Comparison of the condyle-fossa relationship and resorption between patients with and without Juvenile Idiopathic Arthritis (JIA).

PURPOSE: The purpose of this study was 1) to compare condyle - fossa relationships in the temporomandibular joint (TMJ), and 2) to score condylar resorption by using a TMJ indexing system in patients with JIA and without JIA. METHODS: The present retrospective cross-sectional study included cone-beam computed tomography (CBCT) images obtained from the sagittal, coronal, and axial slices. In the multidisciplinary Pediatric Rheumatology Outpatient Clinic at The University of Alabama at Birmingham (UAB) children with JIA are also examined by a group of orthodontists working in the same institute from October 2018 to July 2019. The predictor variable consists of patients with JIA and without JIA. The primary outcome variables are the depth of the mandibular fossa, joint spaces, axial angles, medio-lateral width, and condyle resorption. Other study variables were age and sex. In this study, the measurements obtained from 2 different groups (with JIA and without JIA) are compared using a t-test, where Tukey is utilized to adjust for multiple comparisons. The left and right joints are analyzed separately as the paired t test conducted showed a significant difference between the 2 joints (P < .05). RESULTS: The study was comprised of 34 patients diagnosed with JIA and 34 healthy subjects. The depth of the mandibular fossa, the anterior joint spaces, the axial angles, and the resorption index showed statistically significant differences between the JIA and healthy groups in both left and right sides (P < .05). However, there was no statistically significant difference in the posterior joint spaces and mediolateral width between JIA and healthy groups in both sides (P > .05). CONCLUSIONS: The results of our study presented the destructive potential of juvenile idiopathic arthritis by using CBCT. CBCT scanning is a helpful tool in the evaluation of the radiographic result of TMJ.

Novel Three-Dimensional Understanding of Maxillary Cleft Distraction.

OBJECTIVES: To set forth a universal standard methodology for quantifying volumetric and linear changes in the craniofacial complex, utilizing three-dimensional data captured from a cleft-lip palate patient who underwent rigid external device (RED) distraction. METHODS: Cone beam computed tomography images of a 14-year-old patient were captured using a Kodak 9500 (Atlanta, GA) Cone Beam system device and a stereophotogrammetric system (3dMDface(TM) Atlanta, GA). The subject was a nonsyndromic unilateral cleft-lip palate patient who received RED distraction as part of maxillary advancement in conjunction with orthodontic treatment. Preop (T1) and postop (T2) images were superimposed using Invivo 5.2.3 (San Jose, CA) software. Volumetric rendering of the airway, bone, and soft tissues, as well as linear measurements were analyzed. Each measurement was captured 10 times to ensure reliability and reproducibility of methodology. RESULTS: Data from T1 to T2 revealed mean differences as follows: airway total volume +5250 mm, minimum cross-sectional area +67.84 mm; bone +1719 mm, soft tissue +44,432 mm. Mean of linear measurements: Pronasale 1.98 mm, Subnasale 3.35 mm, Labial superius 10.79 mm, Labial inferius 4.13 mm, Right alare 5.71 mm, Right cheilion 7.83 mm, Left alare 4.97 mm, Left cheilion 5.50 mm, Pogonion 3.01 mm, B-point 2.49 mm, U1-U1 9.77 mm, and L1-L1 0.00 mm. P values are <0.001 for each analysis. CONCLUSIONS: This paper represents a novel and innovative way to look at prepost RED distractions in a three-dimensional format. A universal standard analysis of the craniofacial complex can be implemented using the techniques and method outlined in this study.

Magnetic Resonance Imaging Findings following Intraarticular Infliximab Therapy for Refractory Temporomandibular Joint Arthritis among Children with Juvenile Idiopathic Arthritis.

OBJECTIVE: To evaluate the involvement of intraarticular (IA) infliximab (IFX) in the management of temporomandibular joint (TMJ) arthritis associated with juvenile idiopathic arthritis (JIA) that is refractory to systemic treatment and IA corticosteroid therapy. METHODS: Ours was a retrospective study of children with JIA who received IA IFX into the TMJ. The effectiveness of treatment on the progression of acute and chronic changes was assessed by a quantitative magnetic resonance imaging scoring system. RESULTS: Median acute and chronic scores worsened by 0.25 and 0.75, respectively. In multivariate analysis, worsening acute scores and passage of time predicted worsening of the chronic scores. CONCLUSION: IA IFX allowed for progression of refractory TMJ arthritis in most but not all children with JIA.

Continuous infusion of bupivacaine for pain control after anterior iliac crest bone grafting for alveolar cleft repair in children.

OBJECTIVE: The purpose of this study was (1) to evaluate the analgesic efficacy of continuous infusion bupivacaine, (2) to evaluate the effects of the site-specific catheter infusion on operating room time, narcotic use, ambulatory status, and length of hospitalization, (3) to monitor for adverse outcomes, and (4) to assess patient/family acceptance. DESIGN: Randomized, double-blinded, and prospective study of bupivacaine versus saline for pain control after anterior iliac crest bone grafting for alveolar cleft repair. SETTING: University of Alabama at Birmingham. PATIENTS: A total of 65 pediatric patients with alveolar cleft defects treated between 2006 and 2009. INTERVENTIONS: Anterior iliac crest bone grafting for alveolar cleft repair with assignment to either a bupivacaine or a saline infusion group. MAIN OUTCOME MEASURES: Physical examination, pain ratings, narcotic use, ambulatory status, operating room time, and length of hospital stay. RESULTS: On the blinded physical exam, 71% in the bupivacaine infusion group and 42% in the saline infusion group were assessed as not experiencing pain at the surgical hip site. The experimental group used less narcotics compared with the control group. No significant differences were noted with operating room time, initial ambulatory status, or length of hospitalization (1.09 versus 1.12 days). Satisfaction and acceptance of the catheter treatment was universal. CONCLUSIONS: These results suggest that postoperative infusion of bupivacaine may be efficacious for enhancing pain relief after bone harvest in pediatric patients and may enhance parental perceptions of postoperative care; however, this patient population is difficult to study accurately.