subjective symptoms such as pain and discomfort were improved as well, treatment period of discharged patients was significantly shorter in the self-manipulation group($29.2{\pm}12.3$ weeks) than in the conventional manipulation group ($61.0{\pm}38.0$ weeks) (p<0.01). In conclusion, in the treatment of TMD patients with anterior disc displacement without reduction, the self-manipulation technique which is performed by patients themselves is an effective treatment modality for increasing the range of mouth opening and shortening the total treatment period.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.3
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• pp.189-194
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• 2013

Osteochondroma is a benign neoplasm, osseous projection surrounded with cartilage, 35.8% of benign osseous tumor, 8.5% of whole osseous tumor and usually arises from the skeletal bone. Osteochondroma is a cartilaginous derivation and relatively uncommon in the craniofacial bone. Osteochondroma of the mandible has slow growth rates which mainly affect women around forty years of age and it can appear through the coronoid process and mandibular condyle, especially in the medial half. Clinical finding associated with osteochondroma of condyle are primarily a palpable, painless temporomandibular area mass with facial asymmetry, malocclusion and midline deviations. Sometimes pain and dysfunction like trismus often accompany the anatomic derangement. Other features include malocclusion with open-bite on the affected side and cross-bite on the contralateral side. In this study, a 45-years old female patient exhibits pain on the left temporo-mandibular joint area and malocclusion due to loss of the molar region with osteochondroma on the top left of her mandibular condyle head. The patient is able to recover gradually from the symptom through treatments on manipulation, stabilization splint, arthroscopic lavage and surgical excision, thus, this is reported as a clinical case.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.739-743
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• 2005

Subcondylar fractures have generally been treated by intermaxillary fixation except in cases where there is an absolute indication for open reduction. The reason behind a less aggressive surgical approach lies on the inherent difficulties in manipulating fragments in such a small area at the risk of damaging facial nerves or vessels such as the internal maxillary artery. However, long-term follow-up studies showed that conservative treatment of subcondylar fractures results in disturbances of occlusal function, deviation of the mandible, internal derangement of the temporomandibular joint, and ankylosis of the joint. We carried out open reduction of dislocated subcondylar fractures in 14 patients from 2000 to 2004 by a retromandibular approach. After the reduction of fractured bone, two H-shaped miniplates with 6 holes were fixed with screws at the anterior and posterior surfaces of the subcondyle. The retromandibular approach allowed good access and easy manipulation of the subcondyle. Immediate relief from malocclusion and correction of mandibular midline shifting were observed in all patients. Late temporomandibular dysfunction and ankylosis were not observed. Open reduction with plate osteosynthesis made it possible to avoid IMF in 7 of the 14 patients. The present study shows that open reduction through this retromandibular approach can produce good outcome in adult patients with subcondylar fracture.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.4
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• pp.308-313
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• 2001

The purpose of this study is to validate the potential etiologic factors for temporomandibular disorder(TMD). TMJ arthroscopic examination was performed in upper joint compartment of 32 joints from 20 patients with mandibular fractures. Synovial fluid was collected from the upper joint space during pumping manipulation with normal saline. Cytologic smearing and histomorphologic exam of synovial fluid were performed in 15 joints. Prostaglandin $E_2(PGE_2)$ concentration was measured in 11 joints. Leukotriene $B_4(LTB_4)$ concentration was measured in 8 joints. There were several arthroscopic variables such as ecchymosis, fibrillation, and adhesion. Histomorphologic exam showed a variety of findings such as bloody smears, cellular cluster, degenerated cells and cartilage, undifferentiated crystal. Mean $PGE_2$ concentrations were 316.5 pg/ml. Mean LTB4 concentrations were 45.9pg/ml. This study demonstrated a variety of findings on inflammatory and degenerative changes of TMJ. Because acute trauma such as mandibular fracture is a major etiologic factor in cartilage degradation and biochemical and intraarticular pathology, clinicians must identify and address TMJ signs and symptoms during follow-up periods in the long term.