Analysis of treatment patterns of temporomandibular disorders

Yong-Hoon Cha; Bum-Joon Kim; Jae-Hyung Lim; Kwang-Ho Park; Hyung-Gon Kim; Jong-Ki Huh

doi:10.5125/jkaoms.2010.36.6.520

Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(6) > 1032439

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Cha, Kim, Lim, Park, Kim, and Huh: Analysis of treatment patterns of temporomandibular disorders

Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(6):520-527.

Published online: 7 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.6.520

Analysis of treatment patterns of temporomandibular disorders

Yong-Hoon Cha, Bum-Joon Kim, Jae-Hyung Lim, Kwang-Ho Park, Hyung-Gon Kim, Jong-Ki Huh

Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea

Jong-Ki Huh Department of Oral and Maxillofacial Surgery, Gangnam Severance Dental Hospital, College of Dentistry, Yonsei University 712, Eonju-ro, Gangnam-gu, Seoul, 135-720, Korea TEL: +82-2-2019-3560 FAX: +82-2-3463-4052 E-mail: omshuh@yuhs.ac

Received 24 September 20109 December 2010 Accepted 22 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

This study examined the treatment patterns of temporomandibular disorders (TMD) including conservative and surgical procedures.

Materials and Methods

Patients with TMD who visited Gangnam Severance Hospital from June 2007 to May 2008 were enrolled in this study. All patients were examined from the orthopantomogram, temporomandibular joint (TMJ) tomography, and a clinical examination. The patients who required a further evaluation were examined by magnetic resonance imaging and/or computed tomography. The treatment patterns were divided into counseling, medication, splint therapy, botulinum toxin injection (BTI) and surgical treatment.

Results

Among the 2,464 patients, the average age was 31.8 years (ranging from 6 to 93); 764 (31.0%) were male and 1,700 (69.0%) were female. 2,355 (95.6%) patients were treated with conservative therapy; 1,460 (62.0%) patients were treated with medication, 931 (39.5%) patients were treated with splint, and 46 (2.0%) were treated with BTI. There were 109 (4.4%) patients treated surgically. Eight (0.3%) patients were treated with total temporomandibular joint replacement surgery.

Conclusion

Almost all patients with TMD were treated using conservative methods. Those patients who received surgical treatment because of an ineffective response to conservative treatment had definite problems with the internal derangement and/or osteoarthritis or had severe clinical symptoms.

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Keywords: Temporomandibular joint disorders, Splint, Arthroplasty, Botulinum toxins, Replacement arthroplasty

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Fig. 1.

Treatment protocol.

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Table 1.

Treatment patterns of temporomandibular disorders

Conservative treatments

Counseling

Self-care: moist hot pack, soft diet, mouth opening exercise, massage, etc.

Medication: muscle relaxants, anti-inflammatory analgesics, minor tranquilizer

Splint therapy: anterior positioning splint, occlusal stabilizing splint

Botulinum toxin A injection into masticatory muscles

Surgical treatments

Arthrocentesis

Arthroplasty

Condylectomy

Total temporomandibular joint replacement with alloplastic prostheses

Table 2.

Treatment patterns of 2,464 temporomandibular disorders patients

Treatment Pattern					Patient number (%)
	Counseling and Self-care (n=2,355)	Medication (n=1,460)	Splint (n=931)	BTI (n=46)	Patient number (%)
	O				502 (20.4)	2,355 (95.6)
	O	O			900 (36.6)
	O		O		375 (15.2)
Conservative treatment	O			O	10 (0.4)
	O	O	O		532 (21.6)
	O	O		O	12 (0.5)
	O		O	O	8 (0.3)
	O	O	O	O	16 (0.6)
Surgical treatment	Arthrocentesis				2 (0.1)	109 (4.4)
	Arthroplasty				97 (3.9)
	Condylectomy				1 (0.05)
	Total TMJ replacement				8 (0.3)
	Removal of foreign body				1 (0.05)
	Total				2,464 (100)

(BTI: botulinum toxin injection in the masticatory muscles, TMJ: temporomandibular joint)

Table 3.

Surgical cases according to the diagnosis of TMJ disorders

	Disorders	Number of cases (%)
	DDsR	44 (45.3)
Internal	DDsR + perforation	24 (24.7)	78 (80.4)
Derangement	DDsR + adhesion	5 (5.2)
	DDsR + perforation + adhesion	5 (5.2)
Habitual luxation		3 (3.1)
Osteoarthritis/Osteoarthrosis		9 (9.3)
Synovial chondromatosis		7 (7.2)
Total		97 (100.0)

(TMJ: temporomandibular joint, DDsR: Disc displacement without reduction)

Table 4.

Cases of total TMJ replacement with alloplastic implants

Case No.	Age/sex	Site	Diagnosis	Types of operation
1	38/F	Both	ICR	B-TJR
2	28/F	Both	ICR	B-TJR with Ortho
3	28/F	Both	ICR	B-TJR with Ortho
4	48/F	Right	ICR	U-TJR
5	27/F	Left	ICR	U-TJR
6	56/F	Left	ICR	U-TJR
7	33/F	Left	Osteochondroma	U-TJR with Ortho
8	18/F	Both	Ankylosis by trauma	B-TJR with Ortho

(TMJ: temporomandibular joint, ICR: idiopathic condylar resorption, B-/U-TJR: bilateral/unilateral total TMJ replacement, Ortho: orthognathic surgery)

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