Comparison of transcranial radiograph and magnetic resonance imaging in the evaluation of mandibular condyle position.

OBJECTIVES: Several image modalities have been used to assess the condylar position in the glenoid fossa. However, despite the development of more advanced techniques for imaging the temporomandibular joint (TMJ), the transcranial projection remains widely used in dentistry. The purpose of this study was to compare the condylar position in transcranial radiography (TRANS) with MRI. METHODS: 70 matched pairs of TMJs (35 patients) who had undergone TRANS and MRI were evaluated. The TRANS scans were compared with the lateral, central and medial MRI scans, and the condylar position was assessed in the closed and open mouth position according to subjective and objective methods. The sensitivity, specificity and accuracy values were calculated for each group and Bowker's test was used to analyse the data. RESULTS: There was no statistical significance between TRANS and MRI (P > 0.05). However, even though there were similar mean values between them, the comparison with the lateral image showed higher values, which might be due to TRANS representing the lateral one-third of the condyle. CONCLUSIONS: It can be concluded that TRANS seems to be an acceptable method and its applicability as an adjunctive method in the condylar position should not be rejected.

The prevalence of bifid mandibular condyle detected in a Brazilian population.

OBJECTIVES: To determine the prevalence of bifid mandibular condyle (BMC) detected on panoramic radiographs in a Brazilian population. METHODS: The panoramic radiographs of 50 080 radiographs taken from 1999 to 2006 were retrospectively reviewed in order to identify BMC cases. RESULTS: 9 (0.018%) of the 50 080 patients, 2 men and 7 women, with age ranging from 20 years to 74 years, had BMC. These conditions were unilateral in 7 (78%) subjects and bilateral in 2 (22%) subjects. All patients denied a history of any previous trauma or fracture of the mandible, pain, or trismus. CONCLUSIONS: BMC is an uncommon finding in a group of Brazilian subjects and, although it is rare, dentists should be aware of this condition on routine panoramic radiographs and its implications for function and appropriate treatment modalities.

Role of ocular involvement in the prediction of visual development and clinical prognosis in Aicardi syndrome.

AIMS/BACKGROUND: This study was undertaken to document visual function and acuity in patients with Aicardi syndrome, and to determine whether there is any relation between ocular features of the syndrome exhibited at birth and later visual function. METHODS: Fourteen patients with Aicardi syndrome, all examined and followed by the same ophthalmologist, were reviewed between 1975 and 1992 and their ocular characteristics and visual acuity described. It was hypothesised that larger lacunae may be associated with poorer clinical outcome and therefore the relation between these two variables was investigated. RESULTS: Visual acuity as documented by Snellen, Sheridan-Gardner, preferential looking, or pattern visual evoked potential tests was in the normal to low normal range in six eyes of four patients. Visual function correlated significantly with macular appearance. Good visual function was preserved if the fovea appeared normal on funduscopic examination and was uninvolved by lacunae. The size of the largest chorioretinal lacuna also correlated significantly with clinical outcome: patients with large lacunae were more likely to be immobile and to have no language skills. CONCLUSION: It was concluded that good visual function in patients with Aicardi syndrome may be anticipated if the fovea is normal. Although many patients have severe psychomotor retardation, the presence of predominantly small chorioretinal lacunae may indicate a better prognosis for mobility and language development.

Reproducibility of topographic measurements of the macula with a scanning laser ophthalmoscope.

BACKGROUND: The Heidelberg retina tomograph, a scanning laser ophthalmoscope that uses confocal optics to provide high resolution of images, is able to scan the retina in three dimensions to obtain quantitative topographic measurements. The authors evaluated its usefulness for measuring macular lesions by determining the reproducibility of its topographic measurements at the macula. METHODS: For each of ten healthy patients, the authors took five images with the patient's right eye undilated and five with the eye cyclopleged and dilated. As a measure of reproducibility, the standard deviation of height measurements for the same location at the macula was calculated for each patient and then the pooled standard deviation for all patients was calculated. The authors performed similar calculations for the mean depth within a contour line. RESULTS: The pooled standard deviation for height measurements was 47.4 microns in undilated eyes and 36.0 microns in cyclopleged, dilated eyes. The authors obtained an extremely low standard deviation of 2.2 microns when the software calculated relative differences between measurements, such as the mean depth within a contour line. When the average of three height measurement values on 1 day was compared with the average of the three values on another day, the 95% confidence interval was +/- 58.7 microns for mean height values and +/- 3.7 microns for mean depth values within a contour line. CONCLUSIONS: The authors obtained good reproducibility for height measurements with the Heidelberg retina tomograph and excellent reproducibility when the instrument calculated relative differences in height measurements. The authors recommend that patients, especially young patients, be dilated and cyclopleged to obtain lower variability of measurements. The scanning laser ophthalmoscope could potentially be used to quantify small changes in retinal lesions.

Aicardi syndrome: natural history and possible predictors of severity.

Aicardi syndrome is defined by the clinical triad of infantile spasms, agenesis of the corpus callosum, and pathognomonic chorioretinal lacunae. Almost all patients are girls with severe cognitive and physical handicaps, and epilepsy. Fourteen patients with Aicardi syndrome, seen at The Hospital for Sick Children, Toronto, Ontario, Canada, between 1975 and 1992, were reviewed to document the natural history of the disease and obtain life-table estimates of survival. The relationship between 28 neurologic features present in infancy and clinical outcome, as measured by mobility and cognitive function also was examined. Life-table analysis indicated that the estimated survival rate was 76% at 6 years of age and 40% at 15 years of age. Three of the 14 girls (21%) could walk or crawl and 4 (29%) had some language ability. None of the 28 neurologic features was predictive of ultimate clinical outcome. This information should be discussed with parents of children with Aicardi syndrome.

Mortality of hospitalized patients with Candida endophthalmitis.

BACKGROUND: Candida is becoming an important nosocomial pathogen as the incidence of hospital-acquired candidemia is rising. Candida endophthalmitis is a good indicator of systemic candidiasis in hospitalized patients. METHODS: Thirteen (17%) of 76 ophthalmologic consultations for Candida endophthalmitis in our institution had positive findings during a 12-month period. We studied these 13 patients with Candida endophthalmitis to evaluate their outcomes. RESULTS: All 13 patients were admitted to a large tertiary care hospital, and 10 (77%) were in an intensive care unit. The overall mortality was 77% for all patients and 80% for the intensive care patients. This mortality was higher than the overall mortality for all patients in the surgical intensive care unit in our institution (17%), as well as the mortality for our patients with candidemia in the surgical intensive care unit (61%). CONCLUSIONS: The strikingly high mortality in our group of patients with Candida endophthalmitis reflects the fact that they are a seriously ill group with multiple risk factors for Candida infection. This information suggests that the presence of Candida endophthalmitis is a good indicator of high mortality in seriously ill patients in intensive care units.

Surgical removal of subretinal hemorrhage and choroidal neovascular membranes in acute hemorrhagic age-related macular degeneration.

The visual prognosis in patients with age-related macular degeneration in whom an acute extensive subretinal hemorrhage develops involving the centre of the fovea is extremely poor. We report our results in seven consecutive patients with acute hemorrhagic age-related macular degeneration who underwent pars plana vitrectomy with internal drainage of blood lying beneath the retina and the retinal pigment epithelium. In three of the patients subretinal choroidal neovascular membranes were also removed. Five patients, including three of the four who underwent surgery within 2 weeks of the onset of symptoms, had improved vision following surgery, in one patient choroidal neovascularization recurred, and one patient experienced no change in vision. The best results were obtained in the four patients who did not undergo deliberate dissection of choroidal neovascular membranes.