[Bilateral hyperplasia of the coronoid process in an adolescent patient. case report]. / Hiperplasia bilateral de la apófisis coronoides en paciente adolescente. reporte de caso.

Hyperplasia of the coronoid process is a rare alteration that is characterized by the exaggerated and progressive development of said process over periods of months or years, both in height and volume, which finally causes mandibular hypomobility. It is important to highlight the importance of imaging for the correct diagnosis and treatment of said entity, taking into consideration the great variety of differential diagnoses that can occur. In this sense, conventional radiographs constitute a basic and indispensable tool for approaching the diagnosis. However, it is actually the CT scan that offers the greatest precision. The case of a 14-year-old male patient is presented, with no contributing medical history, who was referred for presenting progressive opening limitation since childhood, for which, after clinical and imaging evaluation, he was treated with total bilateral coronoidectomy, postoperative follow-up was performed. for a year in which recurrence of said entity could be observed. This case demonstrates the importance of correct diagnosis, as well as postoperative control and the rehabilitation scheme carried out by the patient.

[Magnetic resonance arthrography with physiological saline solution in the diagnosis of temporomandibular joint disc perforation. Case report]. / Artrografía mediante resonancia magnética con solución fisiológica en el diagnóstico de la perforación del disco de la articulación temporomandibular. Reporte de caso.

Partial or total perforation of the articular disc is mainly observed in the final stage of temporomandibular disorder. Magnetic resonance imaging (MRI) is considered the gold standard for the diagnosis of joint pathologies; MRI arthrography consists of the infiltration of a contrast medium into a joint, being Gadolinium chelates the most employed medium, however, possible harmful effects have been associated with its use. The aim of this work was to evaluate a case of perforation of the articular disc of the temporomandibular joint by MRI arthrography using physiological solution (NaCl 0.9%) as contrast medium. MR images were obtained with a STIR (Short Tau Inversion Recovery) weighted pulse sequence in the sagittal and coronal planes at maximum mouth opening, after the injection of the physiological solution in the superior articular space. The communication of both articular spaces was identified, observing a greater filling in the inferior articular space, as well as the latero-medial displacement of the disc segments. Arthrography with physiological solution allowed the precise diagnosis of the perforation, which made it possible to guide the treatment plan, reducing diagnostic and surgical times, also considering the reduction of complications and adverse effects related to other contrast media, added to the benefit of the reduction of the cost of the exam.

[Peri-implantitis: current concepts about its etiology, clinical and imaging characteristics. A review]. / Periimplantitis: conceptos actuales sobre su etiología, características clínicas e imagenológicas. Una revisión.

Peri-implantitis (PI) is the inflammatory reaction of the peri-implant mucosa, accompanied by the progressive loss of supporting bone around the implant, which can compromise its stability, function and aesthetics. It is diagnosed by radiographic measurement of the alveolar bone level, with or without clinical symptoms of inflammation and a probing depth greater than 4 mm. The objective of this work was to review the scientific evidence on the prevalence, etiology, predisposing factors, clinical behavior and imaging characteristics of PI. An electronic search was carried out in Google Scholar, PubMed and Scielo, considering the period between 2010-2022, and a total of 40 articles were selected. It is concluded that the main etiological agent of PI is the biofilm, however, its appearance and severity may be associated with the presence of predisposing factors such as Diabetes Mellitus, smoking, pre-existing periodontal disease and absence of keratinized mucosa, among others. Clinically, PI is related to bleeding on probing, gingival recession, and suppuration. Imaging evaluation of the peri-implant defect is routinely performed with periapical radiographs; Recent use of cone-beam computed tomography has allowed three-dimensional assessment of the defect, although considerations of radiation dose to the patient and image artifacts have been made that may limit its extensive use.

Correlation between condylar size on CT and position of the articular disc on MRI of the temporomandibular joint.

Objective: To analyze the relationship between the size of the mandibular condyle and the temporomandibular joint disc position using computed tomography and magnetic resonance imaging.Methods: One hundred joints were retrospectively analyzed. The measures analyzed included the condylar head height, the medio-lateral and antero-posterior dimensions of the condylar head, and the TMJ disc position. ANOVA correlation coefficient and Tukey's post hoc test were employed.Results: The mean age of the subjects was 20.3 years. There were no significant correlations between the disc position in closed-mouth and the condylar head sizes. There was no significant correlation between the position of the disc in open mouth and the height of the condylar head, but there were statistically significant associations between the position of the disc and the horizontal condylar dimensions, the medial-lateral (p < .014), and the anterior-posterior sizes (p < .020).Conclusion: The condylar head size was smaller in subjects with disc displacement without reduction.

Chronic mandibular hypomobility related to a unilateral accessory condyle. A case report.

BACKGROUND: Chronic mandibular hypomobility is characterized by a long-standing limitation of the mouth opening related to multiple etiologies, including elongation of the coronoid apophysis. Unlike the most frequent pathologies that cause coronoid elongation, such as hyperplasia, osteoma (OM), and osteochondroma (OC), the accessory mandibular condyle (AMC) is a rare entity. Clinical Presentation: The AMC shows a configuration similar to a normal mandibular condyle with an articular surface covered by fibrocartilage that articulates with the temporal wall of the zygomatic bone, and histologically, does not show neoplastic growth. The patient was treated with a coronoidectomy, removing the coronoid apophysis as well as the AMC. CLINICAL RELEVANCE: This case report presents a case of an AMC to describe the clinical, imaging, surgical, and histological characteristics, establishing its differential diagnosis with hyperplasia, OM, and OC of the coronoid apophysis.

Evaluación morfométrica del complejo estilohioideo mediante tomografía computarizada multicorte / Morphometric assessment of the stylohioid complex by multislice computed tomography

Objetivo: Estudiar morfométricamente el complejo estilohioideo (CEH) mediante tomografía computarizada multicorte (TCM). Materiales y métodos: Investigación descriptiva, retrospectiva y transversal. La muestra estuvo conformada por 238 estudios de TCM, pertenecientes a pacientes de ambos sexos con edades entre 20 y 87 años, con indicación de tomografía para el macizo craneofacial. Se realizó la medición de la longitud del CEH en vistas laterales de reconstrucciones volumétricas en 3D. Se obtuvo la distribución de estos casos de acuerdo con edad, sexo, lateralidad, tipo de osificación y motivo de indicación del examen. Resultados: La longitud media del CEH fue de 30,66 ± 10,58 mm. Del total de la muestra, 127 (53,4%) individuos mostraron un CEH elongado; de estos, un 63,8% fueron mujeres y un 64,6% de los pacientes presentó un compromiso bilateral del complejo. La mayoría de los sujetos con un CEH elongado tenían edades comprendidas entre 30 y 59 años. El tipo de osificación encontrada con mayor frecuencia fue del tipo I (elongación continua). En cuanto al motivo de indicación del examen, la mayoría de los pacientes fueron referidos para estudio de la articulación temporomandibular. Conclusiones: La TCM es una herramienta útil en la identificación y el estudio morfométrico de la osificación del CEH, tanto en su longitud como tipo. El examen de un CEH osificado es importante para el diagnóstico diferencial de dolor cervicofacial y disfunción de la articulación temporomandibular. (AU)

Objective: tomography (MCT). Materials and methods: This was a descriptive, retrospective cross-sectional study. The sample was made up of 238 MCT studies performed in patients of both sexes between 20 to 87 years of age, with indication of tomography of the craniofacial complex. The length of the SHC was measured in lateral views of 3D volumetric reconstructions. The distribution of these cases was obtained according to age, sex, laterality, type and the reason for the examination. Results: The mean length of the SHC was 30.66 ± 10.58 mm. Of the total sample, 127 (53.4%) individuals showed an elongated SHC; of these, 63.8% were women and 64.6% of the patients presented a bilateral compromise of the complex. Most of the subjects with an elongated SHC were between 30 and 59 years old. The type of ossification most frequently found was type I (continuous elongation). Regarding the reason for the examination, most of the individuals were referred for study of the temporomandibular joint. Conclusions: MCT is a useful tool for the identification and morphometric study of ossification of the SHC, both in length and type. Examination of an ossified SHC is important for the differential diagnosis of cervico-facial pain and temporomandibular joint dysfunction. (AU)

Desplazamiento Posterior Bilateral del Disco de la Articulación Temporomandibular: evidencia en Resonancia Magnética / Bilateral Posterior Displacement of the Temporomandibular Joint Disc: evidence on Magnetic Resonance Imaging

El desplazamiento del disco articular (DA) constituye una artropatía intracapsular en la que el disco se desplaza de su relación funcional con el cóndilo mandibular y la porción articular del hueso temporal. El desplazamiento del disco puede ser antero-medial, anterior, antero-lateral, lateral, medial o posterior, siendo este último uno de los menos frecuentes. El presente reporte tuvo como objetivo describir las manifestaciones clínicas y evaluación imagenológica mediante resonancia magnética (RM) de un desplazamiento posterior del disco (DPD) en la articulación temporomandibular (ATM). Presentación del caso: paciente masculino, de 35 años de edad quien a la exploración clínica, refirió dolor a la palpación lateral y posterior en la ATM izquierda, se observó desvío mandibular hacia el lado derecho, dificultad para realizar movimientos de lateralidad y limitación de la apertura oral. Intraoralmente, se evidenció mordida cruzada en zona canina derecha y facetas de desgaste en caninos superiores e incisivos inferiores. En imágenes sagitales de RM a boca cerrada se verificó en ambas articulaciones, el aplanamiento del DA, la localización de la banda anterior sobre la vertiente anterior de la cabeza de la mandíbula, de manera que el resto del disco estaba extendido hacia la vertiente posterior, ocupando parte de la zona retrodiscal; en el plano coronal la posición del DA estaba íntimamente relacionada con los polos lateral y medial de la cabeza de la mandíbula. Las características imagenológicas fueron sugestivas de DPD. El DPD es una artropatía poco frecuente de la ATM, siendo que las imágenes por RM muestran con precisión la relación DA-cóndilo, lo que posibilita su diagnóstico y permite al clínico tomar las decisiones idóneas para la atención del paciente.

The displacement of the articular disc (AD) constitutes an intracapsular arthropathy in which the disc is displaced from its functional relationship with the mandibular condyle and the articular portion of the temporal bone. It is frequently medial, anteromedial, or anterolateral, with posterior displacement being rare. The objective of this report was to describe the clinical manifestations and magnetic resonance imaging (MRI) of a disc posterior displacement (PDD) in the temporomandibular joint (TMJ). Case presentation: a 35-year-old male patient who reported on clinical examination, pain on lateral and posterior palpation in the left TMJ; mandibular deviation to the right side, difficulty in making lateral movements, and limitation of mouth opening were observed. Intraorally, cross bite was observed in the right canine area and wear facets in the upper canines and lower incisors. In closed mouth MRI sagittal views, the flattening of the DA, the location of the anterior band on the anterior aspect of the mandibular head, was verified in both joints, so that the rest of the disc was extended towards the posterior aspect, occupying part from the retrodiscal zone; in the coronal plane the position of the DA was closely related to the lateral and medial poles of condyle. Imaging characteristics were suggestive of PDD. Conclusions: PDD is a rare arthropathy of the TMJ, since MRI images accurately show the DA-condyle relationship, which enables its diagnosis and allows the clinician to make the best decisions for patient care.

[Clinical and imagenological evaluation of the temporomandibular joint in patients undergoing condylectomy for the treatment of unilateral hyperplasia. Case series study]. / Evaluación clínica e imagenológica de la articulación temporomandibular en pacientes sometidos a condilectomía como tratamiento de hiperplasia unilateral. Estudio de serie de casos.

Unilateral condylar hyperplasia is a non-neoplastic and self-limiting overgrowth of the mandibular condyle that usually begins during puberty, predominates in women and is considered an aberration of the normal growth mechanism of the condyle. This abnormal growth continues until the mid-20s and produces mandibular prognostism, facial and occlusal asymmetry with progressive displacement of the mandible to the contralateral side. The purpose of this report was to describe the cases of two female patients (23 and 25 years old) with unilateral condylar hyperplasia treated with high condylectomy and orthognathic surgery, with emphasis on clinical and imaging aspects and late post-surgical follow-up. Both patients presented satisfactory cosmetic results, without pain / noise related to the temporomandibular joint, mouth opening within the normal range, and class I canine and molar relationship. Computed tomography showed signs of remodeling in the affected condyle. High condylectomy combined with orthognathic surgery is an adequate treatment in cases of unilateral hyperplasia, restoring functionality and aesthetics to the patient. The bone remodeling observed in the intervened condyles seems to indicate that the condylar head maintains its adaptive capacity even in adult patients.

Recomendaciones de bioseguridad para la práctica de la radiología dentomaxilofacial en el contexto de la pandemia por COVID-19 / Biosecurity recommendations for the dentomaxillofacial radiological practice in the context of the COVID-19 pandemic

La enfermedad coronavirus 2019 causada por el SARS- CoV-2, fue declarada pandemia por la Organización Mundial de la Salud el 11 de marzo de 2020. La transmisión directa se produce por vía respiratoria, mientras que en la indirecta es necesario el contacto de la mucosa bucal, nasal u ocular con superficies contaminadas. Ante la presencia de portadores asintomáticos que transmiten el virus, todos los pacientes deben ser tratados como posibles fuentes de contagio. En la atención odontológica, el contacto próximo con el paciente y la saliva hace que el personal esté en alto riesgo de infección cruzada; la práctica de la radiología dentomaxilofacial en centros radiológicos o en la clínica odontológica no está exenta de dicho riesgo. La presente revisión de literatura tuvo como objetivo elaborar recomendaciones de bioseguridad para la práctica de la radiología dentomaxilofacial. Las recomendaciones relacionadas con áreas y equipos señalan la importancia de mantener estas áreas ventiladas, con el menor tráfico de público posible y el uso de protección de barrera, limpieza y desinfección de superficies de alto contacto de los equipos radiológicos. Una de las medidas críticas para evitar la transmisión de la enfermedad es el lavado de manos y debe ser realizado por los pacientes y el personal. Los procedimientos radiográficos extrabucales deben priorizarse antes que los intrabucales. El uso de la telerradiología disminuye la posibilidad de contagio por contacto con superficies contaminadas y agiliza el flujo de información entre el clínico, el paciente y el radiólogo dentomaxilofacial.

The coronavirus disease 2019 caused by SARS-CoV-2, was declared a pandemic by the World Health Organization on March 11, 2020. Direct transmission occurs by respiratory route, while indirect transmission requires contact with the buccal, nasal or ocular mucosa with contaminated surfaces. In the presence of asymptomatic carriers that transmit the virus, all patients should be treated as possible sources of infection. In dental care, close contact with the patient and saliva puts staff at high risk for cross infection; The practice of dentomaxillofacial radiology in radiological centers or in the dental clinic is not exempt from this risk. The objective of the present literature review was to develop biosafety recommendations for the practice of dentomaxillofacial radiology. The recommendations related to areas and equipment indicate the importance of keeping these areas ventilated, with the least possible public traffic and the use of barrier protection, cleaning and disinfection of high-contact surfaces of radiological equipment. One of the critical measures to prevent transmission of the disease is hand washing and should be done by patients and staff. Extra-oral radiographic procedures should be prioritized over intra-oral ones. The use of teleradiology reduces the possibility of contagion by contact with contaminated surfaces and speeds up the flow of information between the clinician, the patient and the dentomaxillofacial radiologist.

Association between temporomandibular joint disc position evaluated by magnetic resonance imaging and mandibular condyle inclination evaluated by computed tomography.

Temporomandibular joint disc displacement is common in the world's population and could be associated with bone and functional characteristics of the temporomandibular joint. The aim of these study was to analyse the association between temporomandibular joint disc position evaluated by magnetic resonance imaging (MRI) and the inclination of the mandibular condyle evaluated by computed tomography (CT). One hundred and seventy temporomandibular joints (TMJ) were retrospectively analysed. The temporomandibular disc position was evaluated by MRI and classified into three types: normal (N), disc displacement with reduction (DDWR) and disc displacement without reduction (DDWoR). The mandibular condyle measurements evaluated by CT included horizontal, sagittal and coronal inclination. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between condylar inclination and disc position. There was an association between disc position and the horizontal and sagittal condylar inclination (P < .05). There are statistically significant differences in the mean of horizontal and sagittal inclination of the mandibular condyle between the DDWoR and the other disc positions (P = .002 and P = .004). Disc position was not statistical associated with coronal inclination of condyle (P > .05). These results indicate that the inclination of the mandibular condyle may be different in TMJ with various disc position. A more medial horizontal inclination and a more posterior sagittal inclination of the mandibular condyle are associated with DDWoR.

Temporomandibular disorders: Guidelines and Self-Care for Patients During COVID-19 Pandemic / Desordem Temporomandibular: Orientações e Autocuidados para Pacientes Durante a Pandemia do COVID-19

Background: Temporomandibular disorder (TMD) belongs to a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, musculature and adjacent components. These conditions can generate signs and symptoms and be influenced by an altered biopsychosocial condition. Objective: This study aims to seek information to assist the patient in the presence of TMD signs and symptoms and Orofacial Pain, associated with the period of social isolation during the COVID-19 pandemic. Material and methods: For the preparation of this manual, a bibliographic search was performed in the databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science and The Cochrane Library, using the keywords: orofacial pain, temporomandibular disorders, bruxism, stress, anxiety, biopsychosocial, diagnosis, self-care with important information on how to reduce and control the signs and symptoms of TMD and Orofacial Pain in this moment of pandemic that we are experiencing a social detachment. Results: The results show that the pandemic of COVID-19 and the need for social isolation, generates psychological impact that raises the pattern of anxiety and can directly affect patients with bruxism and TMD. Conclusion: Psychological factors associated with the pandemic can lead to an increased risk of developing, worsening and perpetuating bruxism, especially waking bruxism and TMD, so dentists should be aware of the occurrence of signs and symptoms to manage the multifactorial aspects of this condition. At that time, individual self-management strategies are advised for the patient, which consist of self-massage techniques, body education, exercise practices, sleep hygiene, meditation also the use of mobile apps and online tools that facilitate this activity. (AU)

Introdução: A Desordem Temporomandibular (DTM) pertence a um grupo heterogêneo de condições musculoesqueléticas e neuromusculares envolvendo o complexo articular temporomandibular, a musculatura e os componentes adjacentes. Essas condições podem gerar sinais e sintomas e serem influenciadas por uma condição biopsicossocial alterada. Objetivo: Esse estudo teve como objetivo buscar informações que possam auxiliar ao paciente na presença de sinais e sintomas de DTM e Dor Orofacial associado ao período de isolamento social durante a pandemia do COVID -19. Material e Métodos: Para a elaboração deste manual, foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science e The Cochrane Library, utilizando as palavras-chaves: dor orofacial, desordem temporomandibular, bruxismo, estresse, ansiedade, biopsicossocial, diagnóstico e autocuidados, com informações importantes sobre como reduzir e controlar os sinais e sintomas de DTM e Dor Orofacial nesse momento de pandemia que estamos vivenciando um distanciamento social. Resultados: Os resultados mostram que a pandemia de COVID-19 e a necessidade de isolamento social, gera impacto psicológico que eleva o padrão de ansiedade e pode afetar diretamente pacientes com bruxismo e DTM. Conclusão: Fatores psicológicos associados à pandemia podem levar a um maior risco de desenvolver, piorar e perpetuar o bruxismo, principalmente bruxismo de vigília e DTM, por isso os cirurgiões-dentistas devem estar atentos a ocorrência de sinais e sintomas para gerenciar os aspectos multifatoriais dessa condição. Aconselha-se, nesse momento, estratégias individualizadas de autogerenciamento para o paciente que consistem em técnicas de automassagem, educação corporal, práticas de exercícios, higiene do sono e meditação. Além do uso de aplicativos digitais e ferramentas online facilitadores dessa atividade (AU)

Pneumatized articular tubercle and discontinuity of the temporal bone mandibular fossa: a computed tomographic study / Neumatización del tubérculo articular y discontinuidad de la fosa mandibular del temporal: estudio mediante tomografía computarizada

Abstract Introduction: air cells in the articular tubercle and the discontinuity of the cortical mandibular fossa are sites of minimal resistance, favoring the extension of various pathologies, which should be differentiated from similar processes involving bone expansion/destruction. The aim of this study was to assess pneumatized articular tubercle (PAT) and discontinuity of the temporal bone's mandibular fossa (DMF) through computed tomography (CT), focusing on its distribution by age, sex, and laterality. Methods: 200 CT studies including both temporomandibular joints (TMJ) were selected, recording age, sex, presence/absence of PAT and DMF and their laterality. Results: 19% of patients had some anatomical variants. PAT was seen in 15.5% of cases (n = 31), 21 females (67.74%) and 10 males (32.26%). DMF was seen in seven cases (3.5%), all in females. 51.62% of PAT were bilateral, and 85.71% of DMF were unilateral. Conclusions: the sample under study has a high prevalence of PAT. DMF should be considered in the evaluation of TMJ by CT, with this being the method of choice to assess bone structures and air spaces in temporal bone.

Resumen Introducción: las celdillas aéreas en el tubérculo articular y la discontinuidad de la cortical de la fosa mandibular representan sitios de mínima resistencia que pueden facilitar la extensión de diversas patologías y es importante diferenciarlas de procesos con aspecto semejante que cursan con expansión/destrucción ósea. El objetivo del presente estudio consistió en estudiar la neumatización del tubérculo articular (NTA) y la discontinuidad de la fosa mandibular (DFM) del hueso temporal, observadas a través de tomografía computarizada (TC), con énfasis en su distribución por edad, sexo y lateralidad. Métodos: se seleccionaron 200 estudios de TC que incluyeran ambas articulaciones temporomandibulares (ATM). Se registró la edad, sexo, presencia/ausencia de NTA y DFM y su lateralidad. Resultados: el 19% de los pacientes presenta algunas de las variantes anatómicas. La NTA fue observada en el 15,5% de los casos (n=31), 21 (67,74%) de sexo femenino y 10 (32,26%) de sexo masculino. La DFM se evidenció en siete (3,5%) casos, todos del sexo femenino. El 51,62% de la NTA fue de tipo bilateral, y el 85,71% de la DFM se encontró unilateralmente. Conclusiones: existe una alta frecuencia de NTA en la muestra estudiada, la DFM es un hallazgo a considerer en la evaluación de la ATM mediante TC, siendo que este método es de elección para valorar estructuras óseas y espacios aéreos en el hueso temporal.

Caracterización clínica, imagenológica y quirúrgica de la discopexia en pacientes con artropatía discal de la art iculación temporomandibular. Estudio de serie de casos / Clinical, imagenological and surgical characterization of discopexia in patients with discal arthropathy of the temporomandibular articulation. Case series study

Introducción: El desplazamiento discal es la artropatía temporomandibular más común. Los desplazamientos discales sin Reducción (DDSR) constituyen una condición clínica en la cual en boca cerrada el disco articular se encuentra desplazado completamente, sin contacto con la vertiente anterior de la cabeza mandibular y en boca abierta el disco no es recapturado. El tratamiento quirúrgico realizado es la discopexia. A pesar de toda la información presente en la bibliografía aún existe controversia entre la elección de tratamiento del DDSR. Objetivo: Presentar la experiencia clínica, quirúrgica e imagenológica de la discopexia en DDSR mediante la presentación de una serie de casos. Metodología: Se realizó un estudio retrospectivo de las historias clínicas del Servicio de Cirugía Bucal y Maxilofacial del hospital General del Oeste "Dr. José Gregorio Hernández", Distrito Capital, Venezuela, entre 2014-2018; se seleccionaron seis casos clínicos que presentaban DDSR, los cuales fueron intervenidos con discopexia, posteriormente se evaluaron clínica e imagenológicamente. Resultados: Los seis casos presentaron particularidades en el transcurso del tratamiento desde la fase inicial y en la postoperatoria. Se evidenció una franca mejoría en las manifestaciones clínicas, en contraste, la resonancia magnética postoperatoria, el cual reveló el desplazamiento discal nuevamente. Conclusiones: La estabilidad en la reubicación discal postoperatoria depende de múltiples factores, tales como la estabilidad oclusal, muscular y presencia de hábitos parafuncionales. El aumento en la apertura bucal fue la característica común en todos los pacientes de este estudio así como la disminución de la sintomatología dolorosa.

Introduction: Disc displacement is the most common temporomandibular arthropathy. The displacements without reduction (DDSR) become a clinical practice in the closed mouth the articular disc is completely displaced, without contact with the anterior vertical of the mandibular head and in the open mouth the disc is not recaptured. The surgical treatment performed is discopexy. Despite all the information present in the literature there is still controversy between the choice of treatment of the DDSR. Objective: To present the clinical, surgical and imaging experience of discopexy in DDSR by presenting a series of cases. Methodology: A retrospective study of the clinical records of the Oral and Maxillofacial Surgery Service of the General del Oeste Hospital "Dr. José Gregorio Hernández ", Capital District, Venezuela, between 2014-2018; Six clinical cases were selected that presented DDSR, which were operated on with discopexy, and then evaluated clinically and imaging. Results: The six cases present particularities in the course of the treatment from the initial phase and in the postoperative period. The evidence is improved in the clinical manifestations, in contrast, in the postoperative magnetic resonance, in the articular disc it moved again. Conclusions: Stability in postoperative disc relocation depends on multiple factors, such as occlusal stability, muscle stability and the presence of parafunctional habits. The increase in oral opening was the common feature in all the patients for this study, as well as the decrease in painful symptoms.

Presentación inusual de cavidad ósea de Stafne: estudio mediante tomografía computarizada y resonancia magnética / Unusual Stafne ́s osseous cavity presentation: computerized tomography and magnetic resonance imaging study

La cavidad ósea de Stafne (CS) ha sido descrita como una radiolucencia oval, de bordes definidos y corticalizados, localizada por debajo del conducto mandibular entre el primer molar y el ángulo de la mandíbula. Casos atípicos de presentación de la cavidad en forma lobulada con márgenes irregulares, escleróticos o incompletos, así como una localiza- ción inusual requieren el empleo de métodos imagenológicos que posibiliten realizar un diagnóstico diferencial, evitando un procedimiento invasivo. El objetivo del presente trabajo fue describir un caso de CS en un paciente masculino de 74 años de edad, con antecedente de cáncer de próstata. Las imágenes de tomografía computarizada de haz cónico evidenciaron una cavidad abierta hacia la tabla lingual por debajo del conducto mandibular. Las imágenes de resonancia magnética y tomografía computarizada mul- ticorte permitieron identificar el contenido del defecto, identificado en ambos méto- dos imagenólogicos como tejido adiposo. El examen radiográfico de una CS de aspecto atípico debe ser complementado con estudios tomográficos y de resonancia magnética, estos proporcionan información relevante para el diagnóstico definitivo, limitando la rea- lización de una exploración quirúrgica. En el caso clínico presentado, la caracterización de la extensión del defecto, su relación con los dientes y estructuras vecinas, así como la identificación del contenido permitieron descartar la presencia de una metástasis de cáncer de próstata.

The Stafne bone cavity (SC) has been described as an oval radiolucence, with defined and corticalized edges located below the jaw duct between the first molar and the angle of the jaw. Atypical cases of presentation of the cavity in lobed form with irregular, scle- rotic or incomplete margins, as well as an unusual location require the use of imaging methods that make possible a differential diagnosis, avoiding an invasive procedure. The purpose of this work was to describe a case of SC in a 74-year-old male patient, with a history of prostate cancer. Cone beam computed tomography images showed an open cavity toward the lingual table below the mandibular canal. Magnetic resonance imaging and multi-cut computerized tomography allowed identifying the defect content, found adipose tissue. The radiographic examination of an atypical SC should be complemented with tomographic and magnetic resonance studies; these provide relevant information to the definitive diagnosis, limiting the performance of a surgical examination. In the clinical case presented, the characterization of the extension of the defect, its relationship with neighboring teeth and structures, as well as the identification of the content allowed us to rule out the presence of a prostate cancer metastasis

CT Findings of Trifid Mandibular Condyle in a 12Year-Old Patient: A Case Report and Review / Hallazgos en TC de Cóndilo Mandibular Trífido en un Paciente de 12 Años: Reporte de Caso y Revisión

ABSTRACT: Bifid or trifid mandibular condyle is an extremely rare entity, of unknown etiology, although it has been associated with trauma in the condyle growth center. The development of imagining techniques has allowed the exact characterization of these alterations, which were incidentally discovered by routine dental x-rays. The aim of this report is to describe a case of a mandibular condyle with a trifid appearance in a twelve year-old individual with a history of mandibular trauma during childhood and a review of the relevant literature.

RESUMEN: El cóndilo bífido o trífido es una entidad extremamente rara de etología desconocida, sin embargo, ha sido asociada con trauma en el centro de crecimiento condilar. El desarrollo de técnicas imagenológicas ha permitido la exacta caracterización de estas alteraciones, las cuales son incidentalmente descubiertas durante radiografías de rutina. El objetivo de este reporte es describir un caso de un cóndilo mandibular con apariencia trífida en un paciente de 12 años de edad con historia de trauma en la mandíbula durante la primera infancia y una revisión de la literatura relevante.

Caracterización clínica, imagenológica y quirúrgica de la perforación discal en pacientes con disfunción de la articulación temporomandibular. Estudio de serie de casos / Clinical, imagenologic and surgical characterization of discal perforation in patients with temporomandibular joint dysfunction. Study of series of cases

Introducción: La perforación discal (PD) del disco articular de la articulación temporomandibular (ATM) consiste en la rotura parcial o total del disco, pudiendo ocurrir en cualquier parte del mismo, siendo que em general, se considera como un signo de osteoartritis avanzada. Objetivo: El propósito del presente trabajo fue caracterizar clínica, imagenológica y quirúrgicamente la PD en una serie de casos con disfunción temporomandibular. Metodología: Se realizó un estudio retrospectivo de historias clínicas de pacientes atendidos entre 2013-016, con diagnóstico de disfunción de la ATM en etapas de Wilkes IV y V. Se seleccionaron aquellos con diagnóstico en resonancia magnética (RM) de PD, sometidos a cirugía abierta de ATM. Resultados: Se encontraron cinco casos en el periodo estudiado correspondiendo a 10 articulaciones. La totalidad de los pacientes fueron mujeres con edad promedio de 49 años, refirieron algún tipo de dolor y presencia de ruído articular con apertura bucal ≤ 32mm. El 60% de los pacientes experimentaron ruido tipo crepitación. La RM, mostró la presencia de desplazamiento y deformidad discal en el 90% de los casos, la efusión en el compartimento intra-articular superior e inferior fue una característica común. La localización más frecuente de la PD fue en la zona central de la banda intermedia (71,42%).Conclusiones: El antecedente de artralgia que no remite, apertura bucal limitada y crepitación de ATM sumado a imágenes de RM con desplazamiento del disco sin reducción, deformidad discal, efusión intra-articular y la interrupción en la señal correspondiente al disco articular podrían estar asociados con la PD

Introduction: Tempomandibular joint (TMJ) disc perforation (DP) consists of partial or total rupture of the articular disc, which can occur anywhere in the disc, being generally considered as a sign of advanced osteoarthritis. Objetive: The purpose of the present study was to characterize clinical, imaging and surgically the DP in a series of cases with temporomandibular dysfunction. Methods: A retrospective study of clinical records of patients treated between 2013-016, with a diagnosis of TMJ dysfunction in Wilkes IV and V stages was carried out. Patients with magnetic resonance imaging (MRI) of DP undergoing open surgery of the TMJ, were selected. Results: Five cases were found in the study period corresponding to 10 joints. All patients were women with mean age of 49 years, who reported some type of pain and presence of articular noise with mouth opening ≤ 32mm. Sixty percent of the patients experienced crepitation type noise. MRI showed the presence of disc displacement and deformity in 90% of cases, effusion in the upper and lower intra-articular compartment was a common feature. The most frequent location of DP was in the central zone of the intermediate band (71.42%). Conclusions: The history of non-remitting arthralgia, limited mouth opening and TMJ crepitation combined with MRI images with disc displacement without reduction, disc deformity, intra-articular effusion and interruption in the articular disc signal could be associated to DP

Evaluación de las vías aéreas superiores a través de trazados cefalométricos / Upper airways evaluation through cephalometric tracings

La cefalometría es un elemento auxiliar de diagnóstico utilizada frecuentemente en el estudio del crecimiento y desarrollo cráneofacial; y en la planificación de terapéuticas de ortodoncia y ortopedia funcional de los maxilares. Además se considera una herramienta importante para evaluar el espacio aéreo nasofaríngeo, ya que, gracias a la observación de los relieves óseos y perfil blando del paciente, se obtiene una información estática y bidimensional sobre el calibre de las vías aéreas superiores. Así, el objetivo del presente artículo es analizar una selección de trazados cefalómetricos orientados a evaluar este reparo anatómico. En tal sentido se realizó una búsqueda por diferentes bases de datos, tales como Pubmed, Medline, Scielo y Google Scholar, en las que se obtuvo información sobre diferentes cefalometrías utilizadas para lograr el propósito de la presente investigación. Los resultados obtenidos en la revisión concluyen que el criterio de selección dependerá fundamentalmente de la información que el clínico desea obtener para cubrir los requerimientos del paciente

Cephalometrics is a tool for the study of craniofacial growth and development; it is considered an important technique to evaluate nasopharyngeal air space, and due to the observation of bony prominences and soft profile of the patient, we can get a two-dimensional and static information about the caliber of the upper airway. Thus, this article aims to present a selection of cephalometric tracings to evaluate upper airway, for which a search for different databases, such as PubMed, Medline, Scielo and Google scholar, among others, in the information on different paths used to achieve the purpose of the investigation was obtained. In conclusion, it was established that the selection criteria depend fundamentally on the information that the clinician want to get to meet the requirements of the patient

Aplicación de las unidades houns en tomografía computarizada como herramienta diagnóstica de las lesiones intra-óseas del complejo maxilo-mandibular: estudio clínico de diagnóstico / Application of houns units in computed tomography as a diagnostic tool for intra-osseous lesions of the maxillo-mandibular complex: diagnostic clinical study

La tomografía axial computarizada (TC) es un recurso imagenológico de gran utilidad que brinda la posibilidad de medir los coeficientes de atenuación de diferentes tejidos examinados mediante una escala de grises, determinado por las Unidades Houns (UH). En medicina se ha venido utilizando con éxito la TC como método "Gold Standard" para el diagnóstico de diversas entidades, sin embargo, en el área maxilofacial, los valores de densidad de las lesiones han sido poco investigados. El objetivo de esta investigación fue determinar los perfiles de UH como herramienta diagnóstica de lesiones intra-óseas del complejo maxilo-mandibular. Metodología: Fue realizada una investigación clínico observacional para la evaluación de las UH como test diagnóstico de las lesiones maxilofaciales. Se incluyeron 42 lesiones intra-óseas de los maxilares evaluadas con TC (sistema CT Scan-multicorte). 11 individuos sin lesiones tumorales o infecciosas que se realizaron TC por razones de implantes fueron incluidos como controles. Se seleccionó un ROI amplio y un ROI reducido para cada lesión, este último para mediciones de UH correspondiente al centro y periferia, para cada plano espacial. El evaluador no tuvo conocimiento del diagnóstico de las lesiones al valorar cada tomografía (enmascaramiento simple). Los datos se analizaron bajo estadística descriptiva comparando el índice de UH con el diagnóstico histopatológico. Resultados: No se observaron diferencias significativas entre las mediciones con ROI amplio y reducido. Los perfiles de UH de mayor densidad se obtuvieron para la displasia ósea y el odontoma compuesto. El tumor odontogénico quístico queratinizante (TOQQ) fue el único grupo de lesiones con valores negativos en su perfil. Se evidenciaron similitudes para el perfil de quiste periapical y quiste óseo simple. Las medias de UH más altas fueron observadas en los casos de displasia ósea y odontoma (1732,4/1698/1707,5 y 1582,9/1523/1512,9 UH respectivamente), mientras que las más bajas fueron observadas en el TOQQ con valores medios alrededor de -15 UH. Conclusiones: Cada lesión muestra un perfil de UH distinto que debe ser utilizado como examen complementario mas no como herramienta diagnóstica única.

Computed tomography imaging is a very useful resource that provides the ability to measure the attenuation coefficients of different tissues examined by a gray scale, determined by Houns Units (HU). In medicine has been used successfully as a method CT "Gold Standard" for diagnosis of several entities, however, in the maxillofacial area, the density values of the lesions have been little investigated. The objective of this research was to determine the validity of the HU as a diagnostic tool for intra-osseous lesions of the maxillo-mandibular complex. Methodology: This was an observational clinical research to evaluate the HU as a diagnostic test of maxillofacial lesions. Were included 42 intra-osseous maxillary lesions evaluated with CT; also 11 cases of individuals without tumor or infections lesions that CT performed because of rehabilitation, as controls. Were selected a wide ROI and reduced ROI for each lesion, the latter for HU measurements corresponding to the center and periphery, for each cut. The evaluator was not aware of the diagnosis lesions when assigning a value for each CT (single blind). Data were analyzed under descriptive statistics comparing the HU index with histopathological diagnosis (gold standard reference test). Results: No significant differences between measurements with wide and reduced ROI were observed. HU profiles with higher density were obtained for osseous dysplasia and odontoma compound type. Keratocystic odontogenic tumor (KCOT) was the only group of lesions with negative values in its profile. Were demonstrated similarities to the profile of periapical cyst and simple bone cyst. The higher HU average was observed in cases of osseous dysplasia and odontoma (1732.4 / 1698 / 1707.5 and 1582.9 / 1523 / UH 1512.9 respectively), while the lowest were observed in the KCOT with average values around -15 UH. Conclusions: Every lesion shows a different HU profile that could be used as a complementary test but not as a single diagnostic tool.

Hallazgo imagenológico de hendidura mandibular media incompleta: reporte de un caso / Imaging findings of an incomplete median mandibular cleft: a case report

La hendidura mandibular media es una rara anomalía congénita la cual ha sido descrita como hendidura Tessier 30, la misma puede estar asociada a una variedad de alteraciones de distinta severidad y por ello expresarse como una simple muesca en el bermellón del labio hasta la ausencia del manubrio esternal. El presente trabajo tuvo como propósito describir un hallazgo imagenológico de hendidura mandibular media incompleta, con énfasis en el recurso de la Tomografía Computarizada (TC) como medio para su caracterización. Paciente masculino de 11 años de edad quien es referido para estudio mediante TC, por la presencia de una imagen radiolúcida en radiografía panorámica previa. Al examen extrabucal, no presentaba herida cutánea o asimetría facial; en el examen intrabucal se observó la ausencia de elementos dentarios permanente en zona anteriosuperior e inferior. En la radiografía panorámica se verificó la retención de los dientes 12-22, 32, 42 y 41, así como una imagen radiolúcida en línea media de la mandíbula, de bordes corticalizados que se extendía desde el borde inferior sin alcanzar la cresta del reborde alveolar. Las reconstrucciones en los planos axial, sagital y coronal obtenidas por TC mostraron la extensión de la imagen hipodensa en sentido vestíbulo-lingual, la cual no ocupaba el espesor del hueso, comprobándose también la corticalización de los márgenes. El uso de la TC permitió conocer los límites y extensión de la alteración, así como confirmar la corticalización de los márgenes en la imagen, lo que permitió formular la hipótesis diagnóstica de hendidura mandibular media.

Median mandibular cleft is a rare congenital anomaly described as Tessier cleft 30, associated with a variety of disorders of different severity; it could be expressed as a notch in the lip vermillion to the absence of the sternal manubrium. The present study was aimed to describe an imaging finding of a median incomplete mandibular cleft, with emphasis on the use of computed tomography (CT) as a means of characterization. An 11 year old male patient referred for CT study, due to the presence of a radiolucent image in a previous panoramic radiograph. The extraoral examination showed no skin wound or facial asymmetry; intraoral exam demonstrated the absence of anterior superior and lower permanent tooth elements. In the panoramic radiograph the impaction of teeth 12 -22, 32, 42 and 41, as well as a midline radiolucent image in the mandible with corticalized margins extending from the inferior border without reaching the alveolar ridge crest was verified . Reconstructions in the axial, sagittal and coronal planes obtained by CT showed extension of the hypodense image in the vestibular-lingual orientation, which did not occupy the entire bone thickness, also it was ascertained margins corticalization The use of CT allowed to know the limits and extent of the alteration, and confirm margins corticalization in the image, allowing to formulate a diagnostic hypothesis of incomplete median mandibular cleft.