Impact of routine open-mouth osseous temporomandibular joint tomography on diagnosis and therapeutic options.

OBJECTIVES: The aim of this study was to evaluate the impact of routine open mouth osseous temporomandibular joint (TMJ) tomography on diagnosis and treatment planning of TMJ conditions. Investigating the need for such images is important to justify the additional radiation exposure imparted by such procedures. STUDY DESIGN: The records of patients who underwent closed- and open-mouth osseous TMJ tomography (planar film tomography up to the beginning of 2006; cone beam computed tomography from 2006 onward) were reviewed. Three examiners formulated a diagnosis and treatment plan based on the history, clinical findings, and tomography interpretation reports of closed-mouth images. Then they reviewed the interpretations of the open-mouth images and recorded whether they would change their original diagnosis and/or treatment plan on the basis of the findings. Descriptive analysis of the results was performed. RESULTS: The impact of routine open-mouth imaging on diagnosis and treatment planning was variable among the examiners. Examiners 1, 2, and 3 had a change in diagnosis in 7%, 5%, and 3% of cases, respectively, and a change in treatment plan in 1%, 1%, and 8%, respectively. CONCLUSIONS: Routine open-mouth osseous TMJ tomography had a minimal impact on diagnosis and treatment planning of TMJ conditions, which varied according to the treating clinician.

Guided Bone Regeneration Using Biphasic Calcium Phosphate With Adjunct Recombinant Human Bone Morphogenetic Protein-2 With and Without Collagen Membrane in Standardized Calvarial Defects in Rats: A Histologic and Biomechanical Analysis.

This study aimed to assess the efficacy of biphasic calcium phosphate (BCP) with adjunct recombinant human bone morphogenetic protein-2 (rhBMP-2), with and without collagen membrane (CM), in regeneration of standardized rat calvarial defects. Thirty female Wistar albino rats with a mean age of 12 weeks and mean weight of 300 g were used. The skin over the calvaria was exposed using a full-thickness flap. A standardized defect measuring 4.6 mm in diameter was created in the parietal bone. The defects were randomly divided into the following groups: (1) no treatment (control group); (2) BCP soaked in rhBMP-2 and then covered with a resorbable CM; and (3) BCP soaked in rhBMP-2. Following euthanasia, histologic, histomorphometric, and biomechanical assessments of the calvarial specimens were performed to assess bone regeneration. The results showed islands of newly formed bone (NFB) between the defect edges in the control group. NFB was observed bridging the defect edges and around the remnants of BCP in the rhBMP-2 + BCP + CM group and only around the BCP remnants in the rhBMP-2 + BCP group. Histomorphometric analysis revealed a significantly higher mean ± standard deviation (SD) percentage of NFB per defect in the rhBMP-2 + BCP + CM group (46.12 ± 2.56) compared with the control (11.79 ± 0.75) and rhBMP-2 + BCP (26.65 ± 1.48) groups. Although no differences were found in the hardness and elastic modulus (EM) of NFB between the rhBMP-2 + BCP + CM (hardness: 687.78 ± 4.74 MPa; EM: 27.71 ± 0.063 GPa) and the rhBMP-2 + BCP (hardness: 637.65 ± 6.32 MPa; EM: 21.49 ± 0.095 GPa) groups, the biomechanical parameters of NFB in the control group (hardness: 286.17 ± 9.49 MPa; EM: 12.62 ± 0.048 GPa) were significantly less. The experiment demonstrated the efficiency of rhBMP-2 + BCP in GBR, wherein the presence of CM leads to a greater percentage of new bone formation within standardized calvarial defects.

Maxillary sinus carcinoma. Natural history and outcome.

OBJECTIVE: To assess natural history, treatment outcome and pattern of relapse in patients with maxillary sinus carcinoma. METHODS: A review was conducted of the medical records of all adult patients with maxillary sinus carcinoma, who were treated at King Faisal Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia, between January 1990 and December 1999. A total of 60 patients were identified for analysis, 36 men and 24 women; the median age was 58-years (range 23-95). Major presenting symptoms were facial swelling 55%, facial pain 50%, and nasal obstruction 43.4%, with a median duration of 5-months (range 1-24). Histology was squamous cell carcinoma in 71.7% and adenoid cystic in 16.7%. They were restaged according to American Joint Committee on Cancer classification 1997 as II, III and IV in 1, 10 and 49. Thirty patients received treatment with curative intent (surgery in 4 patients, radiotherapy in 2, and combined modality in 24), 6 patients refused treatment and 24 were treated palliatively. RESULTS: With a median follow up of 50-months (range 2-128) in surviving patients treated with a curative intent, 12/30 failed locally, 4/30 in the regional neck nodes and 2/30 had systemic relapse. The actuarial 5-year overall survival (OS), relapse free survival (RFS) and local control rate (LC) were 55%, 39% and 51%. Treatment modality was the only significant prognostic factor for outcome, with 5 year OS, RFS and LC of 72%, 49% and 61%, for combined modality using surgery followed by radiotherapy compared to 0% for single approach (p=0.0003, p=0.0052 and p=0.0098) CONCLUSION: This study indicates that the majority of our patients presented with advanced disease, resulting in poor outcome to conventional treatment modalities. Efforts should be directed to minimize the delay in diagnosis at the primary care level. Combined modality treatment should be offered to all patients with locally advanced disease. New approaches such as neoadjuvant or concurrent chemoradiotherapy with or without surgery need to be considered and evaluated in prospective studies.