International journal of oral and maxillofacial surgery
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Int J Oral Maxillofac Surg · Apr 2001
Relationship between temporomandibular joint pain and magnetic resonance imaging findings of internal derangement.
In terms of clinical decision-making in instances of temporomandibular disorders (TMD) and orofacial pain, there is controversy in the literature over the diagnostic significance of the temporomandibular joint (TMJ)-related variable disk-condyle relationship (DCR). The purpose of this study was to investigate whether in patients with TMJ-related pain, the variable of TMJ pain may be linked to magnetic resonance (MR) imaging findings of internal derangement (ID). The study comprised 163 consecutive TMJ pain patients. ⋯ Use of the Kappa statistical test indicated poor diagnostic agreement between the presence of TMJ pain and the MR imaging diagnosis of ID (K=0.16). The results suggest that the clinical variable of TMJ pain may have a significant effect on the prevalences of MR imaging diagnoses of TMJ ID. The data confirm the biological concept of DCR as a diagnostic approach in patients with signs and symptoms of TMJ-related pain.
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Int J Oral Maxillofac Surg · Oct 2000
New perspectives in the management of cranio-mandibular ankylosis.
Cranio-mandibular ankylosis is characterized by the formation of a bony mass, which replaces the normal articulation. Although the bony mass represents the pathology responsible for the ankylosis, it is not a neoplastic process capable of continued growth. ⋯ An osteotomy performed inferior to the base of the ankylotic mass converts this into a situation akin to that of a subcondylar fracture. The technical details of this conceptually new approach to the management of TMJ ankylosis is described and the advantage of this technique over the conventional ones, particularly in cases of recurrent ankylosis, is discussed.
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Int J Oral Maxillofac Surg · Jun 2000
Effect of temporomandibular joint arthrocentesis on synovial fluid mediator level of tumor necrosis factor-alpha: implications for treatment outcome.
Temporomandibular joint (TMJ) pain is a predominant sign and symptom in patients with temporomandibular disorder, and a common cause of chronic orofacial pain. Arthrocentesis of the upper joint space proved to be effective in reducing TMJ-related pain and reestablishing normal mandibular range of movement in patients diagnosed for a 'closed lock'. Using the therapeutic approach of arthrocentesis in TMJ-related instances of capsulitis/ synovitis (C/S) with a recency of first pain onset of < or =6 months, the purpose of the present study was to evaluate whether the TMJ-related variable synovial fluid (SF) level of TNF-alpha may be linked to the cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. ⋯ There was no change in the prevalence of associated TMJ-related diagnoses of internal derangement. In view of the fact that the described technique of TMJ SF analysis may be suggested as a valuable diagnostic method for the detection of biochemical SF events, the results of this study should encourage research in its potential uses so that it can become established as a reliable diagnostic approach. Further, the findings may support the concept of bilateral arthrocentesis to be effective in the treatment of patients with a unilateral specific TMD diagnosis of non-chronic C/S.
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Int J Oral Maxillofac Surg · Oct 1999
A modified submental approach for oral endotracheal intubation.
Hernandez, in 1986, published the first paper on "The submental route for endotracheal intubation". The technique was developed to avoid tracheostomy, particularly in maxillofacial trauma cases, where short-term intermaxillary fixation was required. Gordon & Tolstunov published 2 cases utilizing the technique. ⋯ Fifteen cases utilizing this modified technique are reported, including 14 cases of craniomaxillofacial trauma and one complex orthognathic surgery case. There have been no operative or postoperative complications. Postoperative submental scarring has been acceptable.
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Int J Oral Maxillofac Surg · Apr 1999
Multimodal strategy for reduction of homologous transfusions in cranio-maxillofacial surgery.
The transfusion of homologous blood carries well-known risks that have prompted efforts to develop alternative techniques. Such measures are of particular interest to patients undergoing elective procedures. A total of 204 patients, out of 1470 patients who consecutively underwent major craniomaxillofacial procedures under general anesthesia over a two-year period, were enrolled in a prospective protocol to reduce homologous transfusion requirements when a blood loss in excess of 500 ml was anticipated. ⋯ The overall reduction in the use of homologous transfusions was highly significant. When acute normovolemic hemodilution, controlled moderate hypotension and the cell saver were used in combination, a greater reduction in homologous transfusions was achieved than with the use of either a single modality or combination of any two. No transfusions were required in patients pretreated with erythropoietin.