Diagnostic efficacy of CBCT, MRI, and CBCT-MRI fused images in distinguishing articular disc calcification from loose body of temporomandibular joint.

OBJECTIVES: To evaluate the diagnostic efficacy of CBCT-MRI fused images for articular disc calcification of temporomandibular joint (TMJ). MATERIALS AND METHODS: Twenty patients (24 TMJs) whose image examinations showed dense bodies in the TMJ space were included in the study. The locations of dense bodies evaluated by the three experts were used as a reference standard. Three oral and maxillofacial radiology residents evaluated whether the dense bodies were disc calcification or not, with a five-point scale for four sets of images (CBCT alone, MRI alone, both CBCT and MRI observed at a time, and CBCT-MRI fused images) randomly and independently. Each set of images was observed at least 1 week apart. A second evaluation was performed after 4 weeks. Intraclass correlation coefficients were calculated to assess the intra- and inter-observer agreement. The areas under the ROC curves (AUCs) were compared between the four image sets using Z test. RESULTS: Ten cases were determined as articular disc calcifications, and fourteen cases were recognized as loose bodies in the TMJ spaces. The average AUC index for the CBCT-MRI fused images was 0.95 and significantly higher than the other sets (p < 0.01). The intra- and inter-observer agreement in the CBCT-MRI fused images (0.90-0.91, 0.93) was excellent and higher than those in the other images. CONCLUSIONS: CBCT-MRI fused images can significantly improve the observers' reliability and accuracy in determining articular disc calcification of the TMJ. CLINICAL RELEVANCE: The multimodality image fusion is feasible in detecting articular disc calcification of the TMJ which are hard to define by CBCT or MRI alone. It can be utilized especially for inexperienced residents to shorten the learning curve and improve diagnostic accuracy.

Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography.

OBJECTIVES: To establish one method that can be used to quantitatively evaluate the condyle positional changes with 3D images in postoperative mandibular prognathism patients. MATERIALS AND METHODS: This is a retrospective observational study. Twenty-one patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) were scanned with cone beam computed tomography (CBCT) for temporomandibular joints (TMJs) at 1 week preoperatively (T0), 1 to 2 weeks (T1), 3 months (T2), 6 months (T3), and 12 months (T4) postoperatively. The data were then grouped into T0T1, T1T2, T2T3, T3T4 and T0T1, T0T2, T0T3, and T0T4. Semi-automatic registration was conducted, and the condyle positional changes were measured in segmented 3D models. Inter- and intra-observer variability and the repeatability of registration were analyzed with paired t test; the repeated measurement analysis of variance was used for analyzing the repeatability of the marked points; the consistency of segmentation was analyzed with nonparametric test of multiple paired samples (Friedman test) and the independent-sample t test was applied to comparing changes between different periods of time. Differences were considered to be statistically significant when P < 0.05. RESULTS: In T0T1 and T1T2, the condylar position was changed greatly. In T2T3, the mean condylar translations were less than 0.2 mm in all directions, the mean rotational changes of condyle were less than 0.2 mm; in the period of T3T4, the mean condylar translations in all directions were less than 0.02 mm. For series 2, the condyle translational changes in axial, coronal, and sagittal views were within 0.10 mm, and the rotation direction of condyle in all three views was the same within 1 year after operation. CONCLUSIONS: Fused three-dimensional images can be used to qualitatively and quantitatively evaluate condyle positional changes. The condylar position might be stable at 3 months postoperatively. The condyles of most of patients did not fully return to their preoperative position within 1 year after the operation. CLINICAL RELEVANCE: One method for fusing images has been established to detect the condylar positional changes. This method may be applied to estimate the bony changes of condyle, even bony changes in other part of dentomaxillofacial region. Meanwhile, the data of condyle positional changes from asymptomatic patients after the surgery within 1 year can be used as a reference for further exploration of the relationship between orthognathic surgery and the occurrence of osteoarthritis postoperatively in the future. KEY POINTS: • By fused 3D images, the change of condylar position after bilateral sagittal split ramus osteotomy can be observed intuitively. • For the patients with mandibular prognathism, the condylar position would be stable at 3 months postoperatively. • The condyles of most mandibular prognathism patients did not fully return to their preoperative position within 1 year after operation.

Diagnosis of Bilateral Calcifications of Temporomandibular Joint Disc by Image Fusion.

The calcification of the articular disc is an uncommon lesion, usually discovered in hips, elbows, and shoulders, but rarely in temporomandibular joints (TMJ). The TMJ disc calcification may be related to pain and limitation of the mandibular mobility, however, most of the patients were asymptomatic. A 61-year-old female was referred to our hospital after a maxillofacial fist injury, bilateral TMJ disc calcifications were found accidentally by radiological examination. Here the significance of image fusion of cone-beam computed tomography and magnetic resonance imaging (MRI) in the diagnosis of this lesion was emphasized.

Age estimation based on pulp cavity/chamber volume of 13 types of tooth from cone beam computed tomography images.

AIM: The aims of this study are to identify which type of tooth has the strong relationship between age and pulp cavity/chamber volume among 13 types of tooth from the same dentition and to determine whether the inclusion of multiple types of tooth may improve the accuracy of age estimation. MATERIALS AND METHODS: Cone beam computed tomography (CBCT) images from 115 females and 125 males aged between 16 and 63 years were analyzed. The DICOM data of all the images were imported into ITK-SNAP 2.4 for the calculation of pulp cavity/chamber volumes. Logarithmic regression analysis and multiple linear regression analysis were applied to establish the relationship between age and pulp cavity/chamber volumes. RESULTS: Among the 13 types of tooth, maxillary second molars have the largest R (2) (0.491, 0.642, and 0.498) and the smallest SEE (8.119, 6.754, and 8.022) in male, female, and pooled gender samples, respectively. The multiple linear regression analysis for the combination of multi-types of tooth indicated that a larger R (2) (0.627, 0.701, and 0.631) and smaller SEE (7.100, 6.258, and 6.970) than the counterpart calculated from the logarithmic regression analysis of a single type of tooth in male, female, and pooled gender samples, respectively. CONCLUSION: The pulp chamber volume of the maxillary second molars has the largest correlation coefficient with age. Using multiple types of tooth may improve the accuracy of age estimation compared with only one type of tooth used.

[Diagnosis and treatment of the ganglion cysts and synovial cysts arising from the temporomandibular joints].

OBJECTIVE: To give a reference for the early diagnosis and treatment of the cysts arising from the temporomandibular joint. METHODS: Nine patients finally diagnosed as temporomandibular joint cysts at the Peking University Hospital of Stomatology from May 1998 to August 2013 were selected and reviewed. Their clinical manifestations, imaging features, diagnoses and differential diagnoses, treatments and follow-ups were summarized and discussed. RESULTS: In the 9 patients, 3 were males and 6 females. Their ages ranged from 33 to 62 years with a median age of 39 years; the course of the disease ranged from 2 weeks to 3 years with a median of 4 months. The image examinations were performed with conventional X-ray examinations in 7 cases, CT scans in 8 cases, MRI in 6 cases and ultrasound in one case. Of the 9 cases, 7 were finally diagnosed as ganglion cyst and 2 as synovial cyst. Ganglion cysts mainly presented as the mass of preauricular area or joint area, with no obvious symptoms or only local discomfort, occasionally with pain. The synovial cysts manifested as the painful swelling of preauricular area and limited mouth-opening, accompanying with occlusal disorders. The treatments included surgical resection in 8 cases, repeated arthrocenteses and lavages in one case. The follow-ups were from 3 months to 9 years, one case with recurrence, and the remaining eight cases without recurrence. CONCLUSION: MRI examinations are very helpful in the early diagnosis and treatment planning of temporomandibular joint cysts. Surgical resection can have good results. Repeated arthrocenteses and lavages also have a good result, which may be an alternative choice for synovial cyst, but more accumulation of clinical experience is further needed.

[Investigation on radiographic signs of osteoarthrosis in temporomandibular joint with cone beam computed tomography in adolescents].

OBJECTIVE: To investigate the occurrence and radiographic signs of osteoarthrosis of the temporomandibular joints (TMJOA) with cone beam computed tomography (CBCT) in adolescents. METHODS: Individuals with temporomandibular disorders (aged 10-19 years) in the patients group (n=386) and pre-orthodontic patients with malocclusion (aged 10-19 years) in the control group (n=339) were included in the present study. All the patients in both groups had been examined by CBCT. The abnormalities of the condyle were evaluated. The results of radiological findings were compared between the patients group and the controls by using chi-square tests. Inter- and intra-examiner agreements were assessed using Cohen's Kappa coefficient and all statistical analysis was performed using SPSS 13.0. RESULTS: 157 patients in the patients group and 41 subjects in the control group had radiographic signs of TMJOA. The occurrence of OA was significantly higher in the patients group (40.7%, 157/386) than in the controls (12.1%, 41/339), the difference was statistically significant (P<0.05). The occurrence of TMJOA was significantly higher in females (44.6%, 123/276) than in males (30.9%, 34/110) in the patients group (P<0.05) but showed no significant difference in the controls (females: 13.7%, 32/234, and male: 8.6%, 9/105, P>0.05). In addition, the patients group showed significantly higher occurrence of ill-defined cortical bone (31.7%, 65/205) small bony defect and extensive erosion (25.4%, 52/205) than the controls (1.7%, 1/58 and 5.2%, 3/58, respectively, P<0.05), while the subjects in the control group had significantly higher occurrence of flattening and shortening of the condyle (39.7%, 23/58) and sclerosis (39.7%, 23/58) than patients with temporomandibular disorders (6.3%,13/205 and 14.6%, 30/205, respectively, P<0.05). CONCLUSION: TMJOA is not uncommon in adolescent patients with TMD and with malocclusion. Patients in the two study groups had different radiographic signs of OA. The patients with temporomandibular disorders often demonstrate erosive changes, while the pre-orthodontic patients with malocclusion often demonstrate relatively stable radiographic signs.

Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions.

This study was carried out to assess whether the spatial resolution has an impact on the detection accuracy of proximal caries in flat panel CBCT (cone beam computerized tomography) images and if the detection accuracy can be improved by flat panel CBCT images scanned with high spatial resolution when compared to digital intraoral images. The CBCT test images of 45 non-restored human permanent teeth were respectively scanned with the ProMax 3D and the DCT Pro scanners at different resolutions. Digital images were obtained with a phosphor plate imaging system Digora Optime. Eight observers evaluated all the test images for carious lesion within the 90 proximal surfaces. With the histological examination serving as the reference standard, observer performances were evaluated by receiver operating characteristic (ROC) curves. The areas under the ROC curves were analyzed with two-way analysis of variance. No significant differences were found among the CBCT images and between CBCT and digital images when only proximal enamel caries was detected (p = 0.989). With respect to the detection of proximal dentinal caries, significant difference was found between CBCT and digital images (p < 0.001) but not among CBCT images. The spatial resolution did not have an impact on the detection accuracy of proximal caries in flat panel CBCT images. The flat panel CBCT images scanned with high spatial resolution did not improve the detection accuracy of proximal enamel caries compared to digital intraoral images. CBCT images scanned with high spatial resolutions could not be used for proximal caries detection.

[Detection accuracy of occlusal caries by cone-beam computed tomography images scanned with different parameters].

OBJECTIVE: To compare the detection accuracy of occlusal caries in cone-beam computed tomography (CBCT) images scanned with different scanning parameters. METHODS: Thirty-seven extracted human premolars and molars without restorations or obvious cavities were selected for this study. The teeth 3 or 4 as a group were mounted in 12 plaster blocks and scanned with DCT Pro (VATECH, Co., Ltd., Yongin-Si, S.Korea) at normal and high resolution settings and with ProMax 3D (Planmeca Oy, Helsinki, Finland) at low, normal and high resolution settings. In addition, the tooth blocks were imaged with the ProMax 3D at three different tube currents. Ten doctoral candidates of Peking University School and Hospital of Stomatology evaluated all the images of the tooth blocks using a five-level confident scale. Actual presence and the extent of caries were established by histological examinations. The areas under the ROC curves (Az value) were analyzed. RESULTS: Eleven (29.7%, 11/37) teeth were sound, 13 (35.1%, 13/37) had enamel caries and 13 (35.1%, 13/37) had dentine caries. There were no significant differences between normal resolution and high resolution for DCT Pro on the detection accuracy of occlusal (enamel+dentine) caries (0.698 ± 0.064 vs. 0.735 ± 0.044, P>0.05).No significant differences were found for ProMax 3D among low, normal and high resolution (0.700 ± 0.031 vs. 0.700±0.054 vs. 0.701 ± 0.041, P>0.05). For dentinal caries, there were no significant differences between CBCT images scanned with different resolutions for DCT Pro(0.776 ± 0.078 vs. 0.811 ± 0.047, P>0.05) or ProMax 3D (0.713 ± 0.039 vs. 0.685 ± 0.063 vs. 0.713 ± 0.040, P>0.05). No significant differences were found for enamel caries detection for DCT Pro (0.620 ± 0.068 vs. 0.659 ± 0.048, P>0.05)or ProMax 3D (0.686 ± 0.050 vs. 0.685 ± 0.063 vs. 0.689 ± 0.063, P>0.05). For ProMax 3D, there were no significant differences among different tube currents on the detection accuracy of occlusal caries (0.653 ± 0.065 vs. 0.700 ± 0.054 vs. 0.67 ± 0.062, P>0.05). CONCLUSION: Different resolutions did not have an impact on the detection accuracy of occlusal caries. The tube currents for ProMax 3D did not show any effect on occlusal caries detection.

[Outcomes of combined pulmonary resection and off-pump coronary artery bypass grafting for patients with lung tumor and concurrent coronary heart disease].

OBJECTIVE: To analyze the outcomes of lung resection and off-pump coronary artery bypass grafting (OPCAB) synchronously for the patients with lung tumor and concurrent coronary heart disease. METHODS: Twenty-two patients with lung tumor and concurrent coronary heart disease underwent combined surgical interventions between January 2003 and December 2011. They included 20 males and 2 females with a mean age of (65 ± 4) years. The TNM stage of lung cancer was predominantly at stages I and II. A majority of them had two and three-vessel disease. The tests of cardiothoracic functions were normal. The biopsy of lung tumor was carried out initially through sternotomy approach. Then OPCAB was performed. Finally lung resection was carried out according to the pathological results of lung tumor. RESULTS: All patients survived. The average number of anastomosed coronary vessels was 2.3. After myocardial revascularization through a sternotomy approach, the procedures included lobectomy and partial lung resections through sternotomy only (n = 11), lobectomy through a lateral thoracotomy approach (n = 9) and lobectomy and bypass to left anterior descending (LAD) through left thoracotomy only (n = 2). Neither death nor new MI occurred during the perioperative period. The mean stay in-hospital was (17 ± 7) days and mean operative duration (233 ± 1) min. The diagnoses were non-small cell lung cancer (n = 18) and benign tumor (n = 4). The most frequent complications were cardiac arrhythmias, atelectasis and pulmonary infections. All of them were followed up for 10-60 months. Within this period, 4 patients died from cancer recurrence. CONCLUSION: The combined procedure of OPCABG grafting and pulmonary resection is a safe and effective treatment option for patients with lung cancer and concurrent coronary heart disease.

17-Beta-estradiol enhanced allodynia of inflammatory temporomandibular joint through upregulation of hippocampal TRPV1 in ovariectomized rats.

Temporomandibular disorders (TMDs) predominantly affect reproductive female patients, with pain the most frequent complaint. Although estrogens are believed to play important roles in TMD pain, the mechanism underlying modulation of TMD pain by estrogens remains largely unknown. Accumulating evidence implies that the hippocampus is involved in sexual dimorphism of pain sensitivity. In this study, we investigated the hippocampal TRPV1 (transient receptor potential vanilloid 1) expression in ovariectomized rats that received 17-beta-estradiol substitution and found that 17-beta-estradiol enhanced the mechanical allodynia of inflamed temporomandibular joint (TMJ) induced by complete Freund's adjuvant. Real-time PCR and immunoblotting demonstrated that TMJ inflammation significantly induced hippocampal TRPV1 expression compared with the control group but failed to induce it in the ovariectomized rats that received no estradiol replacement. In addition, estradiol potentiated TMJ inflammation-induced hippocampal TRPV1 expression in a dose-dependent manner in the ovariectomized rats. In contrast, TRPV1 transcription in amygdala, prefrontal cortex, and thalamus was not affected by TMJ inflammation and estradiol. Immunostaining showed TRPV1 localized in the processes and cytoplasm of pyramidal neurons in CA1-CA3 regions of the hippocampus. Moreover, intrahippocampal injection of TRPV1 antagonists capsazepine and 5'-iodo-resiniferatoxin into the CA1 region of the hippocampus significantly attenuated allodynia of inflamed TMJ in both nonovariectomized and ovariectomized rats that received estradiol replacement. Our results suggested that hippocampal TRPV1 can modulate central pain processing and estradiol may contribute to the sexual dimorphism of TMD pain sensitivity through upregulation of TRPV1 expression in the hippocampus.

Requirement of the NF-κB pathway for induction of Wnt-5A by interleukin-1ß in condylar chondrocytes of the temporomandibular joint: functional crosstalk between the Wnt-5A and NF-κB signaling pathways.

OBJECTIVE: We have previously reported that interleukin-1ß (IL-1ß) up-regulates the expression of Wnt-5A and the activation of Wnt-5A signaling induces matrix metalloproteinase (MMP) through the c-Jun N-terminal kinase pathway in condylar chondrocytes (CCs) of the temporomandibular joint (TMJ). These results suggest that Wnt-5A could play an essential role in IL-1ß-mediated cartilage destruction. The objective of this study was to investigate the molecular mechanism underlying IL-1ß-induced up-regulation of Wnt-5A in TMJ CCs. METHODS: Primary CCs, limb chondrocytes (LCs) and SW1353 human chondrosarcoma cells were treated with IL-1ß in the presence or absent of BAY 11-7082 (an inhibitor of IκBα-phosphorylation). Then, expression of Wnt-5A was estimated by real-time reverse transcriptase-polymerase chain reaction (RT-PCR), Western blotting and immunocytofluorescence. Transient transfection of p65 expression vector and chromatin immunoprecipitation (ChIP) assay was performed to define the effect of p65 on Wnt-5A expression. RESULTS: IL-1ß up-regulated Wnt-5A expression at both the RNA and protein levels in articular chondrocytes. The inhibitor of IκBα-phosphorylation, BAY 11-7082, blocked the induction of Wnt-5A by IL-1ß in a dose-dependent manner. Moreover, experiments with overexpression of p65 and ChIP established that induction of Wnt-5A by IL-1ß is mediated through the NF-κB pathway, especially the p65 subunit. CONCLUSION: These results clarify the molecular mechanism underlying up-regulation of Wnt-5A by IL-1ß in chondrocytes, suggesting an important functional crosstalk between Wnt-5A and NF-κB signaling pathways. This finding provides new insights into the involvement of Wnt signaling in the cartilage destruction caused by arthritis.

Bifid variations of the mandibular canal: cone beam computed tomography evaluation of 1000 Northern Chinese patients.

OBJECTIVES: The aim of this study was to evaluate and quantify variations of bifid mandibular canals (BMCs) in a population of Northern China by using cone beam computed tomography (CBCT). STUDY DESIGN: CBCT images of 1000 consecutive patients were analyzed by using the NewTom proprietary software. BMCs were identified and classified on the basis of the Naitoh classification. Linear and angular measurements of BMCs were performed. Statistical analyses were conducted by using χ2 and Wilcoxon tests. RESULTS: BMCs were observed in 13.2% of 1000 patients and 8.4% of 2000 sides. The prevalence of BMCs was significantly lower in patients in the first 2 decades and in cases with a class II molar relationship. The retromolar canal (68.4%) was the most common type of BMC observed. No buccolingual canals were identified; however, 2 special canals were detected. A classification system of 3 subtypes of retromolar canals was suggested. On average, the beginning site of the branches from the opening of the main canal was at a distance of 8.1 mm. The mean diameter and length of BMCs were 2.1 mm and 12.6 mm, respectively. CONCLUSIONS: This study underlined the prevalence and characteristics of BMCs in a population of Northern China. Preoperative identification of BMCs with CBCT may help prevent postoperative complications.

Buccal mucosa cell damage in individuals following dental X-ray examinations.

The aim of the present study was to monitor genotoxic and cytotoxic effect of X-ray on exfoliated buccal mucosa cells and investigate the association between the effects and the accumulated absorbed doses of oral mucosa. 98 participants' buccal mucosa cells were collected before and 10 days after different series of dental radiographs performed. Cytological preparations were successively dyed with the methods of Feulgen and fast-green, and analyzed under a light microscope. Micronuclei (MN)and other cells were scored. Accumulated absorbed dose of buccal mucosa was estimated with the method of anthropomorphic phantom and dosimeter chips. The dose rang was 0.18-3.54 mGy. A significant difference in the rate of MN cell was found before and after X-ray examinations (P = 0.008) as well as in the rates of Pyknotic (p < 0.001) and Karyolytic cell (p = 0.0021). When only the patients whose mucosa absorbed dose is lower than 1 mGy was analyzed, significant differences were not found except for Karyolytic cells (p = 0.0313). There was a correlation between the accumulated does and the change rate (ρ = 0.25, p = 0.0118). The frequency of micronuclei cells in buccal mucosa may be increased when a series of dental radiographs including a CBCT examination was performed.

Aquaporin-1 and aquaporin-3 expressions in the temporo-mandibular joint condylar cartilage after an experimentally induced osteoarthritis.

BACKGROUND: Over 70% of the total tissue weight in the cartilage matrix consists of water, and the early-stage osteoarthritic cartilage is characterized by swelling. Water transport in the cartilage matrix and across the membranes of chondrocytes may be important in normal and pathological conditions of cartilage. The purpose of this study was to identify aquaporin-1 (AQP1) and aquaporin-3 (AQP3) expressions in the mandibular condylar cartilage after experimentally induced osteoarthritis (OA) in rats. METHODS: An experimental temporomandibular joint OA was induced by partial discectomy in rats. The pathological characteristics of the normal, early-stage, and late-stage osteoarthritic TMJ cartilages were verified by histological techniques. The AQP1 and AQP3 gene expressions in the normal and osteoarthritic cartilages were measured using quantitative real-time reverse-transcription PCR analysis. The cartilage sections were incubated in primary polyclonal antibodies to AQP3; immunofluorescent microscopy was used to examine the AQP3 expression shown by its protein level. RESULTS: The mRNA expression levels of AQP1 and AQP3, analyzed using quantitative PCR, revealed that AQP3 mRNA was highly up-regulated in the OA cartilage, which was considered significant. There was no notable difference in the expression of AQP1 mRNA between OA and normal controls. With the progressing of the OA, the localization of the AQP3 protein was quite different from that of the normal cartilage. Compared to the normal cartilage, the expressions of AQP3 protein were observed mainly in the proliferative zone and the upper mid-zone chondrocytes at the early-stage of OA, and were observed to appear frequently throughout the mid- and deep zone during the late-stage of OA. CONCLUSIONS: The high expression of AQP3 mRNA in the OA cartilage and the different localization of the AQP3 protein suggest that it may play a particular role in OA pathogenesis. Further study of AQP3 function may provide new insight into the understanding of the molecular mechanisms underlying OA.

[Investigation of temporomandibular joint space of healthy adults by using cone beam computed tomography].

OBJECTIVE: To investigate the condyle position in the fossa and obtain the reference ranges of Temporomandibular joint (TMJ) space of 50 healthy adults (100 joints) by using cone beam computed tomography (CBCT). METHODS: Fifty healthy adults (100 joints) were selected and undergone CBCT examination in the intercuspal position. Five different methods of joint space measurement were used based on the joint sagittal middle layer of CBCT images and the results were analysed statistically. RESULTS: The reference ranges of TMJ space of CBCT images by using five measurement methods were obtained. The results of the linear measurement methods demonstrated that there were no significant differences between anterior and posterior spaces (Z0.05),no significant differences between the two side joint spaces including anterior, posterior and superior spaces (t0.05 ),and also no significant differences in ln (P/A) values between two side joints (t0.05). CONCLUSION: All the results of the five measurement methods showed that the condyle was located in the center of the fossa with a variation in the healthy adults in intercuspal position.The CBCT image of the sagittal middle layer of the joint could show the joint space accurately and has an important value in the research related to the changes of TMJ space.

[Diagnostic evaluation of the temporomandibular joint osteoarthritis using cone beam computed tomography compared with conventional radiographic technology].

OBJECTIVE: Osteoarthritic lesions of Temporomandibular joint(TMJ) were assessed by dental cone beam computed tomography(CBCT), and compared with conventional radiographic technology. METHODS: The study was conducted retrospectively on 511 joints of 350 patients, who had undergone dental CBCT, panoramic radiography, transcranial projection and transpharygeal projection of TMJ. The results were compared and the accuracy with CBCT was assessed. The types of osseous condylar abnormalities were observed. RESULTS: (1) The occurrence of osteoarthritis in male and female were 59.04% and 69.66%, respectively, with no significant difference. (2) Compared with CBCT, panoramic radiography, transpharygeal projection examination showed no significant difference, with the accuracy being 90.64% and 94.10%, respectively; However, transcranial projection indicated a significant difference in comparison with CBCT and the accuracy was 86.97%. (3) A higher occurrence of osteoarthritic lesions of the condyle was sclerosis (39.86%). Bony proliferation or osteophyte (28.18%) and ill-defined cortical bone (18.90%) were followed. CONCLUSION: Cone beam CT, which reproduces multiple images including axial, coronal and sagittal planes of the joint, provides a complete radiographic investigation of the bony components of the TMJ. It is one of the best choices of imaging diagnosis of TMJ osteoarthritis. Panoramic radiography and transpharygeal projection examination are also good choices for showing osseous condylar abnormalities in the clinic, but transcranial projection examination is inferior.

[Experience in lung resection synchronous with off-pump coronary artery bypass grafting in patients with lung tumor and coronary disease].

OBJECTIVE: To summarize the experience in lung resection synchronous with off-pump coronary artery bypass grafting (OPCABG) in patients with lung tumor and coronary disease. METHODS: The clinical data of ten patients with coronary artery disease and lung tumor, 8 with peripheral malignant tumors and 2 with central benign tumors, all males, aged 56.2 (41 - 782), who underwent lung resection and OPCABG synchronously, were analyzed. RESULTS: There was no hospital death in this series. All patients regained their ideal cardiorespiratory function postoperatively. CONCLUSION: With experienced management, it is feasible and safe to perform lung resection and OPCABG synchronously for strictly selected patients.

[Analysis of the mitochondrial mutations of articular chondrocyte in temporomandibular joint osteoarthrosis].

OBJECTIVE: To explore the significance of mitochondrial DNA mutations of articular chondrocytes in the rat model of temporomandibular joint osteoarthrosis (TMJOA). METHODS: TMJOA models were created in left sides of TMJ of 15 SD rats by the partial resection of the articular disc. The experimental rats were killed 3 months after operation. After the chondrocytes culture, the entire mtDNA were amplified using 32 pairs of overlapping. DNA fragments showing different banding patterns between normal and experimental mtDNA by temporal temperature gradient gel electrophoresis were sequenced to identify the mutations. RESULTS: Of the 35 heteroplasmic pattern PCR products, 42 novel mutations were found, Majority of the novel mutations were in the tRNA and D-loop regions. CONCLUSION: The mutations occurred in the mtDNA of TMJOA articular chondrocytes.

DNA methylation profiling in different phases of temporomandibular joint osteoarthritis in rats.

OBJECTIVE: Temporomandibular joint osteoarthritis (TMJOA) is a complex disease with strong genetic and epigenetic components in its pathogenesis. The aim of this study was to evaluate DNA methylation in mandibular head cartilage in different phases of experimentally-induced TMJOA in rats. DESIGN: DNA methylation was evaluated using microarrays in the mandibular head cartilage of early, intermediate and late stage experimentally-induced TMJOA, and of the normal age-matched control groups. Genes with differentially methylated CpG sites were analyzed to reveal the over-represented gene ontologies and pathways at different stages, and were compared with published expression profiles to assess their overlappings. The DNA methylation patterns of the target genes were validated by methylated DNA immunoprecipitation qPCR in additional independent cartilage samples and mRNA levels were analyzed by real-time PCR. RESULTS: We observed 9489 differentially methylated regions between the TMJOA and controls. A total of 440 consistently altered genes were revealed in all three stages; most (80%) were hypomethylated and many were associated with cell cycle regulation. We also detected different DNA methylation changes in early and late stage TMJOA (Rearly=0.68, Rlate=0.47), while the differences between age-matched healthy cartilage were subtle. Strong inverse changes between methylation status and mRNA levels were confirmed in Adamts5, Chad, Cldn11 and Tnf. CONCLUSIONS: Our data reveals dynamic DNA methylation patterns during the progression of TMJOA, with a different host of genes and pathways. The changes of cartilage DNA methylation patterns might contribute to understand the etiologic mechanisms of TMJOA epigenetically.

Cheek fistula from the ectopic salivary gland: a variant of the oculo-auriculo-vertebral spectrum.

OBJECTIVES/HYPOTHESIS: This study aimed to investigate the diagnosis and management of a distinct developmental deformity syndrome characterized by congenital cheek fistula, ectopic accessory parotid gland, and preauricular appendage. STUDY DESIGN: Retrospective study. METHODS: We analyzed the medical records, radiologic and histopathologic findings, and follow-up data for seven patients (four males) with a congenital cheek salivary fistula. Computed tomography, fistulography, and sialography had been performed for diagnosis. Surgical treatment effect was evaluated. RESULTS: The mean age of the patients was 8.1 years (range, 2-16 years). The distinctive clinical feature was a congenital skin orifice lateral to the commissure with saliva discharge during eating. The cheek fistulae were accompanied by ipsilateral preauricular appendages in all seven patients. The skin orifice connected to an ectopic gland anterior to the masseter and inferior to Stensen's duct. Parotid sialography demonstrated an intact Stensen's duct in all cases. Hypoplasia of the ipsilateral mandible could be observed in five cases. Excision of the ectopic gland, skin orifice, and fistula was performed in five cases resulting in optimal treatment outcomes with no recurrent or adverse events. CONCLUSIONS: A congenital saliva-discharging fistula with an ectopic accessory parotid gland, ipsilateral preauricular appendage, and mandibular hypoplasia constitutes a rare developmental syndrome. Surgical excision can effectively treat congenital cheek salivary fistula. LEVEL OF EVIDENCE: 4.