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1.
Int Tinnitus J ; 19(2): 47-51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-27186932

RESUMO

OBJECTIVE: To compare the prevalence of tinnitus in temporomandibular disorder (TMD) patients affected by either jaw muscle pain, temporomandibular joint (TMJ) internal derangements, or TMJ arthrosis. METHODS: The presence of self-reported tinnitus was assessed in 250 consecutive TMD patients and correlation analysis was performed with clinical TMD signs and symptoms. RESULTS: Tinnitus prevalence in the TMD population was 30.4%. Any significant patterns of correlation were shown for the overall study group, despite a higher tinnitus prevalence in patients with (32.8%) than without masseter pain (24.8%; p = 0.176) as well as in those with (33.7%) than without TMJ arthrosis (26.1%; p = 0.082). Age-stratified analysis showed correlations with masseter pain in older patients (48.3% vs 16; p < 0.05), and with arthrosis in younger patients (57.1% vs 22.2%; p < 0.05). CONCLUSIONS: Any correlation patterns were shown between tinnitus and TMD. Age-stratified analysis suggested possible hypotheses for a symptom-specific clinical correlation that should be assessed with future research.

2.
J Craniofac Surg ; 25(3): 988-90, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24705240

RESUMO

The current article describes a case of a patient with temporomandibular joint (TMJ) ankylosis undergoing surgery performed with a tailored technique for condylar reshaping. A patient with posttraumatic bilateral TMJ ankylosis underwent interpositional arthroplasty with temporalis fascia, and focus was put on the need to maintain the vertical height of the mandible. The postoperative course was uneventful, and positive outcomes were kept during a 1-year follow-up span. The adoption of surgical strategies aiming at restoring a condylar shape as similar as possible to the natural one may be important in the light of the search for surgeries providing and/or recreating normal function of the TMJ.


Assuntos
Artroplastia/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Anquilose/diagnóstico , Anquilose/cirurgia , Fáscia/transplante , Seguimentos , Humanos , Masculino , Côndilo Mandibular/lesões , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/complicações , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico
3.
Am J Otolaryngol ; 34(4): 323-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23357594

RESUMO

OBJECTIVE: To evaluate the outcome of combined surgical treatment of oroantral communications associated with chronic maxillary sinusitis. PATIENTS AND METHODS: 8 consecutive patients affected by complicated oroantral fistula were included in the study. The protocol consisted of: clinical, endoscopic and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy 2 weeks before surgery; one-stage surgical procedure under local anaesthesia consisting in uncinectomy with enlargement of the osteomeatal complex through endoscopic nasal approach associated with the closure of the oroantral communication by means of a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy. Follow-up consisted of weekly clinical evaluation during the first month, and nasal endoscopy at 3, 8 and 24 weeks after surgery. RESULTS: After surgical treatment, all patients were symptom-free and had no endoscopic and radiological evidences of maxillary sinusitis at the 6-month follow-up. No recurrent oroantral fistulas were found. CONCLUSIONS: The current prospective study showed that a one-stage, combined endoscopic and intraoral approach under local anaesthesia represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated oroantral communications. Moreover, it represents an easily applicable approach also in outpatient clinics with minor patient discomfort.


Assuntos
Endoscopia/métodos , Sinusite Maxilar/cirurgia , Fístula Bucoantral/cirurgia , Cirurgia Bucal/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Anestesia Local , Doença Crônica , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Sinusite Maxilar/complicações , Sinusite Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Fístula Bucoantral/complicações , Fístula Bucoantral/diagnóstico por imagem , Estudos Prospectivos , Radiografia Panorâmica/métodos , Procedimentos de Cirurgia Plástica/métodos , Medição de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Oncologist ; 17(8): 1114-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22723507

RESUMO

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-documented adverse event from treatment with nitrogen-containing bisphosphonates (NBPs). During a preliminary histomorphometric study aimed at assessing the rate of bone remodeling in the jaws of patients with surgically resected BRONJ, we found a defect of bone mineralization (unpublished data). We hypothesized that osteomalacia could be a risk factor for BRONJ in patients taking NBPs. Therefore, we looked for static and dynamic histomorphometric evidence of osteomalacia in biopsies from subjects with and without BRONJ. METHODS: This case-control study used histomorphometric analysis of bone specimens of patients using NBPs (22 patients with BRONJ and 21 patients without BRONJ) who required oral surgical interventions for the treatment/prevention of osteonecrosis. Patients were given tetracycline hydrochloride according to a standardized protocol before taking bone biopsies from their jaws. Biopsies with evidence of osteomyelitis or necrosis at histology were excluded from the study. Osteomalacia was defined as a mineralization lag time >100 days, a corrected mean osteoid thickness >12.5 mm, and an osteoid volume >10%. RESULTS: In all, 77% of patients with BRONJ were osteomalacic compared with 5% of patients without BRONJ, according to histomorphometry. Because osteomalacia was found almost exclusively in NBP users with BRONJ, this is likely to be a generalized process in which the use of NBPs further deteriorates mechanisms of bone repair. CONCLUSIONS: Osteomalacia represents a new and previously unreported risk factor for disease development. This finding may contribute to a better understanding of the pathogenesis of this disease and help with the development of strategies to increase the safety of NBP administration.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Conservadores da Densidade Óssea/toxicidade , Difosfonatos/toxicidade , Osteomalacia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/patologia , Conservadores da Densidade Óssea/uso terapêutico , Calcificação Fisiológica/efeitos dos fármacos , Difosfonatos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomalacia/induzido quimicamente , Osteomalacia/complicações , Osteomalacia/patologia , Fatores de Risco
5.
J Oral Maxillofac Surg ; 70(11): 2522-30, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22939642

RESUMO

PURPOSE: To compare the effectiveness of 2 treatment protocols providing 5 weekly temporomandibular joint (TMJ) arthrocenteses immediately followed by injections of 2 different molecular weight hyaluronic acid (HA) drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease. MATERIALS AND METHODS: Patients with a Research Diagnostic Criteria for Temporomandibular Disorders diagnosis of osteoarthritis were randomly assigned to 1 of 2 study groups receiving either low- or medium-molecular weight HA after arthrocentesis. The level of maximum pain at chewing was the primary outcome variable, and maximum pain at rest, subjective chewing efficiency, functional limitation, treatment tolerability, perceived treatment effectiveness, and jaw range-of-motion function in millimeters were the secondary outcomes. All variables were assessed and compared between groups at baseline, at the end of treatment, and 3 months later. RESULTS: Forty subjects entered the study. At the end of the follow-up period, all the outcome variables improved in both groups of patients. A between-group comparison of changes over time showed that differences were not significant for any of the outcome variables, that is, pain at chewing (F = 0.056, P = .815), pain at rest (F = 0.383, P = .541), chewing efficiency (F = 0.050, P = .825), functional limitation (F = 0.268, P = .609), and mouth opening (F = 0.003, P = .954). In addition, no between-group differences were shown for perceived treatment effectiveness and treatment tolerability. CONCLUSIONS: Similar positive effectiveness was shown for 2 treatment protocols for TMJ osteoarthritis (ie, 5-session single-needle arthrocentesis plus low- or medium-molecular weight HA).


Assuntos
Dor Facial/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Osteoartrite/tratamento farmacológico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Viscossuplementos/administração & dosagem , Adulto , Idoso , Artralgia/tratamento farmacológico , Distribuição de Qui-Quadrado , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Mastigação , Pessoa de Meia-Idade , Peso Molecular , Medição da Dor , Amplitude de Movimento Articular , Irrigação Terapêutica
6.
J Oral Maxillofac Surg ; 70(9): 2048-56, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22907107

RESUMO

PURPOSE: To investigate for treatment effectiveness in different age groups of patients with temporomandibular joint osteoarthritis who underwent a cycle of 5 weekly arthrocenteses plus hyaluronic acid injections. MATERIALS AND METHODS: We implemented a retrospective study on 76 patients followed up for 1 year. Outcome variables were pain levels at rest and during chewing, subjective masticatory efficiency, functional limitation, perceived efficacy, and jaw range of motion. Three age groups of patients were identified, and treatment effectiveness was compared among groups by means of a multistrata permutation test. RESULTS: All the partial P values of the subtests related to the age groups, adjusted according to the close testing method for controlling multiplicity, were significant: P = .009 (aged <45 years), P = .001 (aged 45-65 years), and P = .001 (aged >65 years). For the younger age group, the treatment had a significant effect only on the pain at mastication and on the subjective efficacy. For the other age groups, the treatment effectiveness was evident with regard to almost all the considered symptoms. CONCLUSIONS: Our findings suggested that the treatment protocol was more effective in patients older than 45 years, thus having important clinical implications regarding attempts to define tailored treatment protocols for patients with temporomandibular disorders.


Assuntos
Ácido Hialurônico/administração & dosagem , Osteoartrite/tratamento farmacológico , Paracentese/métodos , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Viscossuplementos/administração & dosagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Artroscopia , Ingestão de Alimentos/efeitos dos fármacos , Terapia por Exercício , Feminino , Seguimentos , Cefaleia/complicações , Humanos , Injeções Intra-Articulares , Masculino , Mastigação/efeitos dos fármacos , Pessoa de Meia-Idade , Placas Oclusais , Medição da Dor , Amplitude de Movimento Articular/efeitos dos fármacos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
J Oral Maxillofac Surg ; 68(4): 797-804, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20307765

RESUMO

PURPOSE: To evaluate the occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients exposed to nitrogen-containing bisphosphonates (NBPs) requiring surgical tooth extraction. PATIENTS AND METHODS: Sixty high-risk patients exposed to NBPs underwent surgical tooth extraction with bone biopsy and were treated with a 7-day cycle of oral antibiotics and discontinuation of NBPs for 1 month. BRONJ was defined as the occurrence of any BRONJ stage (0-3) at 3, 6, or 12 months of follow-up. Inferential analysis was performed on a per-bone (maxilla and/or mandible) basis (n = 72). The time to BRONJ was calculated, and age, gender, cancer diagnosis, and baseline osteomyelitis were evaluated as potential predictors. Exact logistic regression was used to model the time-to-outcome relationship, and hazard rates were calculated from logistic probabilities. RESULTS: BRONJ was detected at 3 months' follow-up in 4 bones and at 6 months in 1 further bone. In the whole cohort of bones, the hazard rate of BRONJ was 5.6% at 3 months and 1.5% at 6 months. Baseline osteomyelitis was a strong risk factor for BRONJ development (odds ratio, 156.96; exact 95% confidence interval, 18.99 to infinity; exact P < .0001). CONCLUSION: In this 12-month follow-up study, BRONJ was a rare outcome in high-risk NBP users who underwent surgical tooth extraction. Moreover, baseline osteomyelitis was a very strong risk factor for BRONJ development.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças Maxilomandibulares/etiologia , Osteonecrose/etiologia , Extração Dentária/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Conservadores da Densidade Óssea/química , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Estudos de Coortes , Difosfonatos/química , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Nitrogênio , Razão de Chances , Osteomielite/complicações , Radiografia , Fatores de Risco , Estatísticas não Paramétricas , Alvéolo Dental/diagnóstico por imagem , Alvéolo Dental/cirurgia , Adulto Jovem
8.
Orbit ; 29(2): 70-5, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20394543

RESUMO

PURPOSE: To report the technique and the outcome of modified (enlarged) enucleation via lateral orbitotomy for choroidal melanomas with massive extrascleral extension. METHODS: 5 patients with choroidal malanoma with massive, circumscribed perioptic/posterior extrascleral extension underwent modified enucleation via lateral orbitotomy. After lateral orbitotomy and orbital mass exposure with direct tumor visualization, a long optic nerve stump was cut and the orbital component of the tumor was completely (macroscopically) removed along with the globe in all cases. After haemostasis and orbital reconstruction an orbital implant was then placed. Follow-up was longer than 12 months. RESULTS: Excellent cosmetic outcome was acheived in all patients (100%) without operative or postoperative complications. At pathologic examination, tumors were completely removed in all cases (100%). CONCLUSIONS: Modified (enlarged) enucleation via lateral orbitotomy for selectd choroidal melanomas with massive, circumscribed perioptic/posterior extrascleral extension allows complete tumor removal and placement of an orbital implant, avoiding the long healing process of orbital exenteration with excellent clinical and cosmetic outcome.


Assuntos
Neoplasias da Coroide/cirurgia , Enucleação Ocular/métodos , Melanoma/cirurgia , Neoplasias Orbitárias/cirurgia , Doenças da Esclera/patologia , Idoso , Neoplasias da Coroide/patologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Órbita/cirurgia , Neoplasias Orbitárias/secundário , Prognóstico
9.
Cranio ; 28(2): 105-13, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20491232

RESUMO

Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.


Assuntos
Bruxismo/diagnóstico , Oclusão Dentária , Transtornos da Articulação Temporomandibular/diagnóstico , Adulto , Artralgia/diagnóstico , Bruxismo/complicações , Oclusão Dentária Central , Oclusão Dentária Traumática/diagnóstico , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Previsões , Humanos , Funções Verossimilhança , Modelos Logísticos , Masculino , Má Oclusão/complicações , Má Oclusão/diagnóstico , Pessoa de Meia-Idade , Razão de Chances , Mordida Aberta/diagnóstico , Osteoartrite/diagnóstico , Sensibilidade e Especificidade , Transtornos da Articulação Temporomandibular/etiologia
10.
Cranio ; 27(3): 200-10, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19697649

RESUMO

This is a case of unilateral masseter muscle hypertrophy (MMH) treated with botulinum toxin (NHAI-normalised hemi-facial asymmetry index improvement from 5.48 to 3.04). After 19 months the treatment was repeated because of hypertrophy relapse (NHAI increase up to 6.82). The volume variations in the masseter area were monitored during 25 months using a laser scanner to compute facial volume. In order to relate the cause of hypertrophy and relapse to the presence of parafunctional activities, a nocturnal electromyography (EMG) study was conducted with positive results (nocturnal parafunctions of patients 4074.99 microV to be compared with a control group value of 1644.63 microV). The lack of the left inferior molars and the consequent right occlusal support seemed to justify the hypertrophy of right masseter (MMRight-POC [percent overlapping coefficient] 91.9%). However, the prosthetic rehabilitation did not prevent relapse in the same muscle. The EMG analysis of both the muscular activation (MMRight-POC 66.0% after relapse) and inhibition activity in Maximum Voluntary Clench (MVC) resulted in contradictory conclusions. At present, the available knowledge regarding MMH physiopathology is very limited and does not support a therapeutic rationale for relapse prevention.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Músculo Masseter/patologia , Doenças Musculares/patologia , Fármacos Neuromusculares/uso terapêutico , Adulto , Cefalometria , Eletromiografia , Lateralidade Funcional , Humanos , Hipertrofia/tratamento farmacológico , Masculino , Músculo Masseter/efeitos dos fármacos , Músculo Masseter/fisiopatologia , Doenças Musculares/tratamento farmacológico , Doenças Musculares/fisiopatologia , Recidiva , Falha de Tratamento
11.
J Craniomaxillofac Surg ; 36(7): 403-9, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18657432

RESUMO

OBJECTIVE: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements' outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, a better standardization of both surgical and post-surgical phases should further improve the efficacy of treatment. MATERIALS AND METHODS: The case report describes the surgical and post-surgical phases of treatment in a patient who underwent a total unilateral joint replacement for TMJ ankylosis, along with a proposal for a post-surgical rehabilitation protocol providing strong passive and active physiotherapy and hyaluronic acid injections to the contralateral joint. RESULTS: The post-operative (PO) course was uneventful. The patient showed a marked improvement up to about 60% in mouth opening and had no pain on either side at the 1-year follow-up. CONCLUSION: In a patient with unilateral TMJ ankylosis, total TMJ replacement was successful. A carefully tailored post-surgical rehabilitation protocol helped the patient to gain a clinically significant improvement in jaw function. Longer follow-up periods are needed to assess the long-term maintenance of results. Clinical trials are strongly recommended to assess the relative efficacy of different PO protocols.


Assuntos
Anquilose/cirurgia , Artroplastia de Substituição/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/cirurgia , Adulto , Artroplastia de Substituição/reabilitação , Terapia por Exercício , Feminino , Seguimentos , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Prótese Articular , Desenho de Prótese , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento , Viscossuplementos/administração & dosagem , Viscossuplementos/uso terapêutico
12.
J Oral Maxillofac Surg ; 66(4): 691-8, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18355592

RESUMO

PURPOSE: To noninvasively assess the facial soft tissues and masticatory muscle function before and after orthognathic surgery. PATIENTS AND METHODS: Eight patients aged 18 to 36 years, all with a skeletal Class III and mandibular asymmetry, were assessed both before (on average, 2 months) and after (on average, 10.5 months) surgical intervention (mandibular reduction by sagittal split osteotomy and Le Fort I maxillary advancement). From the 3-dimensional coordinates of soft tissue facial landmarks, the inclination of facial planes was calculated. Surface electromyography of the masticatory muscles was performed and indices of muscular activity computed. Data were compared with reference values collected in healthy subjects of the same gender, age, and ethnic group. RESULTS: Before surgery, facial planes were significantly less horizontal (frontal plane) than in the reference subjects (P < .05). The sagittal projection of the mandibular plane was more inclined relative to the norm (P < .001). During teeth clenching, all indices of standardized muscular symmetry, torque, and activity (P < .05) were smaller than the reference values. After surgical treatment, the inclinations of facial planes became more homogenous (P < .05). The inclination of the frontal and sagittal planes came next to the reference values, but still differed significantly in the patients (P < .05). The mean symmetry index of masseter muscle, torque coefficient, and pooled muscle activity increased, but the patient values remained significantly under the reference values (P < .05). CONCLUSION: The morphologic and functional approach used in this study proved useful as a complementary diagnostic aid, enabling quantitative evaluation of the final results of surgery, without submitting the patients to invasive procedures.


Assuntos
Cefalometria/métodos , Face/anatomia & histologia , Má Oclusão Classe III de Angle/cirurgia , Músculos da Mastigação/fisiologia , Procedimentos Cirúrgicos Bucais , Adolescente , Adulto , Força de Mordida , Estudos de Casos e Controles , Eletromiografia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Mandíbula/cirurgia , Osteotomia de Le Fort , Valores de Referência , Resultado do Tratamento
13.
Cranio ; 26(2): 126-35, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18468272

RESUMO

The present investigation is a preliminary double-blind, controlled placebo, randomized clinical trial with a six month follow-up period. The study aimed to assess the efficacy of type A botulinum toxin (Botox, Allergan, Inc. Irvine, CA) to treat myofascial pain symptoms and to reduce muscle hyperactivity in bruxers. Twenty patients (ten males, ten females; age range 25-45) with a clinical diagnosis of bruxism and myofascial pain of the masticatory muscles were enrolled in a double-blind, controlled placebo, randomized clinical trial, with a treatment group (ten subjects treated with botulinum toxin injections- BTX-A) and a control group (ten subjects treated with saline placebo injections). A number of objective and subjective clinical parameters (pain at rest and during chewing; mastication efficiency; maximum nonassisted and assisted mouth opening, protrusive and laterotrusive movements; functional limitation during usual jaw movements; subjective efficacy of the treatment; tolerance of the treatment) were assessed at baseline time and at one week, one month, and six months follow-up appointments. Descriptive analysis showed that improvements in both objective (range of mandibular movements) and subjective (pain at rest; pain during chewing) clinical outcome variables were higher in the Botox treated group than in the placebo treated subjects. Patients treated with BTX-A had a higher subjective improvement in their perception of treatment efficacy than the placebo subjects. Differences were not significant in some cases due to the small sample size. Results from the present study supported the efficacy of BTX-A to reduce myofascial pain symptoms in bruxers, and provided pilot data which need to be confirmed by further research using larger samples.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Bruxismo/complicações , Fármacos Neuromusculares/uso terapêutico , Síndrome da Disfunção da Articulação Temporomandibular/tratamento farmacológico , Adulto , Atitude Frente a Saúde , Toxinas Botulínicas Tipo A/administração & dosagem , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Masculino , Músculo Masseter/efeitos dos fármacos , Mastigação/fisiologia , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Medição da Dor , Satisfação do Paciente , Projetos Piloto , Placebos , Músculos Pterigoides/efeitos dos fármacos , Amplitude de Movimento Articular/fisiologia , Músculo Temporal/efeitos dos fármacos , Síndrome da Disfunção da Articulação Temporomandibular/etiologia , Síndrome da Disfunção da Articulação Temporomandibular/fisiopatologia , Resultado do Tratamento
14.
Prog Orthod ; 9(2): 8-19, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19350055

RESUMO

BACKGROUND: Current methodologies in the prevision of post-surgical features of the face in orthognathic surgery are mainly 2-D. An improvement is certainly given by the introduction of CT, but its acceptance is controversial due to its high biological cost. As an alternative, in this study an effective procedure for the construction of a 3-D textured digital model of the face and dental arches of patients with dentofacial malformations using a 3-D laser scanner at no biological cost is presented. METHODS: A 3-D Laser scanner Konica-Minolta VIVID 910 is used to obtain multiple scans from different perspectives of the face of patients with dentofacial malocclusions requiring orthognathic surgery. These multiple views are then recombined, integrating also the maxillary and mandibular arch plaster casts, to obtain the 3-D textured model of the face and occlusion with minimal error. RESULTS: A viable methodology was identified for the face and occlusal modeling of orthognathic patients and validated in a test case, confirming its effectiveness: the 3-D model created accurately describes the actual features of the patient's face; the proposed methodology can be easily applied in the clinical routine to accurately record the steps of the surgical treatment and to perform accurate anthropometric analyses of the facial morphology, and thus constitute the necessary database for the development of previsional tools in orthognathic surgery. CONCLUSIONS: The proposed method is effective in recording all the morphological facial features of patients with dentofacial malformations, to develop a facial modification database and tools for virtual surgery.


Assuntos
Bases de Dados como Assunto , Face , Imageamento Tridimensional , Má Oclusão/cirurgia , Adulto , Cefalometria , Arco Dental/patologia , Arco Dental/cirurgia , Feminino , Previsões , Humanos , Processamento de Imagem Assistida por Computador/métodos , Lasers , Masculino , Mandíbula/patologia , Mandíbula/cirurgia , Maxila/patologia , Maxila/cirurgia , Modelos Dentários , Ortodontia Corretiva , Planejamento de Assistência ao Paciente , Interface Usuário-Computador , Adulto Jovem
15.
Br J Oral Maxillofac Surg ; 45(2): 138-44, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16483700

RESUMO

Nine patients aged between 18 and 35 years who had severe skeletal Class III malocclusion and moderate-to-severe mandibular asymmetry, were assessed by a non-invasive, landmark-based, three-dimensional system before and after mandibular reduction by sagittal split osteotomy and LeFort I maxillary advancement. The three-dimensional coordinates of 50 facial soft tissue landmarks were collected, and a series of anthropometric measurements was calculated and compared with reference values from 240 healthy subjects of similar sex, age, and ethnic group. Patients were more asymmetrical than normal subjects before the operations, particularly in the gonion. Postoperatively, total and lateral asymmetry was considerably reduced. The three-dimensional approach was a valuable complementary diagnostic aid that enabled quantitative evaluation of the final soft-tissue results without invasive procedures.


Assuntos
Cefalometria/métodos , Face/anatomia & histologia , Imageamento Tridimensional/métodos , Má Oclusão Classe III de Angle/cirurgia , Procedimentos Cirúrgicos Bucais , Adolescente , Adulto , Estudos de Casos e Controles , Assimetria Facial/etiologia , Assimetria Facial/patologia , Assimetria Facial/cirurgia , Feminino , Humanos , Masculino , Má Oclusão Classe III de Angle/complicações , Má Oclusão Classe III de Angle/patologia , Valores de Referência , Resultado do Tratamento
16.
J Oral Maxillofac Res ; 5(1): e6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24800055

RESUMO

BACKGROUND: The literature on total alloplastic temporomandibular joint (TMJ) reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant. METHODS: The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries. RESULTS: Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion. CONCLUSIONS: Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries) and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated) should be better standardized and define in future studies.

17.
Stomatologija ; 15(2): 54-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24037303

RESUMO

The present paper describes the design features, potential indications and a clinical application of a newly designed device for jaw motion rehabilitation, the Spring-Bite. This device is characterized by a first class lever mechanism, which allows performing passive jaw motion rehabilitation at constant load without an active participation by the patient. Spring-Bite was developed for the management of temporomandibular joint (TMJ) hypomobility and its application may be much useful in the post-operatory phases of TMJ or orthognathic surgeries as well as in patients with reduced muscular force.


Assuntos
Má Oclusão Classe III de Angle/cirurgia , Aparelhos Ortodônticos , Transtornos da Articulação Temporomandibular/reabilitação , Humanos , Masculino , Má Oclusão Classe III de Angle/complicações , Má Oclusão Classe III de Angle/reabilitação , Músculos da Mastigação/fisiopatologia , Desenho de Aparelho Ortodôntico , Osteotomia de Le Fort , Amplitude de Movimento Articular , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/cirurgia , Trismo/reabilitação , Adulto Jovem
18.
Oral Maxillofac Surg ; 16(2): 221-5, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21938392

RESUMO

BACKGROUND: The present paper reported the case of a trauma-related myositis ossificans, with focus on considerations for a differential diagnosis process. CASE REPORT: A 50-year-old male with a severe painful limitation (12 mm) of jaw opening referred a trauma to the right temporomandibular joint (TMJ) area occurring about 40 days before. Posttraumatic TMJ ankylosis was ruled out on the basis of negative magnetic resonance and cone-beam computerized tomography findings, and the patient underwent treatment with arthrocentesis, botulinum toxin injections, and physiotherapy on the basis of two diagnostic hypotheses, viz., an anchored disk phenomenon or a myofibrotic contracture of the right masseter muscle due to prolonged myospasm. After 4 months, jaw opening was slightly increased to 23 mm, but limitation and pain persisted. A new CT was performed to investigate for the emerging clinical picture compatible with traumatic myositis ossificans of the right temporalis muscle. Once the diagnosis was confirmed, the patient underwent surgery for coronoidectomy. At the 6-month follow-up, mouth opening was increased to up to 35 mm and pain was absent. DISCUSSION: It is fundamental that patients suspected of having uncommon clinical pictures leading to mouth opening restriction are promptly referred to specialized centers, where the differential diagnosis process should be based on a comprehensive assessment taking into account for the potential etiologic factors described in the literature.


Assuntos
Anquilose/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Contratura/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Miosite Ossificante/diagnóstico por imagem , Músculo Temporal/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/lesões , Anquilose/cirurgia , Contratura/cirurgia , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miosite Ossificante/cirurgia , Amplitude de Movimento Articular/fisiologia , Músculo Temporal/cirurgia , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/cirurgia
19.
Oral Oncol ; 47(5): 420-4, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21439892

RESUMO

Surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is controversial. Current recommendations contraindicate aggressive surgery because its results are unpredictable and may trigger disease progression. In this prospective study, we assessed the effectiveness of surgical resection of the jaws in cancer patients with BRONJ. Between June 2004 and July 2009, 30 cancer patients with refractory BRONJ underwent surgical resection of the jaws at our Units. They were followed-up weekly for the first month, at 3-month intervals up to 1 year, and at 6-month intervals up to 2 years. Panoramic radiographs and CT-scan were obtained at 3, 6, 12, 18 and 24 months. Primary outcomes were the 24-month recurrence rate of BRONJ and the 24-month mortality rate. Secondary outcomes were post-operative complications, duration of hospital stay after surgery, time to return to oral diet, and degree of oral pain. The 30 patients had a median age of 66 years and were mostly females (80%). Twenty-eight underwent a single resection and two had both jaws resected, for a total of 32 resected jaws. The cumulative recurrence rate of BRONJ in resected jaws 3.1% and 9.4% at 3 and 6 months, respectively. All the jaws with recurrent BRONJ had osteomyelitis at the margins of bone resection. The cumulative incidence of death was 3%, 12% and 16% at 12, 18 and 24 months. Surgical resection of BRONJ was highly effective, with few post-operative complications and were not associated with long-term mortality.


Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Doenças Maxilomandibulares/cirurgia , Osteonecrose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/complicações , Feminino , Humanos , Doenças Maxilomandibulares/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Osteonecrose/induzido quimicamente , Estudos Prospectivos , Neoplasias da Próstata/complicações , Resultado do Tratamento
20.
Oral Maxillofac Surg ; 14(1): 29-34, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19821126

RESUMO

AIM: To provide data on the short-term effect of a cycle of five weekly arthrocenteses plus hyaluronic acid injections in the management of signs and symptoms of painful disc displacements. METHODS: Thirty-one consecutive patients (25 females, six males; mean age 42.4) with a combined diagnosis of disc displacement with reduction and arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent a cycle of five arthrocenteses with injections (one per week) of 1 ml hyaluronic acid. A number of subjective and objective clinical parameters were assessed at the time of the diagnosis (baseline), at each appointment during the treatment, at the end of the treatment, and three follow-up appointments (1 week, 1 month, and 3 months). RESULTS: At the end of the treatment period, marked improvements with respect to baseline values were recorded in all the outcomes variables, and they were maintained over the 3-month follow-up span. Significant changes were shown in subjective outcome variables, viz., masticatory efficiency, maximum pain levels, functional limitation, perceived efficacy, and objective clinical parameters, viz., jaw range of motion on different movements. Tolerability of treatment was acceptable since the first intervention and was moderately improved over time. CONCLUSIONS: A cycle of five weekly hyaluronic acid injections performed immediately following arthrocentesis is effective to improve signs and symptoms in patients with painful temporomandibular joint disc displacement with reduction and to maintain them over a 3-month follow-up.


Assuntos
Artralgia/terapia , Ácido Hialurônico/administração & dosagem , Luxações Articulares/terapia , Paracentese , Disco da Articulação Temporomandibular , Articulação Temporomandibular , Adulto , Artralgia/diagnóstico , Terapia Combinada , Feminino , Seguimentos , Humanos , Injeções Intra-Articulares , Luxações Articulares/diagnóstico , Masculino , Pessoa de Meia-Idade , Medição da Dor
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