RESUMO
The objective of this study was to assess the value of cone-beam computed tomographic (CT) images in the primary diagnosis and management of 128 outpatients with disorders of the temporomandibular joint (TMJ). Before a diagnosis was made and treatment planned, the history was taken, physical examination made, and the orthopantomogram studied. After assessment of the cone-beam CT, the oral and maxillofacial surgeon (specialist or resident) was allowed to revise the provisional primary diagnosis and management. The degree of certainty was rated by the clinician before and after the cone-beam CT had been assessed. The primary diagnosis was changed in 32 patients (25%), additional diagnostic procedures were changed in 57 (45%), and the treatment was changed in 15 (12%) (in 4 the treatment was changed to a (minimally) invasive procedure). A total of 74 patients (58%) had their diagnosis and management changed after the cone-beam CT had been assessed. Changes in diagnosis and management were clinically relevant in 9/32 and 9/61 patients, respectively. The clinician's certainty about the primary diagnosis increased after the cone-beam CT had been assessed in 57 patients. Logistic regression analysis showed that the odds in favour of changes in primary diagnosis and management increased when limited mandibular function was a primary symptom, the patient was taking medication for pain, and the articular eminence could not be assessed on OPT. Assessment of cone-beam CT led to changes in primary diagnosis and management in more than half the patients with disorders of the TMJ.
Assuntos
Tomografia Computadorizada de Feixe Cônico/normas , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Adulto , Analgésicos/uso terapêutico , Bruxismo/fisiopatologia , Tomada de Decisões , Diagnóstico Diferencial , Dor Facial/fisiopatologia , Feminino , Humanos , Masculino , Músculo Masseter/fisiopatologia , Anamnese , Planejamento de Assistência ao Paciente , Exame Físico , Radiografia Panorâmica/normas , Amplitude de Movimento Articular/fisiologia , Som , Osso Temporal/diagnóstico por imagem , Músculo Temporal/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/terapiaRESUMO
OBJECTIVES: This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. MATERIALS AND METHODS: As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. RESULTS: Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior-posterior change in the occlusion (-1.3 ± 1.5 mm) in the oral appliance group compared to the CPAP group (-0.1 ± 0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (ß) = -0.02, 95 % confidence interval (-0.04 to -0.00)]. CONCLUSIONS: Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. CLINICAL RELEVANCE: Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.
Assuntos
Oclusão Dentária , Aparelhos Ortodônticos , Apneia Obstrutiva do Sono/terapia , Dente Pré-Molar/patologia , Pressão Positiva Contínua nas Vias Aéreas , Dente Canino/patologia , Feminino , Seguimentos , Humanos , Registro da Relação Maxilomandibular/métodos , Estudos Longitudinais , Masculino , Má Oclusão/classificação , Má Oclusão/etiologia , Mandíbula/patologia , Avanço Mandibular/instrumentação , Pessoa de Meia-Idade , Modelos Dentários , Aparelhos Ortodônticos/efeitos adversos , Sobremordida/classificação , Sobremordida/patologia , Estudos Prospectivos , Fases do Sono/fisiologia , Ronco/terapiaRESUMO
Habitual temporomandibular joint (TMJ) luxation is a serious condition for the patient, and is often managed by extensive open joint surgery. Arthroscopic eminoplasty is an alternative, but this technique could also cause concomitant damage to the articular surface. The aim of this study was to evaluate the therapeutic effects and side effects of arthroscopic electrocautery of retrodiscal tissues in habitual TMJ luxation. All patients with habitual TMJ luxations who needed surgical management from 1 January 2000 to 31 December 2009 in the authors' institution in The Netherlands, were included in this study. All patients were primarily treated with arthroscopic electrocautery. Pre- and postoperative evaluation parameters were: TMJ luxations, maximum mouth opening, translatory capacity, pain and joint noises. Sixteen patients with habitual luxation were treated with arthroscopic electrocautery. Patient reluxation occurred in one. None of the patients had joint pain or mobility restrictions. The overall success rate was 95%. After 86 months there was a high success rate for this therapy. No other morbidity was seen, in contrast with open joint surgery or using sclerosing agents. The authors conclude that arthroscopic eletrocautery of retrodiscal tissues is a highly successful minimal invasive therapy in habitual TMJ luxation without side effects.
Assuntos
Cauterização/métodos , Luxações Articulares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Disco da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Adolescente , Adulto , Artroscopia/instrumentação , Artroscopia/métodos , Doença Crônica , Feminino , Humanos , Luxações Articulares/patologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Amplitude de Movimento Articular , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/patologia , Resultado do Tratamento , Adulto JovemRESUMO
In 1985, the dissertation 'Temporomandibular joint. Articular cartilage structure and function' was published. Much was known at the time concerning the (clinical) pathogenesis of osteoarthrosis of the temporomandibuIar joint, the associated radiographical characteristics and the results of non-surgical treatment. Little was known, however, concerning the processes that lead to the loss of bone tissue and other degenerative changes. The current idea that osteoarthrosis was histopathologically characterized by defects in the joint surfaces did not seem to apply to temporomandibular joints. In temporomandibular joints, the phenomenon was recognized of degenerative changes in the deeper layers of the articular cartilage and the subchondral bone, while the articular surface could be microscopically intact. A dislocated articular disc was seen as part of the disease osteoarthrosis. Clear insight into the origins of osteoarthrosis was not achieved.
Assuntos
Cartilagem Articular/patologia , Cartilagem Articular/fisiologia , Osteoartrite/etiologia , Osteoartrite/patologia , Articulação Temporomandibular/patologia , Cartilagem Articular/anatomia & histologia , Humanos , Luxações Articulares/patologia , Côndilo Mandibular/patologiaRESUMO
This study analysed the relationship between complaints and mandibular function after closed treatment of fractures of the mandibular condyle in a prospective study. In a 1-year follow-up, complaints were assessed during physical examination and function was assessed using the mandibular function impairment questionnaire (MFIQ), scoring range 0-68. Data from 114 patients (41 women, 73 men), mean age 28.1 years (SD 13.3), were available. On average the MFIQ scores were low 3.4 (SD 7.3). Ten patients (9%) experienced pain and 45 (39%) patients had a MFIQ score > 0. Mean mouth opening was 51.9 mm (SD 8.4). Occlusion was perceived as moderate or poor by 24% of the patients. In the logistic regression analysis mandibular function impairment (MFIQ score > 0) was entered as a dependent variable. Risk factors for mandibular function impairment were: pain, perceived occlusion (moderate or poor), absolute difference between left and right horizontal movements and age. A protective factor was mouth opening. The results of this study show that complaints (i.e. pain, perceived occlusion, reduced mouth opening, difference between left and right lateral movements and increased age) are predictors of mandibular function impairment after closed treatment of fractures of the mandibular condyle.
Assuntos
Mandíbula/fisiopatologia , Côndilo Mandibular/lesões , Fraturas Mandibulares/terapia , Adulto , Fatores Etários , Estudos de Coortes , Ingestão de Líquidos/fisiologia , Ingestão de Alimentos/fisiologia , Dor Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Riso/fisiologia , Masculino , Má Oclusão/fisiopatologia , Côndilo Mandibular/fisiopatologia , Fraturas Mandibulares/psicologia , Mastigação/fisiologia , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Fatores de Risco , Autoimagem , Fala/fisiologia , Bocejo/fisiologiaRESUMO
The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of conducted pharmacodiagnostic tests, consisting of the consecutive intravenous administration of drugs. Visual analogue scale scores were retrieved from all patients, based on which they were classified into different responder groups. In total, 46 pain profiles were analysed. Of these, 16 patients (35%) could be classified into one or more pain categories, while 30 patients (65%) could not be classified into any pain category. The pain duration or medication use did not influence the classification. Based on the results of this retrospective study, it seems that classification into subgroups is possible after intravenous testing in a minority of clinically unclassifiable patients. In patients where there is a substantial need for additional diagnostic information, these results may be of value. Recommendations are made for further research, which should include validation in patients with known pain mechanisms.
Assuntos
Dor Facial/classificação , Medição da Dor/métodos , Adulto , Doença Crônica , Diagnóstico Diferencial , Dor Facial/diagnóstico , Dor Facial/tratamento farmacológico , Feminino , Humanos , Injeções Intravenosas , Masculino , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
The aims of this study were to assess changes in the upper airway morphology associated with an oral appliance in situ in patients suffering from the obstructive sleep apnoea-hypopnoea syndrome and to relate these changes to treatment response. Changes in upper airway morphology as a result of an oral appliance were assessed in 52 patients with obstructive sleep apnoea-hypopnoea syndrome by means of cephalometric analysis. Lateral cephalograms were taken at baseline and after 2-3 months of treatment. Baseline and follow-up cephalograms were traced twice and cephalometric variables were compared. The predictive value of changes in upper airway morphology for the treatment response was evaluated in univariate and multivariate regression analyses. Oral appliance therapy resulted in an increased posterior airway space at the level of the second vertebra, the uvular tip and the base of the tongue. The increase of the posterior airway space at the level of the second vertebra and the uvular tip were the best predictors for relative improvement of the apnoea-hypopnoea index. However, the predictive value for treatment response of these cephalometric upper airway changes should be interpreted with caution.
Assuntos
Avanço Mandibular/instrumentação , Faringe/patologia , Apneia Obstrutiva do Sono/terapia , Adulto , Cefalometria/métodos , Feminino , Seguimentos , Humanos , Osso Hioide/patologia , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Prognóstico , Apneia Obstrutiva do Sono/patologia , Articulação Temporomandibular/patologia , Resultado do TratamentoRESUMO
In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned 103 individuals to oral-appliance or CPAP therapy. Polysomnography after 8-12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance (76.5%) and for 43 of 52 persons using CPAP (82.7%). For the difference in effectiveness, a 95% two-sided confidence interval was calculated. Non-inferiority of oral-appliance therapy was considered to be established when the lower boundary of this interval exceeded -25%. The lower boundary of the confidence interval was -21.7%, indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea. However, subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease (apnea-hypopnea index > 30). Since these people could be at particular cardiovascular risk, primary oral-appliance therapy appears to be supported only for those with non-severe apnea.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Avanço Mandibular/instrumentação , Placas Oclusais , Aparelhos Ortodônticos Removíveis , Apneia Obstrutiva do Sono/terapia , Adulto , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Polissonografia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Oral appliance therapy is an alternative to continuous positive airway pressure (CPAP) for treating the obstructive sleep apnea-hypopnea syndrome. However, the ability to pre-select suitable candidates for either treatment is limited. The aim of this study was to assess the value of relevant variables that can predict the outcome of oral appliance and CPAP therapy. Fifty-one patients treated with oral appliance therapy and 52 patients treated with CPAP were included. Relevant clinical, polysomnographic, and cephalometric variables were determined at baseline. The predictive value of variables for treatment outcome was evaluated in univariate and multivariate analyses. The outcome of oral appliance therapy was favorable, especially in less obese patients with milder sleep apnea and with certain craniofacial characteristics (mandibular retrognathism in particular). Neither univariate nor multivariate analyses yielded variables that reliably predicted the outcome of CPAP. We conclude that the variables found in this study are valuable for pre-selecting suitable candidates for oral-appliance therapy.
Assuntos
Índice de Massa Corporal , Pressão Positiva Contínua nas Vias Aéreas , Placas Oclusais , Apneia Obstrutiva do Sono/terapia , Adulto , Cefalometria , Oclusão Dentária , Humanos , Modelos Logísticos , Mandíbula , Pessoa de Meia-Idade , Polissonografia , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
The aim of this case-controlled study was to assess satisfaction with facial appearance and function, and health-related quality of life (HRQL) in bilateral cleft lip and palate patients (BCLP). The study sample was composed of adult BCLP subjects and controls matched for age, gender and socioeconomic status. Outcome measures included a self-administered questionnaire evaluating satisfaction with facial appearance, function and HRQL. Bivariate statistics were computed to analyse the association between BCLP status and outcome measures. Forty-three treated adult BCLP patients (mean age 28.2 years, SD 7.8) were compared to 43 controls without clefts (mean age 28.5 years, SD 8.0). Quantitative and qualitative assessment revealed that BCLP patients were significantly less satisfied with the appearance of the upper lip, the nose and nasal breathing. Additionally, satisfaction with facial appearance correlated positively with HRQL. For speech, hearing and drinking, quantitative scores did not differ between BCLP and controls, while qualitative assessment revealed that BCLP patients had considerable problems and concerns with these functions. This study underlines the importance of qualitative assessment of patient satisfaction with treatment outcome to identify individual problems and concerns not revealed by quantitative measures alone.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida/psicologia , Adulto , Fenda Labial/fisiopatologia , Fenda Labial/psicologia , Fissura Palatina/fisiopatologia , Fissura Palatina/psicologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
Dental practitioners as well as general practitioners are frequently confronted with patients complaining of pain in the orofacial region. Diagnosing these pains often poses a challenge to the clinician. Currently, the diagnosis of orofacial pains is biaxial. In determining a diagnosis, it is important to consider, in addition to the condition which is causing the pain (axis I-diagnosis), the impact of the pain on the patient's ability to function (axis II-diagnosis). The compilation of a thorough medical history represents the most important diagnostic tool and basis for clinical examination. Based on the axis I-diagnosis several treatment options are suggested; the strategy for managing the pain is, however, largely determined by the axis II-diagnosis.
Assuntos
Odontologia/normas , Dor Facial/classificação , Dor Facial/diagnóstico , Medicina de Família e Comunidade/normas , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Padrões de Prática MédicaRESUMO
Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. Neuralgic pain is distinguished into trigeminal neuralgia, glossopharyngeal neuralgia, Horton's neuralgia, cluster headache and paroxysmal hemicrania. In 2 cases trigeminal neuralgia is successfully managed with a neurosurgical microvascular decompression procedure according to Jannetta. Characteristic pain attacks resembling neuralgic pain result from well understood pathophysiological mechanisms. Consequently, adequate therapy, such as a Janetta procedure and specific pharmacological therapy, is available.
Assuntos
Neuralgia Facial/diagnóstico , Dor Facial/diagnóstico , Dor Facial/etiologia , Neuralgia do Trigêmeo/diagnóstico , Adulto , Idoso , Analgésicos não Narcóticos/uso terapêutico , Diagnóstico Diferencial , Neuralgia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Falha de Tratamento , Resultado do Tratamento , Neuralgia do Trigêmeo/tratamento farmacológicoRESUMO
BACKGROUND: To determine the prognosis of fractures of the mandibular condyle after closed treatment. METHODS: Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on radiographs. Follow-up was after 12 months in which the average pain, experienced during the last week (visual analog scale, 100 mm), and mandibular functioning were assessed (mandibular function impairment questionnaire (MFIQ)). RESULTS: Data of 116 (81%) patients, 41 women (35%) and 75 men (65%), were available for analysis. Condylar neck fractures were most common (52%). Bilateral fractures were present in 28% of the patients. Pain (visual analog scale score >0) was found in 9% of the patients. Impaired mandibular function was found in 40% (MFIQ >0) and 24% (MFIQ > or =4) of the patients. The most important risk factor for pain was being a woman. The most important risk factors for function impairment were > or =25 years of age and gross displacement of the fracture parts. CONCLUSION: The overall prognosis of mandibular function and pain after closed treatment of condylar fractures is good. The most important risk factor for pain persisting for 1 year after closed treatment of a condylar fracture is being a woman. The most important risk factors for function impairment are an age of > or =25 years and gross displacement of the fracture parts.
Assuntos
Fixação de Fratura , Fraturas Mandibulares/cirurgia , Fatores Etários , Feminino , Fixação de Fratura/métodos , Humanos , Modelos Logísticos , Masculino , Fraturas Mandibulares/diagnóstico por imagem , Medição da Dor , Prognóstico , Radiografia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores Sexuais , Resultado do TratamentoRESUMO
A 22-year-old male patient was referred by his dentist to a department of Oral and Maxillofacial Surgery because of recurrent swelling of the oral mucosa of unknown origin in region 17. One year before, molar 17, although clinically sound but showing an apical radiolucency, was endodontically treated. Eight months ago, molar 17 was removed because of recurrent complaints. Clinical examination revealed a fistula with purulent drainage in region 17. Radiographic examination revealed the cause, viz. a follicular cyst originating from the right wisdom tooth located in the maxillary sinus. Thus, the persisting complaints in region 17 were not related to molar 17, but related to a chronically inflamed follicular cyst originating from an impacted third molar.
Assuntos
Fístula Dentária/diagnóstico , Cisto Dentígero/diagnóstico , Seio Maxilar , Extração Dentária/estatística & dados numéricos , Procedimentos Desnecessários , Adulto , Fístula Dentária/etiologia , Cisto Dentígero/complicações , Diagnóstico Diferencial , Humanos , Masculino , Dente Serotino/patologia , Dente Impactado/complicações , Dente Impactado/patologiaRESUMO
The Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. Modification of pharyngeal patency by Oral Appliance (OA) therapy has been suggested as an alternative to various treatment modalities for OSAHS. To determine the evidence base with respect to the efficacy and co-morbidity of OA therapy in OSAHS, we conducted a systematic review of the available literature. Primary outcome measures were the reduction in number of upper-airway obstructions and co-morbidity related to the craniomandibular or craniofacial complex, respectively. Eligible studies regarding efficacy were independently assessed by two assessors using a quality assessment scale. Effect sizes of methodologically sound studies were calculated. In identical interventions, effect sizes were pooled with the use of a random-effects model. Given the scarcity of controlled studies related to co-morbidity, appraisal was confined to a description of eligible studies. Sixteen controlled trials related to efficacy were identified. With respect to the primary outcome measure, OA therapy was clearly more effective than control therapy (pooled effect size, -0.96; 95% confidence interval [CI], -1.49 to -0.42) and possibly more effective than uvulopalatopharyngoplasty. Although patients generally preferred OA therapy, improvement of respiratory variables, such as the number of upper-airway obstructions, was usually better in Continuous Positive Airway Pressure (CPAP) therapy (pooled effect size, 0.83; 95% CI, 0.59 to 1.06). Moreover, specific aspects related to OA design may influence patient-perceived efficacy and preference. Twelve patient-series and one controlled trial related to co-morbidity were identified. Analysis of the data suggests that OA therapy may have adverse effects on the craniomandibular and craniofacial complex. Although CPAP is apparently more effective and adverse effects of OA treatment have been described, it can be concluded that OA therapy is a viable treatment for, especially, mild to moderate OSAHS. Controlled studies addressing the specific indication and co-morbidity of OA therapy are warranted.
Assuntos
Transtornos Craniomandibulares/etiologia , Má Oclusão/etiologia , Avanço Mandibular/instrumentação , Placas Oclusais , Apneia Obstrutiva do Sono/terapia , Comorbidade , Humanos , Placas Oclusais/efeitos adversosRESUMO
When treating the obstructive sleep-apnoea syndrome (OSAS), conservative management and the correction of treatable stenoses in the upper airway should be considered first. If these measures are neither effective nor applicable, then continuous positive airway pressure (CPAP) is the preferred treatment. Surgical interventions should only be considered after failure of non-surgical treatment modalities. Pharmacological management of OSAS is usually only indicated as a form of supplementary treatment in specific patients. Oral-appliance therapy appears to be of value in the management of OSAS and, in specific groups of patients, seems likely to offer a good alternative to CPAP in the future.
Assuntos
Aparelhos Ortodônticos Removíveis , Respiração com Pressão Positiva , Apneia Obstrutiva do Sono/terapia , Feminino , Humanos , Masculino , Respiração com Pressão Positiva/métodos , Fatores de Risco , Apneia Obstrutiva do Sono/tratamento farmacológico , Apneia Obstrutiva do Sono/cirurgiaRESUMO
The craniofacial morphology of 31 male patients diagnosed with obstructive sleep apnoea syndrome (OSAS) and 37 healthy male subjects were compared using cephalometric evaluation of lateral skull radiographs. The aim was to evaluate which cephalometric variables related to craniofacial morphology discriminate between OSAS patients and non-OSAS subjects. Sixteen cephalometric measurements were determined to study the craniofacial morphology. Differences in cephalometric variables between the two groups were analysed with unpaired Student t-tests (significance level 0.05). A multiple regression analysis was used to evaluate the joint predictive value of selected variables. With regard to five variables, significant differences were observed between OSAS patients and non-OSAS subjects (P < 0.05). Data indicated a relatively anterior position of the maxilla, an increase of the mid-facial height and a more inferiorly located hyoid bone in the OSAS patient group. The multiple regression analysis yielded a model discriminating between OSAS patients and non-OSAS subjects, which included two hyoid bone variables and one related with the intermaxillary relationship. A causal relationship between cephalometric variables of craniofacial morphology and OSAS is not sufficiently supported by our data. Presumably, hyoid bone position is of predictive value in the cephalometric discrimination between OSAS patients and non-OSAS subjects.
Assuntos
Cefalometria/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Análise de Variância , Ossos Faciais/anormalidades , Humanos , Osso Hioide/anatomia & histologia , Masculino , Maxila/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , Apneia Obstrutiva do Sono/diagnóstico por imagem , Ronco/etiologiaRESUMO
A substantial part of the maxillofacial surgery practice deals with maxillofacial bone healing. In the past decades, low-intensity ultrasound treatment has been shown to reduce the healing time of fresh fractures of the extremities up to 38%, and to heal delayed and non-unions up to 90% and 83%, respectively. Based on the assumption that the process of bone healing in the bones of the extremities and maxillofacial skeleton is essentially the same, the potential of ultrasound to stimulate maxillofacial bone healing was investigated. Although limited evidence is available to support the susceptibility of maxillofacial bone to the ultrasound signal, ultrasound may be of value in the treatment of delayed unions, in callus maturation after distraction, and in the treatment of osteoradionecrosis.
Assuntos
Consolidação da Fratura , Traumatismos Maxilofaciais/terapia , Fraturas Cranianas/terapia , Terapia por Ultrassom , Animais , Calo Ósseo/crescimento & desenvolvimento , Humanos , Fixadores Internos , Metais , Osteogênese por Distração , Osteorradionecrose/terapiaRESUMO
Patients with a severely degenerated temporomandibular joint (TMJ) may benefit from an alloplastic TMJ replacement. The aim of the study was to develop a safe and properly functioning TMJ prosthesis. The design was based on imitation of anterior condylar translation by an inferiorly located centre of rotation, unrestricted mandibular movements by a double articulation, correct fit to the skull by a self-adjusting skull part consisting of two connected parts, and stable fixation by bone screws that are rigidly connected to the prosthesis parts. The prosthesis consists of a titanium skull part with ceramic inlay, a titanium mandibular part with a ceramic spherical head, and an intervening polyethylene disc. Titanium-alloy bone screws are used for fixation. All parts are available in a number of different shapes. In vitro laboratory and in vivo animal tests showed a low wear rate, the possibility of a close fit to the skull, a stable fixation, sufficient mechanical strength, appropriate choice of materials and proper functioning. Thereafter the step to first patient application was made. First patient application was carried out without adverse events. In conclusion, the presented TMJ prosthesis passed the pre-clinical tests and has progressed to clinical application. The fit to the skull, the expected lifetime of the device and the reliability of the implantation procedure require further evaluation in well-designed clinical trials.