Prevalence and distribution of deep caries and abscess formation in children who required emergency dental general anaesthesia. A retrospective analysis.

AIM: The aim of this study was the assessment of prevalence, distribution, and treatment of deep caries and odontogenic abscess formation in children who received emergency dental general anaesthesia (DGA) at the University Hospital of Cranio-Maxillofacial and Oral Surgery of Innsbruck, Austria. MATERIALS AND METHODS: The study population was composed of 1,184 consecutive cases of emergency DGA from January 2008 to June 2014, in patients ?16 years who had presented with odontogenic pain and/or swelling. Under DGA, the tooth causative for the acute pain, and all teeth with deep caries had been routinely removed. From patient files, demographic data, abscess location and therapy, and the number of teeth extracted under DGA were recorded and analysed by means of descriptive statistics. RESULTS: In 549 cases (46.4%) (mean age 5.29±2.39 years), an abscess formation was recorded; 90.5% of all abscesses were submucous, and 9.5% affected fascial spaces. Decayed primary molars and maxillary primary incisors and canines were most often causative for abscess formation. Drainage was in most cases performed by tooth extraction with/without an intraoral incision under antibiotic therapy. Per case, a mean of 5.91±4.04 primary teeth were extracted. In 77 individuals (mean age 9.83± 2.59), a mean of 1.92±1.02 permanent first molars were extracted. CONCLUSION: In the study population, prevalence of deep caries and abscess formation was alarmingly high. In consideration of the medical risks and high efforts immanent in DGA, educational measures should address parents in order to raise awareness of their responsibility for their children´s health.

The impact of ageing on cranio-maxillofacial trauma-a comparative investigation.

The number of patients older than 65 is increasing in developed societies. The impact of age on injuries and their outcome has been well documented in several fields of traumatology. Data on a broad cohort suffering from oral and maxillofacial injuries are missing. In this study, the data of 12,572 such patients were collected, of which 11,798 were younger and 774 were older than 65 years. With increasing age the risk of a domestic accident increased. The accident mechanism in elderly people was most frequently a fall (72%) or was not reproducible (12%). There was a significant difference between groups regarding concomitant injuries. Additional neurological symptoms occurred in 26% of the older and 15% of the younger patients (P<0.001). Until the age of 65 the risk of concomitant neurological injury increases. Injuries in the older patients mainly affected the soft tissue and midface. No statistical differences in surgical postoperative complications were observed. Due to the changing face of society, the treatment of elderly people is of high relevance. To enable an independent life after trauma, pre- and post-therapeutic care is of major importance. These data support surgical treatment of all patients, regardless of age, driven by general health condition whenever possible.

The effects of guided tissue regeneration (GTR) on modified Le Fort I osteotomy healing in rabbits.

Osteogenesis following surgery depends on the osteoblasts at the wound site. Fibrous nonunions may be the result of differential and rapid migration of fibroblasts compared to osteoblasts into the wound. The present study was designed to test this hypothesis through the use of guided tissue regeneration (GTR) in a rabbit model. Bilateral, Le Fort I osteotomies (n=20) were produced in the maxillae of 10 New Zealand White rabbits. The segments were advanced 6mm and rigidly fixed using microplates and screws. One side was covered with a resorbable collagen membrane or left uncovered. Rabbits were followed for four weeks with radiographs and the maxillae were harvested for histology. Cephalometry revealed that membrane-covered defects had significantly (P<0.01) reduced defect area (by approximately 70%) compared to uncovered defects. Histologically, membrane-covered defects showed more organized osteogenesis and less fibrous tissue than uncovered defects. Histomorphometry revealed that membrane covered defects had significantly (P<0.05) reduced defect areas (by approximately 20%) compared to uncovered defects. While findings suggest that GTR can facilitate osseous wound healing in Le Fort I osteotomies, results also caution against relying exclusively on two-dimensional radiography to assess bony wound healing in lieu of three-dimensional imaging and evaluations.

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.

Placental growth from the first to the second trimester of pregnancy in SGA-foetuses and pre-eclamptic pregnancies compared to normal foetuses.

The aim of this study was to determine placental growth between 12-22 weeks in normal pregnancies compared to pregnancies complicated by foetal SGA and maternal pre-eclampsia (PE). The placentae of 1199 women were measured 3D sonographically at 12, 16 and 22 weeks of gestation. Placental volume growth was then calculated. Neonatal birthweight, birth centile and the occurrence of pre-eclampsia were recorded in every woman and correlated with placental growth (four groups: normals, SGA, PE, SGA+PE). SGA-placentae are already smaller at 12 weeks but then develop in a similar way to normal placentae. PE placentae are slightly, but significantly, larger at 12 weeks, grow rapidly until 16 weeks and then stop growing normally between 16 and 22 weeks. If SGA goes together with PE, both placental volume (PV) at 12 weeks as well as growth is reduced significantly. Nevertheless, placental growth between week 12 and 22 is too heterogeneous to justify using this method as a clinical tool, but it can provide new information on placental physiology underlying unfavourable obstetric outcomes.

Facial injuries in skiing. A retrospective study of 549 cases.

In the last 2 decades, reports of skiing injuries have shown an increasing number of skiers with severe trauma. This article provides an account of a retrospective study of 549 patients with 1155 facial injuries sustained while skiing who received treatment at the Department of Oral and Maxillofacial Surgery at the University Hospital in Innsbruck, Austria between 1991 and 1996. The study was based on a questionnaire answered by the patients and on case report forms. Most of the patients were male (65.2%) and were aged between 3 and 81 years (average 28.4 years). A simple fall while skiing was the main type of accident (45.9%), followed by collisions with other people (23.5%). Injuries were classified into 1 of 3 groups: (i) lesions of the soft tissue (32.2% of all injuries); (ii) dentoalveolar traumas (24.3%); and (iii) fractures of facial bones (43.5%). Lacerations and haematomas were the most frequent lesions in patients with injuries to the soft tissues. The group of patients with dentoalveolar trauma mainly presented with fractures of tooth crowns. Fractures involving the mandible and the zygomatic bone were predominant in patients in the third group. Concomitant injuries mainly included injuries to the brain and skull fractures. Treatment was ambulatory, or by admission and surgery. We did not observe an increase in the number of skiing accidents causing facial injury in the last 5 years. Facial injuries represented 4% of all skiing injuries, a lower proportion than in other sports.

Multivitamin administration before ischemia reduces ischemia-reperfusion injury in rabbit skeletal muscle.

This study investigated the effect of a multivitamin preparation administered before ischemia or before reperfusion, on ischemia-reperfusion (I/R) injury of skeletal muscle. An in vivo hindlimb skeletal muscle I/R model (2.5 h/2 h) was carried out on adult New Zealand white rabbits. Animals used as I/R models were treated with a multivitamin preparation (0.4 ml/kg bw i.v. bolus), containing alpha-tocopherol, ascorbic acid, retinol, vitamin B complex, 30 min before starting ischemia (group MV(isc)) or 5 min before reperfusion (group MV(rep)) and compared to animals with I/R without treatment (group IR) and sham operated animals (group SHAM). Interstitial edema (muscle interfiber area, %MIFA) and changes in microvessel size (microvessel cross sectional area, MVCSA, microm(2)) were measured. Plasma malondialdehyde concentrations (MDA-TBA, nmol/ml) served as a measure of lipid peroxidation. After 2h of reperfusion, ischemia-reperfusion developed a significant microvascular constriction and an interstitial edema (IR, vs SHAM;P<< 0.01), but administration of antioxidative vitamins before the onset of ischemia reduced microvascular constriction and edema formation (P<< 0.05 vs IR group). In a similar manner, administration of vitamins before ischemia lowered plasma MDA-TBA levels as compared to the untreated group during reperfusion (p<< 0. 05). In animals treated with vitamins before reperfusion, the biochemical and morphological results showed no differences as compared to the untreated group. Antioxidative treatment with a multivitamin preparation exerted a beneficial effect on I/R injury of skeletal muscle when the aforementioned vitamins were administered before ischemia but not before the onset of reperfusion.

Tissue engineering and dentistry.

This article assesses the current state of the art of tissue engineering and its applications in dentistry, especially in the reconstruction and repair of orofacial tissues, including bone and oral mucosa, for the restoration of function and improved cosmetics. The article discusses at length the tissue engineering of bone and cartilage, including guided tissue techniques, in which some of the most interesting advances in the field are being made.

Maxillofacial trauma due to work-related accidents.

Even though numerous reports on maxillofacial trauma exist, only a few give detailed information about work-related maxillofacial injuries. The purpose of this study was to reveal the significance of maxillofacial injuries related to accidents occurring at work by evaluating a large number of patients with maxillofacial injuries over a 9-year period. Out of the 8704 trauma patients treated between 1991 and 1999 in the Department of Oral and Maxillofacial Surgery at the University of Innsbruck, Austria, 463 (5.4%) were injured at work. All charts were reviewed and analyzed according to age, gender, cause of accident, occupation, type of injury, location and frequency of fractures. The highest incidence of maxillofacial injury was found among construction workers (a total of 124 patients, 26.8%), followed by craftsmen (102 patients, 22.0%) and office employees (69 patients, 14.9%). The sex distribution showed an overall male-to-female ratio of 11.8:1 and those in the age group most affected were between 20 and 29 years of age. The most frequent cause of injury was a blow in 48.4%, followed by falls and falls over obstacles, accounting for 27.9% and 7.1%, respectively. Of all trauma, 45.4% (210 persons) sustained 423 maxillofacial fractures, 31.7% (147 patients) suffered 232 dento-alveolar injuries, and 21.2% (98 people) showed 430 soft-tissue injuries. One-fifth (20.7%) of all patients displayed concomitant injuries with cerebral and cranial trauma being the most common. The probability of sustaining maxillofacial trauma at work is correlated to the nature of the occupation. Individuals (mostly men) using tools or machines at work are exposed to a much higher risk of work-related maxillofacial trauma.

Mountainbiking--a dangerous sport: comparison with bicycling on oral and maxillofacial trauma.

The popularity of bicycling is reflected in the number of cycling-related oral and maxillofacial injuries. Five hundred and sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, between 1991 and 1996, accounting for 31% of all sports-related accidents and 48.4% of all traffic accidents. A review of the patient records revealed more severe injury profiles in sixty mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma and 23% soft tissue injuries, compared to 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures and 14% soft tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% LeFort I, II and III fractures. Condyle fractures were more common in bicyclists, with 18.8% compared to 10.8% in mountainbikers. Reduction of facial injuries due to cycling-related accidents needs appropriate design of helmets with faceguards and compulsory helmet use for all cyclists, and particularly mountainbikers.

Effect of temporomandibular joint arthrocentesis on synovial fluid mediator level of tumor necrosis factor-alpha: implications for treatment outcome.

Temporomandibular joint (TMJ) pain is a predominant sign and symptom in patients with temporomandibular disorder, and a common cause of chronic orofacial pain. Arthrocentesis of the upper joint space proved to be effective in reducing TMJ-related pain and reestablishing normal mandibular range of movement in patients diagnosed for a 'closed lock'. Using the therapeutic approach of arthrocentesis in TMJ-related instances of capsulitis/ synovitis (C/S) with a recency of first pain onset of < or =6 months, the purpose of the present study was to evaluate whether the TMJ-related variable synovial fluid (SF) level of TNF-alpha may be linked to the cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. In 23 patients with a specific temporomandibular disorder diagnosis of unilateral C/S with a recency of first pain onset of < or =6 months, TMJ SF aspirates were obtained from the pain and contralateral non-pain sides immediately before and after arthrocentesis. Visual analog scales were used for pre- and postoperative self-assessment of TMJ-related pain during function, while enzyme-linked immunosorbent assays were applied for measurement of the tumor necrosis factor-alpha (TNF-alpha) concentration. With a mean SF TNF-alpha level of 13.91 ng/ml associated with the pain side, and a mean SF TNF-alpha level of 7.73 ng/ml associated with the non-pain side, a statistically significant difference was found between the sample groups (P=0.001). Arthrocentesis led to a significant intraoperative decrease of the respective preoperative SF TNF-alpha levels, namely 61.64% (P=0.000) on the pain side and 89.50% (P=0.000) on the non-pain side, while reduction of TMJ-related pain during function was 73.17%, (P=0.000). Clinical evaluation showed a significant reduction in the prevalence of TMJ-related diagnoses of C/S (P<0.001). There was no change in the prevalence of associated TMJ-related diagnoses of internal derangement. In view of the fact that the described technique of TMJ SF analysis may be suggested as a valuable diagnostic method for the detection of biochemical SF events, the results of this study should encourage research in its potential uses so that it can become established as a reliable diagnostic approach. Further, the findings may support the concept of bilateral arthrocentesis to be effective in the treatment of patients with a unilateral specific TMD diagnosis of non-chronic C/S.

Maxillofacial fractures masking traumatic intracranial hemorrhages.

Maxillofacial trauma may mask intracranial injuries prompting intensive care treatment. The purpose of this study was to identify whether craniofacial fracture patterns predispose patients with maxillofacial fractures to different types of intracranial hemorrhages. Within 7 years, 6649 patients with craniomaxillofacial injuries were admitted for treatment. The charts of the patients were analyzed according to age, sex, cause and mechanism of injury, type and location of facial injury, and intracranial trauma; 2195 sustained maxillofacial fractures. Statistical analyses were followed by logistic regression analyses for the four main types of intracranial hemorrhage to determine the impact of the different maxillofacial fractures. Intracranial hemorrhages in 212 patients (9.7%) occurred as epidural (2.5%), subdural (4.3%), subarachnoid (5.3%), and intracerebral hemorrhages (6.3%). Le Fort, orbit, nose, zygoma, and maxillary fractures increased the risk for accompanying intracranial hemorrhage by two- to fourfold (P < 0.05). Basal skull fractures caused a multiplication of the risk up to 17-fold, while fractures of the cranial vault were associated with a risk up to 14-fold. Nearly 10% of patients with craniomaxillofacial fractures sustain intracranial hemorrhages requiring frequently immediate neurosurgical intervention. Those patients, suffering from central midface fractures and skull base fractures, are prone to highly significant elevated risks of intracranial hemorrhage.

Interaction of strain and interleukin-1 in articular cartilage: effects on proteoglycan synthesis in chondrocytes.

In temporomandibular joint disorders, the release of proinflammatory cytokines such as interleukin-1 (IL-1) initiates an inflammatory process disrupting cartilage homeostasis, ultimately leading to cartilage destruction. Additionally, mechanical stimuli affect articular chondrocyte metabolism. While articular chondrocytes generate nitric oxide (NO) in the presence of IL-1 proteoglycan synthesis is consecutively suppressed. The purpose of this study was to assess the effects of proinflammatory cytokines and mechanical strain in the form of cyclic tensile stretch on proteoglycan synthesis in chondrocytes, as compared to the NO competitive inhibitor L-N-monomethyl arginine (LMA), and to assess whether this effect is secondarily related to the activity of growth factors such as transforming growth factor beta (TGF-beta). Lapine articular chondrocytes were exposed to one of four different treatment regimens: no cyclic tensile stretch, IL-1, cyclic tensile stretch, or IL-1 plus cyclic tensile stretch. NO production was determined as medium nitrite accumulation. TGF-beta-bioactivity in chondrocyte conditioned medium was measured with the mink-lung epithelial cell bioassay. Proteoglycan synthesis was measured as the incorporation of 35-[S]-sodium sulfate into macromolecules separated from unincorporated label by gel filtration on PD-10 columns. In resting chondrocyte cultures, only baseline levels of NO were measured and the application of stretch for 24 h did not affect NO production. Addition of IL-1 provoked a large increase in NO synthesis which was abrogated in the presence of LMA. Application of stretch decreased the IL-1 induced NO synthesis, but did not modify the effect of LMA (being a competitive inhibitor of the inducible NO synthase) inhibiting IL-1 induced NO production. Glucosaminoglycan production was noted as proteoglycan synthesis showing almost no effect of cyclic stretch alone in comparison to the control condition, which correlates with the missing NO production in control and stretch conditions. Addition of IL-1 strongly inhibited proteoglycan synthesis, which was partly restored in the presence of LMA. However, cyclic stretch acted as a stronger restorer of proteoglycan synthesis in IL-1 treated conditions in the absence, and even more in the presence, of LMA. It was concluded that motion in the form of cyclic tensile stretch is a remarkable anti-inflammatory stimulus reversing the IL-1 induced suppression of proteoglycan synthesis in chondrocytes. These findings have therapeutic implications for the treatment of temporomandibular joint disorders, supporting early onset of postoperative and post-traumatic continuous passive motion therapy.

The diagnostic value of ultrasonography to determine the temporomandibular joint disk position.

OBJECTIVE: Temporomandibular joint (TMJ) arthrography and magnetic resonance imaging are the imaging techniques of choice in patients presenting with signs and symptoms of TMJ disorders suggesting soft tissue pathosis. With the disadvantage of arthrography as an invasive procedure and magnetic resonance imaging posing a problem in clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to assess the presence or absence of disk displacement in patients with TMJ disorders. STUDY DESIGN: In 17 patients, 100 TMJ positions were investigated by static and dynamic ultrasonography to analyze the disk-condyle relationship. To compare the respective findings with those of a diagnostic method offering high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. RESULTS: With static ultrasonography showing a sensitivity of 0.41 and a specificity of 0.70 and dynamic ultrasonography a sensitivity of 0.31 and a specificity of 0.95, the data revealed that static and dynamic ultrasonography are marginal in detecting the presence of disk displacement, but dynamic ultrasonography is sensitive in detecting the absence of disk displacement. However, with a positive predictive value of 0.61 and a negative predictive value of 0.51 for static ultrasonography, and a positive predictive value of 0.88 and a negative predictive value of 0.55 for the dynamic technique, the results indicate that both modalities are insufficient in establishing a correct diagnosis for the presence or absence of disk displacement. CONCLUSION: In view of the fact that dynamic ultrasonography proved to be a reliable diagnostic aid for the detection of normal disk position, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Prevalence of dental trauma in 6000 patients with facial injuries: implications for prevention.

OBJECTIVE: In contrast to epidemiologic studies on facial injuries reporting on dental trauma, facial bone fractures with dentoalveolar injuries, or soft tissue injuries individually, the purpose of this study was to evaluate the overall place of dental trauma in facial injuries. This was a retrospective investigation of the impact of sport, work, violence, traffic, household, and play accidents in the relationships among dental trauma, facial trauma, and other concomitant trauma. Finally, preventive considerations are discussed. STUDY DESIGN: Six thousand patients registered at the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery during a period of 6 years 4 months were admitted for dental trauma, facial trauma, or both. Records were analyzed for cause of injury, age, gender, monthly distribution, frequency, type of injury, and frequency of dental trauma in relation to facial injuries and concomitant injuries. RESULTS: The incidence of dental injuries with respect to the total number of facial injuries was as follows: 57.8% in play and household accidents, 50.1% in sports accidents, 38.6% in accidents at work, 35.8% in acts of violence, 34.2% in traffic accidents, and 31% in unspecified accidents. The overall incidence revealed was 48.25%. CONCLUSION: Our findings support the fact that in the mosaic of traumatic injuries, the frequencies of tooth trauma and its sequelae are underestimated and that such trauma and sequelae occur without a predictable pattern of intensity and extensiveness. Preventive approaches are the sole way to minimize the number of these injuries. Substantial progress made in treating facial and dental trauma in the last 2 decades only improves functional and esthetic outcomes among the population that has suffered dental injury.

Temporomandibular joint pain: relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha.

OBJECTIVES: The purpose of this study was to investigate whether patients with temporomandibular joint (TMJ)-related pain classified as capsulitis/synovitis may be linked to magnetic resonance imaging (MRI) findings of internal derangement, osteoarthrosis, or the synovial fluid aspirate findings of tumor necrosis factor-alpha (TNF-alpha) level. STUDY DESIGN: The study comprised 23 patients with temporomandibular disorders (TMD), who had nonchronic pain (pain onset < or =6 months) and a unilateral TMJ-related diagnosis of capsulitis/synovitis. Bilateral sagittal and coronal magnetic resonance images were obtained to establish the presence or absence of internal derangement, osteoarthrosis, or both. TMJ synovial fluid aspirates were obtained from the pain and contralateral nonpain sides to determine the TNF-alpha level. RESULTS: Comparison of the TMJ side-related data showed a significant relationship between the clinical TMD diagnosis of capsulitis/synovitis and the MRI diagnoses of TMJ internal derangement (P =.002) and of TMJ internal derangement type (P =.04). The mean TNF-alpha level in synovial fluid aspirates from TMJs assigned a clinical TMD diagnosis of capsulitis/synovitis was significantly higher than in those obtained from contralateral nonpain sides (P =.001). There was no correlation between the clinical diagnosis of capsulitis/synovitis and the MRI diagnosis of TMJ osteoarthrosis (P =.13) or between the MRI diagnosis of TMJ osteoarthrosis and that of TMJ internal derangement (P =.70) or TMJ internal derangement type (P =.33). CONCLUSIONS: The results suggest that the TMJ pain condition of capsulitis/synovitis is related to TMJ-side specific MRI diagnoses of internal derangement and internal derangement type, and synovial fluid aspirate findings of TNF-alpha level. The data confirm the concept of elevated mediator level as a diagnostic approach for patients presenting with TMJ-related pain. MRI and synovial fluid aspirates may be used as diagnostic methods for evaluating TMJ-related pain conditions.

Effect of arthrocentesis and hydraulic distension on the temporomandibular joint disk position.

OBJECTIVE: Recent studies have suggested arthrocentesis and hydraulic distension as an effective treatment modality in patients demonstrating clinical findings consistent with the diagnosis of disk displacement without reduction, normal range of motion thereby being restored and pain of the temporomandibular joint reduced. In view of the fact that only a few studies have been performed to verify the biologic concept of disk displacement without reduction as a diagnostic and therapeutic approach in patients with "closed-lock" symptoms, the purpose of this study was to investigate whether temporomandibular joint-related variable disk position might be linked to cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. STUDY DESIGN: The study compared 15 patients, each of whom was assigned a clinical unilateral temporomandibular joint-related diagnosis of internal derangement (ID) type III (disk displacement without reduction) in combination with capsulitis/synovitis. Clinical diagnoses were made according to the Clinical Diagnostic Criteria for Temporomandibular Disorders. Bilateral sagittal and coronal magnetic resonance images were obtained immediately preoperatively and at 2-month follow-up to establish the presence or absence of associated types of ID. Temporomandibular joint-related pain, level of function, and mandibular range of motion were assessed preoperatively and the data were compared with the respective 2-month follow-up findings. RESULTS: Comparison of the pretreatment temporomandibular joint side-related data revealed the temporomandibular joint side with an ID-III in combination with capsulitis/synovitis to be associated with significantly more magnetic resonance imaging diagnoses of ID than of an absence of ID (P <.001) and with significantly more disk displacement without reduction than disk displacement with reduction (P <.001). At the 2-month follow-up, clinical evaluation showed a significant reduction in temporomandibular joint-related pain during function (P <.001), a significant reduction in the prevalence of temporomandibular joint-related diagnoses of capsulitis/synovitis (P <.001) and ID-III (P <.01), and a significant increase in mandibular range of motion (P <.01). There was no change in the prevalence rates of associated temporomandibular joint side-related IDs. CONCLUSIONS: The results confirm the concept of disk displacement as a diagnostic approach but not as a therapeutic approach for patients presenting with signs and symptoms of unilateral ID-III in combination with capsulitis/synovitis. In terms of clinical decision-making in temporomandibular disorder-related instances of ID, magnetic resonance imaging may be used as a diagnostic method for identifying the diagnostic validity of the variable "disk-condyle relationship."

Prevalence of cervical spine injuries in patients with facial trauma.

OBJECTIVE: Injuries to the spine may accompany facial trauma. By using a large computerized database the goal of this case control study was to assess the association between facial and cervical spine injuries among patients sustaining facial trauma. STUDY DESIGN: During a period of 4 years (1995 to 1998) 3083 patients, 10 years or older, with facial injuries were admitted to the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery for facial trauma. Records were analyzed for cause of injury, age and gender distribution, frequency and type of injury, and frequency of cervical spine injuries in relation to facial trauma and concomitant injuries. Two hundred six (6.7%) of these patients had experienced a concomitant cervical spine injury (case group). All other patients (2877) were assigned to the control group of facial trauma only. RESULTS: Facial trauma patients with concomitant cervical spine injuries were significantly older (mean age, 42 vs 34 years); no difference existed for the female/male ratio of 30:70. Sports trauma was the main cause of facial trauma in the control group (37.4%), yet traffic accidents accounted for 43.7% of combined facial and cervical spine injuries in the case group. Central mid face fractures dominated in the case group and lateral mid face fractures in the control group. In the case group cervical spine fractures and dislocations occurred in 19.2%. None of them showed evidence of paralysis. Concomitant brain injuries occurred in 21.6% of the case group and 8.8% of the control group. For patients sustaining facial trauma, logistic regression analysis revealed reduced risks for additional cervical spine injuries in younger patients, female patients, absence of brain injury, and in patients with facial soft tissue lesions alone (58.2%) or dental trauma alone (77.5%). CONCLUSION: The results of this study underline the importance of proper clinical and computed tomographic evaluation in cases of facial fractures for recognition of additional cervical spine trauma. Detection of cervical spine trauma can be missed, especially when pain or symptoms from other parts of the body dominate. The typical patient with concomitant neck and facial trauma is male, 40 years old, and usually involved in a traffic accident.

Growth factor and cytokine gene expression in mechanically strained human osteoblast-like cells: implications for distraction osteogenesis.

OBJECTIVE: An understanding of bone cellular biology is a basic necessity to understanding events such as distraction osteogenesis. The goal of this study was to determine the effect of continuous cyclic mechanical stretch as a fundamental event in distraction osteogenesis on the expression of 3 bone growth factors, transforming growth factor-beta 1 (TGF-beta1), insulin-like growth factor 1 (IGF-1), basic fibroblast growth factor (bFGF) and 2 cytokines, interleukin (IL)-1 (IL-1) and 6 (IL-6) in human osteoblast-like cells. MATERIAL AND METHODS: A human osteoblast-like cell line, SaOS-2, capable of forming a ground substance and mineralizing it, was maintained. Cells were transferred to 6-well plates with flexible silicon bottoms grown to confluence and either subjected to tensile stretch for different time intervals or used as the control group. RNA was isolated to conduct Northern blot analysis for the expression of 3 bone growth factors, transforming TGF-beta1, IGF-1, bFGF, and 2 cytokines, IL-1 and IL-6. RESULTS: After 8 hours, mRNA for TGF-beta1 and IGF-1 increased in the experimental group, whereas bFGF decreased but cytokines IL-1 and IL-6 were not affected. At 16 hours, TGF-beta1, IGF-1, and bFGF showed increased levels of mRNA; IL-6 showed a slight increase. After 24 hours, TGF-beta1, IGF-1, bFGF, and IL-6 had increased mRNA levels. IL-1beta did never show significant alterations in mRNA production as compared with the control. CONCLUSION: Tensile stretch on osteoblast-like cells alter local regulation of bone formation, increasing the expression of bone growth factors, whereas catabolic cytokines are unaffected. These findings suggest a direct effect of mechanical strain on osteoblasts and may be the driving factors of bone growth during distraction.