Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists

PURPOSE: Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS: A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS: Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION: The results indicate that playing instruments can play a contributory role in the development of TMD.ope

A Proposal for Botulinum Toxin Type A Injection Into the Temporal Region in Chronic Migraine Headache

Botulinum toxin type-A (BTX-A) injection for treating chronic migraine (CM) has developed into a new technique covering distinct injection points in the head and neck regions. The postulated analgesic mechanism implies that the injection should be administered to sensory nerves rather than to muscles. This study aimed to determine the topographical site of the auriculotemporal nerve (ATN) and to propose the effective injection points for treating CM. ATNs were investigated on 36 sides of 25 Korean cadavers. The anatomical structures of the ATN were investigated focusing on the temporal region. A right-angle ruler was positioned based on two clearly identifiable orthogonal reference lines based on the canthus and tragus as landmarks, and photographs were taken. The ATN appeared superficially in the anterosuperior region of the tragus. The nerve is located deeper than the superficial temporal artery. And it runs between the artery and the superficial temporal vein. In the superficial layer, it is divided into anterior and posterior divisions. The anterior division runs in a superior direction, while the posterior division runs in front of the ear and the several branches are distributed to the skin. We suggest that the optimal BTX-A injection points for CM are in the temporal region. The first point is about 2 cm anterior and 3 cm superior to two orthogonal reference lines defined based on the tragus and canthus, and the second point is about 4 cm superior to the first point. The third and fourth points are recommended about 2 cm superior to the first point, but respectively 1 cm anterior and posterior to it.ope

Congruency of personality and life events in depressive mood

본 연구는 우울의 소인이 되는 사회적 의존성과 자율성이라는 성격의 두 하위차원이 각기 특별히 상응하는 사건군(particular matching class of events)에서만 우울에 취약성을 나타낸다는 성격-사건 일치 가설(Personality-Event Congruency Hypothesis)을 검증하고자 대학생들을 대상으로 하여 6주에 걸쳐 종단적으로 연구되었다. 우울취약성에 해당하는 성격의 두 하위차원으로는 사회적 의존성과 자율성이 있으며, 성격-사건 일치 가설이란 사회적 의존성이 높은 개인은 거절, 갈등, 상실과 같은 부정적인 대인관계사건 뒤에 우울에 취약해질 것이고, 자율성이 높은 개인은 자신의 환경을 통제하는데 실패하거나 목표를 달성하는데 있어 실패하는 것과 같은 부정적인 성취사건 뒤에 우울에 취약해진다는 것을 말한다. 여기서 사회적 의존성(sociotropy)이란 다른 사람과의 관계를 소중히 여기고 그들에게서 자신이 받는 수용과 애정 등에 따라 자신의 가치를 평가하는 성격특성을 말하고 자율성(autonorny)이란 독립성, 자유 그리고 성취하려는 목표를 높이 평가하는 성격특성을 말한다. 이러한 성격-사건 일치 가설을 검증하기위해 대학생집단을 대상으로 우울취약성의 성격특성을 측정하는 Robinse등(1994)이 개발한 성격유형척도(Personal Style Inventory)를 실시하여 이에 의해 사회적 의존성 집단과 자율성 집단으로 분류하였고 우울수준의 측정을 위해 Beck(1979)이 개발한 Beck우울척도(Beck Depression Inventory)를 실시하여 사전우울수준을 측정하였다. 그리고 6주후에 Beck우울척도(Beck Depression Inventory)를 다시 실시하여 사후우울수준을 측정하였으며, 6주동안 경험한 부정적인 생활사건의 영향을 보고하도록 하기위해서 Cochrane Robertson(1973)이 개발해 낸 생활사건척도(Life Events Invento교)를 실시하였다. 그리하여, 사전우울수준의 영향이 통계적으로 통제된 상태에서 그동안 각 집단이 경험한 상응하는 부정적인 생활사건 뒤에, 즉 사회적 의존성 집단은 부정적인 대인관계사건 뒤에 그리고 자율성 집단은 부정적인 성취사건 뒤에, 우울수준의 변화가 있는지 검증해보았다. 본 연구에서는 우울취약성의 성격특성을 측정하기위해 Robins등(1994)이 개발한 성격유형척도(Personal Style Inventory)를 번안하여 요인분석해서 사용하였고, 생활사건의 측정은 Cochrane Robertson(1973)이 개발해 낸 생활사건척도(Life Events Inventory)를 김명권(1984)이 수정해서 만든 것을 사용하였다. 우울의 측정은 Beck(1979)이 개발한 Beck우울척도(Beck Depression Inventory)를 이영호와 송종용(1991)이 번안한 것을 사용하였다. 본 연구의 결과는 다음과 같다. 1. 성격유형척도를 요인분석한 결과 사회적 의존성과 자율성의 2요인으로 구분되었으며, 사회적 의존성 요인은 타인의 생각에 대한 관심, 의존성, 완벽한 이미지 추구, 타인을 만족시키기의 4개의 하위척도들로 구성되었고, 자율성 요인은 통제에 대한 욕구, 타인과의 방어적인 분리로 지칭되는 2개의 하위척도로 구성된다는 것이 밝혀졌다. 2. 사회적 의존성과 자율성의 성격특성은 사전, 사후의 우울감과 모두 유의미한 정적상관을 보였고, 대인관계사건과 성취사건도 두 시기 모두에서 우울감과 유의미한 상관을 보였다. 우울취약성 성격의 두 하위차원인 사회적 의존성과 자율성 간에는 유의미한 상관이 보이지 않았고, 사회적 의존성의 경우 대인관계사건과는 유의미한 정적 상관을 보였으며 성취사건과는 유의미한 상관을 보이지 않았다. 반면에 자율성의 경우는 대인 관계사건과 성취사건 모두에서 유의미한 상관을 나타내지 않았다. 생활사건의 두 하위차원인 대인관계사건과 성취사건은 유의미한 정적상관을 나타내었다. 3. 높은 사회적 의존성을 지닌 집단의 경우, 성격특성인 사회적 의존성과 그에 상응하는 부정적인 대인관계 사건과의 상호작용이 우울에 대하여 유의미한 효과를 나타내지 않았다. 4. 높은 자율성을 지닌 집단의 경우, 성격특성인 자율성과 그에 상응하는 부정적인 성취사건과의 상호작용이 우울에 대하여 유의미한 효과를 나타내었다. 따라서 이러한 결과는 성격-사건 일치가설을 지지하고 있다. 이상의 결과들은 사회적 의존성과 자율성이 각기 그에 상응하는 생활사건과의 연합에서만 즉, 사회적 의존성 집단은 부정적인 대인관계 사건과 연합되었을 때 그리고 자율성 집단은 부정적인 성취사건과의 연합되었을때에만 우울에 취약해진다는 성격-사건 일치 가설을 부분적으로 지지한다.;This study is intended to test the Personality-Event Congruency Hypothesis which that two subdimension of personality become vulnerable to depression only at particular matching class of events. This study has been researched for six weeks longitudinally. Undergraduate students were the subjects of this study. Sociotropy and autonomy are subdimension of personality included in depressive vulnerability. Sociotropy and autonomy are predisposed to depression. Personality-Event Congruency Hypothesis explains following conditions. High sociotropic individuals becomes vulnerable to depression following negative interpersonal events such as rejection, conflict, or loss. High autonomous individuals become vulnerable to depression following negative achivement events such as failure of cintrolling environments or achieving goals. In this hypothesis, sociotropy means personality of an individual who evaluate his/her value depending on affection and acceptance from others, and relationship with others. An autonomous individual highly value independence, freedom and achievement. In this study, Beck Depression Inventory developed by Beck, translated by Lee, Young Ho and Song, Jong Yong(1991), is used to measure depression. Robins's Personal Style Inventory is statistically processed through factor analysis to measure personality of depressive vulnerability. Life Events Inventory developed by Cochrane Robertson(l973), translated by Kim, Myung Kwon(1984), is used to measure life events. For this study, Personal Style Inventory is used to measure personality of depressive vulnerability. Sociotropic group and autonomic group are categorized by the result of measurement. Beck Depression Inventory is used to measure pre-depression and again used to measure post-depression after six-weeks. Life Events Inventory is applied to the subjects to report the impact of negative life events during six weeks. Under the condition of the statistically controlled impact of pre-depression, sociotropic group and autonomous group have been testified to prove whether each group show different depressive level following its matching negative life events: whether sociotropic group have different depressive level after experiencing negative interpersonal events; whether autonomic group have different depressive level after experiencing negative achivement events. The results of this study are as follows: 1. PSI is divided into two factors, sociotropy and autonomy, through factor analysis. Sociotropic factor is consist of four sub-factors which are concerns about other's opinion, dependency, making perfect image and pleasing others. Autonomic factor is consist of two sub-factors which are need for controlling and defensive separation from others. 2. Personality of sociotropy and autonomy have significant positive correlation with both pre-depression and post-depression. There is no significant positive correlation between sociotropy and autonomy (as two subdimension of depressive vulnerability). Interpersonal events turn out to have significant positive correlation with sociotropy, while achivement events do not. On the other hand, both of interpersonal events and achievement events do not have significant positive correlation with autonomy. Both of interpersonal events and achivement events as two subdimension of life events show significant positive correlation with each other. 3. High sociotropic groups do not show the significant interaction between sociotropy and its matching interpersonal events on depression. 4. High autonomic groups show the significant interaction between autonomy and its matching negative achivement events on depression. Therefore this result supports the Personality-Event Congruency Hypothesis. These results partially support the Personality -Event Congruency Hypothesis which testifies that sociotropy and autonomy become vulnerable to depression only at the association with their matching life events. Thus, sociotropic group become vulnerable to depression, being associated with negative interpersonal events, while sutonomic groups become vulnerable, being associated with negative achivements events.목차 = ⅲ 논문개요 = ⅵ Ⅰ. 서론 = 1 Ⅱ. 이론적 배경 = 5 A. 성격과 우울간의 관계 = 5 B. 우울에 대한 스트레스-취약성 모델 = 10 C. 생활사건과 우울간의 관계 = 12 D. 성격, 생활사건 그리고 우울과의 관계 = 13 Ⅲ. 연구방법 = 19 A. 연구대상 및 선정 = 19 B. 절차 = 20 C. 측정도구 = 20 D. 자료처리 = 22 Ⅳ. 연구결과 = 23 A. 성격유형척도의 요인구조 = 23 B. 우울, 성격특성, 생활사건 간의 상관분석 = 25 C. 성격특성과 생활사건이 우울에 미치는 영향 = 27 Ⅴ. 논의 및 결론 = 32 참고문헌 = 38 부록 = 47 Abstract = 6

Vom ,Text zum ,Raum der Interaktion und Verhandlung: zum Wandel des Kulturbegriffs

Trotz des grossen Interesses an neuen Perspektiven für die Forschung und Lehre, trotz der mehrfach erhobenen Forderungen zum Anschluß an ,cultural turn, wie man unter den Germanisten in Korea seit Jahren oft hört, herrscht immer noch ein gewisser Mangel an Bemühungen, wenn es darum geht, sich über theoretische Ansätze der Kulturwissenschaften und deren heuristische Voraussetzungen und Ziele kritisch auszutauschen. In diesem Sinne versucht die vorliegende Arbeit einen Einblick in das schwer durchschaubare Terrain der vielzähligen kulturwissenschaftlichen, kulturtheoretischen Schulen und Ansätze zu gewinnen. Dabei wird der Begriff der Kultur fokussiert, und diese Fokussierung geschieht in zwei Schritten, was wohl dem Wandel vom Kulturbegriff in dem kulturwissenschaflichen Diskurs entspricht. Zuerst befasst sich die vorliegende Arbeit mit einer übergreifenden Metapher, die für die Entstehung und Etablisierung der Kulturwissenschaft(en) in den letzten Jahrzenten entscheidende Rolle gespielt hat: Kultur als Text. Was hat man drunter zu verstehen? Wie und zu welchem Vorteil für die kulturwissenschaftliche Debatte hat dieses Kulturkonzept sich als neues überzeugendes Verständnis vom Forschungsgegenstand Kultur durchgesetzt? Von diesen grundlegenden Fragen geleitet, sind Berührungspunkte, Unterschiede und sonstige Bezugspunkte zwischen Cultural Materialism, New Historicism, Kulturanthropologie, und Michel Foucault usw. hergestellt. Dabei wird auf die Bedeutung und besondere Rolle der literarischen Texte als „Darstellunsformen kultureller Selbstauslegung für die Begriffsbildung des Kulturbegriffs besonders hingewiesen. Dieser Effekt des (literarischen) Textes auf Kultur trennt den heutigen Kulturbegriff von den vielen anderen historischen Kulturbegriffen deutlich. Der Übergang bzw. die Wende zum aktuellen Kulturbegriff, d.h. der kulturellen Interaktion / der Interkulturalität wird gezielt unter folgender Fragestellung beobachtet: Wäre diese Wende nur als konsequent, d.h. in dem textwissenschaflich dominanten Kulturbegriff schon keimend zu betrachten oder als gedanklicher Sprung und Dimensionswechsel, die nicht textuell, sondern ausschließlich kontextuell begründet sind? Das heißt, dass Interkulturalität nichts anderes als die kulturwissenschaftlich servierte Lösung für das rasch weiter anwachsende Ausmaß vom internationalen kulturellen Austausches und Begegnung in der Wirklichkeit sei? Der Abgang der Textualität als Kulturvorstellung ist aber gerade doppelbödig bedingt, einmal durch innerdynamische Erweiterung des Textbegriffs in Richtung zur Intertextualität, dann auch durch wirtschaftlich-politische Refiguration unter den Kulturen. Mit der Interkulturalität wird vor allem wichtiges Erklärungspotenzial für die kulturelle Bedeutung und Produktivität des Kulturkonflikts und der Kulturdifferenz gewonnen, was auf die Kulturpolik im Zeitgeist der Glokalisation sowohl anregend als auch legitimierend wirken kann

Reply: Clinical Implications of the Extension of Platysmal Fibers on the Middle and Lower Face

restrictio

독일 문화와 예술 -인문학적 독일학의 가능성과 문제점에 대하여

독일 문화와 예술은 전교생을 대상으로 개설된 교양강좌이다. 이 강의는 지역학으로서의 독일학에 일차적인 의미를 두었다기 보다는 일반 학생들의 문화와 예술에 대한 고조된 관심에서 출발한 것이었다. 이 두 차원이 강의의 실제에 있어서의 비록 불가분한 것이긴 하지만 지역학적 인식과 지역의 제현상 중의 하나인 문화와 예술에 대한 접근, 제시 방식은 분리하여 고찰되어져야 할 필요가 있다. 이것은 학과내의 지역학에 대한 관심이 상대적으로 낮은 불어불문학과의 프랑스문화와 예술의 경우와 비교해 볼 때 독일문화와 예술이 지역학적 인식으로부터 보다 긴장되고 다양한 문화, 예술의 이해에 다가갈 수 있음을 시사하기 때문이다. 본고는 독일문화와 예술의 예에서 인문학적 기반에서 시도되는 지역학으로서의 독일학의 가능성과 문제점을 살펴보고자 한다

Anatomical insights of the palmaris brevis muscle for clinical procedures of the hand

The purpose of the present study is to provide useful data for anatomists and clinicians by describing the topography of the palmaris brevis muscle, taking particular note of its morphology and distribution pattern of the nerve and artery. Forty-nine hands from Korean adult cadavers were used in this study. Parameters with respect to the size, scale, and location of the muscle were measured using a ultrasonography system, digital caliper, and surgical microscope. Histologic sections were obtained to clarify the positional relationship with surrounding tissues. The branches of the ulnar nerve and artery, which supply the muscle, were observed. The minimum and maximum depths in which the palmaris brevis muscle can be existed, including the thickness of the skin (1.9 mm), were 3.7 and 6.9 mm, respectively. It was inserted into the hypothenar fascia and the dermis. The main trunk of the ulnar nerve and artery were positioned under the lateral side of the muscle. The richest arborization of perforating branches of the ulnar nerve and artery was mostly confined to the distal section of the lateral side of the muscle. Our findings provide theoretical evidence of the palmaris brevis muscle for clinical procedures of the hand, such as botulinum toxin injection. Clinicians should pay attention not to injure the ulnar artery under the lateral side of the muscle. Botulinum toxin should be injected at a depth of between approximately 2 and 7 mm, considering the range of depth of the muscle.restrictio

The risorius muscle: anatomic considerations with reference to botulinum neurotoxin injection for masseteric hypertrophy

BACKGROUND: The botulinum neurotoxin Type A (BTX) injection into the masseter muscle often causes a change in the facial expression. There is as yet no precise anatomic evidence to support this etiologic factor of constrained facial expressions. OBJECTIVE: The aim of this study was to clarify the location and boundaries of the risorius muscle and its topographical relationship with the surrounding structures. MATERIALS AND METHODS: This study involved the dissection of 48 hemifaces. The locations of origin and insertion points of the risorius muscle were measured, and the masseter muscle was divided into 6 equally sized rectangular areas. RESULTS: Cases where the masseter muscle was covered by the risorius muscle were classified into the following 4 types: in Type A, Area III was partially covered by the risorius (17.8%); in Type B, Area VI was partially covered (20.0%); in Type C, Areas III and VI were partially covered (53.3%); and in Type D, Areas II, III, and VI were covered (6.7%). CONCLUSION: These findings suggest that the medial part of the masseter muscle represents a hazard zone into which the injection of BTX may affect the risorius muscle, potentially resulting in iatrogenic unnatural facial expressions.ope

Topography of the greater palatine artery and the palatal vault for various types of periodontal plastic surgery

The purpose of the present study is to provide useful data that could be applied to various types of periodontal plastic surgery by detailing the topography of the greater palatine artery (GPA), looking in particular at its depth from the palatal masticatory mucosa (PMM) and conducting a morphometric analysis of the palatal vault. Forty-three hemisectioned hard palates from embalmed Korean adult cadavers were used in this study. The morphometry of the palatal vault was analyzed, and then the specimens were decalcified and sectioned. Six parameters were measured using an image-analysis system after performing a standard calibration. In one specimen, the PMM was separated from the hard palate and subjected to a partial Sihler's staining technique, allowing the branching pattern of the GPA to be observed in a new method. The distances between the GPA and the gingival margin, and between the GPA and the cementoenamel junction were greatest at the maxillary second premolar. The shortest vertical distance between the GPA and the PMM decreased gradually as it proceeded anteriorly. The GPA was located deeper in the high-vault group than in the low-vault group. The premolar region should be recommended as the optimal donor site for tissue grafting, and in particular the second premolar region. The maximum size and thickness of tissue that can be harvested from the region were 9.3 mm and 4.0 mm, respectively.ope