Prevalence of internal derangements of temporomandibular joint in patients with cleft-lip/palate

Aim: The aim of this study was to estimate the prevalence of internal derangements (ID) of temporomandibular joint (TMJ) in patients with cleft-lip/palate. Also, to evaluate the correlation of diagnosis between Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD) clinical examination and Magnetic resonance imaging (MRI). Methods: Twenty patients with cleft-lip/palate, were clinically evaluated by RDC/TMD and by MRI. The ID of TMJ evaluate were disc displacement with reduction (DDWR) and disc displacement without reduction (DDWOR). Results: The present study showed that 9 (45%) of the patients were diagnosed with ID of TMJ (8 [40%] patients with DDWR and 1 [5%] with DDWOR) and 11 (55%) present no disorders, by RDC/TMD. MRI examination revealed that 15 (75%) of the patients had ID of TMJ (13 [65%] patients with DDWR and 2 [10%] with DDWOR) and 5 (25%) present no disorders. The Kappa index between the clinical and imaging diagnosis was 0.01. Conclusion: In the present study, DDWR was diagnosed in 40-65% by the RDC/TMD and MRI, respectively; DDWOR was diagnosed in 5-10% by the RDC/TMD and MRI, respectively. The diagnostic correlation between the clinical examination based on RDC and on MRI was weak

Neuralgia induzida por cavitação osteonecrótica / Neuralgia inducing cavitational osteonecrosis

JUSTIFICATIVA E OBJETIVOS: Realizar uma revisão sobre a neuralgia induzida por cavitação osteonecrótica (NICO) seu diagnóstico diferencial em relação às principais dores bucofaciais, bem como o seu tratamento. CONTEÚDO: A neuralgia pela NICO é uma doença que tem inúmeras causas, como trauma, infecções, o emprego de anestésicos locais com vasoconstritores que diminuem o fluxo sanguíneo no interior do osso, a aplicação direta e/ou indireta de metais pesados, de corticosteroides, pós-cirurgias bucais, o uso de nicotina e problemas de coagulação. O diagnóstico baseia-se na história clínica associada à qualidade da dor, duração, resposta terapêutica normalmente ineficaz ao uso de diferentes neuromoduladores. Emprega-se, como exames complementares, radiografia periapical padrão da área a ser investigada, radiografia panorâmica, tomografia computadorizada que podem demonstrar, ou não, focos radiolúcidos uniloculares. O exame cintilográfico apresenta normalmente área de hipercaptação. O tratamento pode ser clínico conservador utilizando anticoagulantes, esteroides anabolizantes, injeções de antibióticos no local, ou cirúrgico, promovendo o sangramento local por osteotomia ou ostectomia, dependendo do grau e extensão da NICO. CONCLUSÃO: A pesquisa de novos medicamentos, menos prejudiciais aos tecidos ósseos, e maior informação aos cirurgiões-dentista sobre a NICO podem ajudar a diminuir sua incidência, estabelecendo o diagnóstico mais precocemente e consequentemente tornando mais eficaz as diferentes formas de tratamento.

BACKGROUND AND OBJECTIVES: To review neuralgia inducing cavitational osteonecrosis (NICO), its differential diagnosis with regard to major facial pains as well as its management. CONTENTS: NICO is a disease with numerous causes, such as trauma, infections, use of local anesthetics with vasoconstrictors which decrease blood flow inside the bone, direct or indirect application of heavy metals and steroids after oral surgeries, use of nicotine and coagulation problems. The diagnosis is based on the clinical history associated to pain quality, duration and in general ineffective therapeutic response to different neuromodulators. Complementary exams are standard periapical X-rays of the area to be investigated, panoramic X-rays and CT, which may show or not unilocular radiolucent foci. Scintigraphy normally shows an area of increased uptake. Treatment may be clinical with anticoagulants, anabolic steroids or local antibiotic injection; or surgical promoting local bleeding by osteotomy or ostectomy, depending on NICO level and extension. CONCLUSION: The search for new drugs less detrimental for bone tissues and more information to dentists about NICO may help decreasing its incidence by establishing an earlier diagnosis, thus making different management techniques more effective.