MRI changes and clinical characteristics in temporomandibular joints with displacement of the articular disk without reduction - a cross-sectional observational study.

OBJECTIVES: This study examined changes in magnetic resonance imaging (MRI) of temporomandibular joints (TMJ) with anterior displacement disk without reduction (DDwoR) and its correlation to clinical symptoms. METHODS: 190 individuals with DDwoR were evaluated according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and MRI. Pain's chronicity/intensity and limited mouth opening (locking) were correlated with: TMJ degeneration (MRI T1), effusion (T2), disc's shape and position (proton density). RESULTS: In 103 TMJ with DDwoR, hemiconvex shape (41.6%), sclerosis (45.6%) and mild effusion (47.6%) were the most prevalent findings. There was not association (p > .05) between: different DDwoR positions with pain's intensity/chronicity; effusion with locking. Disk deformation was associated with degeneration (p = .034) and pain's intensity (p = .006). Locking was associated with degeneration (p = .05). CONCLUSIONS: Condylar osteodegeneration is often related to DDwoR. Locking by DDwoR is associated with severe levels of chronic pain and articular disk deformation.

High-frequency (22-MHz) ultrasound for assessing the depth of basal cell carcinoma invasion.

BACKGROUND: High-frequency ultrasound (HFUS) has been studied in the diagnosis and therapeutic management of basal cell carcinoma (BCC). The accuracy of this method for location of deep margins remains unknown. This study evaluates HFUS for localization of deep surgical margins in BCC. MATERIALS AND METHODS: Ultrasound images of 83 lesions from 67 patients with clinical and dermoscopic diagnosis of BCC were compared with histopathological findings. Pearson's correlation coefficient was used to assess the relationship between thickness as measured by HFUS and histopathology. RESULTS: A strong correlation between HFUS and histopathological measurements was identified (r = 0.9744, P < .001). HFUS had sensitivity of 96%, specificity of 84%, and accuracy of 91% for measurement of deep tumor margins. Factors affecting tumor measurement on HFUS include marked basophilic degeneration of collagen, presence of peritumoral hypertrophic glands or hair follicles, fibrosis, and dense inflammatory changes related to the tumor itself or to prior procedures. CONCLUSION: High-frequency ultrasound was effective in localizing deep tumor margins in BCC. Therefore, we believe that this diagnostic imaging method is important when selecting a therapeutic approach, considering Mohs micrographic surgery, and evaluating the surgical site.

Anatomical evaluation of the relationship between the maxillary posterior teeth and maxillary sinus.

Knowledge of the anatomical relationships between the maxillary sinus (MS) and posterior teeth is important to prevent complications when endodontic or oral surgical procedures are performed. The aim of this study was to evaluate the relationships between the root apices of maxillary posterior teeth and the MS floor. Three oral radiologists evaluated 851 posterior teeth (1969 roots) imaged with cone beam computed tomography. The roots were analyzed individually in parasagittal sections, on which the most superior point of the apex was observed. A qualitative evaluation was performed, and each root was assigned a proximity score: 1, root invaginating the MS; 2, root in close contact with the MS floor; 3, root with no relationship with the MS; and 4, root with a measurable proximity to the MS. For roots classified as score 4, the distance to the MS floor was measured (quantitative analysis). Student t tests, 1-way analysis of variance, and simple linear regression analysis were performed (P < 0.05). The qualitative analysis revealed that the mesiobuccal root of the second molar had a pronounced proximity to the MS. The quantitative analysis revealed no differences in distance to the MS between right and left posterior teeth or between the different roots of the same tooth. In relation to the MS, the second molar was positioned closest, followed by the first molar, second premolar, and first premolar. Except for the comparison between mean distances of the second premolar and first molar (P = 0.11), the differences between groups of teeth were statistically significant (P < 0.05). Simple linear regression analysis showed that the more posterior the tooth was in relation to the midline, the shorter the mean distance from the root apex to the MS floor (P < 0.05). The mesiobuccal roots of second molars were closest to the MS. Second molars exhibited the shortest distances between their root apices and the MS and the greatest number of roots that were invaginating or in close contact with the MS. Therefore, second molars require special attention when endodontic or oral surgical approaches involve those regions.

Combined high-frequency and Doppler ultrasound in early diagnosis of atrophoderma of Pasini and Pierini.

Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Periapical and Endodontic Status Scale for Endodontically Treated Teeth and Their Association with Maxillary Sinus Abnormalities: A Cone-beam Computed Tomographic Study.

INTRODUCTION: This retrospective cross-sectional study investigated the applicability of the periapical and endodontic status scale (PESS) to determine the association of endodontically treated teeth with maxillary sinus (MS) abnormalities through cone-beam computed tomographic imaging. METHODS: A total of 631 endodontically treated teeth were analyzed. MS abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification. The PESS was used to evaluate the quality of endodontic treatment as well as periapical tissue conditions. The data were analyzed by chi-square tests (P < .05). RESULTS: MS abnormalities were detected in 70.52% of the sample, with a greater prevalence of mucosal thickening (38.19%), whereas periapical lesions were observed in 55.94% of the cases. Treated root canals with unsatisfactory filling, homogeneity, and coronal sealing had an odds Ratio (OR) of 2.21, 2.88, and 2.99, respectively (P < .001). Periapical lesions larger than 5 mm (OR = 314.95), in more than 1 root (OR = 3.72), involving the furcation region (OR = 5.21), in contact with important structures (OR = 7.37), and with cortical bone destruction (OR = 4.09) were significantly related to the presence of MS abnormalities (P < .001). An OR of 99,668 was observed in periostitis lesions greater than 5 mm (P < .001). CONCLUSIONS: The PESS proved to be an important tool for the analysis of endodontic and periapical conditions and was applicable to determine potential associations with MS abnormalities.

Combined high-frequency and Doppler ultrasound in early diagnosis of atrophoderma of Pasini and Pierini

Abstract: Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery.

OBJECTIVE: The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients. METHODS: The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software. RESULTS: The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups. CONCLUSIONS: Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients. These slides can be retrieved under Electronic Supplementary Material.

Effectiveness of Sequential Viscosupplementation in Temporomandibular Joint Internal Derangements and Symptomatology: A Case Series.

Viscosupplementation is a minimally invasive technique that replaces synovial fluid by intra-articular injection of hyaluronic acid (HA). Although effective in some joints, there is not conclusive evidence regarding temporomandibular disorders. This case series described the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles.

Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever.

The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.

miRNAs: Important Targets for Oral Cancer Pain Research.

Pain is a symptom shared by an incredible number of diseases. It is also one of the primary conditions that prompt individuals to seek medical treatment. Head and neck squamous cell carcinoma (HNSCC) corresponds to a heterogeneous disease that may arise from many distinct structures of a large, highly complex, and intricate region. HNSCC affects a great number of patients worldwide and is directly associated with chronic pain, which is especially prominent during the advanced stages of oral squamous cell carcinoma (OSCC), an anatomical and clinical subtype that corresponds to the great majority oral cancers. Although the cellular and molecular bases of oral cancer pain have not been fully established yet, the results of recent studies suggest that different epigenetic mechanisms may contribute to this process. For instance, there is strong scientific evidence that microRNAs (miRNAs), small RNA molecules that do not encode proteins, might act by regulating the mechanisms underlying cancer-related pain. Among the miRNAs that could possibly interfere in pain-signaling pathways, miR-125b, miR-181, and miR-339 emerge as some of the most promising candidates. In fact, such molecules apparently contribute to inflammatory pain. Moreover, these molecules possibly influence the activity of endogenous pain control systems (e.g., opioidergic and serotonergic systems), which could ultimately result in peripheral and central sensitization, central nervous system (CNS) phenomena innately associated with chronic pain. This review paper focuses on the current scientific knowledge regarding the involvement of miRNAs in cancer pain, with special attention dedicated to OSCC-related pain.

Ultrassonografia de alta frequência (22MHz) na identificação e remoção de ferrão de arraia / High-frequency ultrasonography (22MHz) for identification and removal of a rayfish stinger

A presença de corpos estranhos localizados na pele, sua dimensão, constituição e exata localização muitas vezes não são perceptíveis ao exame clínico dermatológico. Apesar de seu caráter benigno, a existência de corpos estranhos à pele provocam alta morbidade. A ultrassonografia de alta frequência tem sido amplamente utilizada nas diferentes áreas da Dermatologia. O avanço tecnológico com a introdução de aparelhos de alta frequência e resolução torna esse método útil na identificação e orientação da remoção de corpos estranhos localizados na pele. Apresentamos caso em que a ultrassonografia de alta frequência foi utilizada na identificação e retirada de um ferrão de arraia.

The presence of foreign bodies located on the skin, their size, constitution and precise location are often not perceptible on dermatological clinical examination. Despite their benign nature, the presence of foreign bodies in the skin is associated to high morbidity. High frequency ultrasonography has been widely used in different areas of Dermatology. Technological development and the introduction of devices offering high frequency and high resolution makes this method useful in identifying and guiding the removal of foreign bodies located in the skin. The authors describe a case where high frequency ultrasonography was used to identify and remove a rayfish stinger.

High frequency ultrasound with color Doppler in dermatology.

Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.

Diagnosis of temporomandibular joint disorders: indication of imaging exams / Diagnóstico das disfunções da articulação temporomandibular: indicação dos exames por imagem

ABSTRACT INTRODUCTION: Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE: To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS: Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS: Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION: Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Resumo Introdução: O conhecimento dos distintos exames de imagem e sua correta indicação é fundamental para elaboração do diagnóstico das disfunções temporomandibulares, principalmente em pacientes com grande sobreposição de sinais e sintomas. Objetivo: Apresentar e avaliar os principais exames de diagnóstico por imagem das disfunções temporomandibulares, além de discutir racionalmente os seus critérios de indicação, vantagens e desvantagens. Método: Revisão da literatura nas bases de dados Web of Knowledge, PubMed e SciELO, além de busca manual por publicações relevantes nas listas de referências dos artigos selecionados. Resultado: Os exames de tomografia computadorizada e ressonância magnética foram considerados ''padrão-ouro'' para a avaliação dos tecidos duros e moles, respectivamente, da articulação temporomandibular. Cada método de diagnóstico pesquisado apresentou sensibilidade e especificidade distintas para os diferentes subtipos de disfunção da articulação. Conclusão: Considera-se como racional a indicação fundamentada na acurácia, segurança e relevância clínica do exame a ser solicitado, o que implica na adequada determinação do diagnóstico e do plano de tratamento.

High frequency ultrasound with color Doppler in dermatology

Abstract: Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.

Diagnosis of temporomandibular joint disorders: indication of imaging exams.

INTRODUCTION: Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE: To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS: Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS: Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION: Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Magnetic Resonance Image Evaluation of Temporomandibular Joint Osteophytes: Influence of Clinical Factors and Artrogenics Changes.

This research aims to examine the presence of osteophyte in patients with arthrogenic temporomandibular disorders through magnetic resonance imaging (MRI); to investigate the influence of sex and clinical symptoms in its prevalence; and the position of the osteophytes in the condyle. The study was based on 100 MRI and on reports of patients, which corresponded to the evaluation of 200 joints. Patients of both sexes were aged from 18 to 82 years (average = 49.48) and were subjected to the aforementioned examination from January 2006 to March 2009. The assessment considered the type of disc displacement, the presence of effusion, bone marrow edema, condyle changes, joint noise and pain. The MRI machine used was the GE Signa HDX (General Electric, Milwaukee, WI), with T1 and T2-weighted, 1.5 T magnetic field, sagittal oblique (mouth closed, mouth open) and coronal (mouth closed) imaging, with spherical surface coil and an asymmetric matrix. All images were interpreted by an experienced radiologist. A total of 28% (n = 56) of the temporomandibular joints showed osteophytes on the anterior surface of the mandible. No relationship was found between sex and osteophytes. The authors found a statistically significant difference between osteophytes and disc displacement without reduction (P < 0.001). The presence of osteophytes suggested a possible cause and effect relationship between osteoarthritis and disc displacement without reduction; the osteophyte was always located in the anterior surface of condyle, regardless of the sex variable; no significant difference was found between osteophytes and the main complaints of the patient.

Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation.

The present essay is aimed at getting the radiologist familiar with the basic histological skin structure, allowing for a better correlation with sonographic findings. A high-frequency (22 MHz) ultrasonography apparatus was utilized in the present study. The histological analysis was performed after the skin specimens fixation with formalin, inclusion in paraffin blocks and subsequent staining with hematoxylin-eosin. The authors present a literature review showing the relationship between sonographic and histological findings in normal cutaneous tissue, and discuss the technique for a better performance of the sonographic scan. High-frequency ultrasonography is an excellent tool for the diagnosis of different skin conditions. However, as this method is operator-dependent, it is crucial to understand the normal skin structure as well as the correlation between histological and sonographic findings.

O objetivo deste trabalho é familiarizar o radiologista com a estrutura histológica cutânea, o que torna possível uma melhor correlação dos achados ultrassonográficos da pele. Para o exame radiológico foi utilizado aparelho de ultrassom de alta frequência (22 MHz). O exame histológico foi realizado após fixação do material em formol, inclusão em parafina e coloração com hematoxilina-eosina. Os autores fazem uma revisão da literatura, demonstram a relação dos achados ultrassonográficos e histológicos do tecido cutâneo normal e discutem a técnica para o melhor aproveitamento do exame ultrassonográfico da pele. O ultrassom de alta frequência representa uma excelente ferramenta no diagnóstico das diferentes alterações cutâneas. Como o método é operador-dependente, é crucial o perfeito entendimento da pele normal e sua equivalência histológica/ultrassonográfica.

A Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint.

The aim of this study was to evaluate the presence of degenerative bone changes of the temporomandibular joint (TMJ) in individuals suffering from sleep bruxism (SB), associating these characteristics with the quality of sleep. For this, we followed the International Classification of Sleep Disorders for the diagnosis of SB, in addition to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the classification of TMD and cone beam computed tomography. It was found that 97.7% of the individuals with bruxism had at least 1 RDC/TMD group III diagnosis, 75.6% of the subjects considered their sleep quality as poor, and the largest group (23%) had centric bruxism. There was no significant association between the pattern of sleep quality (P = 0.36), the type of SB (P = 0.277), and the presence of degenerative changes of the TMJ. Regardless of the quality of sleep and the type of bruxism presented, the prevalence of degenerative bone disorders was high (67%) among women with a mean age of 46 years and a clinical diagnosis of SB.

Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation / Estudo da anatomia cutânea com ultrassom de alta frequência (22 MHz) e sua correlação histológica

AbstractThe present essay is aimed at getting the radiologist familiar with the basic histological skin structure, allowing for a better correlation with sonographic findings. A high-frequency (22 MHz) ultrasonography apparatus was utilized in the present study. The histological analysis was performed after the skin specimens fixation with formalin, inclusion in paraffin blocks and subsequent staining with hematoxylin-eosin. The authors present a literature review showing the relationship between sonographic and histological findings in normal cutaneous tissue, and discuss the technique for a better performance of the sonographic scan. High-frequency ultrasonography is an excellent tool for the diagnosis of different skin conditions. However, as this method is operator-dependent, it is crucial to understand the normal skin structure as well as the correlation between histological and sonographic findings.

ResumoO objetivo deste trabalho é familiarizar o radiologista com a estrutura histológica cutânea, o que torna possível uma melhor correlação dos achados ultrassonográficos da pele. Para o exame radiológico foi utilizado aparelho de ultrassom de alta frequência (22 MHz). O exame histológico foi realizado após fixação do material em formol, inclusão em parafina e coloração com hematoxilina-eosina. Os autores fazem uma revisão da literatura, demonstram a relação dos achados ultrassonográficos e histológicos do tecido cutâneo normal e discutem a técnica para o melhor aproveitamento do exame ultrassonográfico da pele. O ultrassom de alta frequência representa uma excelente ferramenta no diagnóstico das diferentes alterações cutâneas. Como o método é operador-dependente, é crucial o perfeito entendimento da pele normal e sua equivalência histológica/ultrassonográfica.

Ear Acupuncture Therapy for Masticatory Myofascial and Temporomandibular Pain: A Controlled Clinical Trial.

Ear acupuncture works by reducing painful sensations with analgesic effect through microsystem therapy and has been demonstrated to be as effective as conventional therapies in the control of facial pain. This clinical trial aimed to evaluate the adjuvant action of auricular acupuncture through an observation of the evolution of temporomandibular and masticatory myofascial symptoms in two groups defined by the therapies elected: auricular acupuncture associated with occlusal splint (study) and the use of the occlusal splint plate alone (control). We have selected 20 patients, who were randomly allocated into two groups of ten individuals. Symptoms were evaluated in five different moments, every seven days. We analyzed the orofacial muscle and joint palpation in order to measure the intensity of the experienced pain. Both groups showed a statistically significant decrease in muscle and joint symptoms (p < 0.05). However, comparisons between the groups showed an expressive and significant reduction of symptomatology in the study group (p < 0.05) already on the first week of therapy. According to the results, to the methodological criteria developed and statistical analysis applied, the conclusion is that auricular acupuncture therapy has synergistic action on conventional occlusal splint treatment. It was demonstrated to be effective in the reduction of symptoms in the short term.