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Correlation of clinical findings with arthrographic diagnoses in TMJ patients
176 Reviews and abstracts
Am. J. Orthod.
Dentofac. Orthop. Au@st 1988
method of cephalometric analysis was used to appraise the variable depth, height, and positional relations among the facial components These relationships were evaluated to determine their impact on the configuration of the Down syndrome face compared with the normal face. This investigation has determined distinct proportional variances in craniofacial depth between persons with Down’s syndrome and normal individuals examined. In addition, some proportional differences were distinguished for posterior facial height. The major determinants for the profile of the Down syndrome sample were found to be in the anteroposterior positions of the maxilla and the mandible, and the effective mandibular length in relation to the cranial base. In general, compared to the normal subjects, the maxilla became more retrusive in position, with age becoming significant by adulthood; the mandible was significantly greater in effective length and became more protrusive in position with age. Therefore, the facial imbalance noted in the Down syndrome sample increased with age and was characterized not only by relative size disharmony, but by positional variation also.
higher values for the cleft side than for the noncleft side, both in the cleft lip (CL) and the unilateral cleft lip and palate (UCLP) samples. In the cleft palate (CP) sample and in the controls, unilateral nasal resistance did not differ between the two sides. Comparisons were made between cephalometric measurements for craniofacial form and head posture for each category of the clefting deformity and the controls; the statistically significant differences were tabulated. Previous studies have demonstrated associations between craniocervical angulation and craniofacial morphology, and between airway adequacy and craniocervital angulation. In the present study, differences and correlations were calculated in face height, head posture, and airway resistance that were in agreement with the predicted pattern of associations between craniocervical angulation and craniofacial morphology (face height) and between airway adequacy and craniocervical angulation.
The Measurement of Craniofacial Morphology Head Posture and Nasal Airflow in Patients With Congenital Clefts of the Lip and Palate
Correlation of Clinical Findings With Arthrographlc Diagnoses in TYJ Patients
John Andrew Sandham
Eastman Dental Center, Rochester, NT., 1987
University of Edinburgh, 1987
The present study was both methodological and investigative in nature. This included the development of computerized rhinomanometry and establishment of cephalometric measurement apparatus together with a standardized lateral cephalometric radiographic technique to record natural head posture. The method errors of both the measurement systems and the operator were tested by duplicate determinations and subsequent statistical analysis. Recordings for all the variables in the study were reproducible without systematic error and with a very small method error. Apparatus was used to record nasal respiratory resistance (NRR), craniofacial form, and head posture in a control group for comparison with subjects with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP) . The results of the rhinomanometric recording indicated that the bilateral nasal resistance did not differ significantly between the cleft samples and the controls. Unilateral measurements of nasal resistance showed
ReBearchabstracts
C. A. Roberts, R. H. Tallents, Y. A. Espeland, S. L. Handelman, and R. W. Katzberg
An internal derangement of the temporomandibular joint has been defined as an abnormal relationship of the articular meniscus relative to the glenoid fossa, mandibular condyle, and articular eminence. There are two major types of internal derangements: meniscus displacement with reduction and meniscus displacement without reduction. To date no previous studies have directly compared clinical findings with the arthrographic depiction of meniscal dysfunctions. The purpose of this investigation was to correlate specific clinical findings from patients with TMJ pain and dysfunction to the arthrographic depiction of internal derangements and to assess the possibility of diagnosing internal derangements without radiologic procedures. Two hundred five patients with signs and symptoms of TMJ pain and dysfunction were examined both clinically and arthrographically. The mean age was 30.1 years with a 6.6: 1 female to male ratio. The clinical examination covered an array of subjective and objective findings. The majority of the patients (188 of 205 or 91%) had unilateral arthrograms. Several clinical
Volume 94 Number 2
Reviews and abstracts 177
findings, such as the range of mandibular movements, joint sounds, and the evidence of degenerative joint disease, were strongly associated with specific internal derangements. However, other clinical findings, such as muscle palpation, the history of the patient’s pain, and many occlusal factors, could not be associated with a specific arthrographic diagnosis. By use of decision rules formulated from a stepwise discriminant analysis, we were able to predict arthrographic diagnoses with reasonable accuracy. From a simpler set of rules, reasonable predictions were possible, but not on the total patient population. With both sets of rules, the most difficult patients to predict were those with normal arthrographic findings. We concluded that Q reason&y accurate prediction of internal derangements of the temporomandibular joint can be made from clinical jindings. However, for the dejinitive diagnosis of intracapsular disease, radiologic evaluation may be necessary.
Dimensional Changes as Related to Skeletal
of the Human Face Maturation Indices
Edward P. Snyder Eastman Dental Center, Rochester, N.Y., 1987
Records of 20 female and 18 male subjects collected at the Denver Child Research Council were used. These were taken on a regular schedule from infancy to adulthood and included lateral cephalograms and hand-wrist x-ray films. Tra.cings were made and 29 cephalometric points were marked by means of the definitions established in the Michigan Atlas of Craniofacial Growth by Riolo and associates. These were digitized and 31 linear and 30 angular measurements derived. The skeletal maturity index (SMI) of Fishman was used to establish the skeletal maturity age (SMA) of the subjects at the time each lateral cephalogram was taken. Data from each subject at the age closest to 14 years were collected and compared with the Downs standards. Although differences were rated between the two, they were well within the limits of normal variation, especially for skeletal features. The sample was therefore considered representative of a normal population as defined by Downs. Subjects were separated according to sex and combined into three skeletal maturity levels that represented accelerating peak growth and decelerating phases of the adolescent growth spurt-SMI 1-3, SMI 4-7, and SMI 8-11, respectively. The SMA method was compared with the Michigan standards and found to be a more consistent way of determining growth changes than
chronologic age. The percentage change between these groups was determined and the male and female growth rates found to be essentially the same, indicating that the biologic process controlling growth during the pubertal growth spurt is common to both sexes. Male and female subjects grew the same; they just grew at different chronologic ages.
Collagen Typing of the Human Temporomandfbular Joint Meniscus Paul D. Regan Eastman Dental Center, Rochester, N.Y., 1987
Configuration of the TMJ meniscus is dependent on its collagenous fiber network, which can change in response to stress. Internal derangements may cause or be caused by alteration of the collagen. This research was directed toward development of a reliable method for identifying collagen type in human meniscus as a means of studying the problem. The samples were analyzed via SDS slab gel electrophoresis using acrylamide gel. A stacking gel placed on top of a gradient gel gave greatly improved resolution. Quantitative analysis of the gels was carried out with a Beckman DU-50 spectrophotometer. Type I collagen was identified; but also identified was another substance that may have been Type II or Type III collagen. Work continues to determine whether collagen type in the meniscus varies by region.
Computer Tomographic Evaluation of the Density of the TMJ Meniscus Mario E. Paz, Richard W. Kstzberg, Ross H. Talknts, and J. Daniel Subtelny Eastman Dental Center, Rochester, N.Y., 1987
Pathologic alteration of the attic&r disk including moderate calcification within the disk proper reportedly occurs in as many as 75% of the TMJ dysfunction cases with chronic anterior meniscal displacement. The purpose of this investigation was to measure by direct sagittal computed tomographic (CT) scanning technology, the density (x-ray attenuation) of the meniscus. Fifty-two patients, shown to have meniscus displacement with or without reduction (MD/MDR), and 24 symptomatic patients with normal CTs were evaluated using a GE 8800 CT scanner. Mean attenuation values were extrapolated by use of a symmetrical (1 to 9 pixels) region of interest (ROI) cursor. Density gradients of retromeniscal tissue, lateral pterygoid fat pad, and lat-
Am. J. Orthod.
Dentofac. Orthop. Au@st 1988
method of cephalometric analysis was used to appraise the variable depth, height, and positional relations among the facial components These relationships were evaluated to determine their impact on the configuration of the Down syndrome face compared with the normal face. This investigation has determined distinct proportional variances in craniofacial depth between persons with Down’s syndrome and normal individuals examined. In addition, some proportional differences were distinguished for posterior facial height. The major determinants for the profile of the Down syndrome sample were found to be in the anteroposterior positions of the maxilla and the mandible, and the effective mandibular length in relation to the cranial base. In general, compared to the normal subjects, the maxilla became more retrusive in position, with age becoming significant by adulthood; the mandible was significantly greater in effective length and became more protrusive in position with age. Therefore, the facial imbalance noted in the Down syndrome sample increased with age and was characterized not only by relative size disharmony, but by positional variation also.
higher values for the cleft side than for the noncleft side, both in the cleft lip (CL) and the unilateral cleft lip and palate (UCLP) samples. In the cleft palate (CP) sample and in the controls, unilateral nasal resistance did not differ between the two sides. Comparisons were made between cephalometric measurements for craniofacial form and head posture for each category of the clefting deformity and the controls; the statistically significant differences were tabulated. Previous studies have demonstrated associations between craniocervical angulation and craniofacial morphology, and between airway adequacy and craniocervital angulation. In the present study, differences and correlations were calculated in face height, head posture, and airway resistance that were in agreement with the predicted pattern of associations between craniocervical angulation and craniofacial morphology (face height) and between airway adequacy and craniocervical angulation.
The Measurement of Craniofacial Morphology Head Posture and Nasal Airflow in Patients With Congenital Clefts of the Lip and Palate
Correlation of Clinical Findings With Arthrographlc Diagnoses in TYJ Patients
John Andrew Sandham
Eastman Dental Center, Rochester, NT., 1987
University of Edinburgh, 1987
The present study was both methodological and investigative in nature. This included the development of computerized rhinomanometry and establishment of cephalometric measurement apparatus together with a standardized lateral cephalometric radiographic technique to record natural head posture. The method errors of both the measurement systems and the operator were tested by duplicate determinations and subsequent statistical analysis. Recordings for all the variables in the study were reproducible without systematic error and with a very small method error. Apparatus was used to record nasal respiratory resistance (NRR), craniofacial form, and head posture in a control group for comparison with subjects with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP) . The results of the rhinomanometric recording indicated that the bilateral nasal resistance did not differ significantly between the cleft samples and the controls. Unilateral measurements of nasal resistance showed
ReBearchabstracts
C. A. Roberts, R. H. Tallents, Y. A. Espeland, S. L. Handelman, and R. W. Katzberg
An internal derangement of the temporomandibular joint has been defined as an abnormal relationship of the articular meniscus relative to the glenoid fossa, mandibular condyle, and articular eminence. There are two major types of internal derangements: meniscus displacement with reduction and meniscus displacement without reduction. To date no previous studies have directly compared clinical findings with the arthrographic depiction of meniscal dysfunctions. The purpose of this investigation was to correlate specific clinical findings from patients with TMJ pain and dysfunction to the arthrographic depiction of internal derangements and to assess the possibility of diagnosing internal derangements without radiologic procedures. Two hundred five patients with signs and symptoms of TMJ pain and dysfunction were examined both clinically and arthrographically. The mean age was 30.1 years with a 6.6: 1 female to male ratio. The clinical examination covered an array of subjective and objective findings. The majority of the patients (188 of 205 or 91%) had unilateral arthrograms. Several clinical
Volume 94 Number 2
Reviews and abstracts 177
findings, such as the range of mandibular movements, joint sounds, and the evidence of degenerative joint disease, were strongly associated with specific internal derangements. However, other clinical findings, such as muscle palpation, the history of the patient’s pain, and many occlusal factors, could not be associated with a specific arthrographic diagnosis. By use of decision rules formulated from a stepwise discriminant analysis, we were able to predict arthrographic diagnoses with reasonable accuracy. From a simpler set of rules, reasonable predictions were possible, but not on the total patient population. With both sets of rules, the most difficult patients to predict were those with normal arthrographic findings. We concluded that Q reason&y accurate prediction of internal derangements of the temporomandibular joint can be made from clinical jindings. However, for the dejinitive diagnosis of intracapsular disease, radiologic evaluation may be necessary.
Dimensional Changes as Related to Skeletal
of the Human Face Maturation Indices
Edward P. Snyder Eastman Dental Center, Rochester, N.Y., 1987
Records of 20 female and 18 male subjects collected at the Denver Child Research Council were used. These were taken on a regular schedule from infancy to adulthood and included lateral cephalograms and hand-wrist x-ray films. Tra.cings were made and 29 cephalometric points were marked by means of the definitions established in the Michigan Atlas of Craniofacial Growth by Riolo and associates. These were digitized and 31 linear and 30 angular measurements derived. The skeletal maturity index (SMI) of Fishman was used to establish the skeletal maturity age (SMA) of the subjects at the time each lateral cephalogram was taken. Data from each subject at the age closest to 14 years were collected and compared with the Downs standards. Although differences were rated between the two, they were well within the limits of normal variation, especially for skeletal features. The sample was therefore considered representative of a normal population as defined by Downs. Subjects were separated according to sex and combined into three skeletal maturity levels that represented accelerating peak growth and decelerating phases of the adolescent growth spurt-SMI 1-3, SMI 4-7, and SMI 8-11, respectively. The SMA method was compared with the Michigan standards and found to be a more consistent way of determining growth changes than
chronologic age. The percentage change between these groups was determined and the male and female growth rates found to be essentially the same, indicating that the biologic process controlling growth during the pubertal growth spurt is common to both sexes. Male and female subjects grew the same; they just grew at different chronologic ages.
Collagen Typing of the Human Temporomandfbular Joint Meniscus Paul D. Regan Eastman Dental Center, Rochester, N.Y., 1987
Configuration of the TMJ meniscus is dependent on its collagenous fiber network, which can change in response to stress. Internal derangements may cause or be caused by alteration of the collagen. This research was directed toward development of a reliable method for identifying collagen type in human meniscus as a means of studying the problem. The samples were analyzed via SDS slab gel electrophoresis using acrylamide gel. A stacking gel placed on top of a gradient gel gave greatly improved resolution. Quantitative analysis of the gels was carried out with a Beckman DU-50 spectrophotometer. Type I collagen was identified; but also identified was another substance that may have been Type II or Type III collagen. Work continues to determine whether collagen type in the meniscus varies by region.
Computer Tomographic Evaluation of the Density of the TMJ Meniscus Mario E. Paz, Richard W. Kstzberg, Ross H. Talknts, and J. Daniel Subtelny Eastman Dental Center, Rochester, N.Y., 1987
Pathologic alteration of the attic&r disk including moderate calcification within the disk proper reportedly occurs in as many as 75% of the TMJ dysfunction cases with chronic anterior meniscal displacement. The purpose of this investigation was to measure by direct sagittal computed tomographic (CT) scanning technology, the density (x-ray attenuation) of the meniscus. Fifty-two patients, shown to have meniscus displacement with or without reduction (MD/MDR), and 24 symptomatic patients with normal CTs were evaluated using a GE 8800 CT scanner. Mean attenuation values were extrapolated by use of a symmetrical (1 to 9 pixels) region of interest (ROI) cursor. Density gradients of retromeniscal tissue, lateral pterygoid fat pad, and lat-