Depression and diffuse physical symptoms in southern Chinese with temporomandibular disorders.

The study investigated the experience of depressive symptoms and the relationship with diffuse physical symptoms reporting in southern Chinese seeking professional care for temporomandibular disorders (TMD) in Hong Kong. Eighty-seven new patients [77 females/10 males; mean age 39.3 years (SD 12.7)] referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong participated in this study. The Research Diagnostic Criteria (RDC)/TMD history questionnaire was used to derive Axis II psychological data. Psychological status was assessed through depression and non-specific physical symptoms (NPS) scores (pain items included and excluded) measured with RDC/TMD Axis II instruments; 42.5% of patients experienced moderate/severe depression symptoms; 59.8% and 57.5% had moderate/severe NPS scores when pain items were included and excluded, respectively. Strong, positive and statistically significant correlations were noted between depression scores and the NPS scores that included pain items (r = 0.80) and those that did not (r = 0.80). The correlations remained consistent and were of similar magnitude when male patients were excluded from the computation and also when the possible effect of patient age was controlled. While taking into account the modest patient sample which was related to a low rate of treatment seeking, depressive symptoms were common and similar to other western and Chinese patient groups. NPS reports were higher than in Singapore Chinese patients. There appeared to be a clear association between depression and diffuse physical symptoms. The findings should be considered in the holistic care of Chinese people with TMD.

Pre-emptive ibuprofen arginate in third molar surgery: a double-blind randomized controlled crossover clinical trial.

BACKGROUND: This study evaluated the effectiveness of 400 mg ibuprofen arginate either as a pre-emptive (PRE group) or postoperative (POST group) analgesic using a common dental pain model. METHODS: A randomized double-blind crossover clinical trial involving a series of consecutive patients admitted for bilateral third molar surgery. Results were analysed according to the self-reported pain score and the pattern of rescue medication taken. RESULTS: The mean pain score ranged from 0.73 to 1.60 for the PRE group and 0.47 to 1.41 for the POST group among 30 included subjects. The mean time point when first rescue medication taken was 7.3 hours and 8.3 hours postoperative, respectively. Nine patients (30 per cent) in the PRE group and 12 patients (40 per cent) in the POST group took no rescue medication. There was no statistically significant difference for all parameters between groups, while a majority (53 per cent) found the drug "good" to "excellent" in both groups. CONCLUSIONS: Ibuprofen arginate may be considered effective in reducing surgically induced moderate to severe pain when administered either pre-operatively or postoperatively due to the reported relatively low pain score, less consumption of rescue medication, delayed onset of pain, good number of pain-free patients and a high rating in the global assessment score.

Diagnostic sub-types, psychological distress and psychosocial dysfunction in southern Chinese people with temporomandibular disorders.

The study aimed to assess the distribution of temporomandibular disorders (TMD) sub-types, psychological distress and psychosocial dysfunction in southern Chinese people seeking treatment for TMD using Research Diagnostic Criteria for TMD (RDC/TMD) and investigate potential cross-cultural differences in sub-type prevalence and psychosocial impact. Eighty-seven consecutive patients (77 females; 10 males) with a mean age of 39.3 years (s.d. 12.8) newly referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong over a 20-month period took part in the study. RDC/TMD history questionnaire and clinical assessment data were used to derive Axis I and II findings. Group I muscle disorders were the most common and found in 57.5% of patients. Group II (disc displacement) disorders were found in 42.5% and 47.1% of the right and left temporomandibular joints (TMJ) respectively. Group III disorders (arthralgia/arthrosis/arthritis) were revealed in 19.5% and 23.0% of right and left TMJ's respectively. In the Axis II assessment, 42.5% of patients had moderate/severe depression scores, 59.7% had moderate/severe somatization scores and based on graded chronic pain scores 15.0% had psychosocial dysfunction (grade III and IV). While acknowledging the small sample size, the distribution of RDC/TMD Axis I and II diagnoses was fairly similar in Chinese TMD patients compared with Western and other Asian patient groups. However, in Chinese patients, myofascial pain with limited jaw opening and TMJ disc displacement with reduction were more common and a significant number experienced psychological distress and psychosocial dysfunction. The findings have implications for the management of TMD in Chinese people.

Computed tomography of odontogenic myxoma.

AIM: The aim of this study was to determine the computed tomography (CT) presentation of odontogenic myxoma (OM) in a Chinese population and to compare them with those observed on the accompanying conventional radiographs (CR). MATERIALS AND METHODS: The files of the Department of Oral and Maxillofacial Surgery of the University of Hong Kong between 1989 and 2000 were reviewed for myxoma cases. RESULTS: Ten cases of OM were found of which eight had been investigated by CT. The formatted hard copy was found in seven cases, four in the maxilla and three in the mandible. Most of the OMs had a round shape but one was fusiform. CT was more likely to display a cortex and its perforation. All OMs had perforated cortices on CT with soft tissue appearing outside the bony contour in two cases. Contrast enhancement was apparent in six cases. Both CR and CT displayed septae, but the latter method revealed that most septae were situated at the periphery, presenting as "sunray" type spicules in one case. Tooth displacement and root resorption were more reliably observed on CR. CONCLUSION: The likelihood of perforation and pattern of septa of OM is better displayed by CT. CR should also allow a better assessment of the degree of definition of the lesion's margins with adjacent normal bone. Therefore, both CT and CR should be used in an investigation of an OM.

Three-dimensional virtual-reality surgical planning and soft-tissue prediction for orthognathic surgery.

Complex maxillofacial malformations continue to present challenges in analysis and correction beyond modern technology. The purpose of this paper is to present a virtual-reality workbench for surgeons to perform virtual orthognathic surgical planning and soft-tissue prediction in three dimensions. A resulting surgical planning system, i.e., three-dimensional virtual-reality surgical-planning and soft-tissue prediction for orthognathic surgery, consists of four major stages: computed tomography (CT) data post-processing and reconstruction, three-dimensional (3-D) color facial soft-tissue model generation, virtual surgical planning and simulation, soft-tissue-change preoperative prediction. The surgical planning and simulation are based on a 3-D CT reconstructed bone model, whereas the soft-tissue prediction is based on color texture-mapped and individualized facial soft-tissue model. Our approach is able to provide a quantitative osteotomy-simulated bone model and prediction of postoperative appearance with photorealistic quality. The prediction appearance can be visualized from any arbitrary viewing point using a low-cost personal-computer-based system. This cost-effective solution can be easily adopted in any hospital for daily use.

Computer-assisted three-dimensional surgical planing and simulation. 3D soft tissue planning and prediction.

The purpose of this paper is to report a new technique for three-dimensional facial soft-tissue-change prediction after simulated orthognathic surgical planning. A scheme for soft tissue deformation, "Computer-assisted three-dimensional virtual reality soft tissue planning and prediction for orthognathic surgery (CASP)", is presented. The surgical planning was based on three-dimensional reconstructed CT visualization. Soft tissue changes were predicted by two newly devised algorithms: Surface Normal-based Model Deformation Algorithm and Ray Projection-based Model Deformation Algorithm. A three-dimensional color facial texture-mapping technique was also used for generating the color photo-realistic facial model. As a final result, a predicted and simulated patient's color facial model can be visualized from arbitrary viewing points.

Computer-assisted three-dimensional surgical planning and simulation: 3D color facial model generation.

A scheme for texture mapping a 3D individualized color photo-realistic facial model from real color portraits and CT data is described. First, 3D CT images including both soft and hard tissues should be reconstructed from sequential CT slices, using a surface rendering technique. Facial features are extracted from 3D soft tissue. A generic mesh is individualized by correspondence matching and interpolation from those feature vertices. Three digitized color portraits with the "third" dimension from reconstructed soft tissue are blended and texture-mapped onto the 3D head model (mesh). A color simulated human head generated from frontal, right and left real color portraits can be viewed from an arbitrary angle in an inexpensive and user-friendly conventional personal computer. This scheme is the basic procedure in 3D computer-assisted simulation surgery.

Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy.

A computer-assisted three-dimensional virtual osteotomy system for orthognathic surgery (CAVOS) is presented. The virtual reality workbench is used for surgical planning. The surgeon immerses in a virtual reality environment with stereo eyewear, holds a virtual "scalpel" (3D Mouse) and operates on a "real" patient (3D visualization) to obtain pre-surgical prediction (3D bony segment movements). Virtual surgery on a computer-generated 3D head model is simulated and can be visualized from any arbitrary viewing point in a personal computer system.

Three-dimensional virtual reality surgical planning and simulation workbench for orthognathic surgery.

A new integrated computer system, the 3-dimensional (3D) virtual reality surgical planning and simulation workbench for orthognathic surgery (VRSP), is presented. Five major functions are implemented in this system: post-processing and reconstruction of computed tomographic (CT) data, transformation of 3D unique coordinate system geometry, generation of 3D color facial soft tissue models, virtual surgical planning and simulation, and presurgical prediction of soft tissue changes. The basic mensuration functions, such as linear and spatial measurements, are also included. The surgical planning and simulation are based on 3D CT reconstructions, whereas soft tissue prediction is based on an individualized, texture-mapped, color facial soft tissue model. The surgeon "enters" the virtual operatory with virtual reality equipment, "holds" a virtual scalpel, and "operates" on a virtual patient to accomplish actual surgical planning, simulation of the surgical procedure, and prediction of soft tissue changes before surgery. As a final result, a quantitative osteotomy-simulated bone model and predicted color facial model with photorealistic quality can be visualized from any arbitrary viewing point in a personal computer system. This system can be installed in any hospital for daily use.

Trichinosis associated with carcinoma of the tongue: case report.

A rare presentation of Trichinella spiralis with squamous cell carcinoma of the tongue is reported. The possible carcinogenic potential of trichinosis and its management are discussed.