Magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement--a review of 144 cases.

One hundred and forty four patients underwent magnetic resonance imaging (MRI) for evaluation of suspected internal derangement (ID) of the temporomandibular joint (TMJ). All scans were performed on a state-of-the-art scanner by highly experienced technologists and evaluated by a single Head and Neck/Maxillofacial radiologist. Seventy-nine percent of patients were female and 21% male. Age distribution of the cases was bi-modal with first peak at 20-30 years of age and second peak at 50-60 years of age. Of the 82.5% of cases with disc displacement, 59.5% demonstrated reduction with opening and 40.5% did not reduce. Anterior disc displacement is common (44%) and sideways displacement rare (4%). Antero-lateral displacement was the second commonest type of displacement (29%) probably related to the weakness of the lateral disc attachment.

Interventional sialography: a single-center experience.

PURPOSE: To evaluate interventional sialography for the treatment of chronic recurrent sialadenitis due to calculus and/or stricture. METHODS: We performed a retrospective review and follow-up of 12 patients treated over a 3-year period. The techniques for calculus extraction by papillotomy and basket extraction, and stricture dilatation by a combination of predilation with lacrimal dilators and then angioplasty balloons are described and the literature is reviewed. RESULTS: Follow-up of 1-40 months (mean 14.6 months) showed that 7 of 12 patients remained symptom free and 2 others became asymptomatic after an interval. There were no major complications from the procedure. CONCLUSION: Interventional sialography is a safe and acceptable alternative to surgery and can be considered as first-line therapy for symptomatic salivary duct calculus and stricture.

MRI of car occupants with whiplash injury.

Our purpose was to document and investigate the prognostic significance of features seen on MRI of patients with whiplash injury following relatively minor road traffic crashes. MRI was obtained shortly and at 6 months after the crash using a 0.5 T imager. The images were assessed independently by two radiologists for evidence of fracture or other injury; loss of lordosis and spondylosis were also recorded. Clinical examinations were used to assess the status of patients initially and at 6 months. The results of the independent MRI and clinical investigations were then examined for association using statistical tests. Initial MRI was performed on 29 patients, of whom 19 had repeat studies at 6 months; 48 examinations were thus examined. Apart from spondylosis and loss of lordosis, only one abnormality was detected: an intramedullary lesion consistent with a small cyst or syrinx. There were no statistically significant associations between the outcome of injury and spondylosis or loss of lordosis. No significant changes were found when comparing the initial and follow-up MRI. It appears that MRI of patients with relatively less severe whiplash symptoms reveals a low frequency of abnormalities, apart from spondylosis and loss of lordosis, which have little short-term prognostic value. Routine investigation of such patients with MRI is not justified in view of the infrequency of abnormalities detected, the lack of prognostic value and the high cost of the procedure.

Imaging of large Rathke's cleft cysts by CT and MRI: report of two cases.

Two patients with large Rathke's cleft cysts in the sella turcica and suprasellar region presented with visual impairment and hypopituitarism. The entirely different CT and MRI appearances of the two cysts were thought to depend principally on the protein content of the cyst fluid.

Paranasal sinuses in pediatric patients by MRI: normal development and preliminary findings in disease.

A two-part study using medium field strength magnetic resonance imaging (MRI) was designed to describe the normal paranasal sinus development and to provide preliminary criteria for clinical sinus disease. In part I of the study the paranasal sinuses were retrospectively evaluated in 80 infants and children aged 0-17 years undergoing brain MRI for indications both unrelated and related to sinus disease. We developed MRI criteria for independent grading of paranasal sinus development and 'anatomical' sinus disease, i.e., disease as seen by the radiologist. We quantified the variability in extent of sinus pneumatization (a measure of sinus development) in infants and young children. Part II of the study was a double-blind prospective study in 21 patients to correlate 'anatomical' disease with 'clinical' sinus disease. In this limited preliminary study, clinical sinus disease was only seen in the patients with moderate or severe anatomical disease (sensitivity 100%; specificity 100%).

Mediastinal lipoblastoma of infancy.

We report the case of a rapidly expanding mediastinal and chest wall lipoblastoma in an 11-month old infant. Clinical presentation was respiratory distress and chest radiographs revealed a large soft tissue mass in the anterior mediastinum without specific features. CT scanning demonstrated a mass of principally fat attenuation, with enhancing hyperdense soft tissue whorls, which had a compressive effect on normal intrathoracic structures. At surgery the tumour was removed without complication and histology demonstrated an encapsulated, well differentiated lipoblastoma.

Radiological assessment of hemifacial microsomia by three-dimensional computed tomography.

Hemifacial microsomia (HFM) is the commonest asymmetrical craniofacial deformity leading to underdevelopment of the craniofacial skeleton and soft tissues on the affected side. Timing of reconstructive surgery is based on a comprehensive analysis and classification of the deformity. Lateral cephalometric radiographs are of limited value because of superimposition of normal and abnormal bony structures. The skeletal and soft-tissue findings of six patients with HFM who underwent three-dimensional (3D) CT are presented. This method allows a comprehensive assessment of the deformity at a low radiation dose, 22% of that of a conventional CT scan, by the use of a low dose technique.

Portal hypertension with a large spontaneous spleno-renal shunt in the absence of splenomegaly.

Splenomegaly is a cardinal manifestation of portal hypertension. We describe a case of portal hypertension with a large spontaneous spleno-renal shunt in the absence of splenic enlargement. The vascular anatomy is evaluated by the combined use of duplex Doppler ultrasonography and computed tomography (CT).

The diagnosis of tumours involving the parapharyngeal space by computed tomography.

Tumours arising within or adjacent to the parapharyngeal space are usually large at presentation and present difficulties in the choice of surgical approach. The findings on contrast-enhanced computed tomography (CT) of 30 patients with mass lesions in this region are presented. Contrast-enhanced CT can provide reliable information regarding the size and extent of a mass, its site of origin and likely histological type, as well as its relationship to surrounding neurovascular structures.

A comparison of computed tomography and ultrasound in the assessment of parotid masses.

Computed tomography (CT) and ultrasonography were compared in the evaluation of parotid masses. The findings in 18 patients are presented. Both techniques proved equally effective at locating and predicting malignancy in lesions confined to the superficial lobe of the gland. Tumours in the deep lobe, medial to the ramus of the mandible and those extending beyond the confines of the gland were more reliably assessed by CT. It is recommended that CT is reserved for such problems, and that ultrasonography should be the initial investigation for the evaluation of parotid masses.

The intraoral keratoacanthoma: a diagnostic problem.

A case of keratoacanthoma occurring on the palatal gingivae of a 23 year-old male is reported. The differential diagnosis between this lesion and well-differentiated squamous cell carcinoma is discussed.

Fracture of the hyoid bone associated with a mandibular fracture.

A fracture of the hyoid bone in association with a mandibular fracture in a 29-year-old man is reported. The literature pertaining to this rare injury is reviewed and the clinical presentation, diagnosis, and treatment of fractures of the hyoid bone are discussed.

Bronchogenic carcinoma metastasizing to the orbit. A case report.

A case of an orbital metastasis from a bronchogenic neoplasm is described. The initial clinical presentation was of unilateral facial pain and paraesthesia shortly followed by increasing left-sided external ophthalmoplegia and proptosis and the development of a slight swelling of the left temporal fossa. The diagnosis was established by a biopsy of the temporal mass. The patient died two months after the diagnosis was established. The significance of facial pain and paraesthesia and the literature pertaining to orbital cellulitis and orbital metastases is discussed.

Leiomyosarcoma of the cheek: a case report.

Oral leiomyosarcomata have been reported on only 15 occasions in the world literature. An additional case of leiomyosarcoma of the cheek in an 88-year-old male is reported. The relevant features of leiomyosarcomata are reviewed and discussed.