Bilateral condylar movement patterns in adult subjects.

The purpose of this study was to determine if there was a difference between the temporomandibular condylar movement patterns of a symptomatic adult population and those of an asymptomatic adult population. Thirty-five volunteers who were not seeking treatment for TMD underwent two different assessments for TMD signs and symptoms: (1) a self-administered questionnaire and (2) a clinical examination. Based on the information obtained from the questionnaires, subjects were divided into "reported-symptomatic" and "reported-asymptomatic" groups. Based on the investigator's clinically evaluation of the same subjects, subjects were divided into "clinically symptomatic" and "clinically asymptomatic" groups. To compare condylar movement patterns, both groups of subjects then had their mandibular border condylar movements measured bilaterally using a sagittal recording device during maximum opening, maximum protrusion, and maximum left and right excursion movements. The patterns were separated into two broad groups, "symmetric" and "asymmetric." Symmetric gliding movements were defined as uninterrupted bilaterally mirror-like patterns of each condyle with a difference between left and right total length excursion not exceeding 2 mm during opening in the sagittal plane or horizontal plane. Our results show that 63% of the subjects who reported clinically asymptomatic for TMD demonstrated asymmetric condylar movements. However, 100% of the patients (n = 5) who reported clinically symptomatic for TMD exhibited asymmetric condylar movements. This finding suggests that, while a very high percentage of TMD subjects will have asymmetric condylar movements, condylar movements alone are not necessarily diagnostic of TMD, and the sagittal recording device may alert the clinician to abnormal movements.

Suppression and prevention of the gag reflex with a TENS device during dental procedures.

Individuals who are prone to gagging and apprehension during dental treatments present a problem for the clinician and themselves. Patients may delay prescribed therapy or interfere with the fabrication of accurate oral impressions and diagnostic radiographs, because of this fear. The common wisdom has been to try one of the following procedures: (1) distraction of the patient, (2) forced respiration, (3) induced lagophthalmus, or (4) hypnosis. A preventive approach suggests that the sensory stimulation of the cranial nerves of the superior laryngeal nerve branch, (Cr N, IX, pharyngeal branch of X, Cr. N. V, and Cr N. X.) would block the physiologic response of gagging and retching.

Radiation complications in edentulous patients.

Complete dentures were fabricated for 88 patients following completion of cancericidal doses of radiation therapy to the head and neck regions. All were followed for at least 6 months after delivery. All patients received dentures resting within the radiation field. Three patients developed osteoradionecroses directly attributable to their dentures. These three had been dentulous prior to therapy and had either pre- or posttreatment extractions. Of the 58 patients who had been edentulous prior to therapy, none developed osteoradionecrosis. Five patients developed soft tissue necroses secondary to the use of dentures.

Diagnosis by computed tomography of temporomandibular joint meniscus displacement.

CT may be a practical alternative to arthrography for diagnosing displacement of the meniscus in the TMJ. In a study of 75 patients, 69 were diagnosed by CT to have meniscal displacement. Thirty-four diagnoses were subsequently confirmed by surgery or arthrography. Disadvantages of CT are cost (almost twice as much as an arthrogram), inability to diagnose perforations, and inability to judge meniscus dynamics, which can be done by fluoroscopy. Advantages are patient comfort, safety, and decreased total radiation dose. Continued research and clinical correlation will be needed to determine the role of CT in the diagnosis of meniscus displacement of the TMJ. However, initial results are promising, and CT may quickly replace arthrography as the diagnostic procedure of choice.

Osteonecrosis in patients irradiated for head and neck carcinoma.

One hundred patients irradiated for cancers of the oral cavity, oropharynx, and nasopharynx were evaluated for the occurrence of osteonecrosis and associated predisposing factors. Selection was based on availability of complete dental records, a minimum of six months follow-up, and treatment fields, which included maxilla and/or mandible. Bone doses were calculated by using radiotherapy treatment records, port films, and isodose distributions. Osteonecrosis developed in 19 of 78 dentulous patients and in 3 of 22 edentulous patients. The time of development of osteonecrosis varied; in 15 cases osteonecrosis occurred more than one year after treatment. The most important risk factor for the development of osteonecrosis was the radiation dose to bone, particularly in the less vascular mandible. Osteonecrosis 7500 rads to the bone. None of the patients who received less than 6500 rads developed osteonecrosis. The risk was significantly greater when teeth were removed after therapy compared with those individuals with extractions before radiation or no extractions at all.

Computed tomography of the meniscus of the temporomandibular joint: preliminary observations.

Anterior displacement of the meniscus of the temporomandibular joint (TMJ) was diagnosed in nine patients who had undergone arthrography, and they were later examined with computed tomography (CT) to see if this modality could supplant arthrography in some patients with TMJ dysfunction. The anteriorly displaced menisci were visualized in all nine patients by using sagittal reformations and the blink mode. Four of the nine patients had the diagnosis confirmed at surgery. The precise protocol for the CT examination and how to interpret it are discussed. We are optimistic that CT may replace TMJ arthrography in selected patients.

Temporomandibular joint internal derangements: CT diagnosis.

Two hundred patients with suspected displaced temporomandibular joint meniscus were studied with computed tomography. In 75 cases confirmation of the CT diagnosis was subsequently obtained via surgery or arthrography; correlation was found in 73 cases (97%), with one false-negative and one false-positive examination. When meniscus displacement was graded as "mild," "moderate," or "severe," those cases diagnosed as moderate or severe were more likely to require surgery. The technique and interpretation of this technique is described; in most cases CT can replace arthrography in diagnosing displaced temporomandibular joint menisci.