Purpose: The aim of this study was to evaluate primary treatment in the patients with disk displacement without reduction and no osseous changes. Subjects and Methods: The improvement proportion during three months after onset of treatment was compared in the four groups, 1st group, intraoral a dministration of non steroidal anti inflammatory drug (NSAIDs): 2nd group, NSAIDs and mounth opening exercise: 3rd group, arthrocente sis: 4th group, a combination of arthrocentesis and a single injection of steroid. The subjects analyzed totaled 99 patients consiting of 25 in 1st group, 23 in 2nd group, 28 in 3rd group, and 23 in 4th group.
Result: The improvement rate was 40% in 1st group, 44% in 2nd group, 36% in 3rd grop, and 30% in 4th group.
Conlusion: In terms of improvement rate, no significance was found among 4 groups. However, a combination of intraoral administration of NSAIDs and mouth opening exercise could be most appropriate when primary treatment for TMJ closed lock without OA is evaluated.

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The purpose of this study is examine symptoms of temporomandibular joint. A chinico-statistical study was made in 126 cases of mandibular fracture, and prognostic investigation by questionnaire was performed in 55 cases.
1. Of all mandibular fracture cases, 46 cases (36.5%) were condylar fractures.
2. On condylar fractures, the average of age was younger, and the proportion of female patients was higher than body fractures.
3. The most common causes of body fractures were traffic accidents, but cases of condylar fracture were fall.
4. On follow up study, recovery of mouth open rages were good results. but many patients complain for pain and TMJ sound.
5. Estimation for prognosis was performed on the basis of “prognosis score”. At body fractures, TMJ sound was observed more than condyle fractures.

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Myofascial pain of the masticatory muscles is a disease with dull pain of the muscles at functions, and is confimed by the fact the pain is induced by palpation of the muscle. Although it has been reported that a large number of people have myofascial pain in the U.S. and Europe, no epidemiologic studies in Japan have made because of the difference of the definition for the masticatory muscle disorders. The purpose of this study is to investigate the clinical manifestation of the myofascial pain. We consider these data will give an important basis to our future research of masticatory muscle disorders. The obtained data were as follws:
1) The masticatory myofascial pain consisted of 49 out of 193 consecutive patients with temporomandibular disorders. Of the patients with myofascial pain, 16 (32.7%) were male and 33 (67.3%) were female. The age of the patients ranged from 16 to 75 years with a mean of 41.8 years.
2) The patients complained of headache (53.1%), neck and shoulder pain (71.4%), low back pain (42.9%), sleep disturbance (45.0%), gastrointestinal disorders (65.3%), otologic disorders (36.8%) and urinary bladder disorders (4.1%) as cheif concomitant symptoms.
3) The patients had parafunctional oral habits (65.3%) such as unilateral chewing, clenching and bruxism, and also serious life events (53.1%) that affected their daily life too much.
4) Y-G psychological test revealed some abnormalities (34.7%) such as depression, cyclic tendency, inferior feelings and nervousness.
5) Most patients were treated with a stabilization splint. Their prognosis was classified as “cured” in 9 (18.4%), “improved” in 18 (36.7%), “poor” in 13 (26.5%), “transferred” in 2 (4.1%) and “drop-out” in 7 (14.3%), respectively.

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The purpose of this study was to document the frequency, chinical findings, as well as magnetic resonance images (MRI) findings of the “stuck disc (SD)” of the TMJ. Clinical finding including the duration of trismus, joint pain, joint sound, and degree of mouth opening, MRI finding including disc position, disc reduction, disc shape, degree of disc displacement, bone changes of condyle and condylar translation. An analysis of the 525 TMJs in 410 symptomatic patients was carried out. Of the 525 joints, 138 (26.3%) had SD. In the age distribution, teen agers group had high frequency of SD, and over 60 years group had low one. In clinical findings, significant correlation in the incidence of SD existed in joint sound (p<0.01) and degree of mouth opening (p<0.0001). There were no statistically significant association between the incidence of SD and joint pain. And in MRI findings, existed in disc reduction (p<0.001), disc shape (p<0.001) and condylar translation (p<0.0001). There were no statistically significant association between the incidence of SD and condylar shape.

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This study was performed to investigate magnetic resonance imaging (MRI) features and their correlation with the clinical symptoms and signs of temporomandibular joint (TMJ) disorder in young persons. The MRI systems used in the subject cases were the 1.5-Tesla Signa® (GE Medical System) and ACS-II® (Philips Cs. Lt.), both with bilateral surface coil (3inch). Spin echo (SE) and gradient echo (GE) multisection imaging methods were used in the examinations. The images we examined for this report were the sagittal images of the mouth in the open and closed positions. A total of 40 patients with suspected internal derangement of the TMJ were involved in this study. There were 28 females and 12 males, all from 10 to 18 years of age.
Anterior disk displacement was observed in 33 of the 40 patients. Of these 33 patients, 8 had unilateral anterior disk displacement without reduction, and 13 patients had anterior disk displacement with reduction. Bilateral disk displacement with or without reduction was noted in 12 of the 33 patients.
In cases with no anterior disk displacement, posterior disk displacement at the open position was observed in four patients.
A comparison of the disk displacement in those cases with reduction and those without reduction revealed a severe grade of displacement in the latter.
Joint effusion was detected in a large number (93%) of those patients with disk displacement without reduction.

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The purpose of this study was to evaluate the effect of occlusal treatments on the symptoms of temporomandibular disorders (TMD) by a patient's self-report. Two hundred and sixty-six consecutive TMD patients who had been finished their treatment in our TMD clinic from April 1985 to March 1995 were included in this study. Self-administered questionnaires were sent to patients and 177 (80.0%) patients returned them. These patients were divided into two groups. One was an occlusal treatments (OT) group with ADDWR and ADDWoR (mean age: 44.1±15.5, male/female=6/37, mean age: 48.6±16.7, male/fema le=1/43) who received some sorts of occlusal treatment (e.g., selective tooth grinding, prosthetic and orthodontic jaw repositioning therapy). The other was a non-occlusal treatments (NT) group with ADDWR and ADDWoR (mean age: 32.2±16.2, male/female=17/29, mean age: 36.5±13.9, male/female=7/37) who did not receive any occlusal treatments. The prevalence of self-reported pain in the orofacial region at the first visit was 51.2%, 95.6% in the OT group, and 70.2%, 84.1% in the NT group. The questionnaire included a visual analogue scale of pain (VAS), maximum range of opening (MRO), patient's self-estimation of their treatment outcome (TO score) and daily activity limitation attributable to their TMD symptoms (DAL score). As the result, we could not find any statistically significant difference between the two groups in the three variables (Mann-Whitney U-test). But TO score could find statistically significant in ADDWR (Mann-Whiteney U-test, p<0.05). These results suggest that occulusal treatment might not always be necessary in the TMD treatment modality and even without any occlusal treatment the patients could get substantially enough functionality in their daily lives.

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The purpose of this study was to investigate the association between temporomandibular disorders (TMDs) and the abnormalities of intermaxillar relationships of 811 patients with malocclusion in the Department of Orthodontics at Tokushima University Dental Hospital from 1993 to 1996, and the occurrence rate of TMDs depending on vertically and horizontally intermaxillar relationships was investigated. The following results were obtained.
1. The incidence of TMDs was 10.9% of males and 182% of females.
2. In symptomatic subjects, the incidence of a single symptom was 79.7%. The incidence of temporomandibular joint (TMJ) sounds were 77.3% of patients with a single symptom. In more than one symptom the incidence of TMJ sounds and TMJ pain was 14.8%.
3. In the group which overjet is less than 0mm and overbite is not less than 0mm nor more than 5mm, TMD incidence was significantly lower than that in the control group.
4. TMD incidence of average angle case in Skeletal 1 was 20.7%, TMD incidence of low angle case in Skeletal 1 and Skeletal 3 was 10.1% and 5.0%, respectively.
5. There was no significant difference in TMD incidence between crossbite and non-crossbite.

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Mandibular heads on selective frontal tomographs of the temporomandibular joints (TMJs) of 208 Japanese patients with temporomandibular disorders were classified into four types and an other type according to the Yale's classification. A distribution of the Yale's type of mandibular condyle in female patients statistically showed no diference from that of an investigation on Japanese human dried speciemen. A classification (TAO) of the frontal features of condyle shape newly devised by authors was consisted of 3 alphabetical characters as a symbol, showing the position of a top of condyle, an angle of long axis of the condyle and an outline of the condylar head. The TAO classification was useful for evaluating an asymmetry in shape of patient's condyle and it also might be favour of assessing the joint morphology in relation to mandibular movements.

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Suppurative arthritis of temporomandibular joint (TMJ) is a rare condition due to recent development of antibiotics.
A case of acute suppurative arthritis of the left TMJ complicating rheumatoid arthritis in a 85 years old woman is reported.
She visited our hospital in September, 1991 with the chief complaints of pain and swelling in the left TMJ region.
Clinical signs and symptoms were general malaise, trismus with localized swelling, redness, spontanous pain over the left TMJ, and malocclusion with deviation of the mandible to the healthy side. Mouth opening was limited to 15mm. On radiographic examination, chronic marginal periodontitis of left molar region was found, and posterior joint space was enlarged bone scintigram revealed pronounced accumulation in the left TMJ. This was followed by intra-articular joint puncture, 2ml of pus was aspirated.
Treatments including antiinflammatory therapy, irrigation of the joint cavity and opening mouth rehabilitation were given. The patient had a good clinical course.

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This study was conducted to elucidate the association between condylar position, and disk displacement and disk morphology for patients with internal derangement of the TMJ.
Thirty-two patients with internal derangement of the TMJ were used as subjects and the 50 joints without any deformation of the condyle were studied. All the joints were deviled into ADDW (anterior disk displacement with reduction) group, ADDWO (anterior disk displacement without reduction) group and N (no disk displacement) group according to the MRI findings on the nature of disk displacement. The anterior and posterior joint spaces were measured on the axially corrected sagittal tomograms.
A-P ratio (anterior joint space/posterior joint space) was significantly larger in the ADDW group than in the N group, whereas the value was not statistically different from those in the ADDWO and N groups.
It is shown that condylar position is highly associated with the nature of disk displacement for patients with internal derangement of the TMJ.

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Disc repositioning therapeutic exercise was performed for 117 patients with the click due to disk anterior displacement with reduction and with disk repositioning mandibular position. The effective rate was 47% and the mean duration of disapearance of click in the effective patients was 39.7±21.4 days.
The effective rate of disc repositioning therapeutic exercise was compared about 9 items, including sex, age, presence or absence of pain, click period, timing of click, loudness of click, presence or absence of clenching, presence or absence of grinding of teeth, and presence or absence of eccentric mastication. The following 4 items were thought to be related to the outcomes of the therapy:
1. The effective rate (51.5%) in the the group aged 10 to 39 was higher than in the group aged 40 to 69 (26.3%).
2. The effective rate (54.2%) in the the group which the click period was 3 years or less was higher than the 3 yars or more group (29.4%).
3. The effective rate (58.3%) in the the group of the in early click was higher than middle click (47.1%) and late click (33.3%).
4. The effective rate (62.8%, 45.6%) in the the group of faintly touchable click and apparently touchable click was higher than audible click (11.8%).

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We presented a case of osteochondroma of the mandibular condyle treated by modified Nam's method. A 24-year-old woman was referred complaining of progressive facial asymmetry and malocclusion. Clinical examination revealed the deviation of the mandible to the right, and cross bite on the contralateral side. Preoperative panoramic radiograph and CT scans demonstrated the bony protuberance arising from the anteromedial surface of the left condyle. Hot area was observed in the left condyle in RI examination. Exposure of the condyle and tumor was done via a submandibular approach. A vertical osteotomy was performed from the sigmoid notch to the angle, posterior border of the mandibular ramus was removed from the wound. After resection of the tumor and reshaping of the condyle, osteotomied segment with residual condyle was replaced. Specimen was pathologically diagnosed as osteochondroma. 4 weeks of maxillomandibular fixation was followed by functional physiotherapies. Her clinical course has been favourable with an excellent aesthetic and functional recovery 6 years postoperatively.

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