• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권2호
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• pp.134-140
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• 2010

Synovial condromatosis of the temporomandibular joint (TMJ) is characterized by the presence of loose bodies (joint mices). It can be confused with temporomandibular disorder clinically, and be with chondrosarcoma histologically. The purpose of this clinical report was to review the clinical, radiological, arthroscopic findings, histological feature and the results of surgical treatment of TMJ synovial chondromatosis. Four patients presented with pain of TMJ and limited mouth opening. The dynamic magnetic resonance imaging (MRI) disclosed a characteristic morphologic changes and displacement of the meniscus with limited translation of the condyle head. Bone scans showed progressive resorptive changes with hot-uptake of the radioisotope. The synovial loose bodies in the joint spaces were removed and sent to pathology for diagnosis as the synovial chondromatosis. The follow-up examination with computed tomography (CT) and MRI revealed no evidence of recurrence and good in function until postoperative 18 months. Diagnostically, the distension of the lateral capsule and fluid findings in the joint on the MRI are very suggestive tool for this synovial chondromatosis, but they are not always detected on the preoperative MRI. Arthroscopic approaches are very useful to inspect the joint spaces and to remove the loose bodies without interruption of the whole synovial membranes.

• Imaging Science in Dentistry
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• 제36권4호
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• pp.199-206
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• 2006

Purpose: The purpose of this study was to evaluate comparison of static MRI and pseudo-dynamic (cine) MRI in temporomandibular joint (TMJ) disorder patients. Materials and Methods: In this investigation, 33 patients with TMJ disorders were examined using both conventional static MRI and pseudo-dynamic MRI. Multiple spoiled gradient recalled acquisition in the steady state (SPGR) images were obtained when mouth opened and closed. Proton density weighted images were obtained at the closed and open mouth position in static MRI. Two oral and maxillofacial radiologists evaluated location of the articular disk, movement of condyle and bony change respectively and the posterior boundary of articular disk was obtained. Results: No statistically significant difference was found in the observation of articular disk position, mandibular condylar movement and posterior boundary of articular disk using static MRI and pseudo-dynamic MRI (P<0.05). Statistically significant difference was noted in bony changes of condyle using static MRI and pseudo-dynamic MRI (P<0.05). Conclusion: This study showed that pseudo-dynamic MRI didn't make a difference in diagnosing internal derangement of TMJ in comparison with static MRI. But it was considered as an additional method to be supplemented in observing bony change.

• Journal of Oral Medicine and Pain
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• 제12권1호
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• pp.85-93
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• 1987

The author studied on the effect of TMJ sounds to the patterns and ranges of mandibular border movements in horizontal plane with Pantograph (Denar Corp.). For study, 19 patients with TMJ sounds only and 16 students with no TM disorder were selected and classified as experimental group and control group, respectively. The subject performed right lateral movement, left lateral movement, and forward movement. Each movement were performed 3 times and the movement trajectory obtained with mechanical pantograph were observed for accordance of centric relation position, reproducibility and/or restriction of lateral movement paths, deviation of protrusive path in anterior table, restriction of protrusive condylar movement path in posterior horizontal table, presence of Fisher angle in posterior vertical table. And pantographic reproducibility Index (PRI) were obtained with pantronic by the same movement method as in the mechanical pantograph record. The obtained results were as follows : 1. In experimental group, PRI scores in those who show accordance of centric relation position were 14.4, and were 26.53 in those who did not show accordance of centric relation position. However, the PRI scores of the two subgroups show no statistically significant difference in control group. Therefore, in experimental group, the capability of accordance of centric relation position affected largely the PRI scores than in control group. 2. Deviation of protrusive path was opposite to the affected side in experimental group, and was left side in control group. 3. Restriction side of condylar movement in protrusion was ipsilateral to the deviation side in experimental group, but in control group, restriction side was not related to the deviation side. 4. PRI scores in experimental group were 23.2 (moderate dysfunction category), and in control group, were 17.8 (slight dysfunction category). The PRI scores in control group, however, implies that the evaluation of temporomandibular disorders by the PRI scores only may be unreasonable.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권1호
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• pp.52-56
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• 2015

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권1호
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• pp.202-209
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• 1990

A retrospective study of 498 patients (591 joints) who had diagnosed as having internal derangement of the temporomandibular joint by history, clinical examination, and arthrography were evaluated. 66 patients (70 joints) were diagnosed as having meniscus perforation between the joint compartments. In those patients with pain (11 joints : 15.7%), pain and crepitation (24 joints : 34.3%), pain, crepitation and LOM (31 joints : 44.3%), and painless crepitation with LOM (4 joints : 5.7%) complained clinically. All these patients who had perforation showed irregularity in outline of the contrast material, bone contour-contrast material gaps, flattening of cortical layer of articular eminence. On the 20 joints treated surgically, 17 joints were found to have meniscus perforation at the time of surgery which correlated with their pre-operative radiographic and clinical diagnosis. Three joints could not found perforation of meniscus. This study was designed to examine of the incidences of the meniscus perforation in the above patients and to assess the diagnostic accuracy of arthrography by comparing the results with the finding of direct examination at TMJ surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권1호
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• pp.55-65
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• 2005

Most patients with temporomandibular disorder can be treated conservatively. However, open TMJ surgery can be needed in some patients. We analysed the patients with TMD which open surgery has performed since 1998. Open surgery was carried out in 8 patients. Age ranged from 22 to 61 years, with a mean of 42.8years. All patients were male. Final diagnosis was obtained based upon clinical, radiographic and operative finding as follows; habitual luxation, bony ankylosis, traumatic arthritis, disc displacement with destructive change, disc displacement and adhesion. Etiologic factors included trauma(4), infection(2), and unknown(2). Open surgery included arthroplasty with either of condylectomy, eminectomy, meniscoplasty, capsurrohaphy. All patients were recovered uneventfully without severe complications. Some mouth opening limitation and mouth opening deviation remained. Postoperative aggressive physical therapy and careful follow up were performed. In conclusion, open TMJ surgery must be considered in organic disease such as ankylosis, tumor and TMD without favorable recovery after long-term conservative therapy.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권3호
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• pp.211-216
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• 2007

Temporomandibular joint disorders (TMD) often show muscular disorder, internal derangement and degenerative change of articular surface of the condyle. It is important to choose adequate diagnostic method for obtaining data for the diagnosis and treatment. Magnetic Resonance Imaging (MRI) has some advantages, because it shows good resolution image for the soft tissue and it is not invasive to the human body. We have performed serial research about the retrodiscal tissue of the TMJ according to the progress of the disease, using T2 weighted image, since 2002. In this study, we applicated resized observation area to compare signal intensity between the retrodiscal tissue of the TMJ and cerebral gray matter, using T2 weighted image.

• Imaging Science in Dentistry
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• 제42권4호
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• pp.249-253
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• 2012

Purpose: Diagnosis of osteoarthritis most commonly depends on clinical and radiographic findings. The present study attempted to observe the bony changes in temporomandibular joint (TMJ) patients from all age groups. Materials and Methods: The first-visit clinical records and cone beam computed tomography (CBCT) data of 440 TMJs from 220 consecutive TMJ patients were reviewed retrospectively. Results: The most frequent condylar bony change observed was sclerosis (133 joints, 30.2%) followed by surface erosion (129 joints, 29.3%), flattening of the articular surface (112 joints, 25.5%), and deviation in form (58 joints, 13.2%), which included 33 TMJs in a cane-shape, 16 with a lateral or medial pole depression, 6 with posterior condylar surface flattening, and 3 with a bifid-shaped condyle. Fifty-three joints (12.0%) showed hypoplastic condyles but only 1 joint showed hyperplasia. Osteophyte was found in 35 joints (8.0%) and subcortical cyst in 24 joints (5.5%), 5 of which had surface erosion as well. One hundred nineteen joints (27.0%) had only one kind of condylar bony change, 66 joints (15.0%) had two, 52 joints (11.8%) had three, 12 joints (5.0%) had four, and 6 joints (1.4%) had five kinds of condylar bony changes at the same time. Eighty-five (65.9%) of 129 joints with surface erosion had pain recorded at the chief complaint. Conclusion: With more widespread use of CBCT, more specific or detailed guidelines for osteoarthritis are needed.

• 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.

• 대한치과교정학회지
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• 제30권2호
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• pp.235-243
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• 2000

측두하악관절의 자기공명영상(MRI)은 하악과두와 관절원판(disc)의 관계를 잘 보여주기 때문에 관절내장증(internal derangement)의 진단을 위해 매우 유용하다. 이번 연구의 목적은 서울대학교 치과병원 교정과에 내원한 측두하악관절 장애가 의심되는 환자들의 MRI 자료를 평가하여 관절 내장증의 유무, 발생빈도 및 심도를 파악하는 것이다. MRI를 촬영한 표본은 남자 10명, 여자 40명으로 총 50명이었고 평균 나이는 22.9세였다. 전체 50명 중에 43명에서 positive finding이 관찰되었다. Positive finding을 나타낸 환자 중에서 전방관절원판변위(anterior disc displacement : ADD)는 비정복성이 $56\%$로 가장 많았으며, 양쪽 관절에서 동시에 일어난 경우가 $65\%$로 가장 많았다. Positive finding을 나타낸 환자를 Angle 분류 시, II급 1류 부정교합 환자가 $39.6\%$, II급 2류 부정교합 환자가 $2.3\%$로 II급 부정교합이 $41.9\%$로 가장 많았고, I급 부정교합 환자는 $37.2\%$, III급 부정교합 환자가 $18.6\%$, 확인 안된 경우가 $2.3\%$였다. Positive finding을 나타낸 환자 중에서 안면 비대칭 환자는 $8.6\%$, 개교 환자는 $55.8\%$였다. 결론적으로 측두하악관절의 관절 내장증을 가진 환자에서는 II급 부정교합이 차지하는 비율이 매우 크다고 할 수 있다. 개교나 안면 비대칭은 측두하악관절 장애로 인한 보상적 또는 비보상적인 변형에 의해 나타날 수 있으며 퇴행성 관절 질환으로 진행되는 과정중 안면 골격 개조의 결과로 보인다. 그러므로 개교 및 안면 비대칭이 있는 환자는 교정 치료 시작 전에 측두하악관절의 이상 유무를 MRI로 확인(screening)할 것이 권장된다. 측두하악관절 장애가 있는 경우 교정 치료 후에도 재발의 경향이 크고 측두하악관절에 대한 계속적인 관찰이 필요하므로 감별진단이 필수적이다.