Spindle cell carcinoma arising at the buccal mucosa: a case report and review of the literature

Aims:

Spindle cell carcinoma (SPCC) is a subtype of squamous cell carcinoma, and it mainly occurs in the upper aerodigestive duct. On the other hand, it rarely arises in the head and neck region. The prognosis of this tumor is usually poor because of its highly malignant behavior, such as its high incidence of recurrence or metastasis to cervical lymph nodes. However, the number of accumulated cases is still too low to provide the full details of SPCC.

Methodology:

The case of SPCC was counted by using database, PubMed. The authors also present a case of SPCC arising at the left buccal mucosa in a 72-year-old Japanese female in the current study.

Results:

Only six cases of SPCC arising at the buccal mucosa have been reported previously. The authors’ patient died from a recurrent tumor 15 months after the first operation.

Conclusion:

The authors have added this case to the previous knowledge of SPCC arising at the buccal mucosa, and discuss the clinical behavior of SPCC to help suggest a standard treatment strategy for the disease.     

Conservative reduction by lever action of chronic bilateral mandibular condyle dislocation

Aims:

The treatment of long-standing dislocation of the temporomandibular joint is broadly classified into open reduction and closed reduction. The current study presents a case of long-standing dislocation of the temporomandibular joint treated 3 years after dislocation. In this study, the authors evaluated the long-term outcome of conservative reduction by lever action of chronic bilateral mandibular condyle dislocation.

Methodology:

Manual repositioning of temporomandibular joint dislocation lasting for 3 years in a 31-year-old woman was attempted without success; therefore, conservative reduction by lever action was carried out because the patient declined treatment under general anesthesia.

Results:

The treatment was discontinued after 6 days because of the subluxation of the retaining tooth. The retainer was changed from tooth to screw for intermaxillary fixation, and treatment was reinstituted. Fifteen days later, reduction was achieved and retention was started and continued for 2 months. The outcome was good, with no recurrent dislocation within 24 months of the treatment.

Conclusions:

Conservative reduction by lever action, involving minimally invasive treatment and little dysfunction, should be considered an optional conservative treatment.     

Oral appliances for the treatment of obstructive sleep apnea in patients with low C-PAP compliance: a long-term case series

Objectives:

To assess the effectiveness of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea syndrome (OSAS) over a long-term follow-up in patients non-compliant with continuous positive airway pressure (CPAP) and to identify potential predictive factors of response to MADs.

Methods:

Fifteen OSAS patients were enrolled. Apnea-hypopnea index (AHI) and daytime sleepiness were assessed at baseline and at the end of follow-up. Potential baseline predictors of treatment effectiveness were assessed.

Results:

AHI and Epworth Sleepiness Scale (ESS) scores improved significantly with MADs. Sixty per cent of patients were ‘responders’, of whom 33% were ‘full responders’. Sixty-seven per cent of patients showed total compliance. No correlations between the potential predictors and the response to MAD therapy were found.

Discussion:

Effectiveness of MAD therapy was shown over a long-term follow-up in OSAS patients with low compliance to CPAP. Efforts to identify predictive success factors fell short.     

Features and management of intracranial mandibular condyle dislocation after trauma

Background:

Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc.

Objective:

To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma.

Major findings:

In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors' treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected.

Conculsion:

Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended.     

Oral pre-trigeminal neuralgia pain: clinical differential diagnosis and descriptive study results

Aims:

To better quantify oral pre-trigeminal neuralgia (PTN) symptoms, attempt to identify PTN symptoms that could reliably differentiate between PTN and odontogenic tooth pain, and determine whether an anesthetic test would reliably differentiate these disorders.

Methodology:

This was accomplished through a survey of symptom recall for 49 trigeminal neuralgia patients who had PTN tooth and/or gum pain.

Results:

The variability of oral PTN symptoms, factors that worsened or improved them, and how dental anesthesia affected them, explain the reason for variations found in the literature. A throbbing pain quality is not in the literature, but present for 63% of respondents.

Conclusions:

No specific PTN symptom would reliably differentiate PTN from odontogenic tooth pain. The results also suggest that an anesthetic test would not be totally reliable for differentiating these disorders. A protocol is provided that should help practitioners identify the tooth pain source when there is no dental pathology.     

The role of occlusal factors on the occurrence of temporomandibular disorders

Aims:

The aim of this study was to investigate the relationship between occlusal factors and temporomandibular disorders (TMD).

Methodology:

One hundred patients were selected among those who sought medical or dental care in public practice in Recife, Brazil. The presence of malocclusions and absence of five or more posterior teeth were evaluated by the clinical exam. TMD diagnosis was given using Research Diagnostic Criteria (RDC/TMD). Statistics were carried out using Fisher and Mann–Whitney methods with 5% significance level, as well as multiple logistic regression analysis.

Results:

The sample was mainly comprised of women (83%), individuals over 30 years old (57%) and singles (53%). The percentage of TMD and malocclusion in total sample was 42% and 50%, respectively, while in TMD subjects, malocclusion was present in 38·1%. There was no association between TMD and the occlusal factors studied.

Conclusion:

It can be concluded that malocclusion and loss of five or more posterior teeth does not contribute to TMD.     

How do patients perceive the British orthodontic society online information resource about orthognathic treatment? A qualitative study

Objectives: To explore the accessibility, usability and relevance of the British Orthodontic Society (BOS) online information resource (OIR), Your Jaw Surgery.

Design: Qualitative, cross-sectional study.

Setting: 5 UK sites.

Participants: Patients before, during and after treatment for non-cleft skeletal discrepancy.

Methods: Patients were identified at joint clinics and recruited after having time to view the OIR. Semi-structured interviews were conducted with 17 patients (aged 16–46 years). The interviews were transcribed and thematic analysis was undertaken using a framework approach.

Results: The main themes identified were the overall usefulness, personal relevance and positive perceptions of the OIR. The OIR was seen to be useful for patients considering treatment, and potentially useful for patients undergoing treatment. Participants were looking for a personally relevant resource that would give them the best possible idea of how they would look and feel after surgery. The OIR was perceived as trusted, positive and reassuring.

Conclusions: Patients at different stages of treatment found the OIR helpful and reassuring. Clinicians may find it useful to direct patients to the OIR to complement a professional consultation, but should be aware that patients may perceive it as presenting a positive image of the long-term benefits of orthognathic surgery.     

The efficacy of a specific stabilization splint

Background:

The use of a Tanner type stabilization splint, fabricated on a leaf gauge articulation for the treatment of patients with disc displacement without reduction, is lacking in the literature.

Objectives:

The purpose of the study is to collect non-controlled, therapy-related observations; in other words, to demonstrate the efficacy of this appliance for the treatment of patients with disc displacement without reduction.

Methods:

The study enrolled 55 patients, 5 men, and 50 women, with the clinical diagnosis disc displacement without reduction, 42 with and 13 without limited mouth opening. All patients received a splint in the musculoskeletally stable centric relation (CR) position. Mouth opening, clinical performance, and the timeframe of splint treatment were assessed.

Results:

For 37 patients with a disc displacement without reduction with limited opening, the largest increase in mouth opening (9·5±5·6 mm) occurred in the first week (7·9±2·5 days). No occlusal adjustment of the splint was needed during the treatment sequence. For three patients, treatment took up to 3 months (8·1%), for 13 patients, between 3 and 6 months (35·1%), and for 17 patients, within a year (45·9%), making a total of 89·1% successfully treated patients. Out of 50 patients, 29 had a total resolution of signs and symptoms, whereas 21 patients still suffered from solitary temporomandibular disorder (TMD) signs.

Conclusion:

A Tanner type stabilization splint, fabricated in the musculoskeletally stable CR position, appears to be an effective and efficient means for the treatment of patients with disc displacement without reduction. Its efficacy makes it eligible to be tested in a randomized controlled trial.

Clinical implications:

The efficacy of this specific splint, fabricated in the musculoskeletally stable CR position, makes it a promising tool to treat TMD patients with disc displacement without reduction.     

Mandibular movement during speech of two related Latin languages

Objectives/hypothesis: This study assessed the kinesiographic recordings of jaw movements during reading a text in Galician and Spanish language.

Study design: Cross-sectional blind study.

Methods: A homogeneous healthy group of 25 normal stomatognathic system and native Galician participants was studied. Frontal and parasagittal plane recordings of the intraborder lateral jaw movements and during reading Galician and Spanish texts were recorded using a calibrated jaw-tracking device, kinesiograph.

Results: Although movements were similar in both languages, a greater retrusion of the jaw in the Spanish language was shown; moreover, a tendency exists for a left-side motion envelope in this right-handedness preference sample.

Conclusions: This study supports the hypothesis that speech is controlled by the central nervous system rather than by peripheral factors and that the hemispheric dominance influences the asymmetry of the speech envelope.     

Could different TMJ disc positions observed in MRI cause different sounds? Analysis on a group of subjects with ADD with reduction: a pilot study

Aims:

Magnetic resonance imaging (MRI) is the method of choice for examining soft-tissue pathology of the temporomandibular joint (TMJ). MRI shows a high spatial resolution with accuracy for the identification of internal derangement. Tasaki developed a classification system for disc displacement in the TMJ, identifying eight different types of disc displacements in addition to the superior disc position. This study aims to test the ability of electrosonography (ESG) in discriminating different kinds of disc displacement according to the disc position criteria proposed, comparing the ESG results with those obtained by MRI.

Methodology:

Twenty-seven patients were selected from an initial group of 50 patients with articular disc displacement, selected by means of clinical examinations, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and who had both MRI and ESG studies performed. For each patient and for each peak in ESG, both in the opening and closing movements, three different parts of the sound were analyzed. The frequency (Hz) and the mean amplitude (μV) of the sounds were calculated in the three analyzed windows. Afterwards, gathering the data for the Tasaki’s classes and dividing opening and closing sounds, the number of peaks was calculated, as well as average and standard deviations for both the Hz and µV.

Results:

The peak frequency shows significant differences between different disc positions during the first and second third of the opening phase and during the first third of the closing phase. The peak amplitude shows significant differences between different disc positions during all of the opening and closing phases.

Conclusions:

Although limited by sample size, the present study shows the presence of different sounds with different Hzs and μVs associated with different disc positions that were recorded with ESG.     

Effect of upper costal and costo-diaphragmatic breathing types on electromyographic activity of respiratory muscles

Aim:

To compare electromyographic (EMG) activity in young–adult subjects with different breathing types.

Methodology:

This study included 50 healthy male subjects with complete natural dentition, and no history of orofacial pain or craniomandibular-cervical-spinal disorders. Subjects were classified into two groups: upper costal breathing type, and costo-diaphragmatic breathing. Bipolar surface electrodes were located on sternocleidomastoid, diaphragm, external intercostal, and latissimus dorsi muscles. Electromyographic activity was recorded during the following tasks: (1) normal quiet breathing; (2) speaking the word ‘Mississippi’; (3) swallowing saliva; and (4) forced deep breathing.

Results:

Sternocleidomastoid and latissimus dorsi EMG activity was not significantly different between breathing types, whereas diaphragm and external intercostal EMG activity was significantly higher in the upper costal than costo-diaphragmatic breathing type in all tasks (P<0·05; Wilcoxon signed rank-sum test).

Conclusion:

Diaphragm and external intercostal EMG activity suggests that there could be differences in motor unit recruitment strategies depending on the breathing type.     

Myhre syndrome: a rare craniofacial disorder

Aims:

Myhre syndrome is a rare disorder characterized by abnormal growth of the skeleton, muscles, and joints. The relationship of this syndrome to craniofacial growth and development is unknown. To the authors’ knowledge, this is the first Japanese case ever studied.

Methodology:

At 10 years and 7 months of age, the patient was referred to the Department of Pediatric Dentistry in the authors’ hospital, complaining of a dental problem.

Results:

The craniofacial region exhibited a long lower face, high and narrowed palate with submucous cleft palate, maxillary constriction, prognathism, open bite, and crowding of the dental arch. Some of these morphological disorders could be affected by the functional manifestations of muscular hypertrophy of the cheek region, muscle tenseness, or the low position of the tongue. General disorders of muscular hypertrophy, thickened bones, and limited joint mobility are consistent with craniofacial findings of muscle tension in the cheek region, thickened calvarium, and limitation of temporomandibular joint movement. The submucous cleft palate and crown deformation of the mandibular central incisor may be affected by dysfunctions of SMAD4 signaling.

Conclusions:

Craniofacial growth and development is affected by the general characteristics of Myhre syndrome, and could be important in its diagnosis.     

Comparison of masticatory muscle myofascial pain in patients with and without a chief complaint of headache

Objectives:

Headaches are a common complaint in temporomandibular disorder (TMD) patients. However, few studies have compared the symptom characteristics between TMD patients with and without a complaint of headache. The aim of this study was to compare subjective symptoms and treatment outcomes between myofascial TMD patients who had a chief complaint of headache and those who did not.

Methods:

One hundred sixty one patients underwent comprehensive examinations and scored their pre- and post-treatment symptoms on a form (4 items assessing pain intensity and 1 assessing sleeping difficulty). On the basis of the primary diagnosis, patients were divided into two groups: myofascial pain with and without a chief complaint of headache (MPH and MP).

Results:

Before treatment, patients in the MPH group scored significantly higher with respect to pain intensity and level of sleeping difficulty than did patients in the MP group (jaw/face pain, P = 0·015; headache, P < 0·001; neck pain, P < 0·001, and difficulty in sleeping, P = 0·005; Mann-Whitney U-test). Patients in the two groups demonstrated similar treatment outcomes, except for neck pain.

Conclusion:

Significant differences in symptom characteristics and outcomes were observed between primarily myofascial TMD patients with and without a chief complaint of headache.     

Quantitative measurements of the articular areas of mandibular condyles with temporomandibular joint disorders using magnetic resonance imaging

Objective: The authors sought to clarify the variation in the condylar anterior functional surface (AFS) of patients with temporomandibular joint (TMJ) disorders using quantitative measurements by magnetic resonance imaging (MRI).

Methods:MR images of 68 joints (2 males, 32 females) were used. The subjects were classified into three groups: with/without defects of cortical bone groups and a combination group without defects. The AFS was measured as the length between the protrusive point and the apex of the condyle on MRI (4-mm-thick slices), and the quad value of the length was defined as the area on the slice. The summed quad values of all slices were used as the AFS area. Differences in the areas among the three groups were compared by one-way analysis of variance (ANOVA).

Results:The non-defect group had significantly larger AFS areas than the defect group.

Conclusions:Quantitative measurement on MR images clarified the changes in the condylar sagittal appearance.     

The knowledge and attitudes of orthodontic trainees towards orthodontic therapists: a national survey

Objective: To assess the knowledge and attitudes of orthodontic trainees towards orthodontic therapists (OTs) in the UK.

Design: Cross-sectional survey.

Setting: UK-based orthodontic trainees.

Materials and methods: An electronic survey was sent to all members of the Training Grades Group of the British Orthodontic Society assessing exposure to OTs and their knowledge regarding current supervision guidelines and scope of practice. Attitudes towards OTs were also explored.

Results: Seventy-six responses (response rate 57%) were returned. Nearly 90% of trainees had no formal training regarding OTs. A total of 15.5% were aware of the correct current supervision guidelines and there was large variation in the knowledge of OTs’ scope of practice. The majority of trainees were happy to supervise OTs, but only 22.4% felt prepared for this during training. In total, 63% of trainees felt that OTs could impact their own future job prospects.

Conclusions: Currently, there is minimal formal training provided to trainees regarding the role of OTs. This is reflected in the lack of knowledge regarding supervision guidelines and scope of practice. Overall, trainees felt OTs were positive for the workforce but were concerned regarding the impact of their own future employment.     

The application of the Index of Orthognathic Functional Treatment Need (IOFTN): service evaluation and impact

Objectives: (1) To undertake a service evaluation of the Index of Orthognathic Functional Treatment Need (IOFTN). (2) To determine its suitability to replace the Index of Orthodontic Treatment Need (IOTN) in the assessment of patients with dentofacial deformity.

Design: Laboratory- and questionnaire-based study.

Setting: UK hospital-based orthodontic department.

Methods: Cohen’s Kappa was used to assess inter- and intra-operator reliability for the IOTN and the IOFTN against 30 orthognathic patients’ models scored to a ‘gold standard’. Questionnaires gathered feedback on ease of use of the IOFTN. Change in treatment need status for a further 60 orthognathic patients was estimated utilising the IOTN, the IOFTN and a modified IOTN (mIOTN).

Results: Inter-operator agreement with the ‘gold standard’ for the IOTN and the IOFTN ranged from 0.64-0.90 and 0.61-0.91, respectively. Intra-operator agreement for the IOTN and the IOFTN ranged from 0.46-1.00 to 0.59-0.95, respectively. Mean feedback score was 9.08 out of a maximum score of 10. Overall, 88.9% of patients scored grades 4 or 5 on the IOFTN (IOTN = 87.8%; mIOTN = 77.8%).

Conclusions: The IOFTN is simple and reliable to use. It is an appropriate aid in the prioritisation of surgical patients. Further recommendations are given.     

Disc displacement without reduction: a retrospective study of a clinical diagnostic sign

Objective: The purpose of this retrospective study is to evaluate a clinical diagnostic sign for disc displacement without reduction (DDWR), the absence of additional condylar translation during opening compared with protrusion.

Method: Thirty-eight electronic axiographic and magnetic resonance imaging (MRI) examinations of the TMJ were analyzed in order to compare the opening/protrusion ratio of condylar translation between non-painful DDWR and non-DDWR.

Result: According to the Mann-Whitney U test, the opening/protrusion ratio in non-painful DDWR differs significantly from non-DDWR (p < 0.0001).

Discussion: Among non-painful DDWR, there is no additional condylar translation during opening in comparison with protrusion, and this is probably also the case for DDWR without limited opening, which is a subtype that has not been validated by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Comparative condylar palpation can analyze this sign, and therefore, further comparative investigations between MRI and clinical examination are needed to validate the corresponding clinical test.     

Temporomandibular disorder treatment in a patient wearing removable prostheses: A case report

Aim: The purpose of this intervention was to treat the patient, a 51-year-old woman, who was wearing a maxillary denture and a mandibular bilateral distal-extension partial denture (both unfit) and was suffering from temporomandibular disorder (TMD).

Methodology: The treatment suggested was to construct a superior repositioning splint (SRS), and after remission of the symptomatology, fabricate new dentures.

Results: The occlusal splint was effective and the symptomatology ceased after about five months of treatment. The new dental prostheses were made and followed up for 10 years with no return of the pain.

Conclusions: SRS and subsequent construction of new dentures after remission of the symptomatology was an effective treatment for TMD in the case described.     

Craniofacial growth: evolving paradigms

Aims:

Numerous theories about craniofacial growth have been formulated in the last century. The most influential hypotheses were: genetic, synthetic and functional matrix revisited. Moreover, a large number of experts from different fields tried to explain craniofacial growth and its developmental mechanisms, in order to deliver the best treatment possible to orthodontic patients. The aim of this review is to summarize recent concepts on craniofacial growth, overlap these theories with the development of the general scientific knowledge, and suggest a more integrated multidisciplinary person-based approach.

Methodology:

MEDLINE, EMBASE, Pubmed, CINAHL and Google Scholar were screened from inception to February 2014 for relevant papers. Grey literature was considered as part of the search.

Conclusions:

The influence of new scientific discoveries and intuitions about craniofacial growth produced further insights in orthodontics care, shifting the paradigm from a pre-determined, sectorial treatment to an individualized, multidisciplinary patient-centered approach aiming to enhance the quality of orthodontic assistance.     

Miniscrews for orthodontic anchorage: a review of available systems

Introduction: In recent years, extensive research has introduced novel ways of reinforcing orthodontic anchorage using a variety of devices temporarily anchored in bone (miniscrews). Currently, there are numerous manufacturers with different miniscrew designs on the market.

Aims: The aim of this paper is to discuss the key design features of different miniscrew systems on the market. Furthermore, to present clinical selection criteria of miniscrews in different settings taking into account the determinant factors.

Methods: Review of the literature was carried out using the following search methods: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The search was focused on studies published until January 2018.

Results: We studied each individual miniscrew from all the identified manufacturers in details. All the features were then summarised and presented as a clinical guideline for the selection of miniscrews.

Conclusions: In this article, we reviewed the development of miniscrews and outlined the general design features of miniscrews as well as specific design features of the current miniscrews in the market. Extensive research of the current products was carried out to help clinicians better understand the difference between the various designs of miniscrews that can be used.