• The korean journal of orthodontics
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• v.49 no.6
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• pp.413-426
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• 2019

This study was performed to describe the longitudinal management of recurrent temporomandibular joint (TMJ) ankylosis from infancy to adulthood in perspective of surgical and orthodontic treatment. A 2-year-old girl was referred with chief complaints of restricted mouth opening and micrognathia due to bilateral TMJ ankylosis. For stage I treatment during early childhood (6 years old), high condylectomy and interpositional arthroplasty were performed. However, TMJ ankylosis recurred and symptoms of obstructive sleep apnea (OSA) developed. For stage II treatment during early adolescence (12 years old), gap arthroplasty, coronoidectomy, bilateral mandibular distraction osteogenesis, and orthodontic treatment with extraction of the four first premolars were performed. However, TMJ ankylosis recurred. Because the OSA symptoms reappeared, she began to use a continuous positive airway pressure device. For stage III treatment after completion of growth (20 years old), low condylectomy, coronoidectomy, reconstruction of the bilateral TMJs with artificial prostheses along with counterclockwise rotational advancement of the mandible, genioglossus advancement, and orthodontic treatment were performed. After stage III treatment, the amount of mouth opening exhibited a significant increase. Mandibular advancement and ramus lengthening resulted in significant improvement in the facial profile, Class I relationships, and normal overbite/overjet. The OSA symptoms were also relieved. These outcomes were stable at the one-year follow-up visit. Since the treatment modalities for TMJ ankylosis differ according to the duration of ankylosis, patient age, and degree of deformity, the treatment flowchart suggested in this report could be used as an effective guideline for determining the appropriate timing and methods for the treatment of TMJ ankylosis.

• The Journal of the Korean dental association
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• v.39 no.4 s.383
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• pp.251-257
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• 2001

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.4
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• pp.330-335
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• 2002

The study was performed to investigate the comparison of relative signal intensity of normal- and abnormal-side retrodiscal tissue, and relationship between clinical examination, joint effusion and relative signal intensity of retrodiscal tissue in patients with unilateral TMJ internal derangement. The study group comprised 19 females and 9 males, with a mean age of 29 years. After measurements of the signal intensity were made on the MR imager for the T2 weighted images on retrodiscal tissue and brain gray matter, we calculated relative value and tried to find relationship between clinical examination, joint effusion and relative signal intensity on normal- and abnormal-side. The results are as follows. 1. The gray matter is an appropriate reference point. 2. The relative signal intensity is high significantly in abnormal-side retrodiscal tissue compared with normal-side retrodiscal tissue. 3. The relative signal intensity is high significantly in painful joints compared with nonpainful joints and in joints with joint effusion compared with joints without joint effusion. 4. The relative signal intensity in normal joints, joints with reduction and joints without reduction is increased in order significantly.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.3
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• pp.125-132
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• 2015

Objectives: The purpose of this study was to clarify which findings in magnetic resonance imaging (MRI) are good predicators of pain and mouth opening limitation in patients with temporomandibular joint (TMJ) internal derangement (ID). Materials and Methods: Clinical examinations for pain and mouth opening limitation were conducted for suspected TMJ ID. MRI scans were taken within a week of clinical examinations. On the oblique-sagittal plane image, readings were obtained in terms of the functional aspect of disc position, degree of displacement, disc deformity, joint effusion, and osteoarthrosis. Multiple logistic regression analyses were conducted to identify the predictors of pain and mouth opening limitation. Results: A total of 48 patients (96 TMJs) were studied, including 39 female patients and 9 male patients whose ages ranged from 10 to 65 years. The resultant data showed significant correlations between pain and the MR imaging of the degree of disc displacement (P<0.05). The probability of there being pain in moderate to significant cases was 9.69 times higher than in normal cases. No significant correlation was found between mouth opening limitation and MRI findings. Conclusion: We identified a significant correlation between clinical symptoms and MRI findings of ID. The degree of anterior disc displacement may be useful for predicting pain in patients with TMJ ID.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.1
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• pp.93-107
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• 1997

Magnetic resonance imaging has been used in the temporomandibular joint(TMJ) primarily to define morphology and positional relationship of associating structures. This report examines signal intensity characteristics of the posterior attachment as they related to the severity of internal derangement. Fifty six joints in 35 patients with a history of TMJ dysfunction were imaged writ MR using $T_1$-weighted spin echo sequence. According to disk position, ability to reduction, and the presence of osteoarthritis, the joints were categorized into three groups. A group 1 was anterior disk displacement with reduction; a group 2 was anterior disk displacement without reduction; a group 3 was anterior disk displacement without reduction and condyle had osteoarthritic change. The control group was determined by the clinical absence of any signs or symptoms of current or past TMJ pain and dysfunction. Calculated the relative value of MR signal intensity in posterior attachment and disk to cerebral cortex of temporal lobe by means of computer program, we have compared them with each groups. The result showed statistically little significant difference of disk signal intensity among each groups. but, signal intensity from posterior attachment in group 2 and 3 were significantly(p<0.05) decreased than control group. this might reflect an fibrosis or hyalinization of posterior attachment, which was part of remodeling process that occurs in disk displacement without reduction. However, this study could not demonstrate histologic confirmation of the decreased signal intensity in the posterior attachment. So, further investigation could be needed to understand the association between them.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.6
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• pp.532-535
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• 2005

The objective of this study is assessment of the efficacy of upper joint space arthrocentesis on prevention of TMJ injury from patient with mantibular fractures. We divided the patients into two groups, one which consist of 24 patients who are taken arthrocentesis while open reduction of mandibular fracture, the other which consist of 27 patients without arthrocentesis from Jan 1999 to Dec 2001. We measured maximum mouth opening, excursive movement range respectively one week, one month, three months later after operation. The patients were instructed to mark on 10 cm VAS for evaluation of TMJ pain during resting, mouth opening, and mastication. We evaluated the signs and symptoms of temporomandibular disorder clinically and radiographically 6 months later. The result of this study is that there is a reduction of pain and increase of range of mandibular motion in both groups but in patients with arthrocentesis there is relatively reduction of pain and increase of range of mandibular motion compared with control group. On the points of 6 months later, temporomandibular disorder occurred in 4 patients (16.7%) in group with arthrocentesis and 13 patients (47.1%) in control group. In conclusion, we think that supplemental therapy such as arthrocentesis is helpful for the recovery of jaw function and prevention of the development of temporomandibular disorder after facial trauma.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.1
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• pp.9-14
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• 2019

Objectives: This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. Materials and Methods: Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (${\leq}25\;years$, >25 and ${\leq}40\;years$, >40 and ${\leq}60\;years$), VAS pain level (${\leq}5$, >5 and ${\leq}7$, >7 and ${\leq}10$), and ROM (<25 and ${\geq}25mm$). Odds ratios (ORs) were used to describe the proportional benefit of each variable the on successful outcome of arthrocentesis. For the OR to be clinically relevant or even clinically noticeable, we assumed that the OR would need to be larger than 2. Results: Mean preoperative pain score was $6.49{\pm}1.560$ and at 6 months postoperative was $0.46{\pm}1.147$ with an average decrease of pain score 6 (P<0.001). The mean preoperactive maximum mouth opening was $26.14{\pm}4.969mm$ and mean maximum mouth opening at 6-month inerval was $38.92{\pm}3.392mm$. The mean increase in the mouth opening was a mean difference of 12.78 mm (P<0.001). Logistic regression showed that the maximum benefit occurred in patients aged <25 years (OR, 12.01; P=0.012), a VAS pain level of >7 (OR, 11.25; P=0.039), and a maximum vertical opening of <25 mm (OR, 7.70; P=0.038). Conclusion: Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.6
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• pp.259-265
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• 2014

Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.22 no.2
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• pp.203-213
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• 1992

The purpose of this study was to aid in the evaluation of prognosis of temporomandibular joint following orthognathic surgery. For this study, 20 patients (40 TMJ) who undergone orthognathic surgery were examined. Preoperative and postoperative tomograms of TMJ were taken. And the subjects were divided into 3 groups according to postoperative periods. The obtained results were as follows; 1. There were no significant differences between preoperative and postoperative changes in joint spaces in each group and between groups(P<0.05). 2. There were no significant differences between preoperative and postoperative ratio of joint space(P<0.05). 3. There were no significant differences between preoperative and postoperative changes in the range of motion of condylar head(P<0.05). 4. The bony changes of condylar head were observed in 14(35%) condyles (6 erosion, 2 flattening, 5 double contour, 1 osteophyte).

• Journal of Dental Rehabilitation and Applied Science
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• v.25 no.3
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• pp.237-242
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• 2009

the primary diagnosis of synovial chondromatosis of temporomandibular joint is extremely rare. often many months, or even years pass before the diagnosis is confirmed. synovial chondromatosis is an uncommon disease of cartilage transformation of synovial membrane with formation of loose bodies within the joint space. a 28-year-old women had experienced pain of the left TMJ area at mastication. Radiographs of the left TMJ revealed calcified loose bodies in superior temporomandibular joint space. treatment consisted of removal of calcified loose bodies and synovail membrane. after surgery, pain of Lt temporomandibular area at mastication disappeared. until present after surgery there have been no recuurence of symptoms.