Association of decrease in insula fMRI activation with changes in trait anxiety in patients with craniomandibular disorder (CMD).

Patients with chronic pain and especially with craniomandibular disorder (CMD) show specific psychopathology in trait anxiety. In a previous longitudinal functional imaging study on CMD we found that the anterior insula was modulated by successful therapy intervention and pain relief. We here intended to investigate possible associations between anterior insula fMRI-activation during occlusal movements and trait anxiety over a splint therapy approach in patients with CMD. Three fMRI-investigations of a craniomandibular occlusion task were performed together with pain score evaluations and scoring of trait anxiety (State -Trait Anxiety Inventory; STAI) before, after two weeks and after three months of a DIR-mandibular splint therapy in a small group (n = 9) of CMD patients. Patients showed increased anxiety levels before therapy assessed with the STAI and the depression and anxiety scale (DASS). Besides of relevant reduction in pain the STAI decreased over time. Reduction in STAI was associated with anterior insular fMRI-activation reduction on both hemispheres. We conclude that the anxiety driven anticipation of pain related to occlusal trigger is processed in the anterior insula and might therefore be a main driver of therapeutic intervention by the splint therapy in CMD.

What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. / Welche Rolle spielt die Synovialitis bei der kraniomandibulären Dysfunktion (CMD)? Eine 3T-MRT-Studie.

PURPOSE: The purpose of the present study was to investigate the degree and clinical relevance of synovitis in craniomandibular dysfunction. MATERIALS AND METHODS: In total, 140 temporomandibular joints were examined using a 3 T MRI scanner. Quantitative analysis of synovial enhancement was performed and interrelated with arthrosis deformans, degenerative disc disease, joint effusion, bone marrow edema and restriction of motion. RESULTS: We found a statistically high and significant correlation between the degenerative changes as mentioned above and the intensity of synovial enhancement. CONCLUSION: The study shows that typical MRI findings in CMD patients are often combined with signs of synovitis. Presumably joint inflammation has an effect on the clinical signs and symptoms and also the prognosis of CMD. These results should be taken into consideration when selecting treatment. KEY POINTS: · 3T-MRI using a dedicated coil is the method of first choice in the examination of CMD syndrome.. · MR imaging allows quantification of increased synovial enhancement.. · There is a highly significant correlation between degenerative changes of the disc or cartilage and synovitis.. · Results of the study are relevant for the clinical assessment and therapy of CMD syndrome.. CITATION FORMAT: · Stimmer H, Ritschl L, Goetz C et al. What Role Does Synovitis Play in Craniomandibular Dysfunction (CMD)? A 3T-MRI Study. Fortschr Röntgenstr 2019; 191: 924 - 931.

Complex segregation analysis of craniomandibular osteopathy in Deutsch Drahthaar dogs.

This study investigated familial relationships among Deutsch Drahthaar dogs with craniomandibular osteopathy and examined the most likely mode of inheritance. Sixteen Deutsch Drahthaar dogs with craniomandibular osteopathy were diagnosed using clinical findings, radiography or computed tomography. All 16 dogs with craniomandibular osteopathy had one common ancestor. Complex segregation analyses rejected models explaining the segregation of craniomandibular osteopathy through random environmental variation, monogenic inheritance or an additive sex effect. Polygenic and mixed major gene models sufficiently explained the segregation of craniomandibular osteopathy in the pedigree analysis and offered the most likely hypotheses. The SLC37A2:c.1332C>T variant was not found in a sample of Deutsch Drahthaar dogs with craniomandibular osteopathy, nor in healthy controls. Craniomandibular osteopathy is an inherited condition in Deutsch Drahthaar dogs and the inheritance seems to be more complex than a simple Mendelian model.

IMAGING DIAGNOSIS-MAGNETIC RESONANCE IMAGING FEATURES OF CRANIOMANDIBULAR OSTEOPATHY IN AN AIREDALE TERRIER.

An Airedale Terrier was presented for evaluation of depression and reluctance to be touched on the head. Magnetic resonance (MR) imaging of the head was performed. The images revealed bone lesions affecting the calvarium at the level of the coronal suture and left mandibular ramus, with focal cortical destruction, expansion, and reactive new bone formation. Skull lesions were hypointense on T1-weighted sequences, hyperintense on T2-weighted sequences, and showed an intense and homogeneous enhancement after gadolinium administration. Reactive new bone formation and periosteal proliferation were confirmed histopathologically. The clinical signs, imaging findings, and histopathological examination were consistent with craniomandibular osteopathy.

Orbital involvement in craniofacial brown tumors.

PURPOSE: To describe the clinical and radiologic features of orbital involvement in craniofacial brown tumors and to compare the rate of brown tumors in primary and secondary hyperparathyroidism. METHODS: A retrospective hospital-based study of 115 patients with chronic kidney disease and secondary hyperparathyroidism and 34 with primary hyperparathyroidism was conducted. Laboratory results such as serum levels of alkaline phosphatase, calcium, phosphorus, and parathyroid hormone were recorded. Demographic data (age, sex, duration of disease) and image findings (bone scan scintigraphy, skull and long bone x-rays, CT) were also obtained. The main outcome measures were analysis of clinical, biochemical, and radiologic findings of all patients. RESULTS: Of the 115 patients with chronic kidney disease, 10 (8.7%) had brown tumors in different bones of the skeleton. Five patients had lesions in the craniofacial bones. The maxilla, mandible, maxillary sinus, and nasal cavity were the most affected sites. The orbit was involved in 2 patients with lesions arising in the maxillary and ethmoid sinuses. One patient had facial leontiasis. All patients with brown tumors had extremely high levels of parathyroid hormone (>1,000 pg/ml, normal values 10-69 pg/ml) and alkaline phosphatase (>400 U/l, normal values 65-300 U/l). The mean serum levels of phosphorus and calcium were not abnormal among the patients with brown tumors. Age and time of renal failure were similar for patients with and without brown tumors. Among the patients with primary hyperparathyroidism, only 2 (5.8%) had brown tumors, and in just 1, the lesion was localized in the craniofacial skeleton. A 2-tailed Z test applied to compare the proportion of occurrence of brown tumors in the 2 groups revealed that the difference at the 90% of confidence level was not significant. CONCLUSIONS: Brown tumors are equally found in secondary and primary hyperparathyroidism. Craniofacial brown tumors involve the orbit, usually because of the osteodystrophy process that involves the maxilla and paranasal sinuses. The lesions do not necessarily need to be excised and may regress spontaneously after the control of hyperparathyroidism.

Applications of ultrasonography in oral and maxillofacial surgery: a review of the literature.

Ultrasonography is a diagnostic medical procedure that employs high frequency sound waves to produce dynamic visual images of organs, tissues, or blood flow inside the body. Until recently it found little application in oral and maxillofacial surgery despite the fact that it is readily available, non-invasive, relatively inexpensive, painless and can be repeated as often as possible without risk to the patient. This article reviews the available literature on the ultrasonographic examination of the head and neck with particular reference to oral and maxillofacial surgery and evaluates the applications of this imaging modality in modem clinical practice. It further highlights the need for clinicians to explore and fully appreciate the diagnostic value of this highly under-utilised imaging modality.

[Styloid process: radiograph and craniomandibular dysfunction (CMD)]. / Processus styloideus: Röntgenbild und cranio-mandibuläre Dysfunktion (CMD).

The aim of the study was to investigate the suitability of orthopantomograms for measuring the length of the styloid process (SP), and to determine the frequency of elongated SP in patients with craniomandibular dysfunction (CMD). For 350 patients, two ortho-pantomograms were available, produced by a SIEMENS Orthophos 5 using programs P1 and P6, respectively, plus a craniomandibular function index. The SP length measurements from the orthopantomograms and the palpation findings were correlated. In 34,7% of the 700 orthopantomograms the SP was measurable. The mean length was determined to be 29.1 mm in OPT1 films on both sides. In the OPT6 films the length values were 30.1 mm on the right, and 30.4 mm on the left side. In CMD patients there was no evidence of the SP causing the complaints. Two conclusions can be made: For epidemiologic studies on the length of the styloid process, the orthopantomogram is of limited use. In CMD patients the elongated styloid process is of negligible importance as a cause of complaints.

A comparison of the craniofacial morphology in 2-month-old unoperated infants with unilateral complete cleft lip and palate, and unilateral incomplete cleft lip.

This paper reports a cephalometric analysis of the craniofacial morphology in infants with unoperated unilateral complete cleft lip and palate (UCCLP) and unoperated unilateral incomplete cleft lip (UICL). The purpose of the study was to determine the nature and extent of the craniofacial deviations in UCCLP as compared to the morphology in UICL, which has previously been shown to be close to normal. The samples comprised 82 infants with UCCLP (58 males and 24 females) and 75 with UICL (48 males and 27 females). The mean age was about 2 months in both groups. The cephalometric analysis of craniofacial morphology included the lateral, frontal, and axial projections. The data were presented as mean plots of the craniofacial region including the calvaria, cranial base, orbits, nasal bone, maxilla, mandible, cervical column, pharynx, and soft-tissue profile. The most pronounced deviations in the UCCLP group were observed in the maxillary complex and the mandible. The most striking findings were: markedly increased width of the maxilla, a short mandible, and bimaxillary retrognathia except for the premaxillary area, which was relatively protruding and asymmetric. The study did not support the hypothesis previously suggested in the literature that cleft lip and palate is a craniofacial anomaly as size and shape of the calvaria and cranial base were found to be normal. The etiology of cleft lip and palate is still incompletely understood. Based on the present study, we suggest that facial type may be a liability factor that could represent a developmental threshold increasing the probability of cleft lip and palate.

[The contribution of standard radiographs in the evaluation of masticatory system dysfunction]. / Apport des radiographies standard dans le bilan des dysfonctionnements de l'appareil manducateur (D.A.M.).

Conventional x-ray films (orthopantomogram, teleradiogram) visualize many signs of dysfunction of the manducatory apparatus (DAM). Progress in our knowledge of the pathophysiology of DAM has brought new light to these radiographic signs. The orthopantomogram allows an assessment of modifications in muscle insertion zones secondary to their dysfunction and, more difficulty, the articular remodeling of the TMJ, mainly of the mandibular condyle and the articular space. The lateral teleradiogram studied by architectural and structural analysis provides information on the biomechanical balance of the cranio-facial structures and, especially, on the position of the mandibular rami. These standard radiograms are indispensable in the differential diagnosis, useful in the etiological diagnosis and are preliminary examinations prior to using other imaging techniques (MRI, CT). Standard films are easily reproducible for post-therapy follow-up.

Influence of complete denture renewal on craniomandibular disorders: a 1-year follow-up study.

Great individual variation in the signs and symptoms of craniomandibular disorders (CMD) and in the adaptability of the masticatory system is evident among complete denture wearers. The masticatory system of 64 edentulous patients (41 women, 23 men; mean age 59 years, range 41-80 years), who came to the Institute of Dentistry for renewal of their complete dentures, was examined before prosthetic treatment and after a 1-year follow-up period. The degree of CMD was assessed using the anamnestic and clinical dysfunction indices of Helkimo. The results show that few complete denture wearers had severe signs and symptoms of CMD. No statistically significant correlation was noted between CMD and either the duration of edentulousness or the number of sets of dentures.

Panoramic and transcranial radiology in orthodontics and craniomandibular disorders.

A good summary for the uses of TMJ radiographs was presented by Jeff Okeson in 1989 as follows: "Radiographs have limited use in the identification and treatment of TM disorders. Only through collaboration with clinical findings and history do they gain significance. When there is reason to believe that an organic joint pathosis exists, radiographs of the temporomandibular joints are obtained. Transcranial and panoramic views are used as screening devices for general assessment of bony abnormalities and osteoarthritic changes. Functional movements are also evaluated and correlated with clinical findings. Tomography is reserved for patients in whom the screening radiographs reveal a possible abnormality that needs closer visualization and investigation. Arthrography is a specialized diagnostic tool to be used only when significant doubt exists regarding the position of the articular disc. CT and MRI are reserved for when additional information will improve the adequacy of the diagnosis." I could not improve upon this summary but would like to point out that Jeff is labeling both panoramic imaging and transcranial imaging as screening devices to be later followed up with more definitive type imaging.

Craniomandibular dysfunction in children treated with total-body irradiation and bone marrow transplantation.

The prevalence of pain and dysfunction in the stomatognathic system was studied in a group of 19 long-term survivors after pediatric bone marrow transplantation (BMT), conditioned with total-body irradiation (TBI). Compared with the control group, the children and adolescents in the BMT group had a significantly reduced mouth opening capacity. A reduced translation movement of the condyles was diagnosed in 53% of children treated with TBI, compared with 5% in the control group. Signs of craniomandibular dysfunction were found in 84% of children in the BMT group, compared with 58% in the control group. Both irradiation and chemotherapy induce long-term alterations in connective and muscle tissues resulting in inflammation and eventually fibrosis. These changes in tissue homeostasis and concomitant growth retardation may lead to the observed malocclusion and reduced mobility of the temporomandibular joint, with subsequent muscle pain and headaches, which were found in this study.

[Indications for imagery in dysfunctional temporomandibular pathology]. / Indications de l'imagerie en pathologie temporo-mandibulaire dysfonctionnelle.

Cranio-mandibular disorders include muscular and articular signs. Articular pathology is the only one that need to be structurally studied. Paraclinic indications are based upon physical examination. Bone structure can be explored with tomography or CT scan and intra-articular structures can be explored with M.R.I. or arthrography. Two pathologies have then been found with an excessive frequency, disc displacements and juvenile osteoarthrosis.