Magnetic Resonance Imaging as a Determinant for Surgical Release of Congenital Muscular Torticollis: Correlation with the Histopathologic Findings

OBJECTIVE: (1) To present the magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) of subjects who underwent surgical release and subjects who showed a good prognosis with stretching exercises and (2) to correlate the MRI findings with the histopathologic findings of CMT for subjects who underwent surgical release in order to examine the hypothesis that the MRI findings of CMT can be used as a determinant to perform surgical release of CMT. METHOD: The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management. The MRI findings were correlated with the histopathologic sections of the CMT mass. RESULTS: All 33 subjects (100%) who underwent surgical release showed one or more low signal intensities within the involved sternocleidomastoid muscle (SCM) on the T1- and T2-weighted images of neck MRI. The eighteen non-surgical candidates showed only enlargement of the SCM without low signal intensity within the SCM. The histopathologic findings showed interstitial fibrosis and/or the presence of aberrant tendon-like excessive dense connective tissue that was either well-arranged or disorganized. CONCLUSION: The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM. If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Management of Cervical Dystonia

OBJECTIVE: To evaluate the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the management of cervical dystonia (CD) with botulinum toxin type A (BoNT-A) injection. METHOD: Thirty two subjects with CD were included. A BoNT-A injection was provided either by clinically targeting method (group 1) or by 18F-FDG PET/CT-assisted, clinically targeting method (group 2). In group 2, selection of target muscles and dosage of BoNT-A were determined according to the increased 18F-FDG uptake, in addition to physical examination and functional anatomy. The outcomes of BoNT-A injection was compared between the two groups, in terms of the number of subjects who had reinjection before and after 6 months, the number of reinjections, the interval of reinjections, the duration to the minimal Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the number of adverse events, the reduction rate of TWSTRS at 1-3 months and 3-6 months after injection, and the probability of reinjection-free living. RESULTS: The number of subjects who had reinjection within 6 months was significantly lower in group 2 than in group 1 (10 in group 1 vs. 3 in group 2). The reduction rate of TWSTRS after 3-6 months (37.8+/-15.7% of group 1 vs. 63.3+/-28.0% of group 2) and the probability of reinjection-free living were significantly higher in group 2 than in group 1. CONCLUSION: These findings suggest that 18F-FDG PET/CT study could be useful in management of CD in terms of the identification of dystonic muscles if there is an increase in the 18F-FDG uptake in the cervical muscle of the images.

Problem awareness of old age among dentists in Seoul and the metropolitan area / 대한구강보건학회지

OBJECTIVES: The aim of this study was to examine and analyze the awareness of dentists of the problems of elderly life, and to provide direction for a desirable retirement plan, according to individual awareness. METHODS: A stratified sampling method was used in proportion to the number of dental clinic and dental hospitals practicing in the Seoul metropolitan area, Incheon city, and Gyeonggi province. The data was verified by the Korea Dental Association's 2010 list of dentists, and for stratified random sampling, was stratified according to the number of regional dental clinics. Dentists from 855 dental clinics and dental hospitals were selected between May and Sept. 2010 for a self-administered survey questionnaire, by mail, fax or interview. 484 valid questionnaires (56.7%) were collected from respondents for data analysis. The study used SPSS (ver. 18.0) to analyze Chi-square tests, one-way ANOVA, and independent t-tests on the collected survey data. RESULTS: The responders pointed out that 'health related problems', 'financial problems', and 'isolation from society', were, in order, the main problems of the elderly stage of life. Dentists showed the highest response to their own suitable retirement age of '60- under 70'. The more that responders recognized his or her own good personal health status, the lower the subjective degree of anxiety for financing after retirement (P<0.001). Responders who had monthly net income of 'under 1,500 ten thousand won' showed the highest degree of anxiety, and those who had 'over 2,500 ten thousand won' showed the lowest degree of anxiety, which showed statistical significance (P<0.001). CONCLUSIONS: In conclusion, 'health related problems' was the highest predicted problem for elderly dentists. Therefore, dentists should actively engage in a healthy living style to prepare for a healthy old age. Furthermore, early preparation and establishment of countermeasures to actively manage predictable problems in elderly living is needed.

Comparison of Clinical Severity of Congenital Muscular Torticollis Based on the Method of Child Birth

OBJECTIVE: To compare the clinical severity of congenital muscular torticollis (CMT) based on the method of child birth. METHOD: Children diagnosed with CMT and who were or =6-months-of-age at the time of the first visit. RESULTS: One hundred seventy eight subjects with CMT were enrolled. There was no significant difference in the rate of surgical release according to the method of child birth. For 132 patients <6-month-of-age there was also no significant difference in the rate of stretching exercises. CONCLUSION: There was no significant difference in the clinical severity of CMT based on the method of child birth. This finding suggests that prenatal factors alone could be a cause of CMT and that the clinical severity of CMT in children delivered by Cesarean section is not different when compared with the severity of CMT in children born through vaginal delivery.