Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review.

The objective of this systematic review was to find sufficient evidence to deny or accept the association between the head and cervical posture and temporomandibular disorders (TMDs), and thus assist health professionals in the evaluation and treatment of patients with TMDs. A search was conducted through all publications written in English about this topic using the databases from Medline, ISI Web of Science, EMBASE, PubMed and Lilacs. The abstracts that fulfilled the initial guideline were retrieved and evaluated to ensure they met the inclusion criteria. To assess the methodological quality of the studies, we developed a questionnaire considering the following criteria: participant's eligibility, control group, diagnosis of TMDs, posture diagnosis and randomisation. Twenty-two studies were selected as potential studies based on their abstracts. Only seventeen studies actually fulfilled the inclusion criteria. The search provided information about the methodological quality of the studies, in which several methodological defects were found. The evidence presented in this systematic review shows that the relation between TMDs and the head and neck posture is still controversial and unclear. The insufficient number of articles considered of excellent methodological quality is a factor that hinders the acceptance or denial of this association.

Trigeminal neuralgia: literature review

The trigeminal nerve, fifth equal of cranial nerves, a mixed nerve is considered by possessing motor and sensitive components. The sensitive portion takes to the Nervous System Central somesthesics information from the skin and mucous membrane of great area of the face, being responsible also for a neural disease, known as the Trigeminal Neuralgia. The aim of this study was to review the literature on the main characteristics of Trigeminal Neuralgia, the relevant aspects for the diagnosis and treatment options for this pathology. This neuralgia is characterized by hard pains and sudden, similar to electric discharges, with duration between a few seconds to two minutes, in the trigeminal nerve sensorial distribution. The pain is unchained by light touches in specific points in the skin of the face or for movements of the facial muscles, it can be caused by traumatic sequels or physiologic processes degenerative associate the vascular compression. Prevails in the senior population, frequently in the woman. In a unilateral way it attacks more the maxillary and mandibular divisions, rarely happens in a simultaneous way in the three branches of trigeminal nerve three branches.

Pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement with counterclockwise rotation for Class II anterior open bite malocclusions.

OBJECTIVES: The purpose of this study was to cephalometrically evaluate the pharyngeal airway space and frontal and sphenoid sinus changes after maxillomandibular advancement counterclockwise rotation for class II anterior open bite malocclusion. METHODS: The study included 49 patients (98 lateral teleradiographs; 36 females and 13 males) who were analysed in the pre-operative (1 week before surgery) and post-operative (6 months after surgery) periods. In each lateral teleradiography, the dimensions of the inferior and superior pharyngeal airway space, TB-PhW1 [the point between the posterior aspect of the tongue to the dorsal pharyngeal wall (oropharynx) (TB) and the point on the dorsal pharyngeal wall closest to TB (PhW1)] and UP-PhW2 [and the point between the posterior aspect of the soft palate to the dorsal pharyngeal wall (nasopharynx) (UP) (PhW2)] measurements were evaluated, as well as the dimensions of the frontal and sphenoid sinuses. The differences between the two operative times were evaluated by Student's t-test. RESULTS: All measurements showed excellent reproducibility for the intraclass correlation coefficient (ICC > 0.9; p < 0.0001). There was an increase in the measurements TB-PhW1 and UP-PhW2 and a decrease in the dimensions of the frontal and sphenoid sinuses after orthognathic surgery. CONCLUSIONS: The morphology of the superior and inferior pharyngeal airway space and frontal and sphenoid sinuses changes after 6 months of maxillomandibular advancement counterclockwise rotation for class II anterior open bite malocclusion.

Morphological characteristics of foramen of Vesaliusand its relationship with clinical implications

The aim of this study was to evaluate the incidence as well morphometry of the foramen of Vesalius in humanskulls and analyzing their clinical importance. Dry human skulls (n = 80) and with gender distinction wereused (40 male and 40 female). The results demonstrates an total incidence of 40%, 13.75% skulls with thebilateral presence of the foramen, 26.25% skulls with the unilateral presence of the foramen, 31.25% skullswith foramen only of the right side, 22.50% skulls with foramen only of the left side, 25% masculine skulls withat least 1 foramen and 52.25% skulls with at least 1 foramen. The morphometry showed an average diameterof 1.457 ± 1.043 mm on the right and 1592 ± 0938 mm to the left. The average distance to the foramenovale was 1.853 ± 0.303 mm on the right side and 2.464 ± 0.311 mm on the left. It can be concluded that adeepened anatomical study of the foramen of Vesalius collaborates not only for anatomical knowledge of thisstructure, but also in clinical situations involving this foramen.

Incidence of the ossified pterygoalar ligamentin Brazilian human skulls and its clinical implications

The ossified pterygoalar ligament is formed between the lateral lamina of the pterygoid process and theinfratemporal surface of the sphenoid bone or its greater wing and was not connected to the sphenoid spine.The aim of this study was to evaluate the incidence of the ossified pterygoalar ligament in Brazilian humanskulls and analyzing its clinical importance. 183 Brazilian adult (between 30 to 60 years old) dry human skullswere evaluated. Was evaluated the incidence of skulls with complete or partial ossification of the pterygoalarligament, bilaterally and unilaterally and in the presence on the right and left sides. Were found 5 skulls had theossified pterygoalar ligament, resulting in an overall incidence of 2.73%. There was 1 skull in the presence ofthe incomplete ossification of the pterygoalar ligament, unilaterally and on the left side resulting in incidence of0.54%. There were 4 skulls in the presence of the complete ossification of the pterygoalar ligament, unilaterallyand on the right side resulting in incidence of 2.18%. The ossified pterygoalar ligament is a major cause of theentrapment of the lingual nerve or a branch of the mandibular nerve and may cause mandibular neuralgia. Theincidence of the ossified pterygoalar ligament and the pterygoalar foramen is low in the Brazilian population.However, these structures have clinical significance as this ligament establish relationships with the ovaleforamen and difficulty in accessing in this foramen in a therapeutic approach.

Relationship between the angle of the coronoid process of the mandible and the electromyographic activity of the temporal muscle in skeletal Class I and III individuals.

The aim of the present study was to verify the relationship between the angle of the coronoid process of the mandible in the latero-lateral direction and electromyographic activity of the anterior part of the temporal muscle in skeletal Class I and III individuals. Forty-five volunteers were assessed subdivided into two groups, according to angle ANB, in Class I and III. Two radiographic examinations were performed, one lateral cephalogram to measure angle ANB and one frontal cephalogram to measure the angle of the coronoid process. The electromyographic examination of the volunteers' temporal muscles was performed. Statistical analysis of the data showed that the relationship between the angle of the coronoid process and the skeletal class was negative for both classes analysed. The relationship between electromyographic activity of the temporal muscle and angle of the coronoid process was negative for Class I individuals. In the Class III group, smaller angles of the coronoid process were related to higher values of electromyographic activity of the temporal muscle. There was no statistically significant difference between the electromyographic activity of the temporal muscle in skeletal Class I and III individuals. Based on the results obtained, it was concluded that there was no influence of the skeletal classes analysed on the angle of the coronoid; the angle of the coronoid process may be influenced by the electromyographic activity of the temporal muscle in the Class III group; the electromyographic activity of the temporal muscle is not influenced by the skeletal class in Class III individuals.

Morphological changes in the position of the mandibular foramen in dentate and edentate Brazilian subjects.

This study assessed the mandibular foramen (MF) position variability in dentate and edentate Brazilian mandibles. Eighty dentate and 79 edentate mandibles of unknown sex were measured bilaterally using a digital caliper (0.1-mm precision). Horizontal linear measurements (HM) were done from the MF to the anterior border of the mandibular ramus (MF-A) and from the MF to the posterior border of the mandibular ramus (MF-B). Vertical linear measurements (VM) were done from the MF to the most inferior point of the mandibular notch (MF-C) and from the MF to the inferior border of the mandibular ramus (MF-D). Data were analyzed by two-way ANOVA (alpha = 5%). The HM means and standard deviations (+/-SD) for MF-A were, edentate right (ER): 17.5 (+/-3.2) mm, edentate left (EL): 17.4 (+/-3.4) mm, dentate right (DR): 19.2 (+/-3.6) mm, and dentate left (DL): 18.8 (+/-3.8) mm. The means (+/-SD) for the MF-B measurements were, respectively, ER: 12.8 (+/-2.4) mm, EL: 12.9 (+/-2.3) mm, DR: 14.2 (+/-2.4) mm, and DL: 13.9 (+/-2.6) mm. The VM values for the MF-C measurements were, ER: 23.4 (+/-3.8) mm, EL: 22.9 (+/-3.7) mm, DR: 23.6 (+/-3.1) mm, and DL: 23.1 (+/-3) mm, and for the MF-D measurements, ER: 26.4 (+/-4.2) mm, EL: 26.4 (+/-4) mm, DR 28.3 (+/-3.9) mm, and DL 28 (+/-3.8) mm. Side had no influence (p>0.05) on any edentate or dentate mandible measurement. Dentate mandible measurements showed statistically significant differences compared to the edentate mandibles, except for MF-C. The mandibular foramen position changes with loss of teeth and this variability may be responsible for occasional failure of inferior alveolar nerve block.

Dental anomalies and their value in human identification: a case report.

Forensic odontology and anthropology provide valuable support with regard to human identification. In some cases, when soft tissue is destroyed, carbonized or absent for whatever reason, bones and teeth become the only source of information about the identity of the deceased. In human identification, anything different, such as variation from normality, becomes an important tool when trying to establish the identity of the deceased. This paper illustrates a positive identification case achieved by the diagnosis of an anomaly of tooth position, with confirmation using skull-photo superimposition. Even though forensic science presents modern techniques, in this particular case, the anomalous position of the canine played a key role on the identification, showing that the presence of a forensic dentist on the forensic team can be of great value.

Morphometric analysis of the foramen magnum in human skulls of brazilian individuals: its relation to gender

The morphological characteristics obtained by craniometry may be the key to sex determination and enable us to identify unknown individuals in anywhere in the world. Aims: The purpose of this study was to evaluate the effectiveness of the linear morphometry of foramen magnum to verify the morphological characteristics for gender determination in human skulls of Brazilian individuals. Methods: With a digital caliper, were made three non-consecutive measurements of the foramen magnum in 215 human skulls (139 male and 76 female), from the collection of the Department of Morphology and Descriptive Topography – UNIFESP/SP with registered data on nationality, gender, and age. The craniometric measurements were made in accordance with the protocol defined by Günay and Altinkõk (2000). The data were submitted to intraclass correlation coefficient (ICC) and Student t-test with significance level of 5%. Results: There were no statistically significant differences (chi-square, p > 0.05) between the ethnic groups within each gender. The ANOVA and Tukey tests showed that the gender influenced the width of the foramen magnum. The FM is higher in males (30.3 ± 0.20) than in females (29.4 ± 0.23), but not in length (p < 0.05). Conclusion: The morphometric linear method of the foramen magnum (width) was able to determine the morphological differences between sexes and can be used in conjunction with other anthropological techniques to gender determination of unknown individuals.

Incidence of clavicular rhomboid fossa (impression for costoclavicular ligament) in the Brazilian population: forensic application.

In the last years, anthropology has been widely explored mainly when related to bones due to its morphologic characteristics, such as the rhomboid fossa of the clavicle. This study examined the incidence of the rhomboid fossa in paired clavicles of Brazilian subjects obtained from 209 adult bodies of known age and sex (107 males and 102 females) on which postmortem examinations had been performed by the senior author. The data were submitted to qualitative statistical analysis according to Fisher. There was a statistical difference (p= 5.98 x 10-23) between sexes related to the frequency of the rhomboid fossa. The fossa was absent in 97,1% of the female clavicles and the incidence of bilateral fossa was present in 2,9% of females. The incidence of bilateral fossa was 29% for male clavicles. The sexual or side differences in the incidence of the fossa could be found in this study, and qualitative analysis can corroborate sex determination of unidentified bodies in forensic medicine.

The frontal sinus morphology in radiographs of Brazilian subjects: its forensic importance

The determination of gender of unknown persons is of vital importance in forensic investigations, such as anthropologic,medical and dental forensic studies, mainly in cases where only fragments of the skull remain and there is no possibility of identification based on the dental arch. The aim of the present study was to develop a mathematical method based on logistic regression analysis capable of determining the gender of individuals using measurements of the frontal sinus. The right and left areas and the maximum height and width of the frontal sinus were determined in 100 radiographs taken by the Caldwell technique of 50 women and 50 men between 20 and 30 years old, with the help of the prog ram SIARCS 3.0 (EMBRAPA). The mean values of the frontal sinus were greater in males and the left area was larger than the right area, based on Student’s t-test at the 5% level of significance. The mathematical model based on logistic regression analysis gave a concordanceindex for gender of 79.7% in the cases studied. The areas of the frontal sinus and the logistic regression technique proved to be useful in the determination of gender. (Logit = 1.6905 – 0.5383* left area).