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Internal derangement of the temporomandibular joint: An assessment of condylar position in centric occlusion
CURRENT LITERATURt
622
their effectiveness is a function of inhibition of cyclooxygenase, resulting in a reduction of prostaglandin synthesis. This article reviews the properties, side effects, and dosages of the NSAIDs. Conclusions include: 1) Patients with true aspirin sensitivity are almost invariably sensitive to these drugs; 2) All may produce gastrointestinal irritation; 3) Although it is widely known that aspirin interferes with platelet aggregation, in high doses it inhibits prothrombin production; 4) The pyrazole group of NSAIDS includes phenylbutazone; a significant potential toxic effect of these drugs is severe bone morrow suppression and the pyrazoles are the most potent saltretaining members of the NSAID group; 5) Tolmetin has been cleared for use in children; 6) Renal toxicity may be induced by the NSAIDs, although ibuprofen (Motrin) appears to be the most benign in this regard; 7) Combination of a NSAID with a narcotic may prove beneficial, since the former acts peripherally and the latter centrally.ROBERT CHUONC
Reprint requests to: Clinical Section, Rheumatic Disease Study Group, New York University Medical Center. 5.50 First Avenue, New York, New York 10016.
Ophthalmic Considerations in the Severely Injured Patient. Runyan TE. Symposium on Surgery in the Medically Compromised Patient. Surg Clin North Am 62: 301, 1982 Eye injuries in the severely injured patient can easily be overlooked, misdiagnosed, or ignored in the early postinjury period. Thorough examination of the lids, cornea, conjunctiva, sclera, pupils, extraocular muscles, chambers, lens, fundus, and visual acuity yields information invaluable for comparison with later exams and has major bearing on the visual prognosis. Certain findings necessitate specialized opthomologic management. Penetration of the globe and foreign body presence should be suspected with any through-and-through lid laceration. Direct and consensual response to light and pupillary size, position, and shape yield information regarding the function of the second and third cranial nerves, traumatic mydriasis or miosis, iridodialysis, and cornea1 perforation. Ptosis can occur with contusive injuries to the lid musculature, third nerve, or sympathetic fiber damage. Gaze restriction and diplopia indicate impingement of the extraocular muscles. Caldwell, Water’s, and lateral skull radiographic projections should be performed whenever there is suspicion of intraocular foreign bodies or orbital fractures. Inappropriate management of hyphema may result in irreparable damage or permanent blindness. Traumatic cataract may develop hours or months following trauma. Fundoscopic examination for retinal hemorrhage, hypoxia, and detachment and to evaluate venous pulsations, disc margins, and elevation of the nerve head must be performed at the earliest possible time. In all injuries prompt and appropriate management to ensure the best prognosis is mandatory.-SANDRA M. EDWARDS Reprint requests to Dr. Thomas E. Runyan: Texas A. and M. University School of Medicine, Division of Ophthalmology, Scott and White Clinic, Temple, Texas 76508. Penicillin Prophylaxis in Children With Cardiac Disease: Postextraction Bacteremia and Penicillin-Resistant
Strains of Viridans Streptococci. Hess J. Holloway Daukert J. Infect Dis 147:133, 1983
Y,
Streptococcus viridans is the most frequently involved microorganism in bacterial endocarditis. Penicillin is the antibiotic of choice for prophylactic coverage of susceptible patients undergoing dental procedures. There are. however, penicillin-resistant strains of viridans streptococci that can be isolated from the oral cavity. This study assessed a possible relationship between the presence of penicillin-resistant organisms in the oral flora and the incidence of postextraction bacteremia in children with cardiac disease who received parenteral penicillin prophylaxis before dental treatment. Eighty-two children, ages 5 to 14 years old, were given parenteral penicillin 45 minutes prior to dental extraction of diseased teeth. Cultures were taken of the sulcuses prior to extraction. Five minutes after the extraction blood samples were drawn to determine penicillin concentrations. Postextraction bacteremias occurred in 21% of the patients. Ten patients were positive for viridans streptococci. Cultures of the organism from seven of the patients were penicillin sensitive and three were penicillin resistant. In the gingival
SU~CUS,however, 39% of the children had penicillin-resistant strains. A relationship between the presence of such strains in the gingival sulcus and the occurrence of postextraction bacteremia could not be demonstrated. The authors conclude that parenteral penicillin prophylactic regimens do not always prevent postextraction bacteremias in children at risk.-ALAN STOLL, Reprint requests to Dr. J. Daukert: Department of Hospital Epidemiology, University Hospital Groningen, The Netherlands
Groningen.
Oostersingel
59.
Internal Derangement of the Temporomandibular Joint: An Assessment of Condylar Position in Centric Occlusion. Katzberg R, Keith DA, Eick WR, Guralnick WC. J Prosth Dent 49:2, 1983 Fifty arthrograms of the temporomandibular joint were studied to compare condyle to glenoid fossa relationships in joints with (27) and without (23) internal derangement. From linear tomograms, the condyle-fossa relationship was assessed in centric occlusion and, using a digital computer, areas of the anterior and posterior joint spaces were determined. The ratio of the posterior to anterior joint space area was calculated, and the linear widths of the posterior and anterior joint space areas were compared. Results showed that there was no significant difference between normal joints and those with internal derangement when evaluating the ratio of the areas of the posterior joint space divided by the anterior joint space. Linear measurements of the width of these areas also showed no significant difference. Therefore, it was not possible to diagnose internal derangements of the TMJ by using plain radiographs and demonstrating retrusion of the condyle either alone or in comparison with normal joints. If abnormalities of meniscus function are the primary etiology of painful dysfunction of the TMJ, then the use of a plain film alone is not adequate for diagnosis or assessment of treatment.-DouciLAs W. WALLACE Reprint requests to Dr. RW Katzberg: Department of Diagnostic Radiology, University of Rochester Medical Center. Box 648, Rochester, New York 14642.
622
their effectiveness is a function of inhibition of cyclooxygenase, resulting in a reduction of prostaglandin synthesis. This article reviews the properties, side effects, and dosages of the NSAIDs. Conclusions include: 1) Patients with true aspirin sensitivity are almost invariably sensitive to these drugs; 2) All may produce gastrointestinal irritation; 3) Although it is widely known that aspirin interferes with platelet aggregation, in high doses it inhibits prothrombin production; 4) The pyrazole group of NSAIDS includes phenylbutazone; a significant potential toxic effect of these drugs is severe bone morrow suppression and the pyrazoles are the most potent saltretaining members of the NSAID group; 5) Tolmetin has been cleared for use in children; 6) Renal toxicity may be induced by the NSAIDs, although ibuprofen (Motrin) appears to be the most benign in this regard; 7) Combination of a NSAID with a narcotic may prove beneficial, since the former acts peripherally and the latter centrally.ROBERT CHUONC
Reprint requests to: Clinical Section, Rheumatic Disease Study Group, New York University Medical Center. 5.50 First Avenue, New York, New York 10016.
Ophthalmic Considerations in the Severely Injured Patient. Runyan TE. Symposium on Surgery in the Medically Compromised Patient. Surg Clin North Am 62: 301, 1982 Eye injuries in the severely injured patient can easily be overlooked, misdiagnosed, or ignored in the early postinjury period. Thorough examination of the lids, cornea, conjunctiva, sclera, pupils, extraocular muscles, chambers, lens, fundus, and visual acuity yields information invaluable for comparison with later exams and has major bearing on the visual prognosis. Certain findings necessitate specialized opthomologic management. Penetration of the globe and foreign body presence should be suspected with any through-and-through lid laceration. Direct and consensual response to light and pupillary size, position, and shape yield information regarding the function of the second and third cranial nerves, traumatic mydriasis or miosis, iridodialysis, and cornea1 perforation. Ptosis can occur with contusive injuries to the lid musculature, third nerve, or sympathetic fiber damage. Gaze restriction and diplopia indicate impingement of the extraocular muscles. Caldwell, Water’s, and lateral skull radiographic projections should be performed whenever there is suspicion of intraocular foreign bodies or orbital fractures. Inappropriate management of hyphema may result in irreparable damage or permanent blindness. Traumatic cataract may develop hours or months following trauma. Fundoscopic examination for retinal hemorrhage, hypoxia, and detachment and to evaluate venous pulsations, disc margins, and elevation of the nerve head must be performed at the earliest possible time. In all injuries prompt and appropriate management to ensure the best prognosis is mandatory.-SANDRA M. EDWARDS Reprint requests to Dr. Thomas E. Runyan: Texas A. and M. University School of Medicine, Division of Ophthalmology, Scott and White Clinic, Temple, Texas 76508. Penicillin Prophylaxis in Children With Cardiac Disease: Postextraction Bacteremia and Penicillin-Resistant
Strains of Viridans Streptococci. Hess J. Holloway Daukert J. Infect Dis 147:133, 1983
Y,
Streptococcus viridans is the most frequently involved microorganism in bacterial endocarditis. Penicillin is the antibiotic of choice for prophylactic coverage of susceptible patients undergoing dental procedures. There are. however, penicillin-resistant strains of viridans streptococci that can be isolated from the oral cavity. This study assessed a possible relationship between the presence of penicillin-resistant organisms in the oral flora and the incidence of postextraction bacteremia in children with cardiac disease who received parenteral penicillin prophylaxis before dental treatment. Eighty-two children, ages 5 to 14 years old, were given parenteral penicillin 45 minutes prior to dental extraction of diseased teeth. Cultures were taken of the sulcuses prior to extraction. Five minutes after the extraction blood samples were drawn to determine penicillin concentrations. Postextraction bacteremias occurred in 21% of the patients. Ten patients were positive for viridans streptococci. Cultures of the organism from seven of the patients were penicillin sensitive and three were penicillin resistant. In the gingival
SU~CUS,however, 39% of the children had penicillin-resistant strains. A relationship between the presence of such strains in the gingival sulcus and the occurrence of postextraction bacteremia could not be demonstrated. The authors conclude that parenteral penicillin prophylactic regimens do not always prevent postextraction bacteremias in children at risk.-ALAN STOLL, Reprint requests to Dr. J. Daukert: Department of Hospital Epidemiology, University Hospital Groningen, The Netherlands
Groningen.
Oostersingel
59.
Internal Derangement of the Temporomandibular Joint: An Assessment of Condylar Position in Centric Occlusion. Katzberg R, Keith DA, Eick WR, Guralnick WC. J Prosth Dent 49:2, 1983 Fifty arthrograms of the temporomandibular joint were studied to compare condyle to glenoid fossa relationships in joints with (27) and without (23) internal derangement. From linear tomograms, the condyle-fossa relationship was assessed in centric occlusion and, using a digital computer, areas of the anterior and posterior joint spaces were determined. The ratio of the posterior to anterior joint space area was calculated, and the linear widths of the posterior and anterior joint space areas were compared. Results showed that there was no significant difference between normal joints and those with internal derangement when evaluating the ratio of the areas of the posterior joint space divided by the anterior joint space. Linear measurements of the width of these areas also showed no significant difference. Therefore, it was not possible to diagnose internal derangements of the TMJ by using plain radiographs and demonstrating retrusion of the condyle either alone or in comparison with normal joints. If abnormalities of meniscus function are the primary etiology of painful dysfunction of the TMJ, then the use of a plain film alone is not adequate for diagnosis or assessment of treatment.-DouciLAs W. WALLACE Reprint requests to Dr. RW Katzberg: Department of Diagnostic Radiology, University of Rochester Medical Center. Box 648, Rochester, New York 14642.