Association of radiographic and clinical findings in patients with temporomandibular joints osseous alteration.
- 作者列表："Arayasantiparb R","Mitrirattanakul S","Kunasarapun P","Chutimataewin H","Netnoparat P","Sae-Heng W
OBJECTIVES:To characterize the relationship between radiographic and clinical characteristics of patients with temporomandibular joint (TMJ) osseous changes. MATERIALS AND METHODS:TMJ cone beam computed tomography (CBCT) images of 73 patients (142 joints) with changes in osseous component of TMJ were included in this study. Based on both clinical and radiographic findings, each TMJ was diagnosed as either non-degenerative joint disease (non-DJD) or degenerative joint disease (DJD) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria. The DJD group was further classified into two subgroups of osteoarthritis and osteoarthrosis. The data were analyzed using t test and Pearson's correlation. Level of statistical significance was set at 0.05. RESULTS:Statistically significant relationships were found between TMJ crepitation sound and 4 radiographic characteristics of DJD. DJD group demonstrated statistically significant higher CBCT bone change score (BCS) and age. In contrast, there was no significant difference of BCS between osteoarthrosis and osteoarthritis groups within the DJD group. CONCLUSIONS:Crepitation sounds and osseous changes in TMJ radiograph are confirmed to be important diagnostic criteria for TMJ DJD. However, degree of TMJ osseous changes does not correlate significantly with clinical pain symptom. CLINICAL RELEVANCE:For TMJ DJD diagnosis, dentists should consider both clinical examination for TMJ crepitation and radiographic assessment for TMJ bony changes.
目的: 探讨颞下颌关节 (TMJ) 骨性改变的x线表现与临床特征的关系。 材料和方法: 73 例 (142 个关节) 颞下颌关节骨性成分改变的颞下颌关节锥形束ct (CBCT) 图像纳入本研究。根据临床和影像学表现，每个颞下颌关节均被诊断为非退行性关节病 (non-DJD) 或退行性关节病 (DJD) 根据颞下颌关节紊乱病诊断标准 (DC/TMD) 标准。将DJD组进一步分为骨关节炎和骨关节病两个亚组。T he da t a采用test t和Pearson's correla t ion进行分析。统计学显著性水平设定为 0.05。 结果: TMJ cre音与DJD的 4 个影像学特征之间存在统计学显著关系。DJD组CBCT骨变化评分 (BCS) 和年龄明显高于对照组。相比之下，DJD组骨关节病组和骨关节炎组之间的BCS无显著差异。 结论: 颞下颌关节x线片的cre音和骨性改变是颞下颌关节DJD的重要诊断标准。然而，TMJ骨性改变的程度与临床疼痛症状无显著相关性。 临床相关性: 对于TMJ DJD诊断，牙医应考虑TMJ隆起的临床检查和TMJ骨性改变的影像学评估。
METHODS:BACKGROUND:The anterior oronasal fistulae neighboring the alveolar cleft could persist or reappear after the alveolar reconstruction with cancellous bone grafting. The persistent symptomatic anterior oronasal fistulae need to be repaired, but surgery remains a challenge in cleft care. Surprisingly, this issue has rarely been reported in the literature. The purpose of this long-term study was to report a single surgeon experience with a therapeutic protocol for persistent symptomatic anterior oronasal fistula repair. METHODS:This is a retrospective study of consecutive patients with Veau type III and IV clefts and persistent symptomatic anterior oronasal fistulae managed according to a therapeutic protocol from 1997 to 2018. Depending on fistula size, patients were treated with local flaps associated with an interpositional graft or two-stage tongue flaps (small/medium or large fistulae, respectively). The surgical outcomes were classified as "good" (complete fistula closure with no symptoms), "fair" (asymptomatic narrow fistula remained), or "poor" (failure with persistent symptoms). RESULTS:Forty-four patients with persistent symptomatic anterior oronasal fistulae were reconstructed with local flaps associated with interpositional fascia or dermal fat grafting (52.3%) or two-stage tongue flaps (47.7%). Most of patients (93.2%) presented "good" outcomes, ranging from 87% to 100% (local and tongue flaps, respectively). Three (6.8%) patients presented symptomatic residual fistula ("poor" outcomes). CONCLUSIONS:For the repair of persistent symptomatic anterior oronasal fistulae, this therapeutic protocol provided satisfactory outcome with low fistula recurrence rate.
METHODS:OBJECTIVE:Methadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS. DESIGN/SETTING:This case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995-2011. PATIENTS:Cases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks' gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview. RESULTS:Among 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1-12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2). CONCLUSIONS:These findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk-benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
METHODS::Orthopedic treatment to improve deficient maxillary growth of cleft lip and palate patients is an important part of treatment. The success of this treatment is strongly dependent on the time of initiation of therapy. There has been a large controversy in the available literature regarding the skeletal age of these patients. The aim of the present study was to compare the skeletal age of cleft lip and palate patients with normal individuals.37 unilateral and 14 bilateral cleft lip and palate patients and 47 healthy individuals participated in this cross-sectional study. The patients were classified into 8 to 10 and 11 to 14-year-old individuals. Cervical vertebral maturational stage of participants was evaluated in the lateral cephalometry. The skeletal age of cleft lip and palate patients was compared with normal controls. Chi-square was used for statistical analysis. There was not a significant difference in the skeletal developmental stage of unilateral and bilateral cleft compared to their normal peers according to their age and sex. Also, significant difference in skeletal maturational stage of cleft lip and palate patients was not found between boys and girls (P = 0.8). Similarly, no significant difference was found in the skeletal age of the 3 studied groups without considering the age and sex of participants (P = 0.5). Regarding the similar skeletal maturational stage of cleft lip and palate patients with normal controls in our study, their maxillofacial orthopedic treatment can be initiated at similar time to normal peers.