Comparison of condylar positions at intercuspal and reference positions in patients with condylar bone change.

The purpose of this study was to investigate the condylar displacement from intercuspal position (IP) to reference position (RP), using a jaw movement measuring system with 6 d.f. and helical computed tomography (CT). The 19 patients included in the present study were divided into a group with bilateral condylar bone change (10 subjects, including the sub-groups with flattening and osteophyte formation) and a group with no condylar bone change (9 subjects). The results showed that the bone change group had significantly more superior, posterior and absolute horizontal IP to RP slides than the no bone change group. There was also a significant difference in the amount of antero-posterior and supero-inferior condylar IP-RP displacements related to the type of condylar bone change within the bone change group. The osteophyte sub-group showed the largest posterior displacement, and the flattening sub-group showed the largest superior displacement. These results suggested that this large IP-RP difference in the bone change group might be related to their temporomandibular joint (TMJ) pathology, and it might therefore be useful to keep this difference in mind as one of the clinical indices suggesting the presence of TMJ osteoarthritis (OA).

Embolization of Arteriovenous Malformation. Efficacy and Safety of Preoperative Embolization Followed by Surgical Resection of AVM.

SUMMARY: Treatment options for cerebral arteriovenous malformation (AVM) are still controversial due to the recent result of stereotactic radiosurgery and the improved result of microsurgical resection. We investigated previously treated AVM cases and discussed the efficacy and safety of preoperative embolization especially for microsurgical resection of high-grade AVM in the Spetzler-Martin grading. Efficacy of preoperative embolization was evaluated based on 126 previously treated AVM cases at Shinshu University Hospital during the last 25 years. The safety of embolization was evaluated based on our previously-embolized 58 AVM cases (91 procedures) in the last 11 years after introduction of preoperative embolization for AVM. In all 126 cases, 82 were treated before introduction of embolization and 44 were treated after introduction of embolization. In 82 cases of the pre-embolization era, 63 lesions were removed totally in 63 AVMs (77%), partially resected in 11 (13%) and untreated in eight (10%). In 74 surgically removed cases, 11 (15%) cases showed severe intra/postoperative bleeding. In 44 cases of the embolization era, lesions were removed totally in 29 AVMs (66%), disappeared only with embolization in one (2%), disappeared with radiosurgery in seven (16%) and were untreated in five (11%). In 32 surgically removed cases, only one (2%) case showed severe intra/postoperative bleeding. In all 58 embolized cases, 44 were surgically removed, six were treated with radiosurgery, one was eliminated with embolization alone and six were partially obliterated and followed up for their location. In 91 procedures for 58 cases, two haemorrhagic and three ischemic complications occurred, three were transient and two remained having neurological deficits. The introduction of preoperative embolization improved the total removal rate and reduced the intra/postoperative bleeding rate in surgical removal of AVM. The total risk of embolization is low and well-designed preoperative embolization makes surgical resection safer even in high-grade AVM in the Spetzler-Martin grading.