Simultaneous otoplasty and temporomandibular arthroplasty.

By altering the standard postauricular incision for access to the temporomandibular joint (TMJ), a standard otoplasty can be performed simultaneously with TMJ arthroplasty. The procedure is described and results are presented. In six patients with at least a 2-year follow-up, the esthetic results have been stable. There has been no morbidity as a result of such simultaneous surgery.

Multifactorial facial pain--differential diagnosis: a case report.

A multidisciplinary algology team was formed to facilitate the diagnosis and treatment of complex head and neck pain disorders. The standard patient evaluation includes a history and physical, surface electromyography, Minnesota Multi-phasic Personality Inventory (MMPI), brief psychiatric interview, dental/occlusal analysis, a postural/musculoskeletal examination; and necessary diagnostic imaging. Clinicians meet in conference after each clinic session. Organic and psychiatric findings are compiled and a differential diagnosis is made. Treatment recommendations are outlined and a review of the evaluation and the therapeutic plan are forwarded to the referring doctor. A typical conference discussion is presented here.

Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients.

Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Previous studies may have included both of these disorders as MPDS/TMJDS. While some signs and symptoms are similar, the primary differentiation is based on meniscus displacement present with TMJID patients and pain distribution patterns between the two groups. While MFP/TMJID patients comprise the majority of the facial pain population, a third major group of patients is encountered, being classified under the diagnostic appellation of atypical facial pain (AFP). Patients with AFP usually complain of vague and wandering pain in the maxilla or mandible; however, no identifiable source of infection or organic disease can be uncovered. One hundred fifty patients seeking consultation and care for facial pain met the criteria for inclusion into one of three clinical groups. The groups were compared for age, sex, duration of symptoms, bruxism and/or clenching habits, and disturbed sleep patterns. Differences in surface electromyographic levels from the facial and cervical muscles were also examined. Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.

Neuralgias.

Cranial neuralgias are relatively uncommon but the excruciating nature of the pain they cause make them the focus of much clinical and research interest. The underlying mechanism of the disease remains to be uncovered. The complexities of the trigeminal system make the quest for comprehensive understanding a difficult one. Fortunately, pharmacotherapy is quite effective for many patients. For those patients who cannot be managed medically, there are a variety of surgical options. Criteria have been proposed for evaluating surgical efficacy in trigeminal neuralgia. These parameters should be used when considering the surgical options for each patient. Above all, the Latin motto, Primum non nocerum (first, do not harm) should prevail. With this in mind, the physician and surgeon will make the best choice for the care of each patient.

A simple method of nasoendotracheal tube fixation.

The critical need to maintain closed-circuit airways during maxillofacial surgery has led to a number of innovations in anesthetic tube placement and stabilization. Several redesigns and alterations of endotracheal tubes have been described and are currently in use. Also several methods of securing endotracheal tubes have been described. These range from suturing the tubing to the patient's scalp to fabricating maxillofacial prostheses. In this report, a readily available and easy method of securing anesthetic tubes is described. This technique has been used successfully in hundreds of patients at our institutions.

Odontalgia mimicking trigeminal neuralgia.

Proper diagnosis of facial pain is complex and requires careful evaluation of several organ systems. When patients fail to respond to firstline therapy, a complete differential diagnosis is essential for the prevention of mistreatment or overtreatment. A case is presented in which multispecialty cooperation resulted in successful treatment of chronic pain which had not responded to aggressive primary medical therapy.

Requesting reprints: is it worth it?

Reprint requests are a common means of keeping up with the scientific literature. This study evaluated the efficiency and cost-effectiveness of reprint requests.

Three-dimensional computed tomography for maxillofacial surgery: report of cases.

Methods of three-dimensional analysis of axial computed tomographic images have recently been described. Mostly, reports have concentrated on applications relative to congenital deformities. In this report, one method of three- dimensional reformatting is reviewed. Images formed by this method have solid surface appearance and can be color enhanced and manipulated to isolate anatomic structures of interest. The program allows mathematical quantitation of tissue densities, volumes, and distances. Furthermore, models and implants can be easily made using the programs CAD-CAM ability. These images and models can be generated from data obtained on the most common CT units without any modifications. This report emphasizes maxillofacial applications other than those previously reported in the surgical and radiological literature.

Comparison of magnetic resonance imaging, arthrotomography and clinical and surgical findings in temporomandibular joint internal derangements.

Twenty-four temporomandibular joints were evaluated by means of tomography and magnetic resonance imaging (MRI). Seventeen of these joints were also examined with the use of arthrotomography. Meniscus surgery was carried out on 13 of the temporomandibular joints. The three imaging techniques were compared for diagnosis of disk displacement, of degenerative joint disease, and of perforations. All imaging techniques were compared with clinical and surgical findings. MRI was as accurate as arthrotomography in confirming disk displacement. MRI was more accurate in disclosing gross arthrosis than tomography. The best use of arthrography was in disclosing perforations. The best correlation to surgical findings was shown by the clinical examination.

An unusual submandibular mass--cat scratch disease: report of case.

A case of cat scratch disease, initially considered a malignant disease or an aggressive inflammatory lesion, is reported. The lesion was excised and the characteristic disease pattern was established for this patient. The paper discusses the natural history of the disease and presents an extensive listing of swellings in the lateral part of the neck.

A modified auriculotemporal nerve block for regional anesthesia of the temporomandibular joint.

A technique for producing regional auriculotemporal nerve analgesia is described. Undesirable side effects have been minimized by avoiding facial nerve branches and blood vessels, and injection at the site of the nerve trunk.

Maxillofacial pain.

The paranasal sinuses are a common source of maxillofacial pain. When the sphenoid sinus is involved, 13 different structures can also be affected. The various neuralgias are usually easily recognized by their classic symptoms. Temporal arteritis must be diagnosed early in order to prevent blindness. The temporomandibular joint syndrome remains the most misdiagnosed and misunderstood orofacial pain.

Immunology in dentistry.

Implications of immunology in dental treatment are explained through discussion of the basic scientific principles of allergy, autoimmunity, immunization, immune dysfunction, tumor immunology, immunosuppression, and transplantation immunobiology.

Immune neutrality of calf skin collagen gel used to stimulate revitalization in pulpless open apex teeth of rhesus monkeys.

A collagen mineral gel has recently been shown to stimulate revitalization of pulpless open apex teeth when syringed into debrided root canals. Experiments were conducted to examine possible stimulation of the immune system by the experimental procedure. Ring tests (interface precipitation analysis), Ouchterlony plates and hemagglutination tests on plasma samples taken from experimental rhesus monkeys throughout the healing process indicate a complete lack of humoral immune responsiveness to the injected collagen.