Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ--a pilot study.

The aim of this study was to compare sensitivity, specificity, accuracy and positive and negative predictive value for high-resolution ultrasonography (HR-US) in diagnosing degenerative changes, effusion and disk displacement using magnetic resonance imaging (MRI) as a reference. Over a period of 6 months, 100 patients with TMJ disorders (200 TMJs) were investigated by an experienced radiologist with HR-US and magnetic resonance imaging (MRI). The MRI investigation showed degenerative changes in 190 joints (95%), while an effusion was found in 59 (29.5%) joints. At closed-mouth position a disc dislocation was found in 138 joints (69%) and in maximum-mouth-opening position disc dislocation was diagnosed in 76 joints (38%). In the determination of degenerative changes HR-US showed a sensitivity of 94%, a specificity of 100% and an accuracy of 94%. In the detection of effusion HR-US yielded a sensitivity of 81%, a specificity of 100% and an accuracy of 95%. In the determination of disk displacement at closed-mouth position HR-US showed a sensitivity, specificity and an accuracy of 92% each. At maximum-mouth-opening position HR-US reached a sensitivity of 86%, a specificity of 91% and an accuracy of 90%. The results of the current study imply that HR-US is a valuable diagnostic imaging method of the TMJ which can be used as an alternative method to a MRI-investigation, but is yet not able to replace it. Further studies have to be done to reduce false-negative results.

The diagnostic value of ultrasonography in the detection of orbital floor fractures with a curved array transducer.

The aim of the study was to investigate the diagnostic value of ultrasonography (US) in orbital floor fractures and orbital rim fractures with a curved array scanner. Over a period of 10 months, 60 patients with an orbital trauma have been investigated. Orbital trauma was defined by clinical and ophthalmologic investigation. Computed tomography (CT) was used as the reference method to evaluate the diagnostic value of US in the determination of an orbital floor fracture and was performed by a well-experienced radiologist. Coronal and sagittal images were made. The US investigation was performed with a 7.5 MHz curved array transducer.The US investigation of the infraorbital rim showed a sensitivity of 94% and a specificity of 92% with a diagnostic accuracy of 92%. The positive predictive value (PPV) reached 91% and the negative predictive value (NPV) reached 92%, while the US investigation of the orbital floor showed a sensitivity of 95% and a specificity of 100% with a diagnostic accuracy of 98%. PPV reached 100% and NPV reached 77%. Ultrasonography is a cost-effective and widely available method without disadvantages such as radiation exposure. The results in the current study imply that ultrasonography can be used as an alternative method in the investigation of orbital floor fractures.

[Imaging diagnosis of medial and lateral orbital wall fractures. Sonography versus computed tomography]. / Bildgebende Diagnostik von medialen und lateralen Orbitawandfrakturen. Ultraschall versus CT.

PURPOSE: The purpose of the study was to evaluate the diagnostic value of a curved array scanner in the diagnosis of medial and lateral orbital wall fractures. MATERIAL AND METHODS: Fifty-three patients with the clinical diagnosis of an orbital trauma were investigated prospectively within a period of 16 months by CT and ultrasonography. The intraoperative findings were used as a reference. RESULTS: CT reached a sensitivity of 100% and a specificity of 96% in the diagnosis of medial orbital wall fractures, while ultrasound yielded a sensitivity of 80% and a specificity of 96%. There was no significant difference found between CT and ultrasonography ( p=0.402). In the investigation of lateral orbital wall fractures, CT reached a sensitivity of 88% and a specificity of 87%, while ultrasonography yielded a sensitivity of 97% and a specificity of 95%. Ultrasonography achieved significantly better results than CT ( p=0.008). CONCLUSION: The ultrasound investigation with a curved array scanner could be used as an additional method in the diagnosis of medial and lateral orbital wall fractures. Further technical improvements of the transducers need to be developed to increase the sensitivity of ultrasound in the diagnosis of medial orbital wall fractures.

[Temporomandibular disorders in juvenile patients with rheumatic diseases]. / Kiefergelenkbeschwerden bei juvenilen Patienten mit rheumatischen Erkrankungen.

PURPOSE: The aim of the study was to investigate the incidence of temporomandibular disorders (TMD) in juvenile patients with rheumatic diseases. Furthermore, correlations between the degree of the rheumatic disease and the clinical symptoms were evaluated. MATERIAL AND METHODS: In a prospective investigation the temporomandibular joints of 48 children with rheumatic diseases were evaluated clinically regarding clicking, crepitation, pain, duration of the rheumatic disease, and the number of affected peripheral joints. The degree of rheumatic disease was assessed with Steinbrocker's classification. RESULTS: 26 patients (54.17%) showed clinical symptoms of TMD. No significant correlation was found between the degree of the rheumatic disease and the awareness of TMD. A high number of affected peripheral joints does not lead to a significant increase of TMD. A significant correlation between the duration of the rheumatic disease and TMD could be detected. A significant correlation between the duration of the rheumatic disease and clicking or crepitation was found ( p=0.011). CONCLUSION: Rheumatic diseases lead to a higher incidence of TMD in juvenile patients. A longer duration of rheumatic diseases leads to a higher incidence of TMD.

Stability after rigid fixation of simultaneous maxillary impaction and mandibular advancement osteotomies.

The purpose of this study was to investigate the short- and long-term stability of bimaxillary surgery following LeFort I (LF-1) impaction with simultaneous bilateral sagittal split ramus osteotomy (BSSO) and mandibular advancement using the technique of rigid internal fixation (RIF). In order to assess the postoperative maxillary and mandibular movement pattern in 26 patients with vertical maxillary excess and mandibular deficiency, cephalograms were taken immediately preoperatively, and 1 week, 2 months, and 1 year after surgery. With paired t-test showing no statistically significant postoperative change for the point A of the maxilla from immediate postsurgery to longest follow-up (P> 0.05), the used technique of "RIF LF-I impaction and RIF BSSO advancement" tended to render excellent postsurgical stability in the horizontal (0.1+/-0.8mm mean posterior movement) and vertical (0.1+/-0.5mm mean inferior movement) direction. There was no instance of maxillary relapse of >2mm. Regarding mandibular BSSO advancement, the point B showed a significant vertical upward movement (1.6+/-1.2mm) (P< 0.001) and a slight horizontal forward movement (0.3+/-2.0mm) (P> 0.05) at 1-year follow-up. The incidence of posterior relapse of >2mm accounted for 11.5%. The data confirm the concept that the bimaxillary approach of "LF-I impaction and BSSO advancement" using the described technique of RIF is a stable procedure in the treatment of open bite patients classified as vertical maxillary excess in combination with mandibular deficiency.

The diagnostic value of ultrasonography to detect occult lymph node involvement at different levels in patients with squamous cell carcinoma in the maxillofacial region.

The purpose of this study was to evaluate ultrasonography (US) and computed tomography (CT) in detecting lymphnodes of the neck affected with squamous cell carcinoma. From 1987 to 1999 the data from 203 untreated patients with a diagnosis of cancer in the maxillofacial have been investigated. Of these, 115 had a primary squamous-cell carcinoma. US diagnosis was made by an oral- and maxillofacial surgeon experienced in US of the head and neck. CT diagnosis was made by a well-experienced radiologist. The following lymph node levels were assesed: level I (submental and submandibular lymphnodes), level II (lymphnodes distal to level I and confined to the region above the skin crease at or just below the level of the thyroid notch), level III (lymphnodes distal to level II and confined to the anterior cervical triangle including those deep to the sternocleidomastoid muscle), and level IV (lymphnodes distal to level III and confined to the posterior cervical triangle). For all levels US yielded a sensitivity of 71%, and a specificity of 87%, while CT showed a sensitivity of 32% and a specificity of 96%. The sensitivity of US decreased from level I to level IV, whereas the specificity increased from level I to level IV. For lymphnode levels I and II US may be useful for the detection of local metastases while for the other levels the application of advanced techniques of US may have to be investigated.

[Post-traumatic ocular motility in orbital floor fractures]. / Posttraumatische Bulbusmotilität bei Orbitabodenfrakturen.

PURPOSE: The aim of this study was to evaluate post-traumatic ocular motility in orbital floor fractures in relation to the severity of the fracture and concomitant injuries. MATERIAL AND METHODS: Over a period of 6 years, data from 435 patients with orbital floor fractures were re-evaluated. Ocular motility was divided into abduction, adduction, upgaze and downgaze movements. RESULTS: In 54.3% of the cases, there was a reduction in ocular motility. A reduced motility with a movement >20 degrees was found in most of the cases. Concomitant injuries to the eye resulted in a significant increase in the reduction of motility. This reduction depended on the severity of the orbital floor fracture. A reduced upgaze movement was the most common complication in all types of fractures. CONCLUSION: Ocular motility can act as an indication of the severity of the orbital fracture. Concomitant injuries to the eye resulted in a higher incidence of reduced ocular motility.

[Long-term outcome of dentoalveolar trauma in relation to post-traumatic instability]. / Langzeitergebnisse dentoalveolärer Verletzungen in Abhängigkeit von der posttraumatischen Beweglichkeit.

PURPOSE: The aim of this retrospective study was to investigate the long-term outcomes of dental injuries. Subluxated and laterally luxated teeth were evaluated according to the findings of CO2 sensitivity, obliteration, pulpal sclerosis, and the duration of post-traumatic fixation of the injured teeth. MATERIAL AND METHODS: The data of 725 patients were analyzed retrospectively over a period of 14 years. Of these, 108 patients could be investigated for a long-term follow-up. Dental trauma was classified according to the degree of luxation (I-III). RESULTS: There was a significant correlation between the degree of luxation and the post-traumatic findings of CO2 sensitivity. There was no significant correlation between the degree of luxation and the post-traumatic findings of apical inflammation, pulpal sclerosis, and/or obliteration. Long-term fixation of injured teeth had no effect on the short- and long-term occurrence of pathologic processes at the root such as root resorption. CONCLUSION: The post-traumatic finding of CO2 sensitivity was related to the degree of luxation of the injured teeth. Apical inflammation, pulpal sclerosis, and obliteration were not related to the degree of luxation. The results suggest that long-term fixation of injured teeth has no negative effects on the long-term outcomes of subluxated and laterally luxated teeth.

[Management of mid-facial fractures]. / Versorgung von Mittelgesichtsfrakturen.

In the past, treatment of maxillofacial fractures was characterized by low incidences of midface fractures, while severe cases were associated with a high death rate. Over the last decades the application of new techniques has provided a successful outcome in the management of these more frequently observed injuries. With the introduction of antibiotics and the principles of modern anesthesiology, conservative methods of fracture treatment such as intermaxillary fixation and the application of extension devices were increasingly replaced by surgical techniques. The development of different osteosynthesis plate and screw systems in the early 1970s has made three-dimensional reconstruction a standard of care in the surgical treatment of midface fractures. With the recent introduction of commercially available bioresorbable systems, removal of osteosynthesis material has become an unnecessary procedure. Further research in innovative techniques of maxillofacial surgery and imaging, such as image-guided surgery by computer navigation, may be warranted to minimize surgical approaches and decrease incidences of perioperative morbidity.

Effect of segmental Le Fort I osteotomy on maxillary tooth type-related pulpal blood-flow characteristics.

UNLABELLED: Laser Doppler flowmetry (LDF) is a noninvasive method to assess pulpal blood-flow (PBF). Osteotomies may have segment-related losses of pulpal sensibility. OBJECTIVES: To determine the effect of segmental Le Fort I osteotomy on tooth-type related PBF values. MATERIALS AND METHODS: In 12 volunteers, maxillary incisors, canines, and premolars were investigated bilaterally by LDF to assess local PBF values before and after surgery. Perfusion units (PU) were in 3 sessions, on the day before surgery and at 4 and 56 days after osteotomy. RESULTS: Measurements before surgery were significantly higher than at 4 days after surgery for the canine (P <.01) and for the overall PBF values (P <.01). At 4 days assessment, PBF values of tooth types adjacent to vertical osteotomy cuts showed a significant decrease for the lateral incisors (P <.05), canines, and first premolars (P <.05), with no significant differences between the preoperative and postoperative values for tooth types not adjacent to vertical osteotomy cuts (P <.05). CONCLUSIONS: Segmental Le Fort I osteotomy induced a short-term and long-term decrease in maxillary PBF values of tooth types adjacent to vertical osteotomy cuts.

Effect of Le Fort I osteotomy on maxillary tooth-type-related pulpal blood-flow characteristics.

OBJECTIVE: Laser Doppler flowmetry is a noninvasive method of assessing pulpal blood-flow (PBF) to document pulpal vitality. Maxillary osteotomies have been associated with segment-related decreases in local PBF. The aim of this study was to assess the effect of a Le Fort I osteotomy on tooth-type-related PBF values. PATIENTS AND METHODS: Maxillary incisors, canines, and premolars were investigated bilaterally by laser Doppler flowmetry in 14 volunteers to assess local PBF values before and after surgery. Perfusion units were taken in 3 sessions: on the day before surgery (time since osteotomy ¿TSO 0) and at 4 days (TSO I) and 56 days (TSO II) after osteotomy. RESULTS: Analysis of TSO-related PBF measurements revealed a significant difference between TSO 0 and TSO II for the first premolar and between TSO 0 and TSO I and II for the overall tooth-type-related values. CONCLUSIONS: The main findings of this study indicated Le Fort I osteotomy to be associated with a short-term and long-term decrease in maxillary PBF values.

Pulpal blood-flow characteristics of maxillary tooth morphotypes as assessed with laser Doppler flowmetry.

OBJECTIVE: The purpose of this study was to determine the effect of tooth morphotype on intraindividual and interindividual variations of baseline data as well as on temporal variations between testing intervals in the assessment of pulpal blood-flow by means of laser Doppler flowmetry. STUDY DESIGN: In 14 volunteers, maxillary incisors, canines, premolars, and first molars were investigated bilaterally by laser Doppler flowmetry to assess local pulpal blood-flow values. Measurements in perfusion units were taken during 3 sessions, with a time interval of 7 days between sessions. RESULTS: Intraindividual comparisons of tooth morphotype-related pulpal blood-flow values revealed significant differences only for the first molar, whereas significant interindividual differences were found for the lateral incisor, canine, premolars, and first molar. Pulpal blood-flow values for the second premolar (11.1 perfusion units) were significantly higher and those for the central incisor (7.6 perfusion units) significantly lower than those for the lateral incisor (9.2 perfusion units) and first molar (9.4 perfusion units). In contrast, measurements at the lateral incisor, first premolar, and first molar did not differ significantly (P > .05). Multiple testing showed no statistically significant effect on tooth morphotype-related pulpal blood-flow measurements. CONCLUSIONS: The findings indicate that contralateral incisors, canines, and premolars are appropriate intraindividual controls for local pulpal blood-flow recordings. Other studies may identify the effect of environmental and technique-related factors on the assessment of local pulpal blood-flow values.

Neopterin as a prognostic parameter in patients with squamous-cell carcinomas of the oral cavity.

Concentrations of neopterin, which is produced by human monocytes/macrophages upon stimulation by interferon-gamma, were measured in urine specimens in 23 patients with squamous-cell carcinoma of the oral cavity at diagnosis and in 12 treated patients with the same disease when recurrence of the tumor was recognized. Tumor histology and routine laboratory parameters were concomitantly determined. Urinary neopterin values showed no statistically significant correlation with tumor differentiation, tumor size or patient age, but they were significantly higher in patients with a recurrent tumor. Patients were followed for up to 4 years, and the ability of all variables to predict fatal outcome was assessed. In univariate analysis, only neopterin (p = 0.01) and the variable recurrent vs. first-diagnosed tumor were significant predictors of survival. In multivariate analysis, a combination of neopterin (p < 0.01) and the variable recurrent vs. first-diagnosed tumor (p = 0.06) was found to jointly predict survival. Thus, urinary neopterin concentrations provide valuable prognostic information in patients with squamous-cell carcinoma of the oral cavity.

Epileptic seizure associated with intracerebroventricular and intrathecal morphine bolus.

We report on two patients with morphine-related seizures associated with either intrathecal or intracerebroventricular administration. Both patients had a history of malignant tumor and both experienced the seizures following bolus application of morphine, while even higher dosages were well tolerated when continuously infused. Seizures occurred without signs of intoxication. Initiation of intrathecal morphine therapy and bolus application should be performed carefully and only when constant monitoring is provided for at least 12 h. Animal data and possible mechanisms for morphine-related seizures are discussed.

[Fractures of the mandibular collum in childhood--a long-term follow-up with orthopantomography]. / Kiefergelenkfortsatzfrakturen im Kindesalter--eine Langzeitstudie im Orthopantomogramm.

The study including fifty children younger than 10-years-old with dislocated unilateral collum fractures concerns the chronological development of morphological alterations in the orthopantomogramm. Regardless of fracture type, the radiographs indicate, that a very good restitution can be attained with an exclusive functional therapy using an activator in all analyzed patients. A realignment can not be found.

Ultrasonographic anatomy of the anterior neck: implications for tracheostomy.

PURPOSE: Tracheostomy is the preferred intervention for surgical establishment of an upper airway in the treatment of certain elective maxillofacial procedures. Complication rates associated with surgical tracheostomy are largely related to the restricted possibilities in diagnosis of anatomic variations. Therefore, endoscopic-guided tracheostomy is increasingly being used to enhance precision and safety. The purpose of this study was to assess the ultrasonographic anatomy of the anterior neck with regard to the performance of tracheostomy. PATIENTS AND METHODS: Fifty patients underwent ultrasonographic investigation to analyze the relationship of anatomic structures lying in the immediate vicinity of the tracheostomy site. RESULTS: The data presented demonstrate the feasibility and advantage of preoperative ultrasonography to visualize the structures of the infrahyoid region. CONCLUSION: Preoperative ultrasonography may be of great importance in diagnosing individual anatomic variations at the site of tracheostomy and in avoiding complications.

Urinary neopterin excretion in patients with squamous carcinoma of the oral cavity.

Urinary neopterin concentrations were studied in 30 patients with squamous carcinoma or adenoid cystic carcinoma of the oral cavity. Compared to healthy controls 19 patients (63%) had increased neopterin concentrations. There was a statistically significant correlation between neopterin levels and tumor differentiation but no correlation of neopterin values with tumor size. Longitudinal studies will be necessary to evaluate a potential usefulness of neopterin concentrations to predict prognosis in squamous carcinomas of the oral cavity.

[Outcome of wisdom tooth germ transplantation]. / Zur Frage des Erfolges bei Weisheitszahnkeimtransplantationen.

In 68 patients, 79 tooth germs of the third molar were transplanted. Out of this group, 43 patients with 50 transplantations under-went a follow-up examination. All surgery was performed by one surgeon. Retrospectively, we tried to establish whether the success of postoperative healing depends on the donor and receiver regions. Crossing the jaw border clearly worsens the prognosis for transplantation. Altogether 9 transplantations turned out to be failures, 7 of which had been transplanted from the upper to the lower jaw. The results of this investigation showed incomplete root development in 34%, the necessity of endodontic treatment in 6% and enlarged periodontal pockets in 8%. Ankylosed teeth were found in 10%; we did not see any root resorptions.