A case of multiple myeloma in which TMJ disorders were the initial symptom is presented. A 72-years-old female came to our hospital with swelling and pain around the left TMJ region.
A panoramic radiograph showed an osteolytic lesion involving the condylar and coronoid processes. A malignant tumor was suspected and myeloma was diagnosed based on a biopsy specimen. A punched-out appearance was observed in a cranial radiograph and a hot area around the left TMJ was seen in the scintigram. Laboratory tests revealed elevation of γ-globulin and hypercalcemia, but renal failure and Bence Jones proteinuria were not apparent. Bone marrow aspiration revealed over 40% myeloma cells, and immunoelectrophoresis showed the presence of IgG and kappa light chains. Multiple myeloma Stage IIIA was diagnosed, and chemotherapy and radiotherapy were instituted in the department of hematological medicine with a good prognosis. In some cases of multiple myeloma, the initial symptom of the disease appears in the oral and maxillofacial region.
The mandible, especially the condylar process and the posterior region of the ascending ramus, is the commonest site of such a lesion Thus multiple myeloma may be detected by TMJ disorders. However, the clinical signs are not specific, so multiple myeloma should be considered in the differential diagnosis of patients with TMJ symptoms.

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The purpose of this survey was to investigate the prevalence of temporomandibular joint disorder associated with orofacial deformities. The subjects of the epidemiological survey regarding the signs of TMJ disorders (joint noise, joint pain, masticatory muscles pain and jaw movement) were 172 untreated patients with orofacial deformities, who visited Oral and Maxillofacial Surgery I of Tohoku University from 1989 to 1992. The results were as follows:
1. Some symptoms of TMJ disorders were found in 53.5% of the total. No significant difference was found between males and females in the incidence of disorder.
2. Joint noise was found in 38.3%, joint pain in 9.3%, masticatory pain in 7.0% and disturbance of jaw movement in 2.3% of the subjects.
3. The incidence of TMJ disorders was 37.5% in patients under 14 years old and increased with age. It was 77.7% in patients over 30 years old.
4. The patients of skeletal Class I (p<0.01) and ClassII (p<0.05) showed higher incidence of TMJ disorders than ClassIII.

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CADIAX^® is a computer system which measures and analyzes three dimensional condylar movements. The upper and lower facebow of CADIAX^® was fixed on the simulator, and was tested for its accurancy and conditions of measuring on sagittal movements. Accuracy was evaluated by measuring errors and linearity of 10mm straight lines at various conditions; that is, improved upper facebow to hold the parts tightly, measuring area on the flag, and compression rate of styli.
The findings are as follows.
1. Straight lines of 10mm produced large measuring errors in all conditions, ranging from 1.31mm to 2.08mm (mean 1.55mm). The record at the center area of the flag showed a significantly large error compared to the anterior and posterior area of the flag.
2. The best linearity of a 10mm straight line was recorded with 2mm compressed styli and the fixed upper facebow.
3. The results show that CADIAX^® requires a solid upper facebow for an accurate record. They also suggest that CADIAX^® is its present form is inadequate for quantitative analysis.

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We relieved the symptoms of two patients with reciprocal click by using splints. The patients were then treated with orthodontic occlusal reconstruction.
We reached the following conclusions by examining the course of their recovery and the state of the temporomandibular joints after treatment.
1. We were able to relieve symptoms using an anterior repositioning splint for a few weeks. However, stabilization splints were not effective for the same period.
2. Occlusal reconstruction with the multibracket method has many advantages, such as prevention of symptom recurrence due to correction of malocclusion and the lack of need for tooth preparation for occlusal therapy. However, elaborate occlusal adjustments after orthodontic treatment were needed.
3. Following anterior movement of the condylar heads, deposition of newly generated bone (remodeling) took place on the posterior or superior surface of the cordylar heads.
On the other hand, disks were not always reduced in the anatomically normal position, but remained in the functionally displaced position in some cases.

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The purpose of this paper is to summarize our presentation at the symposium at the 5th annual meeting of TMJ society and also our current concept on the treatment for temporomandibular joint disorders (TMJD).
Many epidemiological studies support that there is no special relation between orthodontic treatment and TMJD. However, it is still a controversial problem whether orthodontic treatment may cause TMJD or can cure TMJD symptoms.
In our Department Clinic, Faculty of Dentistry, Tokyo Medical and Dental University, the percentage of patients with TMJ sounds before orthodontic treatment was about 35% of the total number of outpatients.
We have established a functional analysing system for these patients. The system has 3 components, : jaw movements analysis, the EMG analysis and the vibration analysis. We also use the CADIAX, MRI and arthrotomogram if we need more detailed information. We introduced our system with a patient who had an anterior displacement of the articular disc without reduction.

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Nowadays, a mandibular repositioning appliance is often utilized for patients whose TMJs show anterior disk displacement. In the conventional method, the improved position of the disk was determined and recorded when the mandibular position was just before the TMJ clicking occured between ICP and the protrusive position. However the ideal positions of the mandibular head and articular disk when the appliance is used are still unknown. The purposes of this study were firstly to examine the relative position of the mandibular head and articular disk when the repositioning appliance was used for the patients in the conventional method, and secondly to determine the mandibular position which the dentist should record in order to use the appliance. The MRI of the TMJ and TMJ arthrography using a single contrast method were used for each observation of the relative position of the mandibular head and articular disk. The results showed that when using the mandibular repositioning appliances the ideal relative position of the mandibular head and articular disk for all patients was when the protrusive position of the mandible was 2mm more than the conventional position.

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The incidence of TMJ dysfunction symptoms in patients with malocclusion was evaluated by questionnaires and dental casts. Data was obtained from 281 orthodontic patients (84 males and 197 females) aged 4-51 years with a mean of 15.2 years.
The results show that 33 patients (11.7%) havea primary complaint of TMJ dysfunction. 66 patients (23.5%) have no complaint but they hada history of at least one symptom of TMJ dysfunction. 181patients (64.8%) were assessed to be normal and to be free of clinical symptoms of TMJ dysfunction. No significant sex differences were found in the incidence of TMJ dysfunction. The incidence of TMJ dysfunction increased with age. There was no substantial differences in the incidence of TMJ dysfunction between orthodontically treated patients and untreated ones. A significantly high incidence of TMJ dysfunction was found in patients with anterior open bite.

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This is a case report of a lateral displacement of the left articular disc. The patient was a 24 year old man who complained of left TMJ pain, clicking and limitation in opening his mouth. An examination showed that the mandible was shifted to the right. A double contrast CT disclosed a lateral sideways disc displacement on the frontal and lateral section of the TMJ. This case was diagnosed as a malocclusion with lateral displacement of the left articular disc. Arthroscopic suturing for disc recapture was selected as the treatment, because the patient's TMJ symptoms had not resolved with splint therapy. After surgery, the symptoms of the patient's TMJ completely disappeared and the mandible was repositioned 2mm to the left. Consequently, orthodontic occlusal reconstruction was performed with multi-bracket direct bonding at the disc-recaptured mandibular position.

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