Desordens hiperostóticas em American Bully / Hiperostotic disorders in american bully

O complexo de desordens hiperostóticas é uma condição rara e autolimitante, que tem as mesmas características histopatológicas, que cursa com proliferação óssea de caráter não neoplásico. Acomete cães jovens de raças distintas, com variabilidade quanto ao tipo de proliferação óssea e quanto aos ossos acometidos. O complexo é composto pela osteopatia craniomandibular, hiperostose da calota craniana e osteodistrofia hipertrófica. Podendo estar presente nos ossos da calota craniana, mandíbulas, coluna cervical e esqueleto apendicular. O presente relato, descreveu o quadro de uma cadela, da raça American Bully, não castrada, três meses de idade, que foi atendida com queixa de aumento de volume doloroso das mandíbulas, hiporexia e sialorreia há 15 dias, apresentando ao exame físico, amplitude de movimento diminuída e sensibilidade dolorosa da articulação temporomandibular, espessamento firme bilateral do crânio em região de fossa temporal, espessamento palpável de consistência firme das mandíbulas e crepitação respiratória. Após avaliação clínica e realização de exames complementares, chegou-se ao diagnóstico presuntivo, de complexo de desordens hiperostóticas. Foi instituído como conduta terapêutica o suporte analgésico, sendo eficaz para a manutenção das necessidades fisiológicas até a paciente alcançar a fase adulta. O prognóstico para esta paciente foi considerado bom, uma vez que não havia indícios de anquilose da articulação temporomandibular e/ou manifestações neurológicas.

The complex of hyperostotic disorders is a rare and self-limiting condition, which has the same histophatological characteristics, which courses with non-neoplastic bone proliferations. It affects young dogs of different breeds, with variability the bones affected. The complex is composed of craniomandibular osteopathy, calvarial hyperostotic syndrome and hypertrophic osteodystrophy. It may be present in the bones of the skullcap, jaws, cervical spine and appendicular skeleton. The present report describes the condition of a female dog, American Bully breed, entire, three months old, with a complaint of painful swelling of the jaws, hyporexia and drooling for 15 days, presenting on physical examination, reduced amplitude and pain of the temporomandibular joint, bilateral firm thickening of the skull in the temporal fossa region, palpable firm-consistent thickening of the mandibles and respiratory crackle. After clinical evaluation and complementary tests, a presumptive diagnosis of hyperostotic disorders complex was reached. It was instituted pain management as a treatment, being effective for the maintenance of physiological needs until the patient reaches the adulthood. The prognosis for this patient was considered good, since there was no evidence of temporomandibular joint ankylosis and/or neurological manifestations.

Terapias físicas en pacientes con trastornos de la articulación temporomandibular / Physical therapies in patients with temporomandibular joint disorders

RESUMEN Introducción: Se denomina trastorno temporomandibular al conjunto de condiciones musculoesqueléticas que afectan la articulación temporomandibular, los músculos de la masticación y las estructuras anatómicas adyacentes. Objetivo: Evaluar la efectividad de las terapias físicas en pacientes con trastornos de la articulación temporomandibular. Métodos: Se efectuó una intervención terapéutica en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde junio de 2016 hasta febrero de 2020. La muestra quedó conformada por 264 pacientes distribuidos en 4 grupos con 66 integrantes cada uno, a quienes se les aplicaron diferentes terapias físicas, tales como ultrasonido, laserterapia, magnetoterapia y técnica de estimulación eléctrica transcutánea, respectivamente. Se analizaron las siguientes variables: edad, grado de trastorno de la articulación temporomandibular y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: Predominó el sexo femenino en todas las terapias aplicadas con más de 75,0 % y el grupo etario de 40 - 49 años. Al finalizar el tratamiento se observó que en los grupos donde se empleó ultrasonido, láser y magneto, la respuesta fue efectiva en más de 90,0 % de los pacientes, con primacía del primero (96,6 %); sin embargo, en el grupo donde se utilizó la técnica de estimulación eléctrica transcutánea solo se logró en 89,4 % de los afectados. Conclusiones: La ultrasonoterapia fue más efectiva en pacientes con trastornos de la articulación temporomandibular.

ABSTRACT Introduction: A temporomandibular disorder is a group of musculoskeletal conditions that affect the temporomandibular joint, the mastication muscles and the adjacent anatomical structures. Objective: To evaluate the effectiveness of the physical therapies in patients with temporomandibular joint disorders. Methods: A therapeutic intervention was carried out in Mártires del Moncada Teaching Provincial Stomatological Clinic from Santiago de Cuba, from June, 2016 to February, 2020. The sample was formed by 264 patients distributed in 4 groups with 66 members each one, to whom different physical therapies were applied, such as ultrasound, laser therapy, magnetotherapy and technique of transcutaneous electric stimulation, respectively. The following variables were analyzed: age, grade of dysfunction of the temporomandibular joint and therapeutic effectiveness. The percentage as summary measure and the chi-squared test were used with a significance level of 0.05. Results: There was a prevalence of the female sex in all the therapies applied with more than 75.0 % and the 40 - 49 age group. When concluding the treatment it was observed that in the groups where ultrasound, laser and magneto was used, the response was effective in more than 90.0 % of the patients, with primacy of the first one (96.6 %); however, in the group where the technique of transcutaneous electric stimulation was used it was just achieved in 89.4 % of the affected patients. Conclusions: The ultrasonotherapy was more effective in patients with temporomandibular joint disorders.

Prevalence of Temporomandibular Disorders and its Correlation with Stress and Salivary Cortisol Levels among Students

ABSTRACT Objective: To evaluate the prevalence of temporomandibular disorders (TMD) in students and to evaluate if any relationship existed between the stress levels, salivary cortisol levels, and TMD. Material and Methods: A total of 348 students, 187 female, and 161 male students, participated in this cross-sectional study. Students were evaluated based on the Research Diagnostic Criteria for TMD. The stress levels were evaluated using the Perceived Stress Scale. The students were divided into the control and TMD groups. Salivary cortisol levels in the salivary samples were analyzed. Results: The prevalence rate of TMDs was 30.7% in the study population. Of the female students, 61% had TMD compared with 46% of male students. Muscle disorders were the most predominant disorder in 14.2% of the students with TMD. The TMD group showed significantly higher salivary cortisol and stress levels than the control group. The TMD group also showed a moderate positive correlation between cortisol and stress levels (p=0.01). Conclusion: The study showed a strong association between salivary cortisol levels, stress, and temporomandibular disorders. Salivary cortisol could be used as a prognostic biomarker for stress while assessing the severity of TMJ problems in stressed individuals.

Disfunción temporomandibular en pacientes con síndrome de Sjögren / Temporomandibular dysfunction in patients with Sjögren's syndrome

Introducción: El síndrome de Sjögren es una enfermedad reumática, inflamatoria y crónica caracterizada por dolor articular y resequedad de las mucosas. La articulación temporomandibular (ATM) y las glándulas parótidas y salivales suelen estar afectadas. Objetivo: Determinar la prevalencia de la afectación de la articulación temporomandibular en pacientes con síndrome de Sjögren. Métodos: Estudio básico, no experimental, descriptivo y de corte transversal que incluyó a 78 pacientes con diagnóstico de síndrome de Sjögren atendidos en la Unidad Móvil número 2 de Alausi entre 2017 y 2019. Para identificar la afectación de la ATM se realizaron ecosonografías. Se usó la prueba de correlación de Pearson para establecer la relación entre las características de la enfermedad y la presencia de afectación articular. Resultados: El promedio de edad fue de 46,18 años. Predominaron los pacientes entre 40 y 60 años (62,82 por ciento), el sexo femenino (85,90 por ciento), y el tiempo de evolución de la enfermedad entre 3 y 5 años (50,00 por ciento). El 79,49 por ciento presentó síndrome de Sjögren secundario, y la artritis reumatoide fue la causa más frecuente (54,84 por ciento). El 65,38 por ciento tenía algún tipo de afectación de la ATM, y el hallazgo más común fue la disminución del espacio articular (56,86 por ciento). Conclusiones: Existió una elevada prevalencia de afectación de la ATM en los pacientes con síndrome de Sjögren, y el hallazgo principal fue la disminución del espacio articular. Se encontró una correlación positiva media entre el tiempo de evolución de la enfermedad y la presencia de afectación de la ATM(AU)

Introduction: Sjögren's syndrome is a rheumatic, inflammatory and chronic disease characterized by the presence of joint pain and dryness of the mucous membranes. The temporomandibular joint and the parotid and salivary glands usually have a high frequency of involvement. Objective: To determine the prevalence of temporomandibular involvement in patients with Sjögren's syndrome. Methods: Descriptive, correlational and explanatory study that included 78 patients diagnosed with Sjögren's syndrome treated in the mobile unit number 2 of Alausi. Echocardiography of the temporomandibular joints was performed to identify the involvement of the joint. Pearson's correlation test was used to establish a relationship between the characteristics of the disease and the presence of joint involvement. Results: Average age of 46.18 years with a predominance of patients between 40 and 60 years of age (62.82 percent), of the female sex (85.90 percent) and with time of evolution of the disease between 3 and 5 years (50.00 percent). 79.49 percent of the cases presented secondary Sjögren's syndrome, rheumatoid arthritis being the most frequent disease (54.84 percent). 65.38 percent of the patients presented some type of involvement of the temporomandibular joint, with the decrease in joint space being the most frequent finding (56.86 percent). Conclusions: There was a high prevalence of temporomandibular joint involvement in patients with Sjögren's syndrome, with the decrease in joint space being the finding that was most frequently identified. A positive average correlation was found between the time of evolution of the disease and the presence of temporomandibular joint involvement(AU)

Anquilosis de la articulación temporomandibular / Ankylosis of the temporomandibular joint

Introducción: resulta de interés para médicos y especialistas el conocimiento sobre la incapacidad de la apertura de la cavidad oral debido a coaliciones entre los elementos óseos y fibrosos en la región glenoidea. Objetivo: revisar la literatura sobre las características de esta patología. Desarrollo: en el primer trimestre del año 2006, a fin de realizar una revisión bibliográfica no exhaustiva para localizar la información disponible sobre la anquilosis de la articulación temporomandibular, se realizó una búsqueda bibliográfica en Scielo, Medline, Isi Web of Knowlegde y Dialnet, buscando como palabras clave: anquilosis (ankylosis) y articulación temporomandibular (temporomandibular joint). Además de la búsqueda computarizada se realizó una búsqueda manual entre las referencias de los estudios seleccionados. Conclusiones: la anquilosis temporomandibular resulta una entidad clínica compleja, usualmente molesta para los pacientes dada la imposibilidad de alimentarse y nutrirse adecuadamente, además de las deformidades que desde el punto de vista estético afecta la esfera psicológica de las personas aquejadas. Su tratamiento es difícil, no obstante, una atención adecuada minimiza las consecuencias de las complicaciones que pueden aparecer como resultado de la técnica quirúrgica u otros factores no relacionados con ella. Se reconoce que una identificación y tratamiento oportuno del problema puede favorecer los buenos resultados de la conducta médica y la rápida integración del paciente a la sociedad(AU)

Introduction: it is of interest for physicians and specialist's knowledge about the inability of the opening of the oral cavity due to coalitions between the bone and fibrous elements in the glenoid region. Objective: to review the literature on the characteristics of this pathology. Development: in the first quarter of 2006, in order to perform a non-exhaustive literature review to locate the available information on ankylosis of the temporomandibular joint, a literature search was carried out in Scielo, Medline, Isi Web of Knowlegde and Dialnet, searching as key words: ankylosis (ankylosis) and temporomandibular joint (temporomandibular joint). In addition to the computerized search, a manual search was made among the references of the selected studies. Conclusions: the temporomandibular ankylosis is a complex clinical entity, usually annoying for patients given the impossibility of feeding and nourishing adequately, in addition to the deformities that from the aesthetic point of view affects the psychological sphere of the people afflicted. Its treatment is difficult, nevertheless, an adequate attention minimizes the consequences of the complications that can appear as a result of the surgical technique or other factors not related to it. It is recognized that an identification and timely treatment of the problem can favor the good results of medical behavior and the rapid integration of the patient into society(AU)

Tuberculose e suas manifestações na ATM: uma revisão de literatura / Tuberculosis and its manifestations in TMJ: a literature review

A disfunção temporomandibular tem caráter multifatorial e merece uma abordagem diferenciada tanto para seu diagnóstico quanto seu tratamento, sendo frequentemente recomendada a atuação de uma equipe multidisciplinar. Várias são as manifestações que podem acometer as articulações temporomandibulares decorrentes de patologias sistêmicas. Dentre estas, a tuberculose raramente as acomete, mas a ocorrência de manifestações extrapulmonares vem crescendo nos últimos anos. Estima-se que a tuberculose acometa 8.8 milhões de pessoas ao ano, levando 1.45 milhões destas ao óbito. O objetivo desta revisão foi levantar dados e informações para profissionais da área da saúde, em especial os Cirurgiões Dentistas,para um correto e precoce diagnóstico, uma vez que a detecção correta da patologia possibilita tratamento adequado e previne o surgimento de alterações graves na forma e função das articulaçõesenvolvidas.

Temporomandibular disorders are a multifactorial disease, that deserves a special approachfor its diagnosis and treatment, and a multidisciplinary team is suggested. Various systemic pathologies have a TMJ manifestation. Among these diseases, tuberculosis rarely has a temporomandibularjoint occurrence, but extra pulmonary manifestation is increasing in the last years.About 8,8 million people are affected by tuberculosis each year, and 1,45 million die because ofit. The objective of this review is collect data and information for health professional, in special Dentists, in order to clarify the relationship between TMD and tuberculosis, early diagnosis and correct treatment, once that the correct identification of this patology can provide adequate treatment and prevents for more severe complications.

Disfunções temporomandibulares: até onde o cirurgião dentista pode atuar / Temporomandibular disorders: as far as the dentist can act

O objetivo deste trabalho foi realizar uma revisão de literatura sobre as desordens temporomandibulares (DTMs), a fim de enfatizar e definir a atuação do cirurgião-dentista nas condutas terapêuticas empregadas para esta enfermidade. Foram abordados aspectos relacionados à anatomia e neurofisiologia das articulações temporomandibulares, tipos de dor do paciente, sistemas diagnósticos empregados e abordagens terapêuticas propostas para o tratamento das DTMs. As dinfunções temporomandibulares tem sido amplamente divididas em miogênicas e artrogênicas. Os sinais e sintomas associados com DTM são queixas de dor crônica na cabeça e estruturas orofaciais...

Efeitos da remoção do disco e cartilagem articular no crescimento e microarquitetura óssea da mandíbula de ratos: análise por microtomografia / Effects of articular disc and cartilage removal on mandible of growing rats: a micro-computed tomography study

Alterações na articulação emporomandibular (ATM) comumente geram desequilíbrios musculares que estão associados à alterações no tecido ósseo. Esta articulação pode sofrer a influência de traumas, fatores congênitos ou desordens de crescimento. Estudos sobre alterações de crescimento do complexo maxilomandibular decorrentes de problemas da ATM são escassos. O objetivo deste trabalho foi avaliar por meio da microtomografia os efeitos da remoção do disco articular e a remoção conjugada do disco e cartilagem articular no crescimento e na microarquitetura óssea da mandíbula de ratos. Trinta ratos da raça Wistar com um mês de idade foram divididos em três grupos: CTR (controle operado); RD (remoção de disco articular) e RDC (remoção conjugada do disco e cartilagem articular). Apenas o lado direito foi operado; o lado esquerdo permaneceu intacto. Após dois meses de acompanhamento, os ratos foram sacrificados e as hemimandíbulas escaneadas em microtomógrafo A remoção do disco articular e a remoção conjugada do disco e cartilagem articular alteram o volume e microestrutura do osso trabecular da mandíbula de ratos jovens. Estas duas intervenções provocaram uma queda na qualidade de parâmetros da microestrutura do trabeculado do processo angular e diminuição do crescimento da hemimandíbula do lado operado.

Changes in the temporomandibular joint (TMJ) lead to muscle dysfunctions that are associated with bone changes. This joint region can be influenced by trauma, congenital factors or growth disorders. Studies linking TMJ problems and growth alterations are scarce. The aim of this study was to evaluate the effects of the articular disc removal or articular disc and cartilage removal on the bone microarchitecture and mandibular growth of young rats. Thirty Wistar rats (one month old) were divided into three groups: CTR (sham operated); RD (disc removal) and RDC (disc and cartilage removal). Only the right side was operated, keeping the left side intact. After two months, the rats were sacrificed and the mandibles scanned on micro-CT for quantitative analysis. Some microstructural parameters were altered by the disc removal or disc and cartilage removal. The right side presented lower growth than the left side.

Frequência das dinfunções temporomandibulares (DTM) e sua relação com a ansiedade e a depressão entre usuários que procuram o setor de odontologia em uma unidade de saúde / Frequency of temporomandibular disorders (TMD) and their relationship with anxiety and depression among dental patients of a health care unit

As Disfunções Temporomandibulares (DTM) são distúrbios da Articulação Temporomandibular (ATM) comuns em crianças e adolescentes, tendendo a aumentar sua prevalência na fase adulta. Uma vez que poucos estudos discutem a prevalência de DTM em serviços de Atenção Primária (APS), o objetivo do presente estudo foi verificar a frequência das DTMs e sua relação com a ansiedade e a depressão em usuários que procuraram o setor de odontologia de uma unidade de APS. A amostra foi composta por 257 pacientes adultos (maiores de 18 anos) atendidos, de forma consecutiva, na unidade. Para avaliação do grau de DTM entre os pacientes do estudo, foi utilizado questionário proposto por Maciel,15 constituído de 10 perguntas objetivas, que apontam a presença de DTM. Para avaliação da ansiedade, foi usada a Escala Hospitalar de Ansiedade e Depressão (HADS), validada por Marcolino.16 Essa escala possui 14 itens fechados, dos quais 7 são voltados para a ansiedade (HADS-A) e 7 para a depressão (HADS-D). A frequência de DTM encontrada foi de 86,7%, sendo que as DTMs moderadas e severas estavam presentes na maioria dos sujeitos (55,7%), enquanto os não portadores e portadores leves de DTM representaram 45,3% da amostra. Observou-se, também, uma correlação significante entre DTM e ansiedade e depressão (p<0,05) em relação aos não portadores. Esses dados assumem uma relevância ainda maior, por se tratar do contexto de uma unidade de APS, a qual se configura como porta de entrada para o atendimento em saúde do indivíduo.

The Temporomandibular Disorders (TMD) are disorders of the temporomandibular joint (TMJ) common in children and adolescents, tending to increase their prevalence in adulthood. Since few studies discuss the prevalence of TMD in Primary Care Services (PCS), the purpose of this study was to determine the frequency of TMD and its relationship with anxiety and depression in users who searched for the dental treatment in a health unit. The sample comprised 257 adults (18 years) consecutively treated in the dental service of this unit. To assess the degree of TMD among patients in the study, a proposed by Maciel15 was used. This questionnaire consists of 10 objective questions that indicate the presence of TMD. To evaluate anxiety, it was used a Hospital Anxiety and Depression Scale (HADS) validated by Marcolino.16 This scale has 14 items closed, being seven targeted for anxiety (HADS-A) and 7 for depression (HADS-D). The frequency of moderate and severe was 86.7% and TMD were present in most subjects (55.7%), while non-carriers and carriers of light TMD represented 45.3% of the sample. We also observed a significant correlation between TMD and anxiety and depression (p<0,05) compared to non-carriers. These facts assume greater importance because PCS configure a gateway to the health care of the individual.

Lise e lavagem artroscópica da ATM - uma análise de 102 pacientes e 175 articulações / Tmj arthroscopic lysis and lavage - an analysis of 102 partients and 175 joints

O tratamento dos desarranjos internos (DI) da articulação temporomandibular (ATM), é um grande desafio para cirurgiões e clínicos. Na maioria das vezes o tratamento é realizado de forma conservadora através de placas oclusais, fisioterapia e medicamentos. Apenas 2% a 5% dos casos tem indicação cirúrgica, seja através de artroscopia ou artrotomia. No presente estudo foram incluídos 102 pacientes (175 ATMs) com DI da ATM, sendo 8 homens e 94 mulheres, com uma média etária de 32,4 anos, atendidos entre janeiro de 2010 e outubro de 2013, refratários ao tratamento conservador, diagnosticados por exame clínico e por imagem de ressonãncia magnética (IRM), apresentando limitação de abertura bucal e dor localizada em ATM em função. O objetivo do estudo foi avaliar melhora da abertura bucal, melhora da dor, posicionamento do disco articular e complicações pós LLA Os pacientes foram submetidos à lise e lavagem artroscópica (LLA) da ATM sob anestesia geral, e acompanhados por um período de 12 meses com avaliações periódicas. Os resultados mostraram que dos 102 pacientes envolvidos no estudo," (8,8%), após 6 meses de acompanhamento, foram indicados para artrotomia, devido manutenção da limitação de abertura bucal e/ou dor em função. A LLA foi eficiente em 91,2% dos casos estudados, com 90,7% melhora na abertura bucal e 93,6% na redução da dor em função, 68% de melhora na posição discal e índice 6,9% de complicações, as quais foram transitórias

The treatment for internal derangement (10) of the temporomandibular joint (TMJ), is a major challenge for surgeons and clinicians. Most often the treatment is performed conservatively using splints, physical therapy and medications. Only 2% to 5% of cases the treatment is surgical,Only 2-5% of patients require surgery, which is performed by arthroscopy or arthro- tomy. In this study, 102 patients (175 temporomandibular joints) with temporomandibular joint (TMJ) internal derangement (10),8 men, 94 women; mean age, 32.4 years, who were treated between January 2010 and October 2013 were included. These patients did not respond to conservative treatment and were diagnosed by clinical examination and magnetic resonance imaging (MRI) with limited mouth opening and localized functional temporomandibular join pain. This study aimed to assess improvements in mouth opening, pain reduction, articular disc positioning, and postoperative complications of arthroscopic Iysis and lavage (ALL) under general anesthesia. The patients underwent ALL and were monitored for a 12-month perioc with periodic evaluations. Of the 102 patients in the study, 9 (8,8%) required arthrotomvê months into the follow-up period, as they still presented with limited mouth opening and/or joint movement-associated pain. ALL was effective in 93.6% of the analyzed patients: 90.7 reported improved maximum interincisal opening (MIO), 93.6% experienced a decrease in join• movement-associated pain, and 68% reported improved disc positioning. The complicaties were transient and its rate was 6,9%

Diseño de un dispositivo como herramienta diagnóstica en trastornos témporomandibulares / Design of a device as a diagnostic tool for temporomandibular joint disorder

En la práctica odontológica se puede evidenciar una insatisfacción, de los profesionales de la odontología, al solo contar con una imagen diagnóstica de una radiografía panorámica y lo inaccesible que resulta adquirir otros equipos que puedan aportar información para estudiar las afecciones en la Articulación Témporo Mandibular (ATM). Esta investigación orientada al diseño de un dispositivo receptor de imagen que asemeja un arco facial y un audífono, el cual, a su vez posee cámaras para la obtención de imágenes. A su vez, apoyado por un software (matlab) que interpreta los cambios de la imagen como una línea de desplazamiento, arrojando valores que son llevados a formar parte de un diagnóstico, en el estudio de desórdenes témporomandibulares. Este proyecto se enmarco en la modalidad de proyecto factible, con enfoque tecnicistas. Se utilizó una encuesta como técnica de recolección de datos y como instrumento se uso un cuestionario estructurado con preguntas dicotómicas. El estudio se aplico a docentes de la asignatura Oclusión y Rehabilitación Protésica, del Departamento de Prostodoncia y Oclusión de la Facultad de Odontología de la Universidad de Carabobo. Se evidencio que la mayoría de los docentes manifestaron poca confianza en los métodos diagnósticos existentes, ya que no ofrecen imágenes dinámicas y son poco accesibles a la población. Además, se encontró que el 100% está de acuerdo que el desarrollo del dispositivo antes mencionado. Se encuentra que este dispositivo seria innovador y cómodo, además de encontrarse una amplia motivación hacia su aplicación...

The purpose of this research is to develop a design of a receiver device supported by software that interprets the changes in an image as a displacement line of the TMJ. This research aims to present a device as a diagnostic tool for the témporomandibular joint disorder to the professors of the Faculty of dentistry in Carabobo University. This project was delimited as a workable project with a technicist approach where it is used a survey, as data collection technique and a structured questionnaire with dichotomous questions, as instrument. The study was applied to the professors of occlusion and prosthetic rehabilitation subject of the Faculty of dentistry in Carabobo University having 15 professors. It was found that most of the professors manifest a lack of confidence on the methods to study the TMJ disorders, due to it is unable to show the condylar dynamics and are also expensive for most of the population. Plus, it was evidenced that 100% were agree on develop of the device mentioned before, It´s described as comfortable, being motivated for the application..

Adaptación transcultural de los criterios diagnósticos para la investigación de los trastornos temporomandibulares (CDI/TTM) / Cross-cultural adaptation of research diagnostic criteria for temporomandibular disorders (RDC/TMD)

Introducción: el objetivo de este trabajo fue establecer la adaptación transcultural de los criterios diagnósticos para la investigación de los trastornos temporomandibulares (CDI/TTM). Métodos: bajo un diseño de estudio prueba reprueba, fueron evaluadas las propiedades psicométricas de los CDI/TTM versión en español. Sujetos bilingües fueron evaluados para probar la congruencia entre las versiones en español e inglés del instrumento; incluidos ambos ejes I (grupo diagnóstico) y II (perfil psicosocial del paciente). Resultados: la confiabilidad del eje I prueba reprueba para la clasificación del diagnóstico fue excelente (Kappa: 1.0). El análisis de confiabilidad de la prueba reprueba del eje I para la clasificación de los diferentes diagnósticos fue excelente (Kappa: 1.0). Para el eje II, el coeficiente de correlación intraclase (CCI) fue calculado para la escala del grado de dolor crónico GDC (0,96), y para la lista de cotejo de la discapacidad mandibular LCDM (0,77), depresión(0,87) y síntomas físicos no específicos (0,98). Adicionalmente se calculó el Alpha de Cronbach para la LCDM (0,89). Correlaciones de Spearman entre los reactivos del eje II mostraron una mediana de la correlación de 0,50 (0,293-0,856) con valores altos entre la LCDM y la GDC. Dichas correlaciones proveen soporte para la consistencia interna de los CDI/TTM en español. Conclusión: la validez y confiabilidad de los CDI/TTM demostrada se soporta en sus propiedades psicométricas. Su adaptación transcultural permite el uso de dicho instrumento en las poblacioneshispanoparlantes con el objetivo de evaluar el papel de los TTM en esta población.

Introduction: the goal of this study was to establish the cross-cultural adaptation of Research Diagnostic Criteria forTemporomandibular Disorders (RDC/TMD). Methods: with a test-retest design, this study evaluated the psychometric properties of RDC/TMD intheir Spanish version. Bilingual subjects were evaluated in order to test consistency between the Spanish and English versions of the instrument,including axis I (clinical conditions of TMD) and axis II (psychosocial aspects related to TMD). Results: the reliability of axis I test re-test for diagnosis classification was excellent (Kappa = 1,0). The reliability analysis of axis I test-retest for classifying different diagnoses was also excellent(Kappa = 1,0). Concerning axis II, the intraclass correlation coefficient (ICC) was calculated for Graded Chronic Pain Scale (GCPS) (0,96) as well as for Jaw Disability Checklist (JDC) (0,77), depression (0,87), and nonspecific physical symptoms (0,98). Also, Cronbach’s Alpha for JDC wascalculated (0,89). Spearman correlations among axis II reagents showed a median of correlation of 0.50 (0.293 to 0.856) with high values between JDC and GCPS. These correlations provide support for internal consistency of RDC/TMD in Spanish. Conclusion: the demonstrated validity and reliability of the RDC/TMD lie in thier psychometric properties. The cross-cultural adaptation of this instrument allows its use in Spanish-speakingpopulations for the assessment of the role of TMD in this population.

Evaluación morfométrica directa de la asimetría condilar sobre mandíbulas humanas / Direct morphometric evaluation of condylar asymmetry on human mandibles

La asimetría condilar (AC) es una alteración morfológica estructural considerada un importante factor de riesgo para los trastornos de la articulación temporomandibular. Diversas técnicas evalúan la AC, principalmente basadas en mediciones sobre radiografías panorámicas, dado su amplio uso. Sin embargo, los métodos sobre radiografías no son muy sensibles por la magnificación, distorsión, superposición de estructuras y posicionamiento mandibular. El objetivo de este estudio fue determinar los valores reales de los índices de asimetría condilar para una muestra normal con medición directa sobre mandíbulas humanas. Se utilizaron 30 mandíbulas humanas adultas secas pertenecientes a población chilena, y la asimetría condilar fue evaluada las técnicas de Habets y de Kjellberg, y se realizaron los análisis descriptivos de los valores promedios, desviación estándar, mínimo y máximo y los índices de asimetría/simetría de cada método. Según el índice de asimetría condilar de Habets 7 casos (un 23,3%) mostraron valores superiores a un índice de 3% de asimetría, con un rango entre 3,64 y 27,26%. Los parámetros morfológicos del lado derecho e izquierdo no mostraron diferencias significativas (p < 0,05). Según el índice de simetría de Kjellberg, 19 casos (63,3%) mostraron valores inferiores al 93% y fueron clasificados como asimétricos. Los parámetros morfológicos del lado derecho e izquierdo tampoco mostraron diferencias significativas. Al comparar las asimetrías reportadas con ambos métodos, sólo en 4 casos hubo una coincidencia de diagnóstico. Al eliminar factores de distorsión y angulación en las mediciones realizadas, se confirma la existencia de asimetría vertical entre los cóndilos mandibulares del lado derecho e izquierdo, y por otra parte, es evidente que hay diferencias en los valores de asimetría debido a los diferentes métodos utilizados. Sin embargo, todavía no está claro que la asimetría condilar puede considerarse fisiológica.

The condylar asymmetry (CA) is a structural morphological alteration considered an important risk factor for temporomandibular joint disorders. CA can be evaluate by various techniques, mainly based on measurements on panoramic radiographs, given their wide use. However, the methods of x-rays are not very sensitive due to the magnification, distortion, overlapping structures and mandibular positioning. The aim of this study was to determine the values of condylar asymmetry for normal sample by direct measurement in human jaws. Thirty adult human dry mandibles belonging to Chilean population were used. The condylar asymmetry was evaluated by Habets and Kjellberg techniques, and descriptive analysis of mean, standard deviation, minimum and maximum values, and asymmetry/symmetry indexes were performed of each method. According to the Habets' index, 7 cases (23.3 percent) showed a higher rate of 3 percent asymmetry, with a range between 3.64 percent and 27.26 percent. The morphological parameters of the right and left side showed no significant differences. According to the symmetry Kjellberg's index, 19 cases (63.3 percent) showed values lower to 93 percent and were classified as asymmetric. The morphological parameters of the right and left side also showed no significant differences (p<0.05). When comparing the asymmetries reported by both methods, only 4 cases there was diagnostic agreement. By eliminating factors of distortion and angulation on measurements, the existence vertical asymmetry between mandibular condyles of the right and left side is confirmed, and on the other hand, it is clear that there are differences in the values of the asymmetry due to the different methods used. However, it is still unclear that condylar asymmetry can be considered physiological.

Detection of bifid mandibular condyle by panoramic radiography and cone beam computed tomography

Aim: To compare panoramic radiography and cone beam computed tomography (CBCT) in the diagnosis of bifid mandibular condyle. Methods: The sample consisted of 350 individuals who underwent panoramic radiography and CBCT. In the panoramic radiographs and CBCT images, the presence or absence of bifid mandibular condyle was determined. Results: Presence of bifid mandibular condyle was detected in four cases (1.1%). In all cases, the relation of one condylar process to the other was mediolateral and history of trauma was reported. None of the individuals had symptoms. In two cases, panoramic radiography did not reveal the presence of bifid mandibular condyle. Conclusions: Initial screening for bifid mandibular condyle can be performed by panoramic radiography; however, CBCT images can reveal morphological changes and the exact orientation of the condyle heads.

Tratamiento simultáneo de anquilosis temporomandibular unilateral congénita y del microlaterognatismo asociado / Simultaneously treament of congenital unilateral temporomandibular ankylosis and consecutive microlatherognathism

Este artículo tiene como objetivo reportar los resultados obtenidos a corto y largo plazo, del tratamiento con enfoque multidisciplinario de una anquilosis unilateral congénita de la articulación temporomandibular asociada a un síndrome de malformación embrionaria, en un niño de 12 años de edad, en el que se utilizó un distractor externo bidimensional con un doble propósito: como fijador para mantener el espacio logrado con la artroplastia y como distractor para elongar la rama mandibular hipotrófica, activado 5 días después de la osteotomía, con el objetivo de eliminar la anquilosis y el microlaterognatismo mandíbular consecutivo de ella, simultaneamente de manera funcional y dinámica(AU)

The paper reports the short- and long-term results obtained from the multidisciplinary treatment of a congenital unilateral ankylosis of the temporomandibular joint associated to an embryonic malformation in a 12-year-old boy, using an external bidimensional distraction device with a two-fold purpose: as fixator to maintain the space achieved by arthroplasty, and as distractor to elongate the hypotrophic mandibular branch, activated 5 days after osteotomy, with the purpose of eliminating ankylosis and consecutive mandibular microlaterognatism, both functionally and dynamically(AU)

Férulas oclusales / Occlusal splints

Las férulas oclusales son una forma de tratamiento de los TTM y está incluida dentro de las modalidades no-invasivas y reversibles. En busca de mejores resultados, actualmente existen varios diseños de las férulas oclusales, hechos con diversos materiales, pero sólo de cinco tipos de férulas se conoce ampliamente: férula de Estabilización, de Reposicionamiento anterior, placa de Mordida anterior, placa de Mordida Posterior, Pivotante y Blanda; las cuales pueden fabricarse de varias formas y cada una tiene sus indicaciones; lo que junto a un plan de controles adecuado e individualmente indicado para cada paciente, llevan al éxito de los resultados.

Occlusal splints are a form of treatment for TMD and are included into non-invasive and reversible modalities. In search of better results, there are now several designs of occlusal splints, made of different materials, but only five types of splints are widely known: Stabilization splint, Anterior Repositioning, Anterior Bite Plate, Posterior Bite Plate, Pivot and Soft, which can be manufactured in different shapes and each has Its indications, which together with a plan of appropriate controls and individually indicated for each patient, leading to successful outcomes.

Remplazo total de la articulacióntemporomandibular con prótesisaloplásticas estándar / Total replacement of the temporomandibular joint with alloplastic prosthesis stock

Antecedentes: Los trastornos de la articulación temporomandibular (DTM) abarcan ungran número de condiciones clínicas que involucran los músculos de la masticación, laoclusión, la articulación temporomandibular (ATM) y otras estructuras relacionadas, lo queresulta en dolor y disfunción mandibular. Muchos casos de DTM pueden ser manejadoscon tratamiento no quirúrgico; sin embargo, pacientes con daño irreversible de la ATM y enun estadio final de la patología articular necesitan reparación o reconstrucción quirúrgica,procedimiento realizado tradicionalmente con tejidos autógenos, principalmente injertocostocondral. El uso de tejidos autógenos para la reconstrucción de la ATM tiene mayoresdesventajas y un alta tasa de complicaciones. Estas desventajas incluyen morbilidad del sitiodonante y largo tiempo quirúrgico. Las complicaciones comprenden reabsorción del injerto yanquilosis. Las indicaciones para la reconstrucción total de la ATM con prótesis aloplásticasincluyen anquilosis, fractura condilar irreparable, necrosis avascular, reconstrucciones previasfallidas, condiciones inflamatorias y degenerativas, reabsorción condilar idiopática y ciertostrastornos congénitos. Objetivo: Proporcionar al lector una técnica ilustrada para la reconstrucciónaloplástica de la ATM, estableciendo criterios mínimos indispensables para sureconstrucción en situaciones clínicas específicas. Métodos: Guía de práctica clínica basadaen la evidencia científica, con una propuesta de protocolo para la planificación preoperatoria,el manejo quirúrgico y los cuidados postoperatorios en la reconstrucción aloplásticade la ATM con prótesis estándar. Conclusión: Los implantes protésicos estándar para lareconstrucción aloplástica de la ATM proporcionan un método eficaz, seguro, predecible,eficiente y rentable para la reconstrucción en pacientes con patología articular avanzada...

Background: Temporomandibular Joint Disorder (TMD) is a collective term embracing anumber of clinical conditions that involve the masticatory musculature, occlusion, thetemporomandibular joint (TMJ) and other associated structures, resulting in pain andlimitation of mandibular function. Many patients suffering from TMDs can be managedwith non-surgical therapies, but some end-stage TMJ patients require surgical TMJ repairor reconstruction. The most widely used autogenous graft for TMJ reconstruction is thecostochondral graft. The use of autogenous tissue for TMJ reconstruction presents severaldisadvantages and a high rate of complications. These disadvantages include donormorbidity and increased intraoperative surgical time. The complications include graft resorptionand ankylosis. Indications for TMJ total reconstruction with alloplastic prosthesisinclude ankylosis, condylar fracture irreparable, avascular necrosis, failed previous jointreconstruction, inflammatory and degenerative conditions, idiopathic condylar resorptionand certain congenital deformities. Purpose: To provide the practitioner with an illustratedtechnique for alloplastic reconstruction of the TMJ, establishing minimum criteria necessaryfor reconstruction in specific clinical situations. Methods: Evidence-based clinical practiceguidelines, with a proposed protocol for perioperative management, surgical management,and postoperative care in alloplastic reconstruction of the TMJ with prosthesis stock.Conclusion: Stock prosthetic TMJ implants provide a safe, predictable, efficient, and costeffective means for joint reconstruction in patients with advanced joint disease...

Modificación de procedimiento Dautrey en dislocación recurrente mandibular / Dautrey procedure modification, in recurrent mandibular dislocation

El manejo de la dislocación recurrente mandibular, puede representar un reto para el Cirujano Maxilofacial. La decisión tomada debe ser de acuerdo a las demandas de cada caso en particular. El presente caso fue tratado quirúrgicamente mediante el procedimiento Dautrey, debido a la dislocación recurrente crónica unilateral derecha de la articulación temporomandibular. Este procedimiento no perturba el movimiento funcional normal de la articulación, por otra parte previene la excursión excesiva anterior del cóndilo. La técnica quirúrgica propuesta, presenta una modificación al procedimiento original. Con resultados finales favorables para la función.

Managing recurrent dislocations of the mandible, may represent to the Maxillofacial Surgeon a challenge. The chosen decision has to be according to the demands of each case in particular. The present case is treated surgically by Dautrey procedure, because of chronic recurrent unilateral right side dislocation of the temporomandibular joint. This procedure does not disturb normal functional movement of the joint yet prevents excessive forward excursion of the condyle. The surgical technique is presented with a modification of the original procedure. With favorable final results to the function.

Análise dos deslocamentos do disco articular da articulação temporomandibular: revisão de literatura, critérios e exame / Analysis of articular disk displacement of temporomandibular joint: review, criteria and examination

As desordens funcionais da articulação temporomandibular são provavelmente os achados mais comuns em pacientes com desordem mastigatória. O deslocamento do disco articular é a artropatia da ATM mais comum e é caracterizada por vários estágios de disfunção clínica, que envolvem a relação côndilo-disco. O deslocamento de disco com redução é caracterizado por uma relação anormal oumau alinhamento do disco articular e do côndilo, que vai levar a um travamento da mandíbula. Neste processo pode ocorrer o clickarticular ou estalo, durante a abertura da boca, mostrando que o disco foi reduzido. Esta condição pode vir ou não acompanhada de dor e se evoluir e tornar-se crônica, passa de deslocamento de disco com redução para sem redução, onde o disco fica permanentemente numa posição anteriorizada, impedindo o movimento normal do côndilo. O deslocamento de disco sem redução é acompanhado dehipomobilidade mandibular e dor articular ao realizar os movimentosde abrir e fechar a boca. O tratamento conservador nesses casos tem obtido bons resultados na melhora da função mastigatória e na redução da dor. evitando assim o uso de procedimentos cirúrgicos.

The functional disorders of the temporomandibular joint (TMJ) are probably the most common findings in patients with difficulties in mastication. The most common arthropathy of TMJis the articular disk displacement of the joint and is characterized by several stages of clinical dysfunction that involve the condyle-disk relationship. The disk displacement with reduction is characterized by abnormal relationship or improper alignment between the joint disk and condyle, which will lead to jaw locking. In this processthe joint click or snap can occur, during the opening of the mouth, showing that the disk was reduced. This condition can or not be followed by pain and, if it evolves and become chronic, it passesfrom disk displacement with reduction to non-reduction, in which the disc is permanently in a back position, hindering the normal movement of the condyle. The non-reduction disc displacement is followed by jaw hipomobility and pain in joint when carrying through the movements to open and to close the mouth. Theconservative treatment in these cases obtained good results in theimprovement of the masticatory function and in the reduction ofpain, thus preventing the use of surgical procedures.

Prevalence of vertical condilar asymmetry of the temporomandibular joint in patients with signs and symptoms of temporomandibular disorders / Prevalencia de asimetría condilar vertical de la articulación temporomandibular en pacientes con signos y síntomas de trastornos temporomandibulares

Vertical condylar asymmetry (VCA) is considered a risk factor for the development of a temporomandibular disorder (TMD). VCA is determined by comparing the vertical condylar height between the left and right condyle. Several techniques have been developed to evaluate this asymmetry, and the most common among them are developed by Kjellberg et al. (1994) and Habets et al. (1988). The objective of this study was to evaluate the similarity of the Habets' and Kjellberg's methods with regard to these results and analyze the VCA results of the temporomandibular joint in patients with signs and symptoms of TMD. We analyzed 48 patients between 12 and 65 years of age. In each patient, the percentage of condylar symmetry according to the Kjellberg's and Habets' indexes was established and related to sex, age, and signs and symptoms of TMD at admission compared with patients who are symmetrical and asymmetrical. Finally, we compared the results of two indexes. According to Habets' index, 70.8 percent of patients were classified as asymmetric, compared with Kjellberg index where it was only 54.2 percent. No statistically significant difference was found between the severity of signs and symptoms of TMD and sex, age, Habets' index, and Kjellberg's index. We also found no statistically significant difference between patient age and Kjellberg index, but between age and Habets' index, younger patients were symmetrical. We conclude that it is conceivable that the presence of VCA is not a risk factor for TMD development.

La asimetría condilar vertical (ACV) es considerada un factor de riesgo para el desarrollo de un Trastorno Temporomandibular (TTM). ACV se determina al comparar la altura condilar vertical entre el cóndilo derecho e izquierdo. Se han desarrollado diversas técnicas para evaluar esta asimetría, las más conocidas son las desarrolladas por Kjellberg et al. (1994) y Habets et al. (1988). El Objetivo de éste estudio fue evaluar la similitud de la técnica de Habets con la técnica de Kjellberg en cuanto a los resultados y analizar éstos resultados de ACV de la articulación temporomandibular en pacientes con signos y síntomas de un trastorno temporomandibular. Se analizaron 48 pacientes entre 12 y 65 años. En cada paciente se estableció el porcentaje de simetría condilar según el índice de Kjellberg y el índice de Habets y se relacionó con las variables sexo, edad, y signos y síntomas de TTM al momento del ingreso con respecto a los pacientes simétricos y asimétricos. Por último se compararon los resultados de ambos índices. Según el índice de Habets el 70,8 por ciento de los pacientes fue clasificado como asimétrico, en comparación con kjellberg donde fue solo el 54,2 por ciento. No se encontró diferencia estadísticamente significativa entre la severidad de los signos y síntomas de un trastorno temporomandibular y las variables sexo, edad, índice de Habets e índice de Kjellberg. Tampoco se encontró diferencia estadísticamente significativa entre la edad de los pacientes y el índice de Kjellberg, pero si se encontró diferencia entre la edad y el índice de Habets donde los pacientes simétricos tenían menor edad. Se concluye que es posible pensar que la presencia de ACV no representa un factor de riesgo para el desarrollo de un TTM.