[Multidisciplinary treatment of orofacial pain and dysfunction after a transoral condylectomy: the role of pain, sleep, and psychotrauma]. / Multidisciplinaire behandeling van orofaciale pijn en disfunctie na een transorale condylectomie; de rol van pijn, slaap en psychotrauma.

A 45-year-old woman continued to suffer from an open bite, pain in the left temporomandibular joint, jaw muscle tightness, and ringing in both ears 6 months after an unilateral left condylectomy. A recovery surgery was planned to treat the open bite and she was referred to the department for Orofacial Pain and Dysfunction for treatment of the pain complaints, muscle tightness, and ringing in the ears. At this department she was diagnosed with temporomandibular disorders. Muscle tension, oral behaviors, and anxiety were expected to play a role in the etiology. Fear for the recovery surgery contributed to the onset and maintenance of the complaints. A multidisciplinary treatment was started, including counseling, exercise therapy, psychological treatment, and stabilization splint therapy that would take place after the replacement of the temporomandibular joint. After completion of the treatment, the anxiety had disappeared, and the pain and muscle tension were reduced significantly. The remaining pain and muscle tension resolved following a successful recovery surgery and further orofacial physiotherapy.

[Stress and the orofacial area: stress, painful TMD and oral habits]. / Stress en het orofaciale gebied: stress, TMD-pijn en mondgewoonten.

In the context of the growing knowledge about the influence of psychosocial factors on health, this article focuses on the role of stress in painful temporomandibular disorder and oral habits. Knowledge about the influence of stress on health, oral habits, and painful temporomandibular disorders is summarized, making clear that although knowledge is increasing, there is a lot still unclear. With regards to oral habits, it turns out that awake oral habits are, but oral habits during sleep are not influenced by stress, but better diagnostic procedures and more research distinguishing the different types of oral habits are needed in order to further our understanding. Increasing knowledge about the aetiology of painful temporomandibular disorders is showing a complex interplay of aetiological factors. Stress and oral habits are part of this, but much remains to be discovered about the way in which the aetiological factors interact and influence outcomes. When it comes to stress, especially childhood adversity appears to be a promising focus for further research.

[Painful temporomandibular dysfunctions: diagnosis and -treatment]. / Pijnlijke temporomandibulaire disfuncties: diagnose en behandeling.

Painful temporomandibular disorders (TMD pain) are common among the general population. The most common sub diagnoses are myalgia (jaw-muscle pain) and arthralgia (temporomandibular joint pain). The aetiology of TMD pain has a multifactorial nature, and its diagnosis and possible treatment often require a multidisciplinary approach. The most recent insights in the diagnosis and treatment of TMD pain are based on the multidisciplinary guideline 'Chronic Orofacial Pain' that was developed by the Dutch Society of Headache Patients and was published in 2013. Dentists are required to follow the recommendations of this guideline. The authorisation of the guideline by the relevant academic and professional associations in the Netherlands implies that restraint is advised when adopting diagnostic procedures and treatment modalities that are not or are insufficiently based on solid evidence.

Obstruction of the superior vena cava.

A 10 year experience in 66 patients with obstruction of the superior vena cava (SVC) was reviewed. Pathogenesis was malignancy in all except two patients with granulomatous mediastinitis (3%). Venography was especially helpful in determining extent of SVC obstruction and collateral circulation. Only nine patients are still alive; 57 are dead (mean survival, 3.9 months). Patients with upper airway obstruction and/or cerebral edema only survived 1.4 months (P less than 0.001). The two patients with benign obstruction had a new operation to bypass the SVC using a spiral graft of saphlenous vein with complete relief of SVC syndrome up to 26 months. Lymphomas responded to radiation (63% improved), but response in the bronchogenic carcinoma group was variable (42% improved) and was not related to palliative radiation, chemotherapy, or both. Patients receiving full-course mediastinal radiation (more than 5,000 rads) had improved survival (9.9 months). Three patients with bronchogenic carcinoma and severe SVC syndrome (cerebral edema and upper airway obstruction) had excellent palliation using spiral vein bypass graft and postoperative radiation. This experience suggests that treatment of patients with obstruction of SVC based on evaluation of signs, symptoms, and venography may provide extended palliation. If the syndrome is mild, full-course mediastinal radiation is given. If there is cerebral edema or upper airway obstruction, operation to bypass the SVC will relieve SVC syndrome immediately and will allow orderly radiation therapy.

Spontaneous nasal septal perforation in patients with rheumatoid arthritis.

Nasal septal perforation is known to be associated with various traumatic and disease states, yet spontaneous nasal septal perforation (SNSP) is relatively rare. SNSP has been reported in three patients with seropositive rheumatoid arthritis (RA) and we report an additional seven patients with SNSP and RA, four of whom were seronegative and none of whom had Raynaud's, in contrast to those reported previously. Manifestations of overt infectious, neoplastic or granulomatous disease have not been found in our seven patients over several years of close follow-up. We have identified no obvious pathogenesis or specific etiology for SNSP. We suggest that SNSP may represent an unusual manifestation of RA previously not well recognized.

Chrysiasis: the role of sun exposure in dermal hyperpigmentation secondary to gold therapy.

To investigate the role of sun exposure in the pathophysiology of chrysiasis, we studied 10 Caucasian female patients with rheumatoid arthritis: 4 with clinically apparent chrysiasis and 6 without apparent pigmentation. Three patients without chrysiasis had received over 4 g of gold and 3 less than one g. The mean melanin score, determined by histological examination of sun exposed and nonsun exposed skin, was significantly higher in the sun exposed skin of the chrysiasis and high dose controls than low dose controls (p less than .05). Concentration of gold measured semiquantitatively by transmission electron microscopy and quantitatively by atomic absorption showed increased gold concentration in sun exposed when compared to nonsun exposed skin of chrysiasis and high dose controls (p = .26). Low dose controls had no gold demonstrated by either method. Our results suggest that gold deposition in the dermis stimulates melain production and that melanin is important in hyperpigmentation of chrysiasis. Furthermore ultraviolet light may induce preferential uptake of gold by the skin.