Asymptomatic myositis ossificans of the medial pterygoid muscles: a case report.

Traumatic myositis ossificans, also known as myositis ossificans circumscripta or fibrodysplasia ossificans circumscripta, is a form of dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue. This is usually due to a single severe injury or repeated minor injuries to muscle, although cases without a history of injury have been reported. Heterotopic ossification is rare in the orofacial region, especially in the medial pterygoid muscles. A case of medial pterygoid myositis ossificans with unique computed tomography findings is described.

Advanced imaging of osseous maxillary clefts.

A computed tomographic (CT) technique to establish precise two-dimensional (2-D) and three-dimensional (3-D) images of the osseous defects of cleft palates is presented and illustrated by two case studies. Prospective soft tissue algorithms and bone detail imaging was made possible by a retrospective program, a specific software program and vertical reformatting technique leading to 3-D image reconstruction. The two cases illustrate the flexibility of the CT program in accurately providing morphometric and bone density data on the location and size of the osseous defects involved in the cleft. Not every cleft palate patient is a candidate for the procedures outlined; however, the diagnosis of and treatment planning for patients presenting with bilateral or extensive osseous clefting can be more accurate.

A computed tomographic study of the distances between the maxillary sinus floor and the apices of the maxillary posterior teeth.

The mean distance between the apices of the maxillary posterior teeth and the floor of the maxillary sinus was measured from computed tomographic display data from 12 autopsy specimens and 38 human subjects. The distance from these apices to the adjacent lateral bony surfaces was also measured. The apex of the mesiobuccal root of the maxillary second molar was closest to the sinus floor (mean 1.97 mm) but farthest from the buccal bony surface (mean 4.45 mm). The apex of the buccal root of the maxillary first premolar was closest to the adjacent lateral bony surface (mean 1.63 mm) but farthest from the floor of the sinus (mean 7.05 mm).

Estimation of tendon-plane orientation within human masseter muscle from reconstructed magnetic resonance images.

The human masseter is a powerful multipennate jaw elevator with complex internal architecture. The three-dimensional disposition of tendon planes within the muscle is thought to be an important determinant of function. We selected five adult subjects and used cephalometric radiography, magnetic resonance imaging and graphical, three-dimensional reconstruction to describe the organization of these planes within the muscle. Putative tendon planes were fitted to the surfaces of the three-dimensional reconstructions, and these were related to the mid-sagittal plane in the coronal and transverse views. To confirm whether putative planes disclosed by magnetic resonance represented true anatomical entities, a fresh human cadaver head was imaged and the magnetic resonance slices were compared with cryosections obtained in the same planes. Tendon-plane angulation appeared to be related to ramal length and lower face height measured cephalometrically. In the transverse view, the tendon planes appeared roughly to follow the angulations of the zygomatic arch and the lateral face of the mandibular ramus. These findings suggest that the angulation of tendon planes, and possibly pennation angles, are different depending on the viewing angle. Rather than reporting pennation angle as a single angle, alpha, which has been the convention, it may be more appropriate to express it as a three-dimensional angle relative to the normal of a particular tendon plane. The inference is that muscle fibres inserting on either side of a central tendon may need to develop different tensile forces if translation is to occur directly along the tendon axis.

The temporomandibular joint.

MRI is the procedure of choice for diagnosing most internal derangements. MRI provides images that not only demonstrate bony detail but show excellent representation of soft tissues in both anatomic and semifunctional relationships. MRI does not use ionizing radiation and has no known adverse effects. Multiplanar imaging allows a three-dimensional analysis of the TMJ, providing a more complete assessment of the condyle, articular disc, fossa relationships. Whenever capsular adhesions or disc perforations are suspected and are not demonstrated with MRI, then arthrography should be performed.

Mandibular condyle morphology in relation to malocclusions in children.

Recent studies show that forces applied to the mandible during treatment with functional appliances and other orthodontic therapies produce changes in the TMJ. Specific malocclusions might also apply forces that can produce changes in the morphology of the TMJ. This study examined 104 orthodontic patients (44 males and 60 females) prior to treatment. The size and location of the condyle was determined on submento-vertex and tomographic films which was related to clinical findings including age, sex, malocclusion type, facial type, TMJ symptoms, tooth eruption sequence, crossbites and midline discrepancies. The medio-lateral width of the condylar head correlated positively with the patients age (p less than 0.001) and sex (p less than 0.001). Also the antero-posterior widths of the condyle were correlated with age (p less than 0.05). The condylar size in males was found to be greater than in females. Midline discrepancy significantly altered the increase in condylar size during growth. Transversel anomalies had a markedly greater influence on condylar growth compared to other characteristics of occlusion. The major change in condylar size during growth occurred in medio-lateral dimension as compared to the antero-posterior. In addition, the medio-lateral width was affected by midline discrepancy but not the antero-posterior width.

Dental material artifacts on MR images.

Magnetic resonance (MR) imaging of the head and neck is becoming an important aid in evaluating pathologic conditions of the brain, midface, and pharynx. Certain dental materials cause artifacts during MR imaging of the lower midface. These artifacts can obscure the normal anatomy. This study describes the degree of artifact production caused by various materials commonly used in dental restorations. Of the materials tested, those causing artifacts were made of stainless steel, such as orthodontic bands used for braces, and pins or posts that are commonly drilled into teeth to provide structure or stability before filling. Materials used as temporary or permanent fillings or crowns--such as amalgam, gold alloy, aluminum, microfilled resin, and polyvinyl acrylics--did not cause artifacts in the images.

Computed tomography of condylar and articular disk positions within the temporomandibular joint.

The computed tomograms of temporomandibular joints in 25 patients (41 joints) were retrospectively evaluated for condylar position and joint space with General Electric computer software. Computed tomography scans of the temporomandibular joint were made in the axial plane with the teeth in centric occlusion, and measurements were made from vertically reformatted images. Interarticular joint spaces were measured anterosuperiorly, superiorly, posterosuperiorly, and posteriorly from the condylar surfaces. This was repeated in five equidistant (3.1 mm) serial sagittal planes across the condyle, beginning and ending, on average, 2.5 mm from the lateral and medial condylar poles. Articular disk positions (anterolateral, anterior, anteromedial, medial, and normal) were correlated with condylar position. Significant differences between disk positions and joint spaces were found most frequently in the anterosuperior and the superior joint interval. When the disk was positioned normally, the anterosuperior joint space was consistent (1.5 to 2.0 mm) across the joint (standard deviation, 0.3 to 0.8 mm). The superior, the posterosuperior, and the posterior joint spaces in the normal joint were greater than the anterosuperior joint space. When the disk was anterior to the condyle, the anterosuperior joint interval was widened. When the disk was medial, the superior joint space was significantly wider than normal across the breadth of the condyle. In those joints in which the disk was anteromedial, there was an absence (0.2 mm) of joint space, and this occurred in all areas of the condyle except in its medial one fourth. In the internally deranged joint, joint space narrowing may be focal in nature.

Computed tomography of the normal temporomandibular joint.

A study was made in two parts, retrospective (I) and prospective (II), on two samples of 36 and 17 individuals, respectively, who had temporal bone CT studies for reasons unrelated to TMJ pain and dysfunction. Groups I and II had no radiographic signs of TMJ disease and Group II had neither radiographic nor clinical signs of TMJ disease. Both groups were considered to have normal joints. Joint morphometrics for the two groups (I/II) were as follows; transverse condylar dimensions were 18.5/18.1 mm. Condylar angulation averaged 24 degrees/25 degrees and intercondylar distance averaged 83/83 mm while extra condylar distance averaged 118/118 mm. The condyle in the sagittal plane showed a smooth and rounded form with anterior-superior joint space averaging 1.9/1.7 mm while the central-superior joint space averaged 2.3/2.2 mm. The medial-horizontal joint space averaged 3.9/3.7 mm. The slope of the central portion of the articular eminence averaged 60 degrees/60 degrees in the sagittal plane.

CT evaluation of trauma to the temporomandibular joint.

The computed tomograms of 43 patients who had suffered craniofacial trauma and who were referred for evaluation of complaints of temporomandibular joint (TMJ) pain and dysfunction were reviewed. Fifteen of the 43 patients (34%) had sustained fractures, 16 (37%) had documented articular disc derangements without associated fractures, and 32 patients (74%) had degenerative joint changes. Computed tomography (CT) showed fractures, degenerative joint changes, and articular disc displacements not seen on conventional radiographs indicating that CT is particularly useful when patients' symptoms are not adequately explained by conventional radiographs or tomograms.

CT number characteristics of malpositioned TMJ menisci. Diagnosis with CT number highlighting (blinkmode).

The use of computed tomography (CT) number highlighting ("blinkmode") for diagnosing malpositioned temporomandibular joint menisci was investigated. By determining the average CT number, standard deviation, and range for specific periarticular tissues, it is possible to tell how much their attenuation values overlap and, therefore, whether there is a sound basis for distinguishing the disc from adjacent tissues. Fresh and fresh-frozen cadaver specimens, were scanned in axial and direct sagittal planes with 1.5-mm thick overlapping soft-tissue sections. CT number measurements were made for tendon, muscle, fat, and meniscus. Patients also were scanned with overlapping 1.5-mm thick axial soft-tissue sections in order to compare the range of CT numbers in cadavers with that in living subjects. Cadaver joints were cryosectioned at 0.5-mm intervals in the same planes as their CT sections, and the tissue sections were compared with their respective CT highlighted sections. For patients the average CT numbers in Hounsfield units were 88 for tendon, 67 for muscle, -25 for fat, and 100 for meniscus. Fresh unembalmed cadavers showed a higher CT average number for tendon and a lower average CT number for fat. The anatomic sections confirmed the meniscal position seen in the highlighted sections in nine of ten joints (90%) and was equivocal in one. Misshapen and malpositioned discs are seen readily with the blinker function; thinned and normal discs are not. The tendinous insertion of the lateral pterygoid muscle may be confused for meniscus in the medial aspect of the TMJ.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiation dose in radiography, CT, and arthrography of the temporomandibular joint.

Thermoluminescent dosimetry studies were performed on a Rando Humanoid head phantom to compare radiation dosages used in temporomandibular joint examinations. Studies included transaxial and direct sagittal high-resolution CT, reduced milliamperage dynamic CT, tomoarthrography, pluridirectional and linear tomography, pantomography, transcranial plain films, and fluoroscopy. Radiation doses were determined for the brain, lens, pituitary gland, condylar marrow, and thyroid gland. Condylar marrow received doses of 64 and 52 mGy, respectively, for the GE 9800 and 8800 high-resolution scans; 21 and 17 mGy, respectively, for the dynamically sequenced scans; and 26 mGy for the GE 9800 direct sagittal sections. Tomoarthrography yielded 31 mGy and fluoroscopy 12 mGy. Other lower doses showed 5 mGy for polytomography, 3 mGy for ipsilateral joint linear tomography, 1.9 mGy for the GE 9800 slow ScoutView, 1.8 mGy for xeroradiography, 0.9 mGy for contralateral joint linear tomography, 0.3-0.4 mGy for transcranial plain films and pantomography, and 0.2 mGy for the GE 8800 ScoutView. The estimated error in this study was calculated to be +/- 15%. On a relative scale, the radiation doses from high-resolution CT and tomoarthrography are high, dynamic CT yields a medium dose, and all other tomographic and plain-film techniques yield low doses.

Intra- and inter-observer variability and accuracy in the determination of linear and angular measurements in computed tomography. An in vitro and in situ study of human mandibles.

The observer variability and accuracy of linear and angular computed tomography (CT) software measurements in the transaxial plane were investigated for the temporomandibular joint with the General Electric 8800 CT/N Scanner. A dried and measured human mandible was embedded in plastic and scanned in vitro. Sixteen observers participated in the study. The following measurements were tested: inter- and extra-condylar distances, transverse condylar dimension, condylar angulation, and the plastic base of the specimen. Three frozen cadaveric heads were similarly scanned and measured in situ. Intra- and inter-observer variabilities were lowest for the specimen base and highest for condylar angulation. Neuroradiologists had the lowest variability as a group, and radiology residents and paramedical personnel had the highest, but the differences were small. No significant difference was found between CT and macroscopic measurement of the mandible. In situ measurement by CT of condyles with structural changes in the transaxial plane was, however, subject to substantial error. It was concluded that transaxial linear measurements of the condylar processes free of significant structural changes had an error and an accuracy well within acceptable limits. The error for angular measurements was significantly greater than the error for linear measurements.

Correlative thin section temporomandibular joint anatomy and computed tomography.

The author believes that multiplanar CT imaging serves to distinguish the articular disc from other tissues of similar density and is necessary for a detailed temporomandibular joint survey.