doi: 10.1111/j.1741‐2358.2011.00552.x
Study of temporomandibular joint disorder in older patients by magnetic resonance imaging (MRI)
Objectives: To compare characteristics in older patients in a ...sample of the general population of those with temporomandibular joint disorder (TMJD).
Materials and methods: A prospective study was carried out between 2001 and 2008 in patients with TMJD. The whole sample consisted of 141 patients divided in two groups: 31 patients aged over 60 (median age 67.9, ranging from 60 to 82) and the remaining 110 patients (median age 36.3, ranging from 12 to 59) who were seeking treatment. Clinical diagnostics was confirmed by MRI. Pain intensity was rated on a visual analogue scale (VAS 0‐10).
Results: There was no statistical difference between average pain in older patients (6.2) and patients aged up to 59 (5.7) evaluated by VAS. There was a statistically significant difference (p = 0.002) in pain duration: older patients reported shorter duration of experienced pain (7.8 months) than patients aged up to 59 (12.2 months).
Conclusion: In this study, it was found that 22% were older patients with TMJD. A higher level of anxiety was shown in both patients’ groups, regardless of shorter pain experience in the older patients.
Purpose
We conducted a retrospective study to evaluate the influence of different tumor enhancement measurement approaches on the ability of computed tomography (CT) to differentiate between solid ...forms of clear cell renal cell carcinoma (RCC), other RCC histologic subtypes and oncocytomas. Different RCC subtypes have a diverse range of malignant potential; consequently, the information about RCC subtype obtained using minimally invasive imaging method before the treatment could allow the more accurate therapy planning. Differentiation of ccRCCs from oncocytomas is important because oncocytomas are usually benign tumors which could be treated conservatively.
Methods
CT images of 113 patients with 118 solid renal tumors were evaluated. The imaging protocol consisted pre-contrast and post-contrast images during the arterial and nephrographic phases. Renal tumor attenuation values were measured using region of interest covering as much of the solid enhancing tumor tissue as possible. Tumor attenuation values and tumor enhancement ratios were correlated with histologic subtype. One hundred of tumors were diagnosed as clear cell RCC, nine as non-clear cell RCC and nine as oncocytoma.
Results
Tumor attenuation values of >74 HU on the arterial phase scans significantly correlated with clear cell RCC (Az 0.73). The tumor-to-aorta enhancement ratios calculated on tumor attenuation values measured on the arterial phase scans had a cutoff value of >0.29, which significantly correlated with clear cell RCC (Az 0.79). All ROC curves for differentiating the clear cell RCC from oncocytomas have area under the curve too small (0.5 or less) to have chose cutoff value with sensitivity and specificity that could be applied in clinical work.
Conclusion
Enhancement measurements of renal carcinomas on CT images in the arterial phase can be used as an auxiliary method in the pretreatment differentiation of solid forms of the most frequent RCC subtypes in patients not suitable for core biopsy but who are suitable for minimally invasive treatment methods and/or targeted therapy.
Continuous technologic developments and research have increased the clinical applications of MT, HASTE, and FLAIR imaging in neuroradiology. HASTE has become the MR imaging sequence of choice for ...fetal neuroimaging. Other promising uses, such as for diffusion-weighted imaging, have not been fully exploited. FLAIR has been firmly established as one of the cornerstones of brain imaging; however, post-contrast FLAIR images have not offered a clear advantage over standard T1-weighted images as suggested by early studies. FLAIR imaging with echoplanar acquisition is not considered advantageous, because the decreased imaging times are obtained at the expense of lower sensitivity. For a number of applications, diffusion-weighted imaging has surpassed FLAIR. Nevertheless, FLAIR images may be more sensitive for the detection of acute brain infarction. Recently described methods for the elimination of CSF flow artifacts may lead to improved quality and reliability of FLAIR images for subarachnoid space disease. MT preparation is now routinely incorporated in time-of-flight MR angiography and gradient-echo T2*-weighted spine imaging sequences and provides increased sensitivity for postcontrast MR imaging. These applications may not be advantageous in all clinical settings. MTR analysis offers valuable information for an increasing number of pathologic processes but has not yet gained wide clinical acceptance owing to sophisticated postprocessing and significant intercenter variations. Different modifications of these techniques are being evaluated, and further developments are expected.
The effects of the Michigan splint on the change in disc displacement (DD) as well as the position of the condyles were determined by metrical analysis using magnetic resonance imaging (MRI).
...Twenty-five patients with clinical DD symptoms were treated by means of the Michigan splint, and an assessment of the effects of the splint was conducted or verified by MRI before and during the period of therapy, 5 months follow-up. The positions of the condyles and the disc were calculated from the MRI in the parasagittal plane.
There were no changes in the positions of the disc and condyles in the physiological joints of the patients (
n=23) prior to and during the time the splint was in place (
p>0.05). The splint achieved a DD decrease (
p<0.05), and pain was eliminated in 69.2% of the DD joints with reduction (
n=13). As far as the DD joints without reduction (
n=13) are concerned, pain was eliminated in 74.9% of the joints, that is, without any change in the positions of the disc and condyles (
p>0.05).
The evaluation of the Michigan splint therapy showed that it has no influence in the repositioning of the DD joints without reduction, but the DD joints with reduction have a limited positive effect. In both forms of these displacements, conditions for the elimination of the clinical symptoms are created.
Abstract We have retrospectively assessed the accuracy of our MRI protocol on 1.0-T MRI system for preoperative staging of renal cell carcinoma using the 2002 TNM staging system and pathological ...staging as the gold standard. Medical records of 48 patients (mean age, 56.28 years) with 57 renal tumors were reviewed: 52 malignant renal tumors were found; most of the patients were staged T1N0M0. In our study, κ test revealed excellent agreement between all three classes of the TNM staging system.
Okluzija ima istaknuto mjesto unutar multifaktorijalnog koncepta etiopatogeneze temporomandibularnih poremećaja kao i svakog oblika stomatološkog liječanja. Suvremena koncepcija liječenja tih ...poremećaja razlikuje inicijalne od definitivnih oblika terapije. Svrha rada je dati pregled suvremenog shvaćanja uloge okluzije u etiopatogenezi i liječenju temporomandibularnih poremećaja. Žvačni mišići i temporomandibularni zglobovi su izravno povezani s okluzijskim odnosima pa su temporomandibularni poremećaji tradicionalno povezani s okluzijskim poremećajima. Inicijalna okluzijska terapija može biti provedena kod svih pacijenata s temporomandibularnim poremećajima bez obzira na to imaju li intaktne zube u okviru fizioloških okluzijskih odnosa, pacijenata kojima je potrebna ortodontska, protetska terapija ili operacijski oralno kirurški zahvat. U liječenju pacijenata s temporomandibularnim poremećajima postoji nedoumica je li postojala indikacija za definitivnu terapiju, ako se bolni temporomandibularni poremećaj mogao izliječiti oblicima reverzibilne terapije, odnosno inicijalnom terapijom. Druge vrste orofacijalnih bolova, npr. trigeminalna neuralgija, mogu biti u komorbiditetu s temporomandibularnim poremećajima, ali i kao neprepoznata bolest imati za posljedicu nepotrebne intervencije na zubima i protetskim radovima. Iako u struci postoji prevladavajuće shvaćanje važnosti okluzijske terapije temporomandibularnih poremećaja, taj međuodnos je kontroverzan, jer to nije strogo dokazano u brojnim znanstvenim istraživanjima. Okluzija se nije pokazala dominatnim uzročnikom temporomandibularnih poremećaja.
Occlusion has an important place within the multifactorial concept of the temporomandibular disorder (TMD) etiopathogenesis as well as in every form of dental treatment. The modern concept of ...treatment of these disorders differentiates initial and definitive forms of treatment. The aim of this paper is to analyze recent viewpoints on the role of occlusion in the etiopathogenesis and treatment ofTMDs. Masticatory muscles and temporomandibular joints are directly connected with occlusal relations and TMDs are traditionally linked with occlusal disorders. The initial occlusal treatment can be applied to all TMD patients, regardless of their having intact teeth with respect to physiological occlusal relations and in patients in need of orthodontic or prosthodontic treatment or an oral surgical procedure. On managing TMD patients, there are doubts about the indications for definitive treatment and whether there has been a possibility of treating a painful TMD by reversible treatment modalities, that is, by initial treatment. Other types of orofacial pain such as trigeminal neuralgia can be comorbid with TMDs but also result in unnecessary procedures on the teeth and prosthodontic work if they are not recognized. Although dental profession mainly recognizes the importance of occlusal treatment of TMD problems, their relationship is controversial because it is not strictly demonstrated in numerous scientific studies. Occlusion is not the dominant cause of TMD problems.
Temporomandibular disorders (TMDs) are a form of musculoskeletal pain of the temporomandibular joint (TMJ) and/or masticatory muscles of nonspecific etiology. In this study, the relationship between ...embryonic and anatomic-topographic similarities of the TMJ and the ear was analyzed, i.e. secondary otologic symptoms that can be closely connected to TMJ disorder. Nonspecific otologic symptoms are not primary diagnostic symptoms of TMD, but may cause diagnostic confusion due to patients' inability to correctly locate the origin of pain. The most common otologic symptoms that can be related to TMDs are otalgia, tinnitus and vertigo. Otorhinolaryngologists have to differentiate between primary otologic symptoms and those caused by TMJ disorders. In TMD diagnosis, manual techniques are used to determine the arthrogenic or myogenic form, whereas in the diagnosis of arthrogenic disorders magnetic resonance imaging is indicated as the highly specific imaging method ofjoint disk and osteoarthritic changes. Symptomatic treatments for TMD as well as the etiologic diagnosis of the pain require multidisciplinary cooperation between dentists and medical specialists.
Magnetic resonance imaging (MRI) has enabled the accomplishment of a more effective diagnostics of temporomandibular disorders (TMD). The sample included 40 patients with clinical symptoms of disc ...displacement (DD) of temporomandibular joint (TMJ) and 25 subjects included in our study were asymptomatic. DD were diagnosed by clinical examinations which were subsequently confirmed by MRI. DD was found in 18% of the TMJs of the asymptomatic patients. The highest prevalence of total DD without reduction was found in 44.1% of the patients' joints subsequently followed by total DD with reduction comprising 34.9% of the TMJs and by partial DD with reduction comprising 21% of the TMJs. This study may help us clarify the complicated relationship which exists between the radiographic and clinical findings of TMJ disorders.
The aim of this study was to determine the correlation between the static and dynamic occlusal factors in patients with anterior disk displacement (DD) and to compare it with occlusion in ...asymptomatic individuals. The study included a group of 40 patients with DD (median age 35.5) and a control group of 25 students of dental medicine (median age 23.4). In all subjects, the position, i.e. DD was determined by magnetic resonance imaging of temporomandibular joints. The study was focused on data gathered by direct analysis of occlusion: relationship between the molars (Angle class), horizontal and vertical overlap, preservation of occlusal contacts between the molars (Eichner classification), difference between contact points in maximal intercuspidation and centric position, and contact points on the laterotrusive and mediotrusive side. There was a statistically significant difference in tooth contact in maximal intercuspidation and centric positions between patients and asymptomatic subjects (p < 0.0001). There was also a difference between occlusal contact points on the mediotrusive side (p < 0.05) since the hyperbalanced contacts were only determined in asymptomatic subjects. Study results support the fact that a number of occlusal factors are related to DD. The fact that hyperbalanced contacts were only determined in asymptomatic subjects suggests that their mutual etiopathogenetic correlation is not quite clear.
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