Summary: | 移섏쓽�븰怨�/�꽍�궗 [�븳湲�] �썝諛섎쭩移섏씤���뒗 �궗�엺�쓽 �꽦愿��젅 諛쒖깮 以묒뿉 �굹���굹硫� �뼱瑜몄뿉�꽌�뒗 �꽦堉덈㉧由ъ젅�젣�닠�씠�굹 �꽦愿��젅�쓽 愿��젅寃쎌닔�닠 �룄以묒뿉 媛��슫�뜲洹� �넀�긽�쓣 �쑀諛쒖떆�궗 �닔 �엳�뒗 援ъ“濡� 以묒슂�븳 �엫�긽�쟻 �쓽�쓽瑜� 媛�吏꾨떎. �삉�븳 媛�履쎈궇媛쒓렐�씠 愿��젅�썝諛섏쓣 �븵, �븞履쎌쑝濡� 怨쇰룄�븯寃� �옟�븘�떦湲곕뒗 �꽦愿��젅 �옣�븷�떆, 愿��젅�썝諛섏씠 �븵, �븞履쎌쑝濡� 蹂��쐞�릺�뼱 留앹튂堉덉뿉 �뿰寃곕맂 �썝諛섎쭩移섏씤���� �븵留앹튂�씤���뿉 �쓽�빐 媛��슫�뜲洹� �넀�긽�쓣 以� �닔 �엳�뒗 寃껋쑝濡� 蹂닿퀬 �릺�뼱�엳�떎. 吏�湲덇퉴吏� 留롮� �뿰援ъ옄�뱾�씠 �썝諛섎쭩移섏씤�� 諛� �븵留앹튂�씤���뿉 ���븳 諛쒖깮�븰 諛� 議곗쭅�븰�쟻 �뿰援щ뱾�쓣 蹂닿퀬�븳 諛� �엳�쑝�굹, ���옄�뱾�뿉 �뵲�씪 �썝諛섎쭩移섏씤���쓽 議댁옱�� �븵留앹튂�씤���쓽 �삎�깭�븰�쟻 �듅吏� 諛� �엫�긽�쟻 怨좎같�뿉 ���빐�꽌�뒗 �븘吏곴퉴吏� �끉���씠 留롮� �떎�젙�씠�떎. �씠�뿉 ���옄�뒗 �븳援��씤�쓽 �깭�븘 4履쎄낵 �꽦�씤�쓽 癒몃━ 16履쎌쓣 ���긽�쑝濡� 誘몄꽭�빐遺�瑜� �떆�뻾�븯�뿬 �썝諛섎쭩移섏씤���쓽 議댁옱瑜� �솗�씤�븯怨� �썝諛섎쭩移섏씤���� �븵留앹튂�씤�� �쓽 援��냼�빐遺��븰�쟻 愿�怨� 諛� �꽦愿��젅 �옣�븷�� 愿��젴�맂 �빐遺�-�엫�긽�쟻 �뿰愿��꽦�쓣 議곗궗�븯�뿬 �떎�쓬怨� 媛숈� 寃곌낵瑜� �뼸�뿀�떎. 1. �깭�븘�몴蹂몄뿉�꽌 愿��젅�썝諛섏뿉 遺�李⑸맂 �썝諛섎쭩移섏씤���뒗 �슌�졆�븯寃� 留앹튂堉덉� �뿰寃곕릺�뼱 �엳�뿀怨�, �븵留앹튂�씤���뒗 留앹튂堉덈��꽣 �븵履쎌쑝濡� �쐞, �븘�옒痢듯뙋�쑝濡� �굹�돇�뼱 �떖由ш퀬 �옣�옒�쓽 諛붿쐞怨좎떎�땲�깉瑜� 吏��굹 �굹鍮꾩븘�옒�꽦�씤��濡� 怨꾩냽�릺�뼱 �뿰寃곕릺�뒗 �뼇�긽�씠�뿀�떎. 2. �썝諛섎쭩移섏씤���뒗 紐⑤뱺 �뼱瑜� �몴蹂몄뿉�꽌 愿�李곕릺�뿀�쑝硫�, 留앹튂堉� �븵履쎌뿉�꽌 愿��젅�썝諛섏쓽 �뮘�븞履쎌쑝濡� �꼻寃� �띁吏��뼱 �슌�졆�븳 �꽭紐④섦�쓽 �떎�뼇�븳 �몢猿섎�� 媛�吏��뒗 �씤��濡� 愿�李곕릺�뿀�떎. 3. 留앹튂堉덉쓽 �븵履쎌뿉�꽌 怨좎떎 �븵踰쎄퉴吏��쓽 嫄곕━�뒗 �룊洹� 1.13mm (理쒖냼 0.75�댘理쒕� 1.59), 留앹튂堉� �븵履쎈��꽣 諛붿쐞怨좎떎�땲�깉�뿉�꽌 �썝諛섎쭩移섏씤��媛� 愿��젅二쇰㉧�땲濡� 遺�李⑸릺�뒗 遺��쐞源뚯��쓽 嫄곕━�뒗 �룊洹� 5.37mm (理쒖냼 4.53�댘理쒕� 6.07)���떎. �븳�렪 諛붿쐞怨좎떎�땲�깉 遺��쐞�뿉�꽌 �썝諛섎쭩移섏씤���쓽 �룊洹� �룺�� 6.06mm (理쒖냼 4.72�댘理쒕� 7.46)���떎. 4. �썝諛섎쭩移섏씤���쓽 �뮘履� 遺�李⑸��쐞�뒗 留앹튂堉덉뿉 吏곸젒 遺�李⑸릺�뒗 寃쎌슦 (11履�), �븵留앹튂�씤��瑜� �넻�빐 媛꾩젒�쟻�쑝濡� 留앹튂堉덉뿉 遺�李⑸릺�뒗 寃쎌슦 (2履�), 洹몃━怨� �몢 媛�吏� 紐⑤몢 留앹튂堉덉뿉 吏곸젒 �삉�뒗 �븵留앹튂�씤��瑜� �넻�빐 媛꾩젒�쑝濡� 遺�李⑸릺�뒗 寃쎌슦 (3履�)濡� 遺꾨쪟�븷 �닔 �엳�뿀�떎. �썝諛섎쭩移섏씤�� �쓽 �븵履� 遺�李⑸��쐞�뒗 紐⑤뱺 寃쎌슦�뿉�꽌 愿��젅�썝諛섍낵 愿��젅二쇰㉧�땲�뿉 �떯怨� �엳�뿀�쑝硫� �븞履� 紐⑥꽌由щ뒗 諛붿쐞怨좎떎�땲�깉�쓽 �븵�븞履� 遺��쐞�뿉 遺�李⑸릺�뿀�떎. 5. Huguier 愿��쓽 以묎컙 堉덉쑖湲곕줈 �씤�빐 �븵留앹튂�씤���뒗 �썝諛섎쭩移섏씤��媛� �떖由щ뒗 遺�遺꾧낵 援щ텇�릺�뼱 二쇳뻾�븯�뒗 寃쎌슦 (9履�, 56.3%)�� �썝諛섎쭩移섏씤���� �븵留앹튂�씤��媛� 遺꾨━�릺�뼱 二쇳뻾�븯�뒗 寃쎌슦 (7履�, 43.7%)濡� �굹�돇�뼱 愿�李곕릺�뿀�떎. 6. �븵留앹튂�씤���뒗 ��遺�遺� �쐞, �븘�옒痢듯뙋�쑝濡� 援щ텇�릺吏� �븡�븯�쑝�굹 �븵留앹튂�씤���쓽 �쐞履� �꽟�쑀�쓽 �씪遺��뒗 諛붿쐞怨좎떎�땲�깉�쓽 �븵�븞履� 遺��쐞�뿉 遺�李⑸릺怨� �븘�옒履� �씤�� ��遺�遺꾩� 諛붿쐞怨좎떎�땲�깉瑜� 吏��굹 �굹鍮꾩븘�옒�꽦�씤��濡� �뿰寃곕릺怨� �엳�뿀�떎. 7. 留앹튂堉� �븵紐⑥꽌由ъ뿉�꽌 �븵留앹튂�씤��媛� 諛붿쐞怨좎떎�땲�깉瑜� �넻�빐 �굹媛��뒗 吏��젏源뚯��쓽 嫄곕━�뒗 �룊洹� 8.40mm (理쒖냼 6.62�댘理쒕� 11.42)���쑝硫�, �씠 遺��쐞�뿉�꽌 怨좎떎�걟�떊寃� �궗�씠�쓽 嫄곕━�뒗 2.01mm (理쒖냼 1.25�댘理쒕� 3.02)���떎. �씠�긽�쓽 寃곌낵瑜� 醫낇빀�븯硫�, 紐⑤뱺 �뼱瑜� �몴蹂몄뿉�꽌 愿�李곕맂 �썝諛섎쭩移섏씤���뒗 �몴蹂몄뿉 �뵲�씪 洹� �삎�깭�� �몢猿섍� �떎�뼇�븯���쑝硫� �뮘履쎌쑝濡� �썝諛섎쭩移섏씤��媛� 留앹튂堉덉뿉 遺�李⑸릺�뒗 遺��쐞�쓽 �삎�깭�룄 �떎�뼇�븯���떎. �삉�븳 �븘�옒�꽦�쓣 �궡由쇱뿉 �뵲�씪 �썝諛섎쭩移섏씤��瑜� �넻�븳 留앹튂堉덉쓽 ��吏곸엫�� 愿�李곕릺吏� �븡�븯�떎. �븳�렪, �븵留앹튂�씤���뒗 諛붿쐞怨좎떎�땲�깉瑜� �넻�빐 �굹鍮꾩븘�옒�꽦�씤��濡� �뿰寃곕릺�뼱 �엳�뼱�꽌, �븘�옒�꽦�쓣 怨쇰룄�븯寃� ��吏곸��쓣 �븣 �굹鍮꾩븘�옒�꽦�씤���� �븵留앹튂�씤��瑜� �넻�븳 媛��슫�뜲洹��쓽 �엫�긽�쟻 �옣�븷媛� �굹���궇 �닔 �엳�뒗 媛��뒫�꽦�쓣 �쑀異뷀븷 �닔 �엳�뿀�떎. --- �빑�떖�릺�뒗 留� : �썝諛섎쭩移섏씤��, �븵留앹튂�씤��, �굹鍮꾩븘�옒�꽦�씤��, 怨좎떎�걟�떊寃�, 留앹튂堉�, �꽦愿��젅�썝諛�, 諛붿쐞怨좎떎�땲�깉 [�쁺臾�] During temporomandibular joint (TMJ) formation, discomalleolar ligament (DML) and anterior malleolar ligament (AML) are formed within the dorsal end of the 1st branchial arch. But, DML is known as a remnant or the degenerated tissue through the TMJ development. There is few reports said that damage of AML and DML cause the damage of middle ear during surgical procedures. Especially, in case of anterior disk displacement of TMJ, aural symptom can be made via DML due to hyperextension anteriorly. A few studies have been reported about DML and AML in embryological and histological points of view, morphology and clinical aspects of DML and AML are still unclear. Four fetus and sixteen adult hemi-sectioned heads were dissected to clarify the topographical relationship of AML and DML and to find out the anatomico-clinical relevance related with temporomandibular disorder. In fetal specimens, DML was firmly attached from the disk of the TMJ to the malleus. Also, AML in which distinguished into the superior and inferior lamellae was running anteriorly and continuous with the sphenomandibular ligament (SML) through the future petrotympanic fissure (PTF). DML attached to the malleus was observed in all adult specimens and was expanded broadly to the disk and capsule of the TMJ as shown the V shaped-ligament structures. The average distance between the anterior aspects of the malleolar head to the anterior wall of the tympanic cavity was 1.13mm (0.75�댘1.59), and the length of the DML from the anterior aspect of the malleolar head to the attached site to the TMJ capsule at the PTF was 5.37mm (4.53�댘6.07). The average width of the DML at the PTF was 6.06mm (4.72�댘7.46). Most of the posterior attachments of the DML were the cases in which DML was directly attached to the malleus (68.7%). In all specimens, DML was attached to the disk and capsule of TMJ and attached to the anteromedial border of the PTF concurrently. In this study, two morphological patterns of AML were observed according to the presence of the bony ridge on the Huguiers canal in the PTF. The bony ridge of the Huguiers canal showed DML and AML separately in 56.3%, and the fused pattern of DML and AML was observed in 43.7%. AML was not distinguished with two lamellae in most specimens, superior ligament fibers were attached to the anteromedial border of the PTF and most of the inferior lamella was entering the gap in PTF and continuous with the SML. Average length from the anterior aspect of the malleolar head to the exit point of the AML on the PTF was 8.40mm (6.62�댘11.42), and the shortest distance between the AML and chorda tympani was 2.01mm (1.25�댘3.02). Taken all together, DML and AML were not the rudimentary, but the distinguishable structures in adults. Through the various morphological findings, DML and AML were separated ligamentous structures in which might be given rise from the divergent origin. And the anterior hyperextension of the disk of TMJ did not lead the movement of the malleus in the tympanic cavity, whereas, the movement of the malleus followed by the traction of the AML and SML was observed in a few cases. So, this results can be explained the possibility of the clinical symptom on the middle ear in case of the over-traction of the AML and SML. open
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