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Oral radiographic changes in patients with progressive systemic sclerosis (scleroderma)
87
Quarterly Dental Review
but no collagen or precollagen. The appearance was suggestive of early enamel matrix, and pre-ameloblast-like ceils were associated with it. The second typecontained irregularly orientated collagen fibrilsamong which small spherical calcified areas were scattered. The appearance was consistent with pm-dentine. A dense tissue composed of parallel elongated fibres or fibrils formed a border and tall epithelial cells were associated with the tissue. The origins of the cyst are discussed. G. R. Seward
MYALL
R. W. T. and SMITH M. J. A.
The Ramsay Hunt syndrome: a dynamic demonstration of applied anatomy, J. Oral Surg. 35 (1977) 663-666. A Ramsay Hunt syndrome is caused by infection of the geniculate ganglion by varicella-zoster virus to produce a vesicular eruption of the concha, external auditory meatus and oral mucosa with loss of taste and lacrimation on the same side. A 76-year-old man who was recovering from replacement of an abdominal aortic aneurysm by a DeBakey graft developed a stiff neck. Two days later he complained of itching of the right pinna with vesicles in the external auditory meatus. Hearing was affected but the vesicles spread to involve the concha. Ulcersappeared on the right side of the tongue, soft palate and fauces. There was a decreased sense of taste on that side as well as decreased lacrimation. Nine days after the onset a lower motor neurone type complete right side facial paralysis developed. The anatomical basis for the syndrome is discussed. G. R. Seward
SHEPPARD
I. M. and SHEPPARD S. M.
Characteristics of temporomandibular joint problems, J. Prosthat Dent. 39 (1977) 180-191. In a review of the characteristics of 145 patients with temporomandibular joint problems, the authors concluded that the causes are both psychological and physiological. Anatomical abnormalities may also be present in the joint. Surprisingly, the authors point out that a lack of awareness
of the range of condylar movement is contributory to iatrogenic trauma. A classification of the aetiological factors of temporomandibular joint and myofacial pain dysfunction problems is proposed. B. J. Roberts
GLAROSE A. G. The effects of bruxism: a review of the literature, J. Prosrhet. Dent. 39 (1977) 149-157. The authors divided the effects of bruxism into six categories, pointing out that there are effects not only on the dentition but also in the periodontal masticatory muscles and the temporomandibular joint. Head pain and psychological or behavioural effects may also be manifest in the bruxist. The article provides an interesting literature review for those interested in this common problem. B. J. Roberts
WHITES. C.. FREY N. W.. ELASCHKE 0. IX, ROSS M. D.. CLEMENTS P. J. FURST D. E. and PAULUS H. E. Oral radiographic changes in patients with progressive systemic sclerosis Nclerodermal, J. Am. Dent Assoc. 94 (1977) 1178-1182. Progressive systemic sclerosis is a generalized skin condition causing sclerosis of the skin and connective tissues. In addition there may be abnormalities of the gastrointestinal tract, heart, lungs and kidneys and these usually result in serious complications. It has been previously reported that an increase in the thickness of the periodontal membrane space may be seen on dental radiographs in about 7 per cent of cases, Posterior teeth were found to be more commonly affected but the teeth were not mobile and the gingival attachment was intact. Reversibility of this phenomenon has been described. Other findings have been the resorption of mandibular bone with the added complication of fracture. Patients with these bone changes exhibited restricted oral apertures. In a series of 35 patients with progressive systemic sclerosis 13 (37 per cent) were found to have thickening of the periodontal
88
membrane as shown radiographically. This was more clearly demonstrated on intraoral films than panoramic films. Sixteen patients were followed up over 2 years. In 2 patients progressive thickening was observed. In 1 patient the number of teeth affected rose from 1 to 3 whilst in another 1 tooth became involved. There was a strong tendency for posterior teeth to be affected rather than anteriors. In 6 of the patients resorption of bone was observed at the mandibular angles, and in 3 of these patients films were available to demonstrate progression of this phenomenon. Two of the 6 patients showed partial or complete resorption of the coronoid process and this was also seen in another patient. The thickening of the periodontal membrane did not seem to present clinical problems but the resorption of bone at the mandibular angle was regarded as more serious, because of the possibility of a pathological fracture. Although the aetiology of the resorption of mandibular bone is unknown, the authors believe this to be the result of pressure atrophy or ischaemia, this having been reported for other skeletal lesions. E. R. Smart
Journal of Dentistry, Vol. ~/NO. 1
and three for both jaws. Alternate ribs, such as the sixth and eighth or fifth, seventh and ninth, are removed. One edge of the longest rib is removed to open the medullary cavity, and grooves are cut through the superior, medial and inferior surfaces at l-cm intervals or less with a burr. The graft is bent to conform to an acrylic model, fitting it to the lingual side anteriorly, below the maxillary ridge, trimmed to leave sufficient inter-ridge space posteriorly and trimmed again to fit against the medial aspect of the ramus without undue bulk. A similarly prepared rib is fitted to the labial aspect of the residual maxillary ridge, trimming the inner aspect to fit the zygomatic buttress. Cancellous bone is removed from the remaining pieces and the cortical bone cut into 4-6-mm fragments. With the mandible the mylohyoid muscle and superior fibres of genioglossus are detatched. The graft is wired in the midline and to the two rami. In the maxilla augis effected laterally in the mentation posterior part and anteriorly and vertically in the front. Two figure-of-eight wires are inserted anteriorly and two interosseous wires posteriorly. All gaps are packed with bone chips. Perforating sutures from the wires, through the palatal flaps, are used to retain a palatal pressure pack. Many technical details are carefully discussed. G. Ft. Seward
ORAL SURGERY BAKER R. D.. HILL C. and CANNOLE P. W. Re-prosthetic augmentation grafting-autogenour bone, J. Oral Surg. 35 (1977) 541561. Augmentation grafting is used to reinforce a previous graft which bridges a gap where a full thickness segment of jaw has been lost and where the graft is inadequate in strength or alignment. It is also used to fill localized defects in the alveolar process or to restore function and prevent fracture where there is extreme generalized atrophy of the jaws. Methods of augmentation grafting are reviewed. All suffer from certain disadvantages, notably marked early resorption. Rib grafting is now generally accepted as giving the best results. The operative technique is as follows. Lengths of rib measuring 15 cm each are cut; two for the mandible
CHERRY C. 0. and FREW A. L. Bilateral reductions of articular eminence for chronic dislocation, J. Oral Surg. 35 (1977) 598-600. The intention of the operation is to permit unrestrained and unimpaired excursion of the condyles. At operation the joint capsule is exposed and reflected from the articular eminence. Both the tubercle and the inferior eminence are reduced with burrs, leaving no rough edges. The procedure is repeated on the other side and the mandible manipulated to check condyle movement. The wounds are closed with drainage. The results in 8 patients were reviewed. Four were reported as cured, 3 as improved and one as unchanged. Persistent crepitus in the joint was attributed to the condyle sliding out from under the meniscus or to roughness of the reduced eminence left at
Quarterly Dental Review
but no collagen or precollagen. The appearance was suggestive of early enamel matrix, and pre-ameloblast-like ceils were associated with it. The second typecontained irregularly orientated collagen fibrilsamong which small spherical calcified areas were scattered. The appearance was consistent with pm-dentine. A dense tissue composed of parallel elongated fibres or fibrils formed a border and tall epithelial cells were associated with the tissue. The origins of the cyst are discussed. G. R. Seward
MYALL
R. W. T. and SMITH M. J. A.
The Ramsay Hunt syndrome: a dynamic demonstration of applied anatomy, J. Oral Surg. 35 (1977) 663-666. A Ramsay Hunt syndrome is caused by infection of the geniculate ganglion by varicella-zoster virus to produce a vesicular eruption of the concha, external auditory meatus and oral mucosa with loss of taste and lacrimation on the same side. A 76-year-old man who was recovering from replacement of an abdominal aortic aneurysm by a DeBakey graft developed a stiff neck. Two days later he complained of itching of the right pinna with vesicles in the external auditory meatus. Hearing was affected but the vesicles spread to involve the concha. Ulcersappeared on the right side of the tongue, soft palate and fauces. There was a decreased sense of taste on that side as well as decreased lacrimation. Nine days after the onset a lower motor neurone type complete right side facial paralysis developed. The anatomical basis for the syndrome is discussed. G. R. Seward
SHEPPARD
I. M. and SHEPPARD S. M.
Characteristics of temporomandibular joint problems, J. Prosthat Dent. 39 (1977) 180-191. In a review of the characteristics of 145 patients with temporomandibular joint problems, the authors concluded that the causes are both psychological and physiological. Anatomical abnormalities may also be present in the joint. Surprisingly, the authors point out that a lack of awareness
of the range of condylar movement is contributory to iatrogenic trauma. A classification of the aetiological factors of temporomandibular joint and myofacial pain dysfunction problems is proposed. B. J. Roberts
GLAROSE A. G. The effects of bruxism: a review of the literature, J. Prosrhet. Dent. 39 (1977) 149-157. The authors divided the effects of bruxism into six categories, pointing out that there are effects not only on the dentition but also in the periodontal masticatory muscles and the temporomandibular joint. Head pain and psychological or behavioural effects may also be manifest in the bruxist. The article provides an interesting literature review for those interested in this common problem. B. J. Roberts
WHITES. C.. FREY N. W.. ELASCHKE 0. IX, ROSS M. D.. CLEMENTS P. J. FURST D. E. and PAULUS H. E. Oral radiographic changes in patients with progressive systemic sclerosis Nclerodermal, J. Am. Dent Assoc. 94 (1977) 1178-1182. Progressive systemic sclerosis is a generalized skin condition causing sclerosis of the skin and connective tissues. In addition there may be abnormalities of the gastrointestinal tract, heart, lungs and kidneys and these usually result in serious complications. It has been previously reported that an increase in the thickness of the periodontal membrane space may be seen on dental radiographs in about 7 per cent of cases, Posterior teeth were found to be more commonly affected but the teeth were not mobile and the gingival attachment was intact. Reversibility of this phenomenon has been described. Other findings have been the resorption of mandibular bone with the added complication of fracture. Patients with these bone changes exhibited restricted oral apertures. In a series of 35 patients with progressive systemic sclerosis 13 (37 per cent) were found to have thickening of the periodontal
88
membrane as shown radiographically. This was more clearly demonstrated on intraoral films than panoramic films. Sixteen patients were followed up over 2 years. In 2 patients progressive thickening was observed. In 1 patient the number of teeth affected rose from 1 to 3 whilst in another 1 tooth became involved. There was a strong tendency for posterior teeth to be affected rather than anteriors. In 6 of the patients resorption of bone was observed at the mandibular angles, and in 3 of these patients films were available to demonstrate progression of this phenomenon. Two of the 6 patients showed partial or complete resorption of the coronoid process and this was also seen in another patient. The thickening of the periodontal membrane did not seem to present clinical problems but the resorption of bone at the mandibular angle was regarded as more serious, because of the possibility of a pathological fracture. Although the aetiology of the resorption of mandibular bone is unknown, the authors believe this to be the result of pressure atrophy or ischaemia, this having been reported for other skeletal lesions. E. R. Smart
Journal of Dentistry, Vol. ~/NO. 1
and three for both jaws. Alternate ribs, such as the sixth and eighth or fifth, seventh and ninth, are removed. One edge of the longest rib is removed to open the medullary cavity, and grooves are cut through the superior, medial and inferior surfaces at l-cm intervals or less with a burr. The graft is bent to conform to an acrylic model, fitting it to the lingual side anteriorly, below the maxillary ridge, trimmed to leave sufficient inter-ridge space posteriorly and trimmed again to fit against the medial aspect of the ramus without undue bulk. A similarly prepared rib is fitted to the labial aspect of the residual maxillary ridge, trimming the inner aspect to fit the zygomatic buttress. Cancellous bone is removed from the remaining pieces and the cortical bone cut into 4-6-mm fragments. With the mandible the mylohyoid muscle and superior fibres of genioglossus are detatched. The graft is wired in the midline and to the two rami. In the maxilla augis effected laterally in the mentation posterior part and anteriorly and vertically in the front. Two figure-of-eight wires are inserted anteriorly and two interosseous wires posteriorly. All gaps are packed with bone chips. Perforating sutures from the wires, through the palatal flaps, are used to retain a palatal pressure pack. Many technical details are carefully discussed. G. Ft. Seward
ORAL SURGERY BAKER R. D.. HILL C. and CANNOLE P. W. Re-prosthetic augmentation grafting-autogenour bone, J. Oral Surg. 35 (1977) 541561. Augmentation grafting is used to reinforce a previous graft which bridges a gap where a full thickness segment of jaw has been lost and where the graft is inadequate in strength or alignment. It is also used to fill localized defects in the alveolar process or to restore function and prevent fracture where there is extreme generalized atrophy of the jaws. Methods of augmentation grafting are reviewed. All suffer from certain disadvantages, notably marked early resorption. Rib grafting is now generally accepted as giving the best results. The operative technique is as follows. Lengths of rib measuring 15 cm each are cut; two for the mandible
CHERRY C. 0. and FREW A. L. Bilateral reductions of articular eminence for chronic dislocation, J. Oral Surg. 35 (1977) 598-600. The intention of the operation is to permit unrestrained and unimpaired excursion of the condyles. At operation the joint capsule is exposed and reflected from the articular eminence. Both the tubercle and the inferior eminence are reduced with burrs, leaving no rough edges. The procedure is repeated on the other side and the mandible manipulated to check condyle movement. The wounds are closed with drainage. The results in 8 patients were reviewed. Four were reported as cured, 3 as improved and one as unchanged. Persistent crepitus in the joint was attributed to the condyle sliding out from under the meniscus or to roughness of the reduced eminence left at