The accuracy of clinical neurosensory testing for nerve injury diagnosis.

PURPOSE: The accuracy of the clinical neurosensory test to diagnose trigeminal nerve injuries has never been statistically evaluated. The purpose of this study was to determine the statistical efficacy of the clinical neurosensory test using surgical findings as the "gold" standard, and to determine whether a correlation existed between the sensory impairment score obtained by preoperative testing and the degree of nerve injury found at surgery. MATERIALS AND METHODS: A multisite, randomized, prospective, blinded, clinical trial was conducted on 130 patients with inferior alveolar nerve (IAN) and lingual nerve (LN) injuries. Preoperatively, patients were provided a sensory impairment score using a three-level drop-out clinical neurosensory test (NST), and blind comparisons were made with the surgical findings postoperatively. RESULTS: The positive predictive and negative predictive values for LN-injured patients were 95% and 100%, respectively. The positive predictive and negative predictive values for IAN patients were 77% and 60%, respectively. There were statistically significant differences in the distribution of age, duration of injury, cause of injury, presence of neuropathic pain, presence of trigger pain, and degree of injury between the IAN and LN patient populations. There was a statistically significant positive relationship found between the sensory impairment score and the degree of nerve injury. CONCLUSIONS: The NST is a clinically useful method to diagnose IAN and LN injuries. However, the NST results are less efficient for IAN injuries than LN injuries, and have a high incidence of false-positive (23%) and false-negative (40%) results when testing patients with IAN injuries. The different rates of statistical efficiency between the two groups of patients may be attributable to differences in prevalence and biologic covariates.

Longitudinal volumetric computed tomographic analysis of regional brain changes in normal aging and Alzheimer's disease.

OBJECTIVE: This study used a semiautomated image analysis technique to quantify the rate and regional pattern of cerebrospinal fluid (CSF) volume changes in the computed tomographic brain examinations of healthy adults and patients with Alzheimer's disease (AD). DESIGN: Longitudinal, within-subject design, with statistical correction for longitudinal method error (eg, head repositioning effects). SETTING: Palo Alto (Calif) Department of Veterans Affairs Medical Center. PATIENTS AND OTHER PARTICIPANTS: The 41 patients with AD were recruited from the Geriatric Psychiatry Research Unit and the National Institute of Mental Health Clinical Research Center of the Palo Alto Department of Veterans Affairs Medical Center. The 35 healthy control subjects were recruited from the local community. MAIN OUTCOME MEASURES: Cerebrospinal fluid volumes estimated from computed tomographic scans. RESULTS: Even after accounting for an estimate of method error (eg, head positioning effects) across computed tomographic examinations, the patients with AD showed greater annual CSF volume increases than did the control group. This CSF volume enlargement was not uniform across brain regions of interest; rather, the patients with AD showed disproportionate volume increases in the ventricular system and the sylvian fissures. Greater CSF volume changes in the patients with AD were significantly associated with greater cognitive decline on the Mini-Mental State Examination. Furthermore, younger patients with AD showed more rapid progression on computed tomographic scans than did older patients. CONCLUSIONS: The rate of CSF volume enlargement is region specific, with the most marked annual rate of change occurring in the ventricular system and the sylvian fissures. In addition, younger patients show more rapid progression in the ventricular and frontal sulcal brain regions of interest than do older patients.

Arteriovenous malformation of the mandible: life-threatening complications during tooth extraction.

This case illustrates how a vascular malformation can turn an ordinary tooth extraction into an emergency situation. Arteriovenous malformations are rare and difficult to detect on radiographs. Early warning signs are discussed and surgical treatment is described.

Computed tomography and magnetic resonance imaging of cervical metastasis.

Thirteen patients with head and neck cancer underwent staging by clinical examination, computed tomography (CT), and magnetic resonance imaging (MRI) in a standardized blinded fashion. All patients subsequently underwent radical neck dissection with subsequent pathologic staging. CT and MRI each predicted 93% of staging results correctly, with clinical examination correct 67% of the time. Staging of primary tumors had an accuracy of 90% by clinical examination, 40% by CT, and 50% by MRI when compared to staging the pathologic specimen. Understaging was seen in 50% of CT scans and 30% of MRI scans. We believe either CT or MRI should be considered for routine staging of the neck in all head and neck malignancies.

Problems in evaluation of penetrating foreign bodies with computed tomography scans: report of cases.

Computed tomography is the best radiologic modality available in the evaluation of penetrating injuries to the soft tissues. The technique is the best available when the foreign body has a density similar to the surrounding tissues. Limitations of CT scanning include difficulty in identifying small foreign bodies, objects with densities similar to surrounding structures, and detecting vascular injury. Interpretation of postoperative changes is also difficult. Two cases have been presented to illustrate the advantages, and limitations of CT scanning in penetrating soft tissue trauma.

Mesenchymal chondrosarcoma: a case report.

Mesenchymal chondrosarcoma is a rare tumor distinctly different from the more common chondrosarcoma. It shows a predilection for the head and neck in both osseous and extraosseous forms. The prognosis for cure is poor, with a high incidence of local recurrence as well as regional and distant metastasis. Treatment is based on radical surgical excision, although combination chemo-therapy has recently shown promise. Additional experience with this tumor is required to define the most efficacious form of treatment.

The effects of immobilization on the rabbit temporomandibular joint.

While the effects of immobilization of joints covered with hyaline cartilage have been widely studied, the effects on the fibrous tissue-covered temporomandibular joint have not been studied as extensively. This study was designed to determine the short-term effects of immobilization on the rabbit temporomandibular joint. Nineteen rabbits were placed in maxillomandibular fixation. The temporomandibular joints were studied histologically after periods of from ten to 28 days. Significant thinning was observed as early as after ten days, as was degeneration of the cartilage. Degeneration became progressively more severe as the duration of the immobilization increased. Reparative events began appearing after 28 days. These findings suggest that although initially immobilization produces destructive changes, the changes may well be reversible.

Orthognathic surgery in correcting dentofacial defects.

Advances in orthognathic surgery now make it possible to correct most skeletal abnormalities of the face. Simple screening measures can be quickly applied to assess the patient who appears to be a candidate. Cases are carefully planned and coordinated, with the aid of special diagnostic procedures to identify the problem and select the appropriate management. Properly executed, these techniques result in a lifetime of improved function and aesthetics.

The psychological and social aspects of orthognathic treatment.

Cooperative management of dentofacial abnormalities by orthodontists and oral and maxillofacial surgeons has experienced tremendous growth in recent years. Frequently these patients have suffered considerable emotional trauma from ridicule of their deformity. This history of emotional abuse may influence the patient's attitude and expectations regarding corrective treatment and even lead to dissatisfaction in spite of technical success. Review of the literature and interviews with patients previously treated for dentofacial abnormalities revealed a very high rate of satisfaction. This high degree of satisfaction is in contrast to several studies involving patients undergoing cosmetic plastic surgery. However, in spite of over-all satisfaction, retrospective interviews identified a number of concerns which deserve additional attention. These concerns would be best approached with a preoperative interview to delineate the patient's motivation and expectations. Such an interview, including a cursory psychological evaluation, could provide increased insight and communication among orthodontist, surgeon, and patient. The results would help identify and prevent some of the pitfalls leading to patient dissatisfaction after treatment.

Management of acute alcohol withdrawal.

The relationship between maxillofacial trauma and alcohol abuse has been well documented. The onset of acute alcohol withdrawal following the injury can seriously complicate and compromise the treatment of the maxillofacial injuries as well as be potentially lethal for the patient. A clear understanding of the biochemistry, development, signs and symptoms, and management of acute alcohol withdrawal is necessary for the oral and maxillofacial surgeon.

Epidermoid cyst of the floor of the mouth.

The characteristics and incidence of dermoid cysts of the floor of the mouth are reviewed. The epidermoid cyst in the sublingual (genioglossal) position is unique because of its size and the advanced age of presentation. The use of preoperative lateral xerography was beneficial in determining the extent of the lesion and in visualizing the partial obstruction of the upper airway. An intraoral surgical technique was used to treat the cyst.