Computed tomography in the diagnosis of maxillofacial trauma

A study of 34 patients who were investigated for maxillofacial trauma using high resolution computed tomography (CT) scanning is presented. The areas where this increasingly available technique offers more accurate information than conventional plain radiographs are discussed.     

Computerized axial tomography in the diagnosis of head and neck tumours

The development of computerised axial tomography is briefly described and the application of this investigative procedure to the diagnosis of tumours in the maxillo-facial region is illustrated by two cases.     

Computerized expert system for the diagnosis of pulp-related pain

A major problem in the correct diagnosis of pulpal pain is that the associated clinical signs do not predictably correlate with the underlying pathological process. Using conditional probabilities of various pulp conditions from published data, Bayesian Statistical Inference provides the means for deriving a composite probability of the presence of a disease from a multiple set of symptoms. A computer program that can infer a diagnosis for pulpal pain from any combination of 17 clinical symptoms has been developed. From the data, the program provides the computed relative probabilities of a healthy pulp, a saveable pulp, an unsaveable pulp, and a necrotic pulp being present.     

Computerized tomography as a guide in the diagnosis of temporomandibular joint disease

As described, CT is a noninvasive method for providing detailed views of both the soft and hard tissues of the TMJ region. Because internal derangements of the joint involve both of these structures, CT can provide an invaluable tool in the study, diagnosis, and treatment of various disorders of this nature. It is extremely important, however, to create a close working relationship with the radiologist who will be performing these studies. Only with adequate clinical study and information communicated to the radiologist can true benefits be obtained. As CT scans are available nationwide, this technique should be available to nearly any practitioner in the country. CT can be useful in both diagnostic and therapeutic modalities. On a diagnostic basis, it can provide a tomographic study of the osseous structures of the condyle, fossa, articular eminence, and surrounding hard tissues. By varying the slices, views of the medial and lateral poles as well as the central portions of the region, can be obtained. In this way, various arthroses, tumors, cysts, fractures, true ankylosis, neoplasias, developmental abnormalities, and other bony abnormalities can be clearly found. Therapeutically, CT can evaluate the success of treatment aimed at reestablishing proper disk-condylar relationships. However, the major advantage of TMJ CT is the observation of the soft tissue of the articular disk. By the use of CT, especially enhanced by the blink mode, we can see how the disk relates to the condyle. If a series of views are taken in both the closed and open position, we can observe the disk-condylar relationship during this range of motion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Computerized axial tomography in the diagnosis of internal derangements of the temporomandibular joint

Fourteen patients with a history of pain, clicking and locking of the temporomandibular joint were assessed clinically and by using computerized axial tomography (CAT). The findings of the clinical and CAT scan assessment were correlated and compared with surgical observations. Computerized axial tomography scanning proved to be a highly accurate method of assessing meniscal position. With the advent of more sophisticated methods of CAT scanning, it provides an accurate, non-invasive method of assessing the temporomandibular joint and providing a basis for more effective treatment planning of problems related to internal derangements.     

颌面颈部恶性肿瘤侵犯颈动脉的CT诊断

目的　研究颌面颈部恶性肿瘤侵犯颈动脉的CT诊断价值。方法　共收集记录完整、经手术切除治疗的颌面颈部恶性肿瘤 5 3例 (5 5侧病变 )。所有病例均在术前行横断面增强CT检查 ,并与其手术结果对照。结果　CT检查显示颈动脉的异常表现形式有 5种类型 :Ⅰ型 :动脉受压变形(6侧病变 ) ;Ⅱ型 :动脉移位 (15侧病变 ) ;Ⅲ型 :肿瘤围绕颈部血管超过 180°(8侧病变 ) ;Ⅳ型 :位于肿瘤和颈动脉之间的脂肪带或筋膜部分或完全消失 (2 5侧病变 ) ;Ⅴ型 :动脉壁缘模糊 (12侧病变 )。手术记录显示 :2 0侧颌面颈部恶性肿瘤与颈动脉粘连 ,其中 14侧病变的CT异常表现呈多样性 (70 % )。对照手术记录 ,上述CT异常表现的敏感性、特异性和准确率分别为 :30 0 % ,10 0 0 %和 74 .5 % (Ⅰ型 ) ;2 0 .0 % ,6 8.6 %和 5 0 .9% (Ⅱ型 ) ;2 2 .2 % ,10 0 .0 %和 4 9.1% (Ⅲ型 ) ;90 0 % ,80 0 %和 83.6 % (Ⅳ型 ) ;4 5 0 % ,88.6 %和 72 .7% (Ⅴ型 )。结论　颌面颈部恶性肿瘤侵犯颈动脉的CT表现以多样性表现为主。尽管存在不足 ,但部分CT征象 (Ⅰ型、Ⅲ型和Ⅳ型 )对准确判断颌面颈部恶性肿瘤侵犯颈动脉仍具有一定的参考价值     

Computed tomography in oral and maxillofacial surgery

The use of computed tomography (CT) in oral and maxillofacial surgery is discussed. The CT scan delineates lesions in the oral and maxillofacial complex to aid in planning of surgical treatment. Case examples are presented, and the indications for the use of CT scanning are discussed.     

Oral and maxillofacial cancer pain

Pain resulting from oral and maxillofacial cancer is a major problem that requires the attention of all members of the health care team. This attention is important because of the large number of people affected and because the treatment of cancer pain is too frequently inadequate. An understanding of acute and chronic pain, the underlying malignant disease, the complications of cancer treatment, and currently available treatments for pain must form the basis of pain management. A review of the problem of oral and maxillofacial pain in the patient with cancer is presented.     

Physiotherapy in diagnosis and treatment of the myofascial pain dysfunction syndrome.

Thirty-four patients with the Myofascial Pain Dysfunction (M.P.D.) syndrome of the masticatory system were investigated and treated using physiotherapy techniques. Resisted static contraction of the temporomandibular joints, passive movement tests of the muscles and electromyography indicated that the joint function was abnormal in all cases with minimal muscle involvement. Cervical spine tests indicated that pain referral from the cervical spine was involved in 19 of 34 patients (56%). Physiotherapy treatment armed at restoring a normal painless range of movement to the temporomandibular joint was successful in six of 10 patients (60%). Generalized relaxation therapy with biofeedback was successful in 19 of 24 patients (80%). It was found that with the five of 24 patients (20%) in whom generalized relaxation failed, there were significant psychiatric factors.     

Validity of multislice computerized tomography for diagnosis of maxillofacial fractures using an independent workstation

OBJECTIVE: The purpose of this study was to demonstrate the sensitivity and specificity of multislice computerized tomography (CT) for diagnosis of maxillofacial fractures following specific protocols using an independent workstation. STUDY DESIGN: The study population consisted of 56 patients with maxillofacial fractures who were submitted to a multislice CT. The original data were transferred to an independent workstation using volumetric imaging software to generate axial images and simultaneous multiplanar (MPR) and 3-dimensional (3D-CT) volume rendering reconstructed images. The images were then processed and interpreted by 2 examiners using the following protocols independently of each other: axial, MPR/axial, 3D-CT images, and the association of axial/MPR/3D images. The clinical/surgical findings were considered the gold standard corroborating the diagnosis of the fractures and their anatomic localization. The statistical analysis was carried out using validity and chi-squared tests. RESULTS: The association of axial/MPR/3D images indicated a higher sensitivity (range 95.8%) and specificity (range 99%) than the other methods regarding the analysis of all regions. CONCLUSION: CT imaging demonstrated high specificity and sensitivity for maxillofacial fractures. The association of axial/MPR/3D-CT images added important information in relationship to other CT protocols.     

Management of postoperative pain in maxillofacial surgery

In this review we describe the evidence base for postoperative analgesia after maxillofacial surgery. We discuss the implications of poorly managed pain, risk factors for the development of severe pain, and pharmacological and non-pharmacological analgesic strategies to manage it.     

Observer variation in the clinical diagnosis of mandibular pain dysfunction syndrome

In preparation for a survey to investigate the prevalence of mandibular pain dysfunction syndrome (MDS) in a non-hospital group of individuals, the measure of agreement obtained by two observers when recording signs and symptoms of MDS in the same subjects was investigated. The criteria used for this purpose are defined. Two groups of subjects, 50 MDS patients and 50 individuals not complaining of the condition, were examined independently. Considerably more agreement between the two observers was reached with regard to patients than contrast subjects. Both observers showed more agreement in assessment during the opening movement of the mandible. It was suggested, therefore, that in order to reduce the observer error inevitably present during a survey, the signs and symptoms which manifest themselves during the opening movement of the mandible should be used to diagnose MDS rather than a more elaborate time-consuming technique.