A randomized clinical trial comparing the efficacy of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in patients with temporomandibular disorders.
一项比较低水平激光疗法 (LLLT) 和激光针灸疗法 (LAT) 对颞下颌关节紊乱病患者疗效的随机临床试验。
- 作者列表："Madani A","Ahrari F","Fallahrastegar A","Daghestani N
:This study compared the efficacy of low-level laser therapy (LLLT) versus laser acupuncture therapy (LAT) in patients with temporomandibular disorders (TMDs). In this randomized, double-blind clinical trial, 45 TMD patients were randomly divided into three groups. In group 1 (LLLT), a GaAlAs laser was applied on painful masticatory muscles and TMJs (810 nm, 200 mW, 30 s per point, Gaussian beam, spot size 0.28 cm2, 21 J/cm2) two times a week for 5 weeks. In group 2 (LAT), the laser was emitted bilaterally on acupuncture points (ST6, ST7, LI4) with the same settings as the LLLT group. Group 3 (placebo) underwent treatment with sham laser. The patients were evaluated before treatment (T1), after 5 (T2) and 10 (T3) laser applications, and 1 month later (T4). The mandibular range of motion as well as pain intensity in masticatory system was recorded at each interval. There was no significant difference in mouth opening between the groups (p > 0.05), but the amount of lateral excursive and protrusive movements was significantly greater in LLLT and LAT groups than the placebo group at some intervals (p < 0.05). The overall pain intensity and pain degree at masticatory muscles (except temporal muscle) and TMJs were significantly lower in both experimental groups than the placebo group at most intervals after therapy (p < 0.05). Both LLLT and LAT were effective in reducing pain and increasing excursive and protrusive mandibular motion in TMD patients. LAT could be suggested as a suitable alternative to LLLT, as it provided effective results while taking less chair time.
: 本研究比较了低水平激光治疗 (LLLT) 与激光针灸治疗 (LAT) 颞下颌关节紊乱病 (TMDs) 患者的疗效。在这项随机、双盲临床试验中，45 例TMD患者被随机分为三组。在 1 组 (LLLT) 中，a GaAlA s la s er wa s应用于疼痛的ma s术mu s cle s和TMJ s (8 1 0 nm，200 mW，每点 30 s，Gau s s ian beam，s pot s ize 0.28平方厘米，2 1 J/cm2) 每周两次s，共 5 周s。在第 2 组 (LAT) 中，以与LLLT组相同的设置在穴位 (ST6 、ST7 、LI4) 上双侧发射激光。第 3 组 (安慰剂) 接受假激光治疗。分别于治疗前 (t1) 、 5 次 (T2) 和 1 0 次 (T3) 激光治疗后 1 1 个月后 (T4) 进行评价。记录每个间隔的下颌活动范围以及咀嚼系统的疼痛强度。组间张口度差异无统计学意义 (p> 0.05)，但在某些时间间隔内，LLLT和LAT组的侧向偏移和突起运动量显著大于安慰剂组 (p <0.05)。治疗后多数时间点，两组咀嚼肌 (除颞肌外) 和颞下颌关节 (TMJs) 的疼痛强度和疼痛程度均显著低于安慰剂组 (p <0.05)。LLLT和LAT均能有效减轻TMD患者的疼痛，增加下颌角运动和下颌前伸运动。LAT可以被建议作为LLLT的合适替代方案，因为它提供了有效的结果，同时占用的椅子时间更少。
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.