Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series.

BACKGROUND: Chronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other's response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. CASE PRESENTATIONS: Our three Caucasians patients each presented with severe, chronic insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, chronic insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. CONCLUSIONS: These three cases lend support to the hypothesis that chronic insomnia and obstructive sleep apnea share a pathophysiology of chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when chronic insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in chronic stress that causes the patient's chronic insomnia to remit.

Females have greater susceptibility to develop ongoing pain and central sensitization in a rat model of temporomandibular joint pain.

Temporomandibular joint osteoarthritis (TMJOA) is a prevalent source of temporomandibular joint disorder (TMD). Women are more commonly diagnosed with TMD and are more likely to seek care at tertiary orofacial pain clinics. Limited knowledge regarding mechanisms underlying temporomandibular joint (TMJ) pain impairs development of improved pain management strategies. In a rat model of unilateral TMJOA, monosodium iodoacetate (MIA) produces joint pathology in a concentration-dependent manner. Unilateral MIA produces alterations in meal patterns in males and females without altering overnight time spent eating or weight across 2 weeks. Monosodium iodoacetate (80 mg/mL)-treated males develop ongoing pain within 2 weeks after MIA injection. Females develop ongoing pain at a 5-fold lower MIA concentration (16.6 mg/m). Monosodium iodoacetate (80 mg/mL)-treated males show spread of tactile hypersensitivity across the face during the first week after injection and then to the fore paws and hind paws during the second week after injection, indicating development of central sensitization. At the lower dose, female rats demonstrate a similar spread of tactile hypersensitivity, whereas male rats do not develop ongoing pain or spread of tactile hypersensitivity outside the area of the ipsilateral temporomandibular joint. These observations indicate that females have a higher susceptibility to development of ongoing pain and central sensitization compared with male rats that is not due to differences in MIA-induced joint pathology. This model of TMJOA pain can be used to explore sex differences in pain processes implicated in development of neuropathic pain, ongoing pain, and central sensitization, allowing for development of individualized strategies for prevention and treatment of TMD joint pain.

Myofascial Pain: Ultrasound Width of the Masseter Muscle.

AIMS: To determine whether subjects with temporomandibular disorders (TMD) manifesting as chronic myofascial pain (MFP) involving the masseter muscle present with significantly greater masseter muscle width, as evidenced by ultrasound, compared to individuals without MFP. METHODS: A case-control study was carried out. A total of 31 subjects presenting with MFP of the masticatory muscles involving the masseter muscle and 35 controls with TMD but no diagnosis of MFP, matched by age and sex, were included. Ultrasound was used to measure the maximum width of both masseter muscles at the intermediate point between the origin and insertion of the muscle in the light occlusal contact (LOC) position and under maximum contraction. Each side was analyzed separately. Means were compared by using single-factor analysis of variance and Mann-Whitney U test; P < .05 was considered to reflect statistical significance. RESULTS: In the study group, the right masseter muscle had a mean ± standard deviation width of 8.6 ± 1.8 mm under LOC (controls: 8.6 ± 1.6 mm; P = .85) and 11.5 ± 2.1 mm under maximum contraction (controls: 11.7 ± 1.9 mm; P = .86). The analagous measures in the left masseter muscle were 8.6 ± 1.6 mm under LOC (controls: 8.2 ± 1.5 mm; P = .42) and 11.3 ± 1.8 mm under maximum contraction (controls: 11.5 ± 1.8 mm) (P = .79), respectively. The increase in width of the right masseter muscle was 2.9 ± 2.1 mm (controls: 3.1 ± 1.2 mm; P = .67) in absolute terms and 1.4 ± 0.3 mm (controls: 1.4 ± 0.2 mm; P = .91) in relative values (width at maximum contraction/LOC width). In the case of the left masseter muscle, the respective values were 2.8 ± 1.7 mm (controls: 3.2 ± 0.9 mm; P = .25) and 1.3 ± 0.2 mm (controls: 1.4 ± 0.1 mm; P = .32). CONCLUSION: There were no statistically significant differences in masseter muscle width between MFP subjects and control subjects under LOC conditions or maximum contraction. The increase in width under maximum contraction was likewise not significantly different between the groups.

Is Centric Relation Always the Position of Choice for TMDs? Case Report of How TMD and Airway Dimension May Be Associated.

Centric occlusion (CO) and centric relation (CR) have been controversial topics in dentistry for almost 100 years. The concept of CR emerged due to the search for a reproducible mandibular position that would enable the prosthodontic rehabilitation of patients needing denture treatment. The following case study is unique because of 2 questions. Which mandibular treatment splint position (CR or CO) was appropriate for the initial and eventual final treatment of this patient for her temporomandibular disorder/myofascial pain and dysfunction? Also, how might the mandibular position of CR and CO affect the size and shape of the airway? The airway's size and shape is important as it relates to sleep-disordered breathing and potentially leading to obstructive sleep apnea later in life. The authors believe this is the first case report describing how mandibular position of CR and CO may affect not only TMJ position but also the airway shape and size in three dimensions.

Prevalence and pattern of the elongated styloid process among geriatric patients in Saudi Arabia.

OBJECTIVE: The objectives of this study were to assess the elongation of the styloid process on digital panoramic radiographs and to evaluate the prevalence of the elongation according to age, sex and types. PATIENTS AND METHODS: Digital panoramic radiographs of 198 geriatric edentulous patients were analyzed. The radiographic length of the styloid process was measured on both sides using the measurement toolbars on the accompanying analysis software. For statistical analysis, Student's t-test, chi-square test and analysis of variance test were used. RESULTS: The elongated styloid process was seen in 87 of the 198 patients. It was observed that as age increased, elongation of the styloid process increased with a male predominance. Type I elongation was more common than other types of elongation. Bilateral elongation was most commonly found than unilateral elongation, and both types of elongation were frequently seen in males compared with females. CONCLUSION: The prevalence of the elongated styloid process in the present study was higher in comparison to the other reports from edentulous patients.

Unbalanced lateral mandibular deviation associated with TMJ sound as a sign in TMJ disc dysfunction diagnosis.

The aim was to study the characteristics of lateral mandibular horizontal deviations during opening-closing movements and their association with TMJ sounds of the clicking type. Subjects were 28 healthy volunteers and 38 patients diagnosed with MRI imaging as having TMJ disc dysfunction, 22 with disc displacement without (DD) and 16 as having disc displacement with reduction (DDR). TMJ sounds were recorded with miniature microphones placed in the ear canals, and jaw movements were documented with a kinesiograph. A sign, unbalanced lateral deviation (ubd) was defined as a rapid, short duration, change in jaw movement direction from, and back to, a smooth deviation path in the horizontal plane. The hypotheses were that degrees of maximal deviations, proportions of unbalanced deviation (ubd) and such deviation associated with TMJ sounds (ubdS), differ between healthy subjects and patients with DD or DDR. Comparisons between groups were made using one-way anova and chi-square analysis, as appropriate. No differences were found between groups regarding degree of lateral deviation per se. The proportions of ubd and ubdS were significantly higher in patients with DDR than in healthy subjects and than in patients with DD (P < 0·001), but no such differences were found between healthy subjects and patients with DD. For prediction of DDR, the sensitivity and specificity of the sign ubdS were found to be 68·8% and 89·3%, respectively. For the sign ubd, they were 100·0% and 64·3%. This indicates that the sign ubdS has diagnostic value in screening for DDR.

Potential clinical application of masseter and temporal muscle massage treatment using an oral rehabilitation robot in temporomandibular disorder patients with myofascial pain.

OBJECTIVES: To investigate the safety, suitable treatment regimen, and efficacy of masseter and temporal muscle massage treatment using an oral rehabilitation robot. METHODS: Forty-one temporomandibular disorder (TMD) patients with myofascial pain (8 men, 33 women, median age: 46 years) were enrolled. The safety, suitable massage regimen, and efficacy of this treatment were investigated. Changes in masseter muscle thickness were evaluated on sonograms. RESULTS: No adverse events occurred with any of the treatment sessions. Suitable massage was at pressure of 10 N for 16 minutes. Five sessions were performed every 2 weeks. Total duration of treatment was 9·5 weeks in median. Massage treatment was effective in 70·3% of patients. Masseter muscle thickness decreased with treatment in the therapy-effective group. CONCLUSION: This study confirmed the safety of massage treatment, and established a suitable regimen. Massage was effective in 70·3% of patients and appeared to have a potential as one of the effective treatments for myofascial pain.

Management of pain secondary to temporomandibular joint syndrome with peripheral nerve stimulation.

BACKGROUND: Temporomandibular joint syndrome, or Costen syndrome, is a clinically diagnosed disorder whose most common symptoms include joint pain and clicking, difficulty opening the mouth, and temporomandibular joint discomfort. The temporomandibular joint (TMJ) is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve (the V3 branch of the trigeminal nerve). OBJECTIVES: The aim of this study is to assess the effectiveness and safety of permanent peripheral nerve stimulation to relieve TMJ pain. STUDY DESIGN: This case series is a prospective study. SETTING: Pain Unit of a regional universitary hospital. METHODS: The study included 6 female patients with temporomandibular pain lasting from 2 to 8 years that did not respond to intraarticular local anesthetic and corticoid injections. After a positive diagnostic block test, the patients were implanted with quadripolar or octapolar leads in the affected preauricular region for a 2-week stimulation test phase, after which the leads were connected to a permanent implanted pulse generator. Results of the visual analog scale, SF-12 Health Survey, Brief Pain Inventory, and drug intake were recorded at baseline and at 4, 12, and 24 weeks after the permanent implant. RESULTS: Five out of 6 patients experienced pain relief exceeding 80% (average 72%) and received a permanent implant. The SF-12 Health Survey results were very positive for all specific questions, especially items concerning the physical component. Patients reported returning to normal physical activity and rest at night. Four patients discontinued their analgesic medication and 1 patient reduced their gabapentin dose by 50%. LIMITATIONS: Sample size; impossibility of placebo control. CONCLUSION: Patients affected with TMJ syndrome who do not respond to conservative treatments may find a solution in peripheral nerve stimulation, a simple technique with a relatively low level of complications.

Association between mandibular condylar position and clinical dysfunction index.

OBJECTIVES: Condylar position in the glenoid fossa has been associated with temporomandibular disorders. The purpose of the present study was to investigate the correlation between clinical dysfunction index (Di) and mandibular condylar position in patients with temporomandibular joint dysfunction (TMD) using cone beam computed tomography (CBCT). METHODS: In this cross-sectional study, participants were recruited from the Department of Maxillofacial Radiology at Shiraz Dental University in Iran. The condylar position was assessed on the CBCT images of 120 temporomandibular joints in 60 patients with TMD. Patients were divided into 3 groups based on Helkimo's clinical Di. The chi-square test was used to correlate degree of the Helkimo's Di with the mandibular condylar position. The p value was set at 0.05. RESULTS: A total of 60 patients (42 women and 18 men; mean age, 33.4 years) participated in this study. Significant differences in condylar position were found among the 3 groups (Di I, II, and III) (p < 0.05). Patients with mild to moderate TMD were found to have anteriorly and concentric seated condyles. Posteriorly seated condyles were found in patients with severe TMD. CONCLUSION: Condylar position is associated with different severity of TMD.

Aplicación de la termografía infrarroja en medicina legal. ¿Prueba válida para la objetivación de los síndromes dolorosos? Disfunción temporomandibular / Application of Infrared thermography in legal medicine. Is it a valid test for an objective assessment of painful syndromes? Temporomandibular disorder

Uno de los objetos de estudio de la Medicina Legal y Forense es la evaluación de las lesiones causadas a las personas en distintas circunstancias: accidentes de tráfico, accidentes laborales, agresiones físicas, etc... La utilización de pruebas complementarias ha sido, es y seguirá siendo un pilar fundamental para la valoración objetiva de las consecuencias que estas lesiones tienen en quien las sufre. Nuestros informes periciales deben aportar las pruebas necesarias con el fin de justificar la sintomatología residual referida por los lesionados. Uno de los puntos más polémicos es la objetivación del dolor referido por los lesionados. En este sentido, la termografía infrarroja (TIR) se ha convertido en una herramienta complementaria muy útil para la evaluación de los procesos dolorosos, permitiendo identificar alteraciones fisiopatológicas del medio interno que justifican la clínica dolorosa manifestada por los pacientes. Sus aplicaciones médicas son múltiples y actualmente su uso se encuentra regulado y estandarizado por sociedades científicas que velan por el control de la calidad de los estudios. Con el fin de introducir y divulgar la utilización de esta prueba complementaria en el ámbito médico legal, exponemos un caso en que la TIR permitió la identificación de alteraciones en el equilibrio térmico de los músculos masticatorios en una paciente que redfería dolor en la articulación temporomandibular derecha tras un traumatismo craneoencefálico moderado-grave (AU)

One of the aims of Forensic Medicine is the assessment of injuries suffered by patients on different situations (i.e., traffic collisions, work accidents, physical aggression, etc.). The use of complementary tests has always been a key factor for an objective assessment of those injuries’ consequences and our expert reports should include all required evidences to prove the residual symptoms reported by patients. One of the most controversial issues has been and continues to be the verifying referred pain by our patients. In that sense infrared thermography has become a useful tool in the assessment of painful processes allowing us to identify pathophysiological changes in the internal environment that can prove the painful condition. In addition to its multiple medical applications, its use is currently regulated and standardized by scientific associations that ensure the compliance of quality standards. In order to introduce and spread the use of this complementary test in the forensic field, we report a case on which the use of infrared thermography allowed to identify abnormalities in thermal equilibrium of chewing muscles on a patient that reported right temporomandibular joint pain after suffering a moderate to severe head injury (AU)

Arthrocentesis procedure: using this therapeutic maneuver for TMJ closed lock management.

Temporomandibular joint (TMJ) disorder is a term that encompasses a number of overlapping conditions, such as closed lock. Closed lock of the TMJ is considered a consequence of a nonreducing deformed disc acting as an obstacle to the sliding condylar head that usually causes a decrease in the maximum mouth opening and acute pain. The management of the TMJ is still controversial. Thus, arthrocentesis of the TMJ is a valuable modification of the traditional method of arthroscopic lavage, which consists of washing the joint in order to remove chemical inflammatory mediators and intra-articular adhesions, changing intra-articular pressure. TMJ disorder has always presented as a therapeutic challenge to maxillofacial surgeons. Therefore, this paper aimed to describe a clinical report of a closed lock of the left TMJ in a 19-year-old female subject who was successfully treated by arthrocentesis procedure.

Correlation between articular eminence steepness measured with cone-beam computed tomography and clinical dysfunction index in patients with temporomandibular joint dysfunction.

OBJECTIVE: The purpose of this study was to investigate the correlation between articular eminence steepness and clinical dysfunction index (Di) in patients with temporomandibular joint dysfunction (TMD) using cone-beam computed tomography (CBCT). STUDY DESIGN: In this study, CBCT images of 60 temporomandibular joints in 30 patients with TMD were evaluated. The eminence inclination values were measured on CBCT images. Patients were subdivided into 3 groups based on Helkimo's clinical Di. The data were analyzed using Spearman's rho correlation coefficient test. RESULTS: The results of the present study did not confirm any significant differences in the values of articular eminence inclinations among the 3 groups (P value >.05). CONCLUSION: Based on the present study, there is no apparent relationship between the articular eminence inclination and the clinical Di in patients with TMD.

Styloid process elongation and calcification in subjects with tmd: clinical and radiographic aspects.

Knowledge of the Eagle's syndrome shows that its symptoms can be very easily confused with other types of craniomandibular disorders, especially temporomandibular disorders (TMD). The aim of this study was to find a possible correlation between the presence of TMD and elongation of the styloid process as well relate to presence of calcification of the stilohyoid chain. Fifty patients with TMD, confirmed from the RDC/TMD, were examined clinically and radiographically. Radiographic documentation consisted of digital panoramic radiograph and digital lateral cephalometric radiograph. Radiocef software (Radiomemory) was used for the analysis of radiographs by means of specific cephalometric tracing and linear measurements of the styloid process. Each radiograph was traced and measured three times with intervals of 1 month to spread the error. Statistical analysis was performed by Pearson's test (p=0.001) using Biostat 4.0 statistical software. Result showed an incidence of 76% elongation of the styloid process in the sample. There was a correlation between the bilateral measures taken in panoramic radiographs (?<0.001) and also for measures of styloid process length carried out in different panoramic radiographs and lateral cephalometric radiographs (?<0.001). It was concluded that there is prevalence of elongated styloid process in patients with TMD. However, no relationship was found between measurements on the stylohyoid chain and symptoms of headache, orofacial pain, tinnitus and vertigo.

[Contributions to the methodology of study in the functional assessment of temporomandibular joint dysfunctional syndrome]. / Contributii la studiul metodologiei de evaluare functionala a articulatiei temporo-mandibulare în sindromul algo-disfunctional.

AIM: Dysfunctional syndrome of the temporomandibular joint through the complexity and variability of the symptoms may result in significant structural and functional changes leading from discomfort to disability and a negative impact on quality of life. MATERIALS AND METHODS: A prospective study was conducted between October 2009-December 2010, in 52 subjects diagnosed with rheumatoid arthritis and complaining of symptoms in the temporomandibular joint. The functional examination of the joint and muscle has included the assessment of the active range of motion, passive range of motion, resistance range of motions of the temporomandibular joint, dermatomes and the pain in the region of masseter, temporalis, median and lateral pterigoids, digastric, sternocleidomastoid and longus colli muscles. The ultrasound examination has included clinical aspects of alignment, shape, dynamics of the mandibular condyle, of the temporal fossa, aspects regarding the temporal and masseter muscles at rest and at contraction phases. RESULTS: The clinical examination highlighted the presence of pain at temporomandibular jointlevel for all tested pacients. The majority complained the pain from moderate to severe level. For the majorityof cases (59,60%) the pain stars spontaneously, during the day time (80,80%) and the night time (50,60%). Over 50% from the research cases complained cracks at the temporomandibular joint level released by a movement. At the oral and dental examination of the research group 55,8% from the tested pacients presented dental cavities toothless partially or totally duet o additionally overworking temporomandibular joint. The limitation of the range of motion is not the most important detected dysfunction, affecting approximately 30% of the cases that have been studied. Pain and spasm in a very large proportion are present in the masseter and temporal muscles regions. Atrophy is present in a lesser extent. The dysfunctional index shows an involvement of the temporomandibular joint, for over 45% of patients tested. The ultrasound examination revealed degenerative inflammatory lesions at a rate of 38.46%, inflammatory lesions at a rate of 28.85% and mixed lesions at a rate of 9.62%. CONCLUSIONS: The research regarding the clinical paraclinical and functional aspects of temporomandibular joint, permited to highlight the fact that rheumatic inflamatory and degenerative, pathology, characterises it self through a high index of morbidity and disability that lowers the life quality. Establishing a treatment plan involves customizing all clinical, functional and laboratory data.

Electromyographic power spectrum of jaw muscles during clenching in unilateral temporomandibular joint osteoarthritis patients.

The relationship between temporomandibular joints (TMJ) osteoarthritis and masticatory muscle disorders is poorly understood. The data are sparse, the results are conflicting, and electromyographic (EMG) power spectrum analysis has not been used. The aims of this study were to compare the differences in EMG power spectrum during, and pressure pain thresholds (PPTs) before and after, sustained clenching in patients with unilateral TMJ osteoarthritis and healthy control subjects. Nineteen patients with unilateral TMJ osteoarthritis without masticatory muscle pain and 20 control subjects were evaluated. We measured EMG amplitudes at maximum voluntary contraction, median frequency from the EMG power spectrum during sustained clenching at 70% and PPTs before and after the clenching in both temporalis and masseter muscles. There were no significant differences in PPT decrease between muscles or between groups during sustained clenching. There were no significant differences in maximum voluntary contraction EMG activity ratios of affected to unaffected sides between groups, or of masseter to temporalis muscles between affected and unaffected side of patients with TMJ osteoarthritis. Median frequencies decreased from the beginning to the end of the sustained clench, and the interaction between group and clench was significant: the median frequency decrease was larger in the osteoarthritis group. Our results suggested that masticatory muscles of patients with unilateral TMJ osteoarthritis are more easily fatigued during sustained clenching than normal subjects.

Synovial fluid dynamics with small disc perforation in temporomandibular joint.

The articular disc plays an important role as a stress absorber in joint movement, resulting in stress reduction and redistribution in the temporomandibular joint (TMJ). The flow of synovial fluid in the TMJ may follow a regular pattern during movement of the jaw. We hypothesised that the regular pattern is disrupted when the TMJ disc is perforated. By computed tomography arthrography, we studied the upper TMJ compartment in patients with small disc perforation during jaw opening-closing at positions from 0 to 3 cm. Finite element fluid dynamic modelling was accomplished to analyse the pattern of fluid flow and pressure distribution during the movements. The results showed that the fluid flow in the upper compartment generally formed an anticlockwise circulation but with local vortexes with the jaw opening up to 2 cm. However, when the jaw opening-closing reached 3 cm, an abnormal flow field and the fluid pressure change associated with the perforation may increase the risk of perforation expansion or rupture and is unfavourable for self-repair of the perforated disc.

Radiological examination of the articular eminence morphology using cone beam CT.

OBJECTIVE: The purpose of the present study was to investigate the articular eminence inclination and height according to age and gender in patients with temporomandibular joint (TMJ) dysfunction and healthy controls using cone beam CT (CBCT). METHODS: The measurements were performed on CBCT records of 52 TMJ dysfunction patients (11 males and 41 females) and 41 control patients (17 males and 24 females). The eminence inclination and height were measured on the CBCT images. RESULTS: The eminence inclination and height values were higher in males than in females in both TMJ dysfunction patient and control groups; however, these differences were not statistically significant (p>0.05). While no statistically significant differences were found in the eminence inclination and height values between the age groups (p>0.05) in the TMJ dysfunction patient group, there were statistically significant differences in the control group. The eminence inclination was highest between the ages of 21 and 30 years and showed a decrease after the age of 30 years. Additionally, the eminence inclinations of the control patients were statistically higher than those of the TMJ dysfunction patients. CONCLUSION: There were no statistically significant differences in eminence inclination and height according to gender. The eminence inclination reaches its highest value between the ages of 21 and 30 years and shows a decrease after the age of 31 years in healthy patients. The eminence inclination was steeper in healthy control patients than in patients with TMJ dysfunction.

[Diagnosis of masticatory organ dysfunction craniomandibular system dysfunction (CMD)]. / Rágószervi funkciózavarok diagnosztikája--craniomandibularis rendszer dysfunctiója (CMD).

A practising dentist often meets pains of different location and limited ability of mouth opening, locomotor disorder, the cause of which is difficult to identify and explain. There is a particular group of patients with functional disorder who turn to several doctors with their varied and colorful symptoms. Most of these patients suffer from cranio-mandibular disfunction (CMD). You must not indicate any treatment especially not an invasive one without a diagnosis. While relieving the patient's pains, you have to determine the cause and effect. The authors suggest discussing the issue of giving a unanimous definition of masticatory organ disfunction as an interdisciplinary diagnosis which is in accord with international bibliography. They review the algorithm of diagnosis, indication of medical examination by demonstrating some typical cases. They share their experience gained during several decades of clinical practise involving about 2,000 patients.

Prevalence of the types of the petrotympanic fissure in the temporomandibular joint dysfunction.

BACKGROUND: Petrotympanic fissure (PTF) is a fissure in the temporal bone that runs from the temporomandibular joint (TMJ) to the tympanic cavity (TC). In PTF, the discomallear ligament (DML) connects the malleus in the tympanic cavity and the articular disc and capsule of the temporomandibular joint. PTF with the DML is a possible cause of aural symptoms related to temporomandibular joint dysfunction (TMD). PURPOSE: To investigate the prevalence of different types of PTF in TMD using dental volumetric tomography (DVT) and determine whether PTF type correlates with age. MATERIAL AND METHODS: DVT scans in the sagittal planes of PTFs of 134 patients with TMD were examined for the types of PTF present. Three main PTF types were described: wide, tunnel-shaped structure (type 1); tunnel-shaped structure that is wide open in the PTF entrance to the mandibular fossa and gradually thins out in the tympanic cavity (type 2), tunnel-shaped structure that is wide open in the entrance of the mandibular fossa, with a middle region with a flat-shaped tunnel structure and a narrow exit in the tympanic cavity (type 3). RESULTS: In DVT scans, PTF types 1, 2 and 3 were seen in 67.2%, 1.5%, and 31.3% of cases, respectively. We found no significant relationship between age or gender and PTF type. CONCLUSION: The low percentage of type 2 PTF and high percentage of type 1 PTF must be taken into consideration during pre-surgical planning related to TMD. However, future well-designed clinical studies involving larger numbers of subjects will be necessary to confirm the findings of this study.

[Diagnostics of mandibular articulation disorders in TMJ dysfunction patients].

Diagnostics of disorders of mandibular articulation of 95 patients with TMJ dysfunction were described. Collecting the data from transcranial x-ray examination, CT, MRT and computerized axijgraphy of TMJ typical disorders of articulation of the mandibular at 4 base clinio-roentgenogical forms of TMJ dysfunction were found.