Dynamic MRI study on temporomandibular joint and biomechanical analysis / 医用生物力学

Objective To establish a three-dimensional (3D) dynamic model of temporomandibular joint (TMJ) based on data collected from the TMJ movement with multi-level two-dimensional (2D) dynamic magnetic resonance imaging (MRI) and make biomechanical analysis. Methods GE Signa 1.5T TwinSpeed superconductive magnetic resonance scanner was used. TMJs of 2 asymptomatic male volunteers were chosen to be examined with MRI. All the images were imported to the Mimics software. 3D dynamic model of the TMJ was built, and the relationship between the magnitude of mouth opening and the disc transverse diameter was analyzed using linear fitting. Results The 3D dynamic model of TMJ was successfully established. The disc-condyle relationship and the dynamic morphological change of the TMJ disc were showed clearly in this model. The linear fitting equations were y=-0.03x+14.44 (R2=0.591) and y=-0.061x+13.48 (R2=0.306) from volunteers 1 and 2, respectively. A linear trend was observed regarding the relationship between mouth opening position and articular disc transverse diameter. The contact of the condyle surrounded by the TMJ disc varied inversely with the magnitude of mouth opening; the longitudinal diameter of TMJ disc changed along with the magnitude of mouth opening. In the process of mouth opening, the thickest longitudinal diameter of the joint disc was at the middle part of post-zone. The most remarkable changes of the longitudinal diameter of TMJ disc were found at the outer part of the post-zone and the inner part of the mid-zone. Conclusions The 3D dynamic model of TMJ was built successfully to observe the TMJ movement dynamically with 2D dynamic MRI. The model showed the disc-condyle relationship intuitively and precisely, and could be used as an alternative method to make up for the shortage of the 2D static MRI.

Non-involuting congenital hemangioma: a study for diagnosis and treatment / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the history, clinical symptoms, imaging and histology of a rare distinct infantile hemangioma.</p><p><b>METHODS</b>12 patients (5 female, 7 male; aged 18 months - 26 years) diagnosed as non-involuting congenital hemangioma were retrospectively analyzed. The history, imaging, histologic examination and the treatment were collected.</p><p><b>RESULTS</b>Most of the patients had only one lesion which was round or ovoid, flat or plaque-like. The average size was about 5 cm x 6 cm. The overlying skin was usually had coarse telangiectasia with central or peripheral pallor. The skin has a high skin temperature. Magnetic resonance imaging, computed tomography angiography and digital subtraction angiography findings were similar to those of common infantile hemangioma. Histologic examination revealed lobular collections of small, thin-walled vessels with a large, often stellate, central vessel. "Hobnailed" endothelial cells lined along the intralobular vessels. Small arteries were observed "shunting" directly into lobular vessels or into abnormal extralobular veins. All lesions were easily excised without recurrence.</p><p><b>CONCLUSIONS</b>Non-involuting congenital hemangioma is a distinct infantile vascular tumor. It should be diagnose early and treated appropriately.</p>

Superselective ethanol endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce superselective endovascular therapy under digital subtraction angiography for craniofacial arteriovenous malformations using absolute ethanol, and to assess the efficacy and complications of the method.</p><p><b>METHODS</b>A retrospective review of patient medical and imaging records was performed. 8 patients (7 male, 1 female, 11-50 years) with craniofacial arteriovenous malformations underwent staged selective ethanol endovascular therapy (1-4 times, median 2 times). Clinical follow-up (8-24 months, mean 12.1 months) was performed in all patients, and results from imaging follow-up (2-6 months, mean 4.3 months) were available in 4 patients. Therapeutic outcomes were established by evaluating the clinical outcome of symptoms, as well as the degree of devascularization at follow-up angiography.</p><p><b>RESULTS</b>16 sessions of selective ethanol endovascular therapy were performed in 8 patients. 5 of 8 patients were cured, 2 had improvement, 1 had no change. Selective ethanol endovascular therapy was considered effective in 7 patients (87.5%). 4 patients will need further treatment sessions for residual arteriovenous malformations. Blistering, superficial skin necrosis and transient hemolysis occurred in 4 of 8 patients. All the complications were healed with observation. No major complications occurred.</p><p><b>CONCLUSION</b>Superselective ethanol endovascular therapy under digital subtraction angiography has the potential for cure of craniofacial arteriovenous malformations and is able to obtain excellent cosmetic results, and with acceptable risk of complications.</p>

Embolization of craniofacial arteriovenous malformations after the ligation of external carotid artery / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To introduce the method of retrograde embolization through the superficial temporal artery (STA) after the ligation of external carotid artery (ECA) for the treatment of craniofacial arterio-venous malformations (AVM).</p><p><b>METHODS</b>Seven cases of craniofacial AVM were included in the study. After the ligation of ECA, the STA was surgically accessed and a 4F (1F = 0.333 mm) sheath introduced into the artery, and N-butyl-2-cyanoacrylate (NBCA) was selected as the permanent embolization material.</p><p><b>RESULTS</b>The angiogram was successfully carried out in these cases, which showed that some collateral branches from the ophthalmic artery of left internal carotid artery, vertebral artery and thyrocervical trunk provided the blood supply to the AVM nidus. The retrograde embolization with NBCA was completed.</p><p><b>CONCLUSIONS</b>The vascular architecture of craniofacial AVM after the ligated ECA was better demonstrated in angiogram of vertebral artery. The retrograde embolization through STA was an effective method for the treatment of craniofacial AVM.</p>

Surgery of the carotid artery: a retrospective study of 35 consecutive cases / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To retrospectively analyze a single institution's experience with surgery of the carotid artery performed as part of an oncological procedure and emergency hemostasis, with the aim to determine the preoperative methods for evaluation of cerebral circulation, selection of surgical procedures and perioperative complications.</p><p><b>METHODS</b>From January 1999 to December 2004, a total of 35 patients underwent carotid artery surgery including repair of carotid artery in 7 cases, ligation or resection of carotid artery in 17 cases, and reconstruction of carotid artery in 11 cases. All the patients were evaluated for blood flow in the circle of Willis with DSA, DSA plus TBO plus SPECT, and TCD and followed up from 4 months to 4 years. The perioperative complications and surgical outcomes were recorded and analyzed.</p><p><b>RESULTS</b>There were 16 carotid body tumors, 1 malignant carotid body tumor, 17 malignant tumors involving the carotid artery and 1 traumatic arterio-venous fistula. Twenty-seven patients underwent carotid occlusion test, 10 were positive and 17 were negative (tolerable). Of 7 cases with repair of the carotid artery, 1 patient died of uncontrolled bleeding due to rupture of the anastomosis, and the remaining was uneventful. Of 17 cases with ligation or resection of the carotid artery, 4 developed neurologic deficit 2 weeks postoperatively. Three patients with malignant tumors died 1 month, 4 months, and 4 months postoperatively, respectively. One patient with carotid artery body tumor complained of inarticulate speech 4 months after operation; another patient complained of incapability and limited movement of the ipsilateral upper limbs; 5 patients complained of dizziness 4, 6, 12, 24 and 48 months postoperatively. Of 11 patients who underwent carotid reconstruction, no major cerebral complications were noted after operation. One patient died of recurrence, 1 patient with carotid body tumor complained inarticulate speech and incapability of the contralateral limbs, the remaining was uneventful. Color Doppler showed patent vascular graft 1 year postoperatively.</p><p><b>CONCLUSIONS</b>TBO plus SPECT is a reliable method for evaluation of the circle of Willis currently. The short term and long term complications of ligation of carotid artery are high, therefore, resection and revascularization of the carotid artery is advocated for carotid artery tumors when possible.</p>

Diagnosis and treatment of high-flow vascular malformation of the jaws / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To report our experience on diagnosis and treatment of the high-flow vascular malformation of the jaws.</p><p><b>METHODS</b>Thirty-seven cases of high-flow vascular malformation of the jaws (6 cases in maxilla and 31 in mandible) were comprised this study. Twenty-one patients were embolized with coils and N-buty1-2-cyanoacrylate, and 16 cases underwent surgery. The embolization was carried out with both arterial and venous route.</p><p><b>RESULTS</b>Different signs of the lesions were demonstrated on X-ray plain film, such as locular, rough of bone trabecula and soap bubble-like changes, frequently accompanied by dilatation of the mandibular nerve canal. CT scan showed unilocular and multilocular radiolucency. T(1)WI and T(2)WI on MRI exhibited low signal, and varix was found on DSA. The high-flow vascular malformation of the jaws classified into two groups: arterial malformation and arteriovenous malformation according to CT and DSA. The acute bleeding of 16 cases was effectively controlled by embolization. The chronic bleeding in the other 5 cases stopped after the 4 - 59 months and new bone formation was found in the follow-up radiography.</p><p><b>CONCLUSIONS</b>The characteristic signs were not unique on X-ray plain film, and MRI and DSA had diagnostic value. Arteriovenous malformation of the jaws should be embolized by direct puncture in conjunction with endovascular therapy, and arterial malformation be superselectively embolized with NBCA.</p>