악관절 내장증 환자의 하악지 수직골절단술후 초기 악관절 증상의 변화에 대한 연구

IMMEDIATE CHANGE OF THE TEMPOROMANDIBULAR JOINT SYMPTOMS AFTER EVRO(EXTRAORAL VERTICAL RAMUS OSTEOTOMY) WITHOUT FIXATION IN THE TMJ INTERNAL DERANGEMENT PATIENTS

TMJ internal derangement has been treated by the conservative methods and the surgical methods according to the clinical state. There are several surgical methods for treatment of TMJ internal derangement, such as disk repositioning and repair, diskectomy with and without grafts, articular surface contouring, high condylectomy, condylotomy, and arthroscopic surgery etc. Especially, it has been reported that the condylotomy produced the increase of the joint space, the pain relief, the elimination of the joint dysfunction due to the antero-inferiorly movement of the condyle, and the condylar morphologic change resulted from the progressive remodeling in TMJ without the surgical intervention within the TMJ. We have performed EVRO(extraoral vertical ramus osteotomy) to the 5 patients diagnosed as ADDWR(Anterior disk displacement with reduction) from June 1997 to December 1997 in the Chin-Hae military hospital. We diagnosed them with MRI and clinical examination. And we compared the preoperative symptoms with postoperative 2 months symptoms. They were compared by Helkimo index, mandibular mobility index, and pain scale. Anamnestic Index(Ai) was changed from 20 preoperatively to 1.2 postoperatively, clinical dysfunction score from 11.8 to 2.8, and Clinical Dysfunction Index(Di) from 2.8 to 1 2. The pain scale of the affected side was changed from 4.4 to 2.6 and that of the nonaffeted side from 2.2 to 2.6. The maximal mouth opening was changed from 35.2㎜ to 40.9㎜, right lateral excursion from 7.8㎜ to 8.0㎜, left from 8.8㎜ to 7.0㎜, and protrusion from 6.2㎜ to 6.2㎜. In these results, we could not expect any excellent improvement of the clinical symptoms during the immediate postoperative periods. But we could observe the disappearance of the joint noise and the improvement of the clinical dysfunction score. On the basis of the results of the previous investigations about condylotomy effect which presented the condyle position were changed antero-inferiorly in the articular fossa during the immediate postoperative period, the displaced condyles may prevent wide mouth opening. Therefore it is elucidated that the improvement of the maximal mouth opening and other functions were restricted during the immediate postoperative periods. After long term follow-up period, the symptomatic and functional improvement will be expected by the passive repositioning of the proximal segment. We report the preliminary results with the related references.