Appliance of Interocclusal Splint as Initial Treatment of TMJ Dysfunction

TMJ dysfunction has difficulties for diagnosing and treating, and its symptoms are variable. TMJ dysfunction is classified as muscular problem, capsular problem, ligamentous problem, internal derangement, or condylar dislocation etc. Treatment modalities for TMJ dysfunction are surgical or conservative one, but they haven't be standardized. Because of anatomical complexities and difficulties of surgical approaches, conservative treatment have been preferred. We've had 30 cases having impressed capsular tightness or internal derangement. They have made an appeal for pain on TMJ area, ROM limitation of joint, clicking etc. We have used the interocclusal splint as treatment modality. In general, the interocclusal splint is classified as the stabilization splint, the repositioning splint, the pivot splint, the soft splint etc. We have applied the stabilization splint or the repositioning splint to the patients according to diagnosis or symptoms. The interocclusal splint is reported to induced the changing activities of muscle, altering the stress or loading of the joint and recapturing or changing condyle- disc-fossa position. As a result, the pain has become reduced and ROM limitation of joint was improved, clicking is eliminated initially. From January 2001 to May 2002, we treated 30 patients who having TMJ dysfunction. Our treatment modality was performed that the interocclusal splints were worn full time for one to four weeks, then phased out. During the mean 10.5 months of follow-up period there had been significant improvements in pain, ROM limitation of joint and clicking. After 6 months, there had been no recurrence in pain and ROM limitation of joint, but 2 cases recurred in clicking that has disappeared. The appliance of interocclusal splint has been an effective method for the initial nonsurgical treatment of the symptoms of TMJ dysfunction. However, more in-depth study by long term follow-up is needed to evaluate recurrence.

Treatment of Problem Scars through Intralesional Calcium Antagonist Injection

Scars can be problematic if they accompany the skin rash, tenderness, pruritus, limited joint motion, or various cosmetic complaints. Burn scar contractures, hypertrophic scars, irregular elevated scars and keloids are defined as problem scars. Many treatment modalities for control of excessive scars were introduced, but the results was often difficult to predict and some had high recurrence rates. Among current therapies for scar management, calcium antagonists were reported to induce the increasing activity of collagenase and promote the phenotypic changes in fibroblast. As a result, softening of the scars and lightening of color were established by intralesional calcium antagonist injection. From March 2001 to February 2002, we had treated 25 patients who had problem scars. Our treatment modality was performed that the calcium antagonist, as verapamil, was injected intralesionally with a total of 4 times at intervals of 3 weeks. Through the mean 6.2 months of follow-up period, there were 19 patients who had significant improvement in volume, texture, and color of scars. No complications and recurrence occurred with calcium antagonist injections. Intralesional injection of calcium antagonists has been an effective method for the treatment of problem scars, especially in case of worrying side effects or contraindicated situations in steroid therapy.

Trocar Application in The Treatment of Various Facial Bone Fractures

The treatment of facial bone fractures aims at restoring normal anatomical feature and obtaining the physiologic function by accurate fracture reduction and adequate stability. Among various facial bone fractures, displaced mandibular angle and subcondylar fractures are common injuries. Their structural problems such as increased risk of oromasticatory dysfunction and aesthetic drawbacks can be corrected by surgical treatment. In case of displaced comminuted fracture of zygoma, the zygomatic arch should be reduced and rigidly fixed, because it can be used as a key landmark for reconstruction. In case of these fractures, we performed external incision and conventional bicoronal incision to repair mandibular fractures and expose zygomatic arch. However, there are some disadvantages associated with these extensive incisions: a possible facial nerve injury, prolonged massive swelling, noticeable external scarring and increased risk of blood loss. On the other hand, the intraoral incision approach for mandibular angle, subcondyle and zygomatic arch makes possible the anatomic reduction and rigid internal fixation by using a trocar method concomitantly, which requires only an additional small skin incision over the perpendicular point of the fracture site. Additionally, this approach has several advantages, including decreased possibility of facial nerve injury, decreased blood loss, early subsidence of postoperative swelling and minimal external scarring. From March 1997 to November 1999, we used the trocar method for the treatment of various facial bone fractures of 15 males and 3 female patients (age ranged from 17 to 60 years). In this approach, operative endoscope or C-arm was used concomitantly in order to improve the limited operative visual field and to allow surgical access. The use of trocar method through the intraoral and tiny skin incisions provides the accurate reduction and rigid internal fixation. It is considered a good method to minimize the disadvantages of external approaches for the treatment of various facial bone fractures.

EPICANTHOPLASTY USING MODIFIED UCHIDA'S METHOD

In the majority of East Asian eyelids, the presence of a medial epicanthal fold is one of the unique anatomic characteristics. Roundness of medial canthal area and a narrow, short palpebral fissure are aesthetic consequences of this anatomic features. But, the idea of beauty has changed with time by influence of western culture. Many people are favorable to the wide open eye without epicanthal fold, which make improved facial balance. Double-eyelid operation is the most commonly performed procedure of aesthetic surgery field in Korea. However, many cases of successfully done double-eyelid operation results in only partial improvement by leaving medial epicanthal folds. We can get the improved results by utilizing epicanthopasty that lengthens the palpebral fissure, and thus producing the image of a larger, open eye. Consequently the requirements for epicanthoplasty has increased in modern time. The Uchida's split V-W plasty is one of the most frequently used methods. But, it has disadvantages of completely exposed scar, potential for dog-ear formation, and two stage procedure with some cases of double-eyelid operation. We modified the Uchida's method by moving the position of 2 triangular flaps more laterally and conjoining the incision line of double-eyelid operation with that of epicanthoplasty. The purposes of our modification are not complete elimination but relieving the epicanthal fold, hiding the minimal scar behind the new relieved the new relieved fold and preventing the dog-ear on the transitional zone. From January, 1995 to June, 1999, this method was applied to 93 patients who have medial epicanthal folds and performed with double-eyelid operation concomitantly. Age ranged From 12 to 47 years and the mean age was 23 years. Through the mean 15 months of follow up, the mean widening of the palpebral fissure width was 2.5mm and the mean reduction of the intercanthal distance was 5mm. The modified Uchida's method has advantages of simplicity in procedure, effectiveness in results, minimal scarring with hiding behind the new small fold, and one stage procedure with double-eyelid operation. We think it can be applied generally to almost of all double-eyelid operation except epicanthal fold is marked severe.