Semiquantitative SPECT imaging for assessment of bone reactions in internal derangements of the temporomandibular joint.

The temporomandibular joints (TMJs) of 60 patients with arthrographically confirmed internal derangements and 30 volunteers were examined with single photon emission computed tomography (SPECT). Semiquantitative evaluation was done by forming a quotient from the counts of a constantly sized TMJ-ROI relative to the overall counts of the cranium. The TMJ/cranium quotient depended on the age of the subject, with younger patients showing a larger quotient than older ones. Normal joints were separated from the afflicted ones by means of a discriminant analysis. Sensitivity of semiquantitative evaluation was 78% (disc displacements with reduction) and 89% (disc displacements without reduction). Correct visual evaluation was made in 53% of the reducing and 75% of the nonreducing discs. Semiquantitative SPECT of the TMJs provides important information on the extent of osseous changes in afflicted joints and is suitable for follow-up of splint therapy. It may also be helpful as a screening method in detecting clinically normal joints before arthrography is carried out and in assessing the presumptive response to treatment with a splint.

Significance of arthrography and computed tomography in the assessment of internal derangement of the temporomandibular joint.

Arthrography was performed on 56 joints of 47 patients presenting with symptoms of pain and dysfunction of the temporomandibular joint. The diagnosis could be confirmed in 53 joints. In addition, there was evidence of 13 perforations and 7 joints with adhesions. In 51 of the affected joints, computed tomography (CT) was also performed to compare both methods. The same CT procedure was performed on 12 joints of patients without any joint problem. Almost consistently (88%), an arthrographically anteriorly dislocated disc was detectable in the axial CT scans. 92% of the healthy joints showed normal soft tissue structures. For CT visualization of a displaced disc sagittal reformations or primary sagittal scans are not necessary. Confirmation of possible perforations or adhesions cannot be made by CT. Comparing the advantages and disadvantages, arthrography must still be regarded as superior to CT. In some cases, however, CT is a valuable tool in assessing an internal derangement.

[Computed tomography of anterior dislocation of the temporomandibular articular disk]. / Computertomographie der anterioren Diskusdislokation des Kiefergelenkes.

In a prospective study, the findings on arthrography and CT in 51 TMJs with anterior meniscus dislocation were compared. The CT diagnosis of anterior dislocation was made by a standardised method which we have developed and which depends upon evaluating axial sections. Sensitivity of the CT methods was 87%. In the absence of arthrography, a negative diagnosis in the asymptomatic contralateral side was made in 81%. Ruptures and adhesions could not be demonstrated by CT. For these reasons, arthrography is to be preferred to CT for making the initial diagnosis. CT should be carried out for special indications, such as contrast sensitivity, the documentation of a clinically confirmed diagnosis and for follow-up of treatment. Currently an attempt is being made to stage the disease by computed tomography.

[Semiquantitative SPECT of anterior dislocation of the temporomandibular joint disk]. / Semiquantitative SPECT bei anteriorer Diskusdislokation der Kiefergelenke.

SPECT examination of the TMJ using 99m Tc-MDP was performed in 43 patients with arthrographically proven anterior dislocation of the disc and in 30 normals. The results were evaluated visually and also in a semi-quantitative manner that took account of relative 99m Tc activity in the TMJ and of the age of the patient. In the presence of arthrographically proven anterior, but reversible, disc dislocation, the semi-quantitative method proved positive in 75% of cases (28 cases). In joints with fixed anterior dislocation (29 cases), bone changes were demonstrated in 86%. Visual evaluation was positive in 50% of reversible, and in 72% of non-reversible dislocations. Semi-quantitative SPECT of the TMJ is excellent for demonstrating bone reaction resulting from TMJ dysfunction and for indicating the severity of the joint abnormality.

[Arthrography of the temporomandibular joint. Indications, technic and interpretation]. / Die Arthrographie des Kiefergelenkes. Indikation, Technik und Interpretation.

Articular dysfunction of the TMJ with anterior displacement of the disc ("internal derangement") is an entity which has been separated from other types of the "myofascial pain syndromes" and which can be treated conservatively or by surgery. Arthrography of the TMJ has contributed greatly to an understanding of normal and abnormal function and, in many cases, it can provide a diagnosis. On the basis of our experience with 80 investigations we discuss technical problems and the clinical indications. The indications for arthrography are in the pre-operative diagnosis, when clinical findings are uncertain, in order to demonstrate perforation, in order to confirm a suspected diagnosis and to assist in prosthetic treatment.

[Histiocytosis X. Follow-up for over 20 years in a patient with Hand-Schüller-Christian disease]. / Histiozytosis X. Verlaufsbeobachtung über 20 Jahre bei einem Patienten mit Morbus Hand-Schüller-Christian.

Since 1963 we have observed a patient with Hand-Schüller-Christian disease with involvement of the skeleton, skin and hypophysis/hypothalamus with diabetes insipidus. The diabetes insipidus was successfully treated initially with chlorpropamid and later with carbamazepin. Alterations of the lung parenchyma were seen radiologically in 1966, and two years later the patient complained of exertional dyspnea. The lung disease was progressive with the deterioration of lung function despite corticosteroid and D-penicillamine treatment. The patient now has marked dyspnea even at rest. The osteolytic lesions have not changed in recent years.

A systematic approach to the diagnosis of transethmoidal fractures in CT.

The experience of this study is based on about 50 Le Fort II and III fractures that have been visualised by CT. A systematic approach is offered to diagnose these fractures which may be summarised under the heading of transethmoidal fractures. This will enable the radiologist to establish a meaningful diagnosis of these lesions at an early stage when the severely traumatised patient undergoes his first cranial CT. It needs only little extra time, but the patient is saved additional investigations requiring a specialist's attention, time, transportation, and changes in position that may, at times, be hazardous.

Frontometaphyseal dysplasia: symptoms and possible mode of inheritance.

Frontometaphyseal dysplasia is a rare syndrome of which only 20 cases have been described thus far. In this paper we report a 46-year-old man who showed a medium degree of manifestation of the disorder. The variable expressivity in both sexes, as derived from the careful study of reported symptoms in all known cases, was discussed. On the basis of the published pedigrees and additional information from our case, the possible mode of inheritance was debated.

[Computed tomography of basal skull fractures]. / Die Computertomographie der Schädelbasisfrakturen.

In 241 patients examined for trauma of the skull by computed tomography, 36 fractures of the skull base were diagnosed, in addition to their intracranial lesions. Computed tomography demonstrated twice as many fractures as conventional radiography. Amongst surviving patients, 30% showed abnormalities which were directly related to fractures of the skull base. The type, complications and therapeutic consequences of skull base fractures are discussed. These observations show that the bony injury needs to be carefully considered in order to avoid extensive and time-consuming investigations which might otherwise become necessary later.

Sphenotemporal buttress fracture. A report of five cases.

A new fracture type visible on CT images of the base of the skull is described. In this fracture the sphenoidal connection to the zygomatic and temporal bone breaks off all its three extensions. It was recognized in five patients with severe head injuries. In three surviving patients it was associated with ipsilateral persistent amaurosis. This fracture should alert the investigator to the possible sequelae of the head injury.

[Value of computed tomography for tumors of the epi- and oropharynx]. / Wertigkeit der Computertomographie bei Tumoren des Epi- und Oropharynx.

The results of computed tomography in 89 patients with tumours of the epipharynx and oropharynx involving the mouth are compared with the findings of other forms of clinical examination. In 26 patients, CT provided additional relevant information, in eight patients CT provided less information than clinical examination. The value of CT depended largely on the localisation of the tumour; the poorest results were found in tumours of the tonsils and the soft palate. CT provided additional information most commonly with large tumours, since these are frequently associated with bone destruction, local infiltration and occlusion of large vessels.

[CT analysis of facial skull fracture]. / Die Analyse der Gesichtsschädelfrakturen im CT.

Computer tomography of the facial bones provides the maxillo-facial surgeon with valuable information regarding the type and extent of typical mid-facial fractures (le Fort fractures I to III, fractures of the malar bone, orbital fractures, fractures of the skull base close to the facial bones). The procedure takes little extra time. The patient is saved additional investigations, requiring changes in position which may, at times, be hazardous. Our experience extends to 59 examinations, which is used for an analysis of mid-facial fractures. Some typical examples are given.