Morphometric analysis of the Korean mandibular ramus for distraction osteogenesis using micro-computed tomography.

When performing distraction osteogenesis, the osteotomy is normally applied to the cortical bone posterior to the mandibular second molar. We measured the topographic thickness of the cortical and trabecular bone of the mandibular ramus and at the mandibular canal (MC) to provide crucial anatomic data aimed at minimizing complications and elucidating the most appropriate site for placing the distractor. Forty sides of the mandibles were prepared from 20 Korean cadavers (10 men and 10 women with a mean age of 68 years). The specimens were scanned and reconstructed into three-dimensional images using a micro-computed tomography system. Coronal and horizontal sectional images of the mandibular ramus were taken at thickness intervals of 2 mm from the reconstructed three-dimensional images. Image analysis software was used to measure the thicknesses of the cortical and trabecular bone and to identify the locations of the MC within the body and the mandibular ramus on each section. The mean thicknesses of the buccal cortical plate, trabecular bone, and lingual cortical plate were 2.9 mm (men, 3.0 mm; women, 2.8 mm), 9.1 mm (men, 9.8 mm; women, 8.5 mm), and 2.2 mm (men, 2.3 mm; women, 2.1 mm), respectively. The distance from the buccal surface of the mandible to the MC increased from 5.3 to 10.0 mm (men, 5.3-10.0 mm; women, 5.3-9.1 mm) when moving progressively anterosuperior from the mandibular angle region. Morphometric analyses of the mandibular ramus can provide crucial data when performing mandibular osteotomy and locating an appropriate placement site for a distractor device during the distraction-osteogenesis procedure.

Total alloplastic temporomandibular joint reconstruction combined with orthodontic treatment in a patient with idiopathic condylar resorption.

This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic improvement.

Scrambler therapy for the treatment of neuropathic pain related to leukemia in a pediatric patient: A case report.

RATIONALE: Cancer-related neuropathic pain often responds poorly to standard pain treatments. Scrambler therapy has relieved refractory chronic pain in several uncontrolled clinical trials. PATIENT CONCERNS: An 11-year-old female patient was suffering from left groin and medial thigh pain after irradiation to the knee. The girl was diagnosed with precursor B-cell lymphoblastic leukemia 2 years ago. Extramedullary relapse of leukemia developed 1 month ago and pain had started. She was treated with oral medications, but she was continuously complaining of severe pain. DIAGNOSIS: Neuropathic pain caused by obturator nerve involvement in leukemia. INTERVENTION: Scrambler therapy. OUTCOME: Pain reduction. LESSONS: Scrambler therapy is noninvasive, is not associated with any complications, causes minimal discomfort during treatment, and is very effective in a pediatric patient with cancer-related neuropathic pain.

Magnetic resonance imaging characteristics of synovial chondromatosis of the temporomandibular joint.

AIMS: To determine the characteristic magnetic resonance imaging (MRI) findings of synovial chondromatosis of the temporomandibular joint (TMJ). METHODS: MRI was carried out in 11 cases of synovial chondromatosis of the TMJ, which had been confirmed surgically and histologically. RESULTS: Severe bony changes were not apparent. One or more hypointensive loose bodies were seen in 7 of the 11 cases. A considerable amount of synovial fluid, often with capsular expansion, was a common finding. CONCLUSION: A diagnosis of synovial chondromatosis of the TMJ must be considered when the amount of synovial fluid is abnormally large and the disc position is fairly normal, as seen on closed- and open-mouth MRI of the TMJ, without any associated severe changes in disc shape or bony structure.

Magnetic resonance imaging of temporomandibular joint synovial fluid collection and disk morphology.

OBJECTIVE: The purpose of this study was to determine the features of synovial fluid, the shape of the disk, and the presence of disk displacement without reduction (DDsR) of the temporomandibular joint. STUDY DESIGN: A total of 612 bilateral temporomandibular magnetic resonance images of 306 patients were reviewed. The status of the joint was categorized as follows: normal disk position, disk displacement with reduction, acute DDsR, subacute DDsR, and chronic DDsR. The disk shape was characterized as one of following: biconcave, cap-shaped, cup-shaped, flattened, eyeglass-shaped, amorphous, or discontinuous. The amount of synovial fluid was divided into 4 categories: not observed, small, moderate, or large. RESULTS: Synovial fluid collection was observed more frequently with subacute DDsR and when the disk was a folded shape. CONCLUSION: Synovial fluid collection, which was observed on T2-weighted magnetic resonance images, is more frequent in the early stage of DDsR. In addition, high signal intensity within the disk space should be considered a simple matter of fluid collection.

Endotracheal tube intubation with the aid of a laryngeal mask airway, a fiberoptic bronchoscope, and a tube exchanger in a difficult airway patient: a case report.

A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations.

Alloplastic total temporomandibular joint replacement using stock prosthesis: a one-year follow-up report of two cases.

Alloplastic total replacement of the temporomandibular joint (TMJ) was developed in recent decades. In some conditions, previous studies suggested the rationale behind alloplastic TMJ replacement rather than reconstruction with autogenous grafts. Currently, three prosthetic products are available and approved by the US Food and Drug Administration. Among these products, customized prostheses are manufactured, via computer aided design/computer aided manufacturing (CAD/CAM) system for customized design; stock-type prostheses are provided in various sizes and shapes. In this report, two patients (a 50-year-old female who had undergone condylectomy for the treatment of osteochondroma extending to the cranial base on the left condyle, and a 21-year-old male diagnosed with left temporomandibular ankylosis) were treated using the alloplastic total replacement of TMJ using stock prosthesis. The follow-up results of a favorable one-year, short-term therapeutic outcome were obtained for the alloplastic total TMJ replacement using a stock-type prosthesis.

[Total alloplastic temporomandibular joint reconstruction combined with orthodontic treatment in a patient with idiopathic condylar resorption]. / Reconstitutions totales des articulations temporo-mandibulaires par des implants alloplastiques combinées à un traitement d'orthodontie dans un cas de résorption condylienne idiopathique∗

This case report describes the successful treatment of an adult patient with skeletal Class II open-bite malocclusion secondary to idiopathic condylar resorption. Total alloplastic joint reconstruction and counterclockwise rotation of the maxillomandibular complex combined with orthodontic treatment provided a satisfying outcome with maximum functional and esthetic improvement.

Clinical and radiological findings of discogenic low back pain confirmed by automated pressure-controlled discography.

OBJECTIVE: Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. METHODS: Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. RESULTS: Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. CONCLUSION: APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.

Treatment of primary snoring using radiofrequency-assisted uvulopalatoplasty.

Laser-assisted uvulopalatoplasty (LAUP) reduces the need for general anesthesia, bleeding and the operation time compared with uvulopalatopharyngoplasty (UPPP), but the postoperative pain is more severe due to the thermal damage to tissues, and the procedure often causes serious scar contracture of the soft palate, with foreign body sensation also occurring occasionally. Radiofrequency-assisted uvulopalatoplasty (RAUP) uses the same surgical method as LAUP, but employs RF instead of laser. RF surgery induces temperatures of 70-85 degrees C, and causes less damage to the surrounding tissues. Thus, on the assumption that it may reduce problems in LAUP, we applied LAUP and RAUP at random to patients with primary snoring, and compared the results of the two types of operation and both their advantages and disadvantages. Forty-four patients with primary snoring but without apnea were prospectively evaluated with a follow-up period of 6 months: 20 patients received LAUP and 24 patients received RAUP. Postoperative changes in the subjective degree of snoring, the Epworth sleepiness scale score, and the operation time, postoperative pain, episodes of delayed bleeding, globus sensation and scar contracture were compared between the two surgical methods. Snoring symptoms, ESS scores and episodes of delayed bleeding did not differ significantly between the two groups. The operation time was shorter in the LAUP group, and the postoperative pain and postoperative complications (globus sensation and scar contracture) were less in the RAUP group. RAUP results in significantly lower postoperative pain, complications and other problems experienced in LAUP, while maintaining the advantages of LAUP.