非復位性の関節円板前方転位症例における臨床経過と顎関節構成体の形態的変化

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  • Clinical history and morphological changes of temporomandibular joint structures in patients with anterior disk displacement without reduction

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The purpose of this study was to clarify the relationship between clinical history and morphological changes of the temporomandibular joint structures in patients with internal derangement. Seventy-five patients (86 joints) arthrographically diagnosed as anterior disk displacement without reduction were divided into four groups according to their clinical history before closed-locking, such as joint-sound and joint-pain. Clicking sound in mouth-opening and/or closing was always noticed during some periods in 38 joints of 35 patients (reciprocal clicking group). Seventeen patients sometimes had clicking sound in 21 joints on various mandibular movements (other clicking group). Fourteen patients noticed crepitation in 17 joints (crepitation group). No sound was experienced in 10 joints of 9 patients (no-sound group). Age, duration of closed-lock, symptoms, clinical history, arthrographic findings and several other findings were investigated and compared among these groups.<br>(1) The average age was 32.7 years in the reciprocal clicking group, 44.2 years in the other clicking group, 41.4 years in the crepitation group and 36.6 years in the no-sound group. There was a significant defference between the reciprocal clicking group and the other clicking group.<br>(2) In the reciprocal clicking group, the patients had similar clinical histories: TMJ locking followed painless clicking. On the other hand, the patients in the other groups had various clinical histories.<br>(3) In the reciprocal clicking group, no adhesion in the upper joint cavity was seen in 22 joints (57.8%) and the condylar shape was flat in 20 joints (52.6%). In the other group, the morphological changes were more advanced than in the reciprocal clicking group: severe disk-adhesion was seen in 42.8-70% of the joints. Moreover, the articular surface of the condyle was erosive in 50-64.7% of the joints.

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