Comparison of cone-beam computed tomography cephalometric measurements using a midsagittal projection and conventional two-dimensional cephalometric measurements / 대한치과교정학회지

OBJECTIVE: This study investigated whether it is possible to use a two-dimensional (2D) standard in three-dimensional (3D) analysis, by comparing the angles and lengths measured from a midsagittal projection in 3D cone-beam computed tomography (CBCT) with those measured by 2D lateral cephalometric radiography (LCR). METHODS: Fifty patients who underwent both LCR and CBCT were selected as subjects. CBCT was reoriented in 3 different methods and the measuring-points were projected onto the midsagittal plane. Twelve angle values and 8 length values were measured on both LCR and CBCT and compared. RESULTS: Repeated measures analysis of the variance revealed statistically significant differences in 7 angular and 5 linear measurements among LCR and 3 types of CBCT (p < 0.05). Of these 12 measurements, multiple comparisons showed that 6 measurements (ANB, AB to FH, IMPA, FMA, Co-Gn, Go-Me) were not significantly different in pairwise comparisons. LCR was significantly different from 3 types of CBCT in 3 angular (SN to FH, interincisal angle, FMIA) and 2 linear (S-Go, Co-ANS) measurements. The CBCT method was similar for all measurements, except for 1 linear measurement, i.e., S-N. However, the disparity between the mean values for all parameters was within the range of clinical measurement error. CONCLUSIONS: 3D-CBCT analysis, using midsagittal projection, is a useful method in which the 2D-LCR normative values can be used. Although the measurements changed with reorientation, these changes were not clinically significant.

Thoracic Outlet Syndrome Caused by Schwannoma of Brachial Plexus

Schwannomas are benign, usually slow-growing tumors that originate from Schwann cells surrounding peripheral, cranial, or autonomic nerves. The most common form of these tumors is acoustic neuroma. Schwannomas of the brachial plexus are quite rare, and symptomatic schwannomas of the brachial plexus are even rarer. A 47-year-old woman presented with a 1-year history of dysesthesia, neuropathic pain, and mild weakness of the right upper limb. Results of physical examination and electrodiagnostic studies supported a diagnosis as thoracic outlet syndrome. Conservative treatment did not relieve her symptoms. After 9 months, a soft mass was found at the upper margin of the right clavicle. Magnetic resonance imaging showed a 3.0x1.8x1.7 cm ovoid mass between the inferior trunk and the anterior division of the brachial plexus. Surgical mass excision and biopsy were performed. Pathological findings revealed the presence of schwannoma. After schwannoma removal, the right hand weakness did not progress any further and neuropathic pain gradually reduced. However, dysesthesia at the right C8 and T1 dermatome did not improve.

Efficacy of Ultrasonography-Guided Injections in Patients with Facet Syndrome of the Low Lumbar Spine

OBJECTIVE: To investigate the efficacy of ultrasonography (US)-guided injections in patients with low lumbar facet syndrome, compared with that in patients who received fluoroscopy (FS)-guided injections. METHOD: Fifty-seven subjects with facet syndrome of the lumbar spine of the L4-5 and L5-S1 levels were randomly divided into two groups to receive intraarticular injections into the facet joint. One group received FS-guided facet joint injections and the other group received US-guided facet joint injections. Treatment effectiveness was assessed using a visual analogue scale (VAS), physician's and patient's global assessment (PhyGA, PaGA), and the modified Oswestry Disability Index (MODI). All parameters were evaluated four times: before injections, and at a week, a month, and three months after injections. We also measured, in both groups, how long it took to complete the whole procedure. RESULTS: Each group showed significant improvement from the facet joint injections on the VAS, PhyGA, PaGA, and MODI (p0.05). Statistically significant differences in procedure time were observed between groups (FS: 248.7+/-6.5 sec; US: 263.4+/-5.9 sec; p=0.023). CONCLUSION: US-guided injections in patients with lumbar facet syndrome are as effective as FS-guided injections for pain relief and improving activities of daily living.

Balance Control and Knee Osteoarthritis Severity

OBJECTIVE: To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax(R)). METHOD: A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax(R), which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax(R). RESULTS: Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups. CONCLUSION: These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.

The Effect of Shock Wave Therapy on Upper Limb Spasticityin the Patients with Stroke

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity of elbow and wrist affected by stroke. Methods: We studied 21 patients affected by stroke with spasticity in upper limbs. The neurological status of the stroke patients were evaluated by K-NIHSS and the evaluation of efficacy on the upper limb spasticity were based on modified Ashworth scale (MAS), modified Tardieu scale (MTS), and active elevation of upper limb. Treatment was performed 1 session/week, total 3 sessions in each patient. Patients were evaluated at baseline and 4 weeks after treatment using MAS of elbow flexor and active elevation of upper limb. Patients were monitored at baseline, after sham stimulation, and at 1, 4 weeks after ESWT using MTS of elbow flexor and wrist pronator. RESULTS: After ESWT, patients showed significant improvement in muscle tone of elbow flexor and wrist pronator after the 1st and 4th weeks compared with baseline and sham stimulation (p<0.001). The active elevation of hemiplegic upper limb was significantly increased (p<0.05). CONCLUSION: We suggest the ESWT could be a useful treatment method on upper limb spasticity in the patients of stroke. Further studies with a larger group of patients are warranted.