明海大学歯学雑誌 ３８‐１／１．Ｓａｔｏ
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1 J Meikai Dent Med 381, 35 52, Hz 1,500 Hz Hz 900 Hz 350 Hz Hz Hz 7 The Generation Mechanism of Temporomandibular Joint Sounds Sayuri HANAWA 1, Makiko IKE 2, Yuki SHINOHARA 2, Fumi YAMAAKI 2, Takusei GON 1 and Yasuhiko OKUMURA 1 1 Division of Dental Radiology, Department of Diagnostic & Therapeutic Sciences, Meikai University School of Dentistry 2 Meikai University Graduate School of Dentistry Abstract : This study attempted a more quantitative approach in diagnosing temporomandibular jointtmjarthorosis. Particular emphasis was placed on quantitative analysis of one of the major symptoms of TMJ arthorosis, TMJ sounds. It is
2 36 38, 2009 believed that this approach can help identify symptoms, assess effectiveness of treatments, and uncover the causes of TMJ arthorosis. TMJ sounds were analyzed to examine where in the craniofacial bone structure resonances occur, what kinds of resonances occur, and why TMJ sounds generate different sound waves at each occurrence. Following are the interesting insights regarding mechanism of TMJ sounds this research has provided. Following points were covered in this experiment. 1. Fabricating sound collection devices and sound analysis 2. Assessing acoustic characteristics of the sound collecting devices 3. Measuring of locations and frequencies using dry human skulls In order to extract temporomandiblar joint sounds of temporomandiblar joint arthrosis, the sound collecting devices was produced, dried human skulls were also used with gnathosoundscope in similar manners to collect data for sound wave analysis. The following conclusions were drawn. 1. Regarding the mechanism of TMJ sound occurrence, there was an initial impulse which triggered sympathetic vibrations in various locations in the skull. The resonances resulting from the sympathetic vibrations were then collected as TMJ sounds. 2. Resonances in the skull varied between 200 Hz and 1,500 Hz frequencies. 3. Resonances in maxilla and mandibular bones also showed variations within the 200 Hz 1,500 Hz range. 4. Frequencies at temporomandibular joint and mandibular angle showed characteristics of being around 450 Hz and 300 Hz. Frequencies in the malar bone area were around 350 Hz. Other areas did not show notable characteristics regarding frequencies. 5. TMJ sounds of around 220 Hz collected by stethoscope were caused by vibrations in the soft tissues surrounding the temporomandibular joint. 6. Resonant frequencies fluctuated about 100 Hz, depending on the structure of the resonating bodies and surrounding soft tissues, including variations in composition or thickness. 7. In the experiment using human models, differences in resonant frequencies were observed between the medial and lateral poles when the mandibular condyle was tapped with a mallet. It is believed that TMJ frequency analysis may further provide useful data for TMJ diagnosis. Key words : TMJ sounds, TMJ sounds wave analysis, microphone 1 2, Ekensten Watt
3 ECM-TL1 AT-PMX 5 P DS ms/div 50 µs 5, Region of Interest ROI ROI 1,024 ROI Fast Fourier Transform FFT FFT Hz Sound Pressure Level SPL SPL 300 Hz SPL SPL 100 Hz2,100 Hz 300 Hz SPL 50 db 3 Fig 1 A a B b C c D d E e F f G g H h 16 2 MODEL 19 WAVETEK, San Diego, CA, USA 300 Hz FE 133FOSTEX 2chFFT ANALYZER 50 cm Fig 1 Various microphone positionsright and Left side. A, R-TMJ: B,R-mandible : C,R-zygomatic : D,R-mastoid: E,R-frontal : F,R-temporal : G,R-occipital : H,R-parietal a, L-TMJ: b, L-mandible : c, L-zygomatic : d,l-mastoid : e, L-frontal : f,l-temporal : g, L-occipital : h, L-parietal
4 38 38, 2009 Fig 2 Silicone head hammer and hitting point of upper and lower jaw. Fig 2 No 147 R Fig 3 3 Fig Hz
5 39 Fig 3 Mandible holding between human thumb and forefinger, and holding condition of mandible packed konnyaku. Fig 4 Upper and lower jaw soaked in the water. Fig 5 Human soft tissue model. 200 Hz 200 Hz 5cm10 cm 8mm Fig
6 40 38, Fig Fig Hz 600 Hz Hz Left side Left side A B Right side Right side Frequenc [Hz] Fig 7 Clicking sound waves and spectra taken from microphone positions on left and right TMJ area. A, clicking sound wave. B,clicking sound spectra. 2 1 Fig 8 34 db 64 db 2 Fig Hz2,100 Hz Output [V] Fig 8 Input [db] Characteristics of input output relation. Left side Right side A Fig 6 Clicking sound wave taken from microphone positions on left and right TMJ area. A, leftside.b,right side. B Fig 9 Frequency characteristic of microphone.
7 Fig 10 a 1,050 Hz 450 Hz 600 Hz A 1,050 Hz 600 Hz 450 Hz b, B 450 Hz 1,050 Hz bb 1,050 Hz 450 Hz Figs 11, 12 Figs 13, Hz, 500 Hz 900 Hz1,100 Hz 350 Hz 550 Hz, 650 Hz, 850 Hz 450 Hz, 900 Hz 500 Hz600 Hz 2 Fig 15A Fig 15B 30 ms 40 ms 500 Hz 15 ms Hz 500 Hz100 Hz 400 Hz 500 Hz 500 Hz 400 Hz Fig 16 a 900 Hz 800 Hz b A 900 Hz B 900 Hz A A a a B B b b Fig 10 Artificial clicking sound waves and spectra of the mandible. a, b, A and B show the positions demonstrated in Fig 1, respectively.
8 42 38, 2009 G H E F D A C e h g f c a d Fig 11 Artificial clicking sound waves of the skullright side. A, C, D, E, F, G and H show the positions demonstrated in Fig 1, respectively. Fig 12 Artificial clicking sound waves of the skullleft side. a, c, d, e, f, g and h show the positions demonstrated in Fig 1, respectively.
9 43 G H E F D A C Fig 13 Artificial clicking spectra of the skullright side. A, C, D, E, F, G and H show the positions demonstrated in Fig 1, respectively. e h g f c a d Fig 14 Artificial clicking spectra of the skullleft side. a, c, d, e, f, g and h show the positions demonstrated in Fig 1, respectively.
10 44 38, 2009 A B Fig 15 Comparison of artificial clicking waves form free vibrationaand neck holdingb. 150 Hz, 250 Hz, 450 Hz, 700 Hz, 850 Hz 100 Hz850 Hz 1 1,050 Hz 900 Hz 3 Fig 17 a100 Hz, 200 Hz, 350 Hz, 500 Hz A A a a B B b b Fig 16 Artificial clicking sound waves of mandible packed by konnyaku. A, a, B and b show the positions demonstrated in Fig 1, respectively. A A a a B B b b Fig 17 Artifisial clicking sound waves of mandible soaked in the water. A, a, B and b show the positions demonstrated in Fig 1, respectively.
11 45 G H E F D A C Fig 18 Artifisial clicking sound waves of skull soaked in the waterright side. A, C, D, E, F, G and H show the positions demonstrated in Fig 1, respectively. e h g f c a d Fig 19 Artifisial clicking sound waves of skull soaked in the waterleft side. a, c, d, e, f, g and h show the positions demonstrated in Fig 1, respectively.
12 46 38, 2009 b 100 Hz 350 Hz A 150 Hz 350 HzB 100 Hz 350 Hz 350 Hz Figs G H E F D A C Fig 20 Spectra of clicking sound waves skull soaked in the waterright side. A, C, D, E, F, G and H show the positions demonstrated in Fig 1, respectively. e h g f c a d Fig 21 Spectra of clicking sound waves skull soaked in the waterleft side. a, c, d, e, f, g and h show the positions demonstrated in Fig 1, respectively.
13 47 f h 200 Hz 3 5 a 450 Hzd 250 Hz 350 Hzf 350 Hzc 200 Hz, 400 Hz 550 Hzeh 350 Hz a cf 350 Hz400 Hz A 350 Hz 400 Hz DC F 600 Hz f f Hz200 Hz Fig Hz 1,100 Hz 500 Hz, 1,100 Hz 100 Hz200 Hz 5 3 Figs Hz 450 Hz 900 Hz 400 Hz450 Hz 400 Hz 900 Hz 400 Hz 900 Hz 400 Hz 400 Hz A B C Fig 22 Comparison of artificial clicking sound waves with and without between soft tissue lying and not lying. A, without soft tissue lying. B,hitting point at by soft tissue lying. C,hitting point at by soft tissue lying.
14 48 38, 2009 L R L R A B A B L C D Fig 23 Comparing of the artificial clicking sound waves of various mandibular hitting points Inner pole of mandible head. A, leftside.b,right side. C,leftside. D,right side. R L C Fig 25 Comparing of the artificial clicking sound waves of various mandibular hitting pointshorizontal hitting of mandible head. A, leftside. B,right side. C,leftside. D,right side. D R A A L L B Fig 24 Comparing of the artificial clicking sound waves of various mandibular hitting pointsexternal pole of mandible head. A, leftside.b,right side. C,leftside. D,right side. B R R
15 Hz1,000 Hz 14 1,000 Hz Hz2,000 Hz 100 Hz2,000 Hz Hz400 Hz Hz 1,050 Hz 350 Hz 650 Hz 2 18
16 50 38, Hz 400 Hz 500 Hz Hz 400 Hz 100 Hz a 900 Hz 800 Hz a 900 Hz 1 1,050 Hz 900 Hz Hz400 Hz 900 Hz 400 Hz 350 Hz450 Hz 400 Hz500 Hz 350 Hz Hz 400 Hz 200 Hz Hz 400 Hz 500 Hz 200 Hz 200 Hz Hz Hz1,400 Hz Hz
17 51 1,500 m/s 200 Hz m 1,000 Hz 1.5 m Hz Hz200 Hz 200 Hz Hz200 Hz Hz 900 Hz 400 Hz 400 Hz Hz1,500 Hz Hz 900 Hz 350 Hz Hz Hz 7 McNeill C : History and evolution of TMD concepts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83, 51 60, 1997 EBM. Inpp50 61, 2005 In pp , , 284, 1956
18 52 38, , 1996 Watt DM : Clinical applications of gnathosonics. J Prosthet Dent 16, 83 95, 1966 Ekensten B : Phonograms of anomalies of the temporomandibular joint in motion. Odontol Tidskr 60, , 1952 Watt DM : A preliminary report on the auscultation of the masticatory mechanism. Dent Pract Dent Rec 14, 27 30, 1963 Watt DM : GnathosonicsA study of sounds produced by the masticatory mechanism. J Prosthet Dent 16, 73 82, 1966 Watt DM and Hedegard B : The stereostethoscopean instrument for clinical gnathosonics. J Prosthet Dent 18, , , , , , , , , 2008 Ciancaglini R, Sorini M, De Cicco L and Brodoloni F : Digital phonoarthrometry of temporomandibular joint sounds : a preliminary report. J Oral Rehabil 14, , 1987 Gay T and Bertolami CN : The spectral properties of temporomandibular joint sounds. J Dent Res 66, , 1987 Gay T and Bertolami CN : The acoustical characteristics of the normal temporomandibular joint. J Dent Res 67, 56 60, , , , ,
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