• Imaging Science in Dentistry
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• v.45 no.1
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• pp.1-5
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• 2015

Purpose: Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. Materials and Methods: Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fisher's exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. Results: Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. Conclusion: In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable.

• Journal of Oral Medicine and Pain
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• v.17 no.2
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• pp.51-61
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• 1992

저자는 서울대학병원 치과진료부 구강진단과를내원한 두 개하악장애 환자 중, 악관절음이 있음을 호소하는 환자 106명을 대상으로 SonoPAK을 이용하여 악관절음을 분석하고 Transcranial TMJ Series와 파노라마상 판독결과를 종합하여 다음과 같은 결론을 얻었다. 1. SonoPAK에 기록된 210회의 발생 악관절음 중 왕복성 관절음은 44건, 88회 발생하였고, 개구시 관절음은 74회, 그리고 폐구시 관절음은 48회 발생하였으며, 개구시에 관절음이 더 빈번히 나타났다. 2. 왕복성 악관절음이 있다고 인정되는 혼자군에서, 개구시 평균 최대 단위는 18.6(%)$\pm$15.6(%), 폐구시 평균 최대 진폭은 16.6(%)$\pm$17.4(%) 이었으며, 개폐구간 진폭의 차이에는 유의성이 없었다. (p>0.05). 3. 악관절음을 미약한 소리, 중간소리, 큰소리로 분류할 수 있었으며 각각 110, 79,21회의 발생을 기록하였다. 4. (>300Hz)/(<300Hz)의 비율이 0인 경우는 34회 였고, 300Hz 이상의 주파수가 관찰된 경우는 176회였다. 5. Transcranial TMJ projection series 와 파노라마상의 판독 결과 하악과두의 골 변화가 인정된 환자군에서 SonoPAK 기록의 평균 주파수 비율((>300Hz)/(<300Hz))은 0.387$\pm$0.284이었고 골 변화가 인지되지는 않았으나 주파수 비율이 0.01 이상인 환자군의 평균은 0.286$\pm$0.227이었다.

• The korean journal of orthodontics
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• v.36 no.2 s.115
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• pp.136-144
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• 2006

The purpose of this study was to determine whether association exists between temporomandibular joint (TMJ) characteristics in transcranial radiographs and TMJ internal derangement and to evaluate the validity of transcranial radiographs in diagnosis of internal derangement. Transcranial radiographs and magnetic resonance imaging (MRI) of 113 TMJs from 76 subjects were used for this study and all TMJs were classified into 3 groups according to the results of MRI: normal disk position, disk displacement with reduction, and disk displacement without reduction. Transcranial analysis included linear measurement of joint spaces and condylar head angle measurement. To determine any relationship between transcranial measurements according to disk displacement, one-way ANOVA was used. The results showed that condyle-fossa relationship in standard transcranial radiographs had no relationships with disk displacement. And, as disk displacement progressed, condylar angle between head and neck increased significantly. This result can be interpreted that condylar head angle reflects structural hard tissue change according to internal derangement progress. But this is insufficient in the determination of internal derangement. Therefore, although still clinically helpful, the validity of standard transcranial radiographs to diagnose TMJ internal derangement was questioned.

• Journal of Oral Medicine and Pain
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• v.32 no.2
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• pp.227-239
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• 2007

To evaluate the treatment outcome after conservative treatment in patients with osteoarthritis of the TMJ(OA), the subjects were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Hospital, diagnosed as osteoarthritis of the TMJ, and treated with conservative methods from 1994 to 2006. 101 patients with diagnosis of osteoarthritis of the TMJ were selected as the experimental group and 74 patients with diagnosis of masticatory muscle disorders(MMD) were selected as the control group. Subjective symptoms and clinical findings were investigated to evaluate and compare the subject's status at the first and the last visit. The results were as follows : 1. In the OA group, satisfactory treatment outcome was obtained with conservative methods. But, at the last visit, the symptoms of the OA group were not improved enough compared with those of the MMD group. 2. In the OA group, radiographic findings of panorama view and transcranial projection were positive by about 60 percent. But, computed tomography and single photon emission computed tomography were positive by more than 90 percent. 3. At the last visit of the OA group, the joint noise was reduced significantly. 4. In the majority of the OA group, satisfactory treatment outcome was obtained with conservative methods such as medication, physical therapy, and occlusal stabilization appliance. In the majority of the MMD group, satisfactory outcome was obtained with medication and physical therapy. 5. It took the OA group from 6 months to 2 years to be cured well while the MMD group within 6 months.6. The OA group needed more than 10 times' treatment for satisfactory outcome while the MMD group needed less than 10 times' treatment.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.87-95
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• 2013

Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a severe form of temporomandibular disorders (TMDs), presenting gradual breakdown of articular cartilage and subchondral bone by the functional load sustained to exceed the physiologic tolerance of the joint. In such a joint loaded, offensive bioactive materials such as matrix degrading proteins, cytokines, and free radicals increase in concentration to shift the tissue response in the joint to degeneration from regeneration or remodeling. Recently, it has been issued that obesity can play an offensive role in pathogenesis of OA in a metabolic way. Adipokines released by adipose cells are present at higher concentration in the arthritic joint and joints of obese individuals. However, because of conflicting data reported, further scientific study should be performed to elucidate the practical role of adipokines in pathogenesis of TMJ OA. As far as the clinical signs and symptoms of TMJ OA are not much different from those of other forms of TMD and any definitive treatment modality to control directly the bone resorptive activity is not available yet, the treatment of TMJ OA should be directed to reduce the physical load and enhance the physiologic tolerance of the joint by means of conservative treatment such as physical therapy, medication, and occlusal splint therapy for sufficient period and, if needed after that, supplementary surgical procedure such as intra-articular injection, arthrocenthesis, and arthroscopic surgery that have turned out to be effective to control OA signs and symtpoms. Enthusiastic reassurance and motivation for patients to control behaviors for themselves to reduce unnecessary functional load in daily life is very important for the joint to reach to more favorable orthopedic stability of the TMJ more quickly, guaranteeing more successful management TMJ OA.

• Journal of Oral Medicine and Pain
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• v.36 no.1
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• pp.39-51
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• 2011

The aims of this study were to investigate whether the facial skeletal patterns previously reported to be related to temporomandibular disorder (TMD) in other studies could be consistently observed in the TMD patients diagnosed according to Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) Axis I and evaluate its usability in the orthodontic clinics to examine the patients with TMD related symptoms. The clinical records and radiographs of female patients who visited the TMD and Orofacial Pain Clinic of Seoul National University Dental Hospital and were diagnosed as TMD were consecutively filed for this study. Patients were clinically examined and diagnosed according to the revised diagnostic algorithms of RDC/TMD Axis I and the lateral cephalogram, panoramic orthopantomogram, temporomandibular joint (TMJ) orthopantomogram, and transcranial radiograph of each patient were taken and digitalized. The data of patients who were under 18 years of age or had any systemic disease, trauma history involving the TMJ, or skeletal deformity at the time of the first examination were excluded. The remaining data of 96 female patients were finally analyzed. The obtained results were as follows: 1. There are no significant differences of cephalometric measurements between RDC I (muscle disorders) diagnostic groups. 2. Only the articular angle of the RDC group IIc (disk displacement without reduction without limited opening) patients was larger than patients of the no diagnosis of RDC II group (disk displacement). 3. Larger articular angle and smaller facial height ratio were observed in RDC IIIc group (osteoarthrosis) compared to IIIa group (arthralgia). Larger articular angle, larger Bjork sum, smaller posterior facial height, and smaller facial height ratio were observed in RDC group IIIc compared to no diagnosis of RDC III group (arthralgia, arthritis, and arthrosis). 4. According to the results of cephalometric analysis in simplified RDC groups, smaller overjet was observed in muscle disorders (MD) group. Facial height ratio and IMPA were smaller and articular angle was larger in disk displacements (DD) group than in no diagnosis of DD group. In arthrosis (AR) group, posterior facial height, and facial height ratio were smaller, and articular angle, gonial angle, facial convexity, FMA, Bjork sum, and ANB were larger than in no diagnosis of AR group. In joint pain (JP) group, only posterior facial height was smaller than no diagnosis of JP group. In conclusion, Facial morphologic patterns showing posterior-rotated mandible and lower posterior facial height is related to RDC group II and III diagnosis of the TMJ in female TMD patients. RDC/TMD Axis I diagnosis can provide a good clinical diagnostic tool for the standardized examination of the TMJ in orthodontic clinics.

• Journal of Oral Medicine and Pain
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• v.34 no.1
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• pp.81-90
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• 2009

This study is designed to assess Relationship between clinical diagnosis of Temporomandibular Joint Disorder and diagnostic finding of Cone Beam Computed Tomography(CBCT) The author performed clinical examination for TMD Patients who visited Orofacial pain clinic, Jin-ju ooo Dental office. CBCT(Cone beam computed tomography) was taken for 190 joints in 95 subjects. A Oral medicine and Oral radiologist evaluated CBCT each other. then we compared with that result, Condyle bony changes were classified by no bone change, flattening, erosion and osteophyte. The obtained results were as follow: 1. The Kappa index of the diagnosis between oral medicine and oral radiogist were high, the index of diagnosis by degenerative joint disease were more higher. 2. The Kappa index of panoramic view and CBCT was low, more condylar bone chages were observed by CBCT diagnosis 3. Condylar bone changes of the 54.2% of non-DJD group clinicaly was observed by CBCT diagnosis and no bone changes of the 15.3% of DJD group.was observed by CBCT 4. TMJ pain was associated with erosion of condyle bone change of TMJ. Crepitation and longest duration of TMD were associated with osteophytic bone change.

• Journal of Oral Medicine and Pain
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• v.14 no.1
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• pp.113-121
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• 1989

In this study, 94 patients with temporomandibular disorders were interviewed to evaluate the effect of the treatment they received at the department of Oral diagnosis and oral Medicine in Seoul national university Hospital. The treatment administered to the patient were patient education, relaxation procedures, physical therapy, occlusal splint therapy and selective grinding of teeth. The following results were disclosed : 1. 97.9% of the patients reported no pain or considerably less pain than they had reported at their first visits to the department. 2. 89.3% of the patients thought that the treatment provided was either complete or considerably successful. 3. TMJ and facial pain was resolved within average 3.0 months 4. Of the 70 patients who previously reported having jaw joint sound, 34 patients (48.6%) no longer reported int. 5. Of the 48 patients who previously reported having headache regularly, 3 patients (68.8%) no longer reported headache regularly. 6. Of the 66 patients who previously reported having masticatory muscle pain, 41 patients (62.1%) no longer reported masticatory muscle pain. 7. Analysis of the data did not disclose a subgroup or factor, such as age, the stage of internal derangement, capsulitis, bruxism, MPD, duration of symptoms, that could be correlated with the reduction of pain or the patient's perception of success of treatment.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.22 no.2
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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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• v.36 no.2
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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.