측두하악장애 환자의 저작계 기능분석에 관한 연구

Abstract

[한글]

측두하악장애 환자에 나타나는 저작계 기능 이상을 연구하고자 총 76명의 측두하악장애 환자를 대상으로 Mandibular Kinesiograph를 이용하여 하악의 개폐구운동, 운동속도, 연하 및 저작운동을 관찰하고 또한 전측두근과 교근의 Electromyography를 시행하여 근활성도를 측정하고 다음과 같은 결과를 얻었다.

1. 최대개폐구시 상하거리와 전후거리 및 절치간거리는 환자군에서 남녀간에 매우 유의한 차이가 있었고 (p<0.01), 여자에서는 환자군과 정상군의 비교에서 유의한 차이가 있었다(p<0.05).

2. 개폐구운동속도는 환자군에서 남녀간에, 남자와 여자에서 각각 환자군과 정상군간에 유의한 차이가 있었다(p<0.05).

3. 환자군 남자의 58.3%와 여자의 34.6%가 유아성연하를 하였다.

4. 우측저작시 저작형태는 남녀환자 모두 TYPE Ⅲ가 가장 빈도가 높았다(41.7%와 36.5%). 그러나 좌측저작시에는 보다 균등하게 Type Ⅰ에서 Ⅶ까지 분포되었다.

5. 좌우측으로 저작시 남자환자군은 정상군에 비해 개구량이 매우 적었고(p<0.01), 여자환자군도 정상군과 비교할 때 차이가 있었다(p<0.05).

6. 안정위와 empty clenching 그리고 cotton roll clenching의 경우 저작근의 근활성도는 환자군 남녀간에, 남자와 여자에서 각각 환자군과 정상군간에 대부분 유의한 차이가 없었다(p>0.05).

7. 환자군의 좌우 비교에서, 최대개구시와 저작시에 우측으로의 편위량이 컸으며(p<0.01), empty clenching과 cotton roll clenching 시에는 좌우측 교근의 근활성도에 매우 유의한 차이가 있었다(p<0.01).

결론적으로 남자 24명, 여자 52명의 측두하악장애 환자에서 저작계기능의 이상유무를 알기 위해 하악운동의 궤적을 추적하고 근전도검사를 한 결과, 측두하악장애환자는 최대개폐구시 운동거리나 속도가 정상군과는 다른 현상을 보였으며, 많은 환자가 유아성 연하

형태를 보였다. 또한 저작형태도 정상군과는 다른 분포를 보였으며, 저작시 개구량도 남녀 모두 정상군에 비해 적음을 알수 있었다. 그러나 전측두근과 교근의 근전도검사를 이용한 근활성도의 비교에서는 각 군간에 뚜렷한 차이가 발견되지 않았다.

A STUDY ON THE FUNCTIONAL ANALYSIS OF THE MASTICATORY SYSTEM IN PATIENTS WITH

TEMPOROMANDIBULAR DISORDER

Hyun-Kwon Koh, D.D.S., M.S.D.

Department of Dental Science, The Graduate School, Yonsei University

(Directed by Associate Professor, In-Kwon Kim, D.D.S., M.S., Ph.D.)

Functional analysis of the masticatory system in patients with Temporomandibular

Disorder was performed far 76 patients using kinesiographic and electromyographic

methods.

Within the limits of this study, the results were as follows :

1. In maximum open-close cycle, the difference between male and female patients

for vertical, anterior-posterior, and interincisal distance was highly

significant(p<0.01). In females, the difference between the patient group and the

normal group was significant(p<0.05),

2. When comparing the opening and the dosing velocity, the differences between

male and female patients, the normal group and the patient group for both sexes

were significant, respectively(p<0.05).

3. Significant number of male(58.3%) and female(34.6%) patients assumed infantile

swallowing.

4. When chewing on the right side, Type Ⅲ pattern was the most frequent one for

male patients(41.7%) and also for female patients(36.5%). Chewing pattern was more

evenly distributed when chewing on the left side.

5. In chewing cycle, the difference in vertical distance was highly significant

between male patients and the male normal group(p<0.01), and was significant

between female patients and the female normal group(p<0.05).

6. In rest position, empty clenching, and cotton roll clenching, the differences

of electromyographic muscle activities of the anterior temporalis and masseter were

not significant between male and female patients, male patients and the male normal

group, and female patients and the female normal group, respectively(p>0.05).

7. When comparing the right and left side of the patients, deviation to the right

was significantly higher in maximum open-close cycle and in chewing cycle(p<0.01).

The difference of masseteric muscle activities between the right and the left side

was highly significant in empty clenching and cotton roll clenching(p<0.01).

In conclusion,24 male and 52 female patients with Temporomandibular Disorder were

examined using kinesiographic and electiomyographic methods. The results revealed

that the difference between the patient and the normal group was significant in

many aspects of mandibular movements, although the difference of electromyographic

muscle activities was net significant between two groups.

[영문]

Functional analysis of the masticatory system in patients with Temporomandibular Disorder was performed far 76 patients using kinesiographic and electromyographic methods.

Within the limits of this study, the results were as follows :

1. In maximum open-close cycle, the difference between male and female patients for vertical, anterior-posterior, and interincisal distance was highly significant(p<0.01). In females, the difference between the patient group and the normal group was significant(p<0.05),

2. When comparing the opening and the dosing velocity, the differences between male and female patients, the normal group and the patient group for both sexes were significant, respectively(p<0.05).

3. Significant number of male(58.3%) and female(34.6%) patients assumed infantile swallowing.

4. When chewing on the right side, Type Ⅲ pattern was the most frequent one for male patients(41.7%) and also for female patients(36.5%). Chewing pattern was more evenly distributed when chewing on the left side.

5. In chewing cycle, the difference in vertical distance was highly significant between male patients and the male normal group(p<0.01), and was significant between female patients and the female normal group(p<0.05).

6. In rest position, empty clenching, and cotton roll clenching, the differences of electromyographic muscle activities of the anterior temporalis and masseter were not significant between male and female patients, male patients and the male normal group, and female patients and the female normal group, respectively(p>0.05).

7. When comparing the right and left side of the patients, deviation to the right was significantly higher in maximum open-close cycle and in chewing cycle(p<0.01).

The difference of masseteric muscle activities between the right and the left side was highly significant in empty clenching and cotton roll clenching(p<0.01).

In conclusion,24 male and 52 female patients with Temporomandibular Disorder were examined using kinesiographic and electiomyographic methods. The results revealed that the difference between the patient and the normal group was significant in many aspects of mandibular movements, although the difference of electromyographic muscle activities was net significant between two groups.