Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Clinical Assessment and Cephalometric Characteristics in Patients with Condylar Resorption

하악과두흡수 환자의 임상적 평가 및 악안면 골격형태에 대한 연구

  • Koo, Seon-Ju (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Kim, Kyun-Yo (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Hur, Yun-Kyung (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Chae, Jong-Moon (Department of Orthodontics, School of Dentistry, Wonkwang university Daejeon Dental Hospital) ;
  • Choi, Jae-Kap (Department of Oral Medicine, School of Dentistry, Kyungpook National University)
  • 구선주 (경북대학교 치의학전문대학원 구강내과학교실) ;
  • 김균요 (경북대학교 치의학전문대학원 구강내과학교실) ;
  • 허윤경 (경북대학교 치의학전문대학원 구강내과학교실) ;
  • 채종문 (원광대 대전치과병원 교정학교실) ;
  • 최재갑 (경북대학교 치의학전문대학원 구강내과학교실)
  • Published : 2009.03.30
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Abstract

Condylar resorption, or condylysis can be defined as progressive alteration of condylar shape and decrease in mass. Condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. The aim of this study was to investigate clinical assessment and cephalometric characteristics in 224 patients with condylar resorption, who visited in the Department of Oral Medicine Kyungpook National University Hospital at 2006, by use of panorama, transcranial view and lateral cephalometric radiograph. The results were as follows; 1. Clinical assessment 1) Total number of patients who visited with chief complaints of TMD were 2419 and 224 (9.3%) among them revealed the condylar resorption, Among patients group with condylar resorption, female was 183 and male was 41, females were predominant. 2) Patient's age ranged from 12 to 70 and mean age was 30.6 years old with a strong predominance for 10s and 20s. Distribution of a showed as follows; 10s was 26.3%, 20s was 34,8%, 30s was 13.8%, 40s was 11.2%, 50s was 7.1%, 60s was 6.3% and 70s was 0.4%. 3) Most of the patients had parafunctional habit. 4) The case of showing the pain in condylar resorption was 145, the case of not showing the pain was 79. 5) Treatment duration of the patients was relatively short. 2. Cephalometric Characteristics 1) ANB which means the retruding of the mandible increased significantly than normal group. The ANB of female was lager than male group as the means of ANB were 5.05 in female and 3.57 in male, 2) SN-GoMe and FMA increased in resorption patients, but FH-PP did not show any significant difference. The FMA of female was lager than male group as the means were 31.69 in female and 30.44 in male. 3) Total posterior facial height was significantly smaller and total anterior facial height showed no significant increase as compared with those of the normal group. Condylar resorption was predominant in young female which was caused by more vertical facial pattern in female than male and increase of parafunctional habit in young age. It was thought that the patients who have a risk factor increasing the compressive stress at condyle caused by obliquely inclined masseter and medial pterygoid show high prevalence of condylar resorption.

2006년 한 해 동안 경북대학교 구강내과에 측두하악장애를 주소로 내원한 전체 환자 중에 파노라마 방사선 사진 상에서 인정될만한 하악과두흡수가 관찰된 환자를 대상으로 측모두부방사선 사진을 촬영하였으며, 측두하악장애의 임상적 평가와 악안면 골격형태를 분석하여 다음과 같은 결론을 얻었다. 1. 임상적 평가 1) 측두하악장애를 주소로 내원한 총 환자 수는 2419명 이었고 그중 224명 약 9.3%가 과두흡수를 나타내었다. 과두흡수가 있는 환자군 중 여자는 183명(81.7%)이고 남자는 41명(18.3%)으로 여자에서 월등히 많이 유발되었다. 환자의 연령은 12세에서 70세에 걸쳐 분포되었으며 평균 연령은 30.6세였다. 연령분포는 10대가 26.3%(59명), 20대가 34.8%(78명), 30대가 13.8%(31명), 40대가 11.2%(25명), 50대가 7.1%(16명), 60대가 6.3%(14명), 그리고 70대가 0.4%(1명)로 나타났다. 2) 과두흡수 부위의 통증을 호소한 경우는 145명, 통증을 호소하지 않은 경우가 79명이었다. 3) 과두흡수 환자 중 이갈이 습관을 53명, 이깨물기 습관은 80명이 호소하였으며, 다른 기타 습관들을 보고한 경우가 204명이었다. 4) 과두흡수 부위의 통증을 호소한 환자의 치료기간은 1개월 미만이 81명으로 전체적으로 치료기간이 짧게 나타났다. 2. 악안면 골격 형태 평가 전체 과두흡수 환자 224명중 18세 이상의 186명(여자 155명, 남자 31명)만이 한국 성인 정상교합자의 측모두부방사선사진 계측연구 결과와 비교하였다. 1) SNA, SNB는 남녀 모두에서 유의한 작은 값을 나타냈고, ANB항목에서는 남자는 평균 3.57 여자는 5.05으로 여자 환자에서 큰 값을 보여 남자에 비해 하악이 더 후퇴되어 있음을 알 수 있다. 2) 남녀 모두 SN-GoMe, FMA의 각도가 과두흡수 환자에서 유의하게 상당히 커져 있음을 보였다. FMA는 남자는 평균 30.44, 여자는 31.69로 여자에서 수직적 성장이 더 크게 나타났다. 3) 총후안면고경(posterior facial height)이 과두흡수 군에서 모두 작은 것이 특징으로 보였으며, 총전안면고경(Anterior facial height)은 과두흡수 환자군에서 남녀 모두 정상군에 비해 차이가 없었다. 저자의 연구에서 얻어진 결과에 의해 하악과두흡수는 정형외과적으로 퇴행성관절염과는 달리 젊은 여성에서 유병률이 높았으며 이는 남성보다 여성에서 수직적 골격 성장 양상으로 인해 하악과두 전방부의 압축응력을 증가시키는 위험요인을 가진 환자에서 발현이 높은 것으로 생각되며 그리고 노년층보다는 젊은 사람에서 이상기능활동으로 인한 부하의 증가 때문이라 생각한다. 하악과두흡수를 보이는 환자들의 치료기간이 대체적으로 짧으며, 나이가 증가함에 따라 내원하는 환자수가 증가하지 않는다는 것은 이 질환이 자기한정적임을 알 수 있고, 생리적 내성 범위 이상의 부하가 가해져 발생한 하악과두의 재형성 과정으로 생각한다.

Keywords

References

  1. Huang YL, Pogrel MA, Kaban LB. Diagnosis and management of condylar resorption. J Oral maxillofac Surg 1997;55(2):114-120 https://doi.org/10.1016/S0278-2391(97)90222-6
  2. Norman JED, Bramley P. A textbook of colour atlas of the temporomandibular joint. Wolfe 1990:69-77
  3. Arsever CL, Bole GG. Experimental Osteoarthritis induced by selective myectomy and tendotomy. Arthritis Rheum 1986;29:251-261 https://doi.org/10.1002/art.1780290214
  4. Carreno MR, Muniz OE, Howell DS. The effect of glycosaminoglycan polysulfuric acid ester on articular cartilage in experimental osteoarthritis: Effects on morphological variables of disease severity. J. Rheumatol 1986;13(3):490-497
  5. 대한정형외과학회. 정형외과학. 최신의학사 2006:253-261
  6. 임상류머티스학 편찬위원회. 임상류머티스학. 제 1판. 한국의학사 2006
  7. Hwang SJ, Haers PE, Seifert B, Sailer HF. Nonsurgical risk factors for condylar resorption after orthognathic surgery. J Craniomaxillofac Surg 2004;32(2):103-111 https://doi.org/10.1016/j.jcms.2003.09.007
  8. Hwang SJ, Haers PE, Zimmermann A, Oechslin C, Seifert B, Sailer HF. Surgical risk factors for condylar resorption after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000(May);89(5):542-552 https://doi.org/10.1067/moe.2000.105239
  9. Hoppenreijs TJ, Stoelinga PJ, Grace KL, Robben CM. Long-term evaluation of patients with progressive condylar resorption following orthognathic surgery. Int J Oral Maxillofac Surg 1999;28(6):411-418 https://doi.org/10.1016/S0901-5027(99)80052-6
  10. Wolford LM, Cardenas L. Idiopathic condylar resorption: Diagnosis, treatment protocol, and outcomes. Am J Orthod Dentofacial Orthop 1999;116 (6):667-677 https://doi.org/10.1016/S0889-5406(99)70203-9
  11. Tanne K, Tanaka E, Sakuda M. Stress distributions in the TMJ during clenching in patients with vertical discrepancies of the craniofacial complex. J of Orofacial Pain 1995;9:153-160
  12. 대한치과교정학회. 한국성인 정상교합자의 측모두부방사선사진 계측연구 결과보고서. 부정교합백서발간위원회
  13. Arnett GW, Milam SB, Gottesman L. Progressive mandibular retrusion-idiopathic condylar resorption. Part I. Am J Orthod Dentofacial Orthop 1996;110(1):8-15 https://doi.org/10.1016/S0889-5406(96)70081-1
  14. Aufdemorte TB, Van SJE, Dolwick MF et al. Estrogen receptors in the temporomandibular joint of the baboon (Papio cynocephalus): An autoradiographic study. Oral Surg Oral med Oral pathol 1986;61:307-314 https://doi.org/10.1016/0030-4220(86)90407-X
  15. Milam SB, Aufdemorte TB, Sheridan PJ et al. Sexual dimorphism in the distribution of estrogen receptors in the temporomandibular joint complex of the baboon. Oral Surg Oral med Oral pathol 1987;64:527-532 https://doi.org/10.1016/0030-4220(87)90025-9
  16. Mogil JS, Sternberg WF, Kest B, Marek P, Liebeskind JC. Sex differences in the antagonism of swim stress-induced analgesia: Effects of gonadectomy and estrogen replacement. Pain 1993;53:17-25 https://doi.org/10.1016/0304-3959(93)90050-Y
  17. 임상류머티스학 편찬위원회. 임상류머티스학 제 1판. 한국의학사 2006
  18. Kiliaridis S. Endurance test and fatigue recovery of the masticatory system. J Dent Res 1991;70:342
  19. Benington PC, Gardener JE, Hunt NP. Masseter muscle volume measured using ultrasonography and its relationship with facial morphology. European J Orthodontics 1999;21:659-670 https://doi.org/10.1093/ejo/21.6.659
  20. Haas AJ. A biological approach to diagnosis, mechanics, and treatment of vertical dysplasias. Angle Orthod 1980;50:279-300
  21. Takada K, Lowe AA, Freund VK. Canonical correlations between masticatory muscle orientation and dentoskeletal morphology in children. Am J Orthod 1984;86:331-341 https://doi.org/10.1016/0002-9416(84)90144-1
  22. Hur YK, Park HS, Choi JK. Lateral cephalometric assessment in patients with condylar resorption. Korean J Oral Med 2006;31:337-346
  23. DeBont LGM, Boering G, Leim RSB et al. Osteoarthritis and internal derangement of the temporomandibular joint: A light microscopic study. J Oral Maxillofac Surg 1986;44:634-643 https://doi.org/10.1016/S0278-2391(86)80075-1
  24. Mills DK, Daniel JC, Herzog S, Scapino RP. An animal model for studying mechanisms in human temporomandibular joint disc derangement. J Oral Maxillofac Surg 1994;52:1279-1292 https://doi.org/10.1016/0278-2391(94)90051-5
  25. Helmy E, Bays R, Sharawy M. Osteoarthrosis of the temporomandibular joint following experimental disc perforation in Macaca fascicularis. J Oral Maxillofac Surg 1988;46:979-990 https://doi.org/10.1016/0278-2391(88)90335-7
  26. Quinn JH, Stover JD. Arthroscopic management of temporomandibular joint disc perforations and associated advanced chondromalacia by discplasty and abrasion arthroplasty: A supplemental report. J Oral Maxillofac Surg 1998;56:1237-1239, discussion 1239-1240 https://doi.org/10.1016/S0278-2391(98)90597-3
  27. Stegenga B, de Bont LG, Boering G, van Willigen JD. Tissue responses to degenerative changes in the temporomandibular joint: a review. J Oral Maxillofac Surg 1991;49:1079-1088 https://doi.org/10.1016/0278-2391(91)90143-A
  28. Stegenga B. Temporomandibular joint osteoarthrosis and internal derangement: Diagnositic and therapeutic outcome assessment. 1991, Groningen, Drukkerij Van Denderen BV, pp. 500
  29. Stegenga B, de Bont LG, Boering G. Osteoarthrosis as the cause of craniomandibular pain and dysfunction:a unifying concept. J Oral Maxillofac Surg 1989;47:249-256 https://doi.org/10.1016/0278-2391(89)90227-9
  30. de Bont LG, Stegenga B. Pathology of temporomandibular joint internal derangement and osteoarthrosis. Int J Oral Maxillofac Surg 1993;22:71-74 https://doi.org/10.1016/S0901-5027(05)80805-7
  31. Bollet AJ. An essay on the biology of osteoarthritis. Arthritis Rheum 1969;12:152-163 https://doi.org/10.1002/art.1780120212
  32. Radin EL, Paul IL, Rose RM. Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet 1 1972:519-522 https://doi.org/10.1016/S0140-6736(72)90179-1
  33. Mejersjo C. Therapeutic and prognostic considerations in TMJ osteoarthrosis: A literature review and a long-term study in 11 subjects. Cranio 1987;5:69-78 https://doi.org/10.1080/08869634.1987.11678177
  34. de Leeuw R, Boering G, Stegenga B, de Bont LGM. Temporomandibular joints osteoarthrosis: Clinical and radiographic characteristics 30 years after non-surgical treatment: a preliminary report. J Craniomandib Pract 1993;11:15-24
  35. de Leeuw R, Boering G, Stegenga B, de Bont LGM. Clinical signs of TMJ osteoarthrosis and internal derangement 30 years after non-surgical treatment. J Orofacial pain 1994;8:12-18
  36. de Leeuw R, Boering G, Stegenga B, de Bont LGM. Symptoms of TMJ osteoarthrosis and internal derangement 30 years after non-surgical treatment. J Craniomandib Pract 1995;13:81-88
  37. Langland OE, Langlais R, Morris CR. Principles and practice of Panoramic Radiology. WB Saunders Co 1982:426-429
  38. Worth HM. Radiology of the temporomandibular joint. In Zarb GA, Carlsson GE, (Ed). Temporomandibular joint: function and dysfunction. St Louis, 1979, Mosby, pp. 321-372
  39. Hatcher DC. Craniofacial imaging. J Calif Dent Assoc 1991;19:27-34
  40. Hur YK, Ko MY, Ahn YW. The Relationship between anterior disc displacement without reduction and development of anterior open bite. Korean J Oral Medicine 2007;32(3):293-303
  41. 이 현경, 정 규림, 박 영국. 수직적 분류에 의한 골격성 III급 부정교합자의 측모특성에 관한 연구. 대치교지 1992;22:205-226
  42. 김 태우. 측두하악관절 퇴행성관절질환을 동반한 전치부개교환자의 측모두부방사선계측학적 연구. 대치교지 1993;23:455-474
  43. 배 근욱. 유 영규. 악안면 두개골격의 수직 수평적 부조화에 관한 두부방사선 계측학적 연구. 대치교지 1988;18:175-187
  44. Nahoum HI. Vertical proportions: A guide for prognosis and treatment in anterior open-bite. Am J Orthod 1977;72:128-146 https://doi.org/10.1016/0002-9416(77)90055-0
  45. 전 윤식, 유 영규. 수직두개계측법에 의한 과개교합 및 개교에 관한 연구. 대치교지 1981;11:109-123
  46. Nickerson JW, Boering G. Natural course of osteoarthrosis as it relates to internal derangement of the TMJ. Oral Maxillofacial Surgery Clin North Am 1989;1:27-45
  47. Nickerson JW, Moystad A. Observation on individuals with radiographic bilateral condylar remodeling. J. Craniomandibular Pract 1982;1:21-37
  48. Stringert HG, Worms FW. Variations in skeletal and dental patterns with structural and functional alterations of the temporomandibular joint: A preliminary report. Am J Orthod 1986;89:285-297 https://doi.org/10.1016/0002-9416(86)90050-3
  49. Burch JG, Tallents RH, Wade DB, Beck FM. Lateral cephalometric analysis of asymptomatic volunteers and symptomatic patients with and without bilateral temporomandibular joint disc displacement. Am ortho-DO 1988:248-55 https://doi.org/10.1016/S0889-5406(98)70206-9