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Intra-articular disk displacement: its questionable role in TMJ pathology
260
British
Journal
of Oral
and Maxillofacial
Surgery
age 28 years), 55% females (mean age 25 years); 31% were students or unemployed, 69% were in employment; 85% of patients had experienced at least one episode of preoperative pain from their wisdom teeth and 48% had been kept awake at night by this pain; 55% had used analgesics and 46% had been prescribed antibiotics to control their symptoms; 34% had suffered facial swelling. Of those in employment 27% had taken at least one day off work because of their symptoms. The majority of patients who are booked to have their wisdom teeth removed under the care of consultant oral & maxillofacial surgeons have suffered significant morbidity from these teeth prior to removal. Intra-articular TMJ pathology.
disk M.
displacement: its Franklin Dolwick.
questionable
role
University
in
of Florida,
Gainesville, USA. With the introduction of arthroscopy and arthrocentesis and lavage for the temporomandibular joint (TMJ), simple lysis and lavage and the use of hydraulic pressure in the upper joint space were found to be highly effective in re-establishing normal maximal mandibular opening and reducing TMJ pain. The success of such treatment cast doubt as to the true mechanism of closed lock and the source of TMJ pain in that it did not support the idea of changes in disk shape or position as being the main cause. The relationship of disk displacement of pain and mandibular dysfunction remains unclear. Alternative explanation for these problems are plausible and should be considered. In fact evaluation of current information indicates that the role of disk displacement as the primary pathologic factor may not be justified. Although much research remains to be done, the evidence strongly suggests that TMJ internal derangement is a much more complicated processthan simply disk displacement. TMJ internal derangement also involves inflammation, changes in articular surfaces, alteration in joint pressures and synovial fluid, production of a variety of biochemical substances and probably several yet to be defined factors. Consequently, the focus of classification, diagnosis, and treatment of TMJ internal derangement on disk position should be re-evaluated. Maxillofacial
injuries
in
professional
Department of Oral-Facial UK.
footballers.
I?
D.
Earl.
Surgery, Worcester Royal Infirmary,
A few years ago maxillofacial injuries caused by elbows in clashes during football matches became highlighted in the press and media with high profile injuries to some well known players. As a football club doctor and a maxillofacial surgeon, a rise in incidence of maxillofacial injuries appeared to be noticeable at club level. A literature search failed to find any data on incidence or prevalence of injuries in British football or trends over the years. A study was therefore undertaken to collect prospective data for season 1993/4 and data from about five seasons previously. Opinions were sought from club doctors about injuries. The results would suggest that there does appear to be a genuine rise in the percentage of more serious injury and almost half the records for cause in season 1993/4 implicated elbows, but the way the data is compiled would make accurate statistical assumption cautious. There is no doubt that awareness has been strengthened by media ‘hype’ but some of these injuries are potentially serious and the concern by football authorities about such clashes and injuries is justified. Salivary lithotripsy using M. McGurk. UMDS,
a dedicated
machine.
M.
P. Escudier
&
Guy’s Dental School, Guy’s Hospital,
London Bridge, UK. Traditionally 25% of submandibular stones can be removed by a simple intra oral procedure. The remaining submandibular and parotid stones require invasive therapy in the form of surgical removal of the gland. Extra corporeal shockwave lithotripsy is an established technique in the treatment of renal and biliary calculi but has only recently been introduced to the management of sali-
vary stones with the advent of a dedicated sialolithotripter. The aim of this study was to report the results of the first 45 cases treated. In the period October 1994 to December 1995 45 patients were treated (parotid N= 15, SMG N= 30) using lo-20 thousand shocks at a frequency of 2 Hz and a pressure wave of 25-35 MPa. Patient’s symptoms were assessedpre and post-treatment and stone position confirmed in all instances by sialography and ultrasound. Patients have been followed up thereafter. In a series of 15 parotid stones fragmentation and resolution of symptoms were achieved in 86% of cases although only 13% were rendered stone free. Thirty submandibular gland stones were treated with 18% completely cleared from the duct system and 93% of patients rendered asymptomatic. Complications were minimal, 4 patients with chronic infection developed an acute exacerbation and required systemic antibiotics. Distal calculi were treated surgically. In conclusion, salivary lithotripsy is a new treatment which requires further research but has real potential. Primary oral M. Ethunandun,
leiomyosarcoma Sheila E. Fisher
Centre/University
a rare
but
signilicant
tumour.
& N. R. Gr@n. Queens Medical Hospital NHS Trust, Nottingham, UK.
Primary oral leiomyosarcoma is a rare condition. In an extensive review of the literature this century only 32 definite casescould be identified. Consequently, there is no comprehensive study of this lesion, nor have there been recommendations as to its management based on other than experience of single cases. Further to the diagnosis of a further case in our Unit, we have undertaken a full review of the information available. This suggests that primary oral leiomyosarcoma behaves differently from leiomyosarcoma elsewhere and there is also variation according to the site of origin within the oral cavity. The aim of this paper is to present a comprehensive review of the literature with emphasis on the presentation, behaviour, treatment, metastasis and outcome. Reconstruction of nasal defects using Branemark retained nasal prostheses. T. R. Flood & K. M. Russell. Odstock Centre for Bums,
Plastic and Maxillofacial Salisbury, UK.
Surgery, Salisbury District Hospital,
Reconstruction and rehabilitation of patients with large nasal defects can be extremelv difficult. Traditionallv. defects of this sort have been reconstructed using rotation flaps- from the forehead. However, this is not without its disadvantages. Since the advent of Branemark osseo integrated implants, there has been a resurgence of interest in utilizing implants for facial reconstruction. We present our experience gained in the management of patients with nasal defects following ablative surgery and describe the difficulties encountered with the technique and the surgical and prosthetic innovations developed in a response to a series of 15 patients. Development M. McGurk,
of a facial soft tissue mapping D. de Cunha & H. Slabbert.
system.
N. M. Girdler,
Guy’s Hospital Dental School & Newcastle University Dental School, UK. Current methods of measuring facial soft tissue changes during growth or following surgery are complex and expensive. The aim of this study was to develop a simple, non-invasive threedimensional method of facial soft tissue mapping using an optical system. The structured light technique consists of projecting a light pattern onto the subject followed by viewing from different directions by two video cameras. The images are captured and analysed to provide a three-dimensional surface image displayed as a colour coded map on a PC screen. The accuracy of the system for measuring surface depth and volume changes was validated using a mannikin head. Wax onlays of known volume were moulded onto the manikin face and volume differences were determined between asymmetric features either side of the midline. The errors in depth and volume estimation were 1.0 mm and 0.3 cm3 respectively.
British
Journal
of Oral
and Maxillofacial
Surgery
age 28 years), 55% females (mean age 25 years); 31% were students or unemployed, 69% were in employment; 85% of patients had experienced at least one episode of preoperative pain from their wisdom teeth and 48% had been kept awake at night by this pain; 55% had used analgesics and 46% had been prescribed antibiotics to control their symptoms; 34% had suffered facial swelling. Of those in employment 27% had taken at least one day off work because of their symptoms. The majority of patients who are booked to have their wisdom teeth removed under the care of consultant oral & maxillofacial surgeons have suffered significant morbidity from these teeth prior to removal. Intra-articular TMJ pathology.
disk M.
displacement: its Franklin Dolwick.
questionable
role
University
in
of Florida,
Gainesville, USA. With the introduction of arthroscopy and arthrocentesis and lavage for the temporomandibular joint (TMJ), simple lysis and lavage and the use of hydraulic pressure in the upper joint space were found to be highly effective in re-establishing normal maximal mandibular opening and reducing TMJ pain. The success of such treatment cast doubt as to the true mechanism of closed lock and the source of TMJ pain in that it did not support the idea of changes in disk shape or position as being the main cause. The relationship of disk displacement of pain and mandibular dysfunction remains unclear. Alternative explanation for these problems are plausible and should be considered. In fact evaluation of current information indicates that the role of disk displacement as the primary pathologic factor may not be justified. Although much research remains to be done, the evidence strongly suggests that TMJ internal derangement is a much more complicated processthan simply disk displacement. TMJ internal derangement also involves inflammation, changes in articular surfaces, alteration in joint pressures and synovial fluid, production of a variety of biochemical substances and probably several yet to be defined factors. Consequently, the focus of classification, diagnosis, and treatment of TMJ internal derangement on disk position should be re-evaluated. Maxillofacial
injuries
in
professional
Department of Oral-Facial UK.
footballers.
I?
D.
Earl.
Surgery, Worcester Royal Infirmary,
A few years ago maxillofacial injuries caused by elbows in clashes during football matches became highlighted in the press and media with high profile injuries to some well known players. As a football club doctor and a maxillofacial surgeon, a rise in incidence of maxillofacial injuries appeared to be noticeable at club level. A literature search failed to find any data on incidence or prevalence of injuries in British football or trends over the years. A study was therefore undertaken to collect prospective data for season 1993/4 and data from about five seasons previously. Opinions were sought from club doctors about injuries. The results would suggest that there does appear to be a genuine rise in the percentage of more serious injury and almost half the records for cause in season 1993/4 implicated elbows, but the way the data is compiled would make accurate statistical assumption cautious. There is no doubt that awareness has been strengthened by media ‘hype’ but some of these injuries are potentially serious and the concern by football authorities about such clashes and injuries is justified. Salivary lithotripsy using M. McGurk. UMDS,
a dedicated
machine.
M.
P. Escudier
&
Guy’s Dental School, Guy’s Hospital,
London Bridge, UK. Traditionally 25% of submandibular stones can be removed by a simple intra oral procedure. The remaining submandibular and parotid stones require invasive therapy in the form of surgical removal of the gland. Extra corporeal shockwave lithotripsy is an established technique in the treatment of renal and biliary calculi but has only recently been introduced to the management of sali-
vary stones with the advent of a dedicated sialolithotripter. The aim of this study was to report the results of the first 45 cases treated. In the period October 1994 to December 1995 45 patients were treated (parotid N= 15, SMG N= 30) using lo-20 thousand shocks at a frequency of 2 Hz and a pressure wave of 25-35 MPa. Patient’s symptoms were assessedpre and post-treatment and stone position confirmed in all instances by sialography and ultrasound. Patients have been followed up thereafter. In a series of 15 parotid stones fragmentation and resolution of symptoms were achieved in 86% of cases although only 13% were rendered stone free. Thirty submandibular gland stones were treated with 18% completely cleared from the duct system and 93% of patients rendered asymptomatic. Complications were minimal, 4 patients with chronic infection developed an acute exacerbation and required systemic antibiotics. Distal calculi were treated surgically. In conclusion, salivary lithotripsy is a new treatment which requires further research but has real potential. Primary oral M. Ethunandun,
leiomyosarcoma Sheila E. Fisher
Centre/University
a rare
but
signilicant
tumour.
& N. R. Gr@n. Queens Medical Hospital NHS Trust, Nottingham, UK.
Primary oral leiomyosarcoma is a rare condition. In an extensive review of the literature this century only 32 definite casescould be identified. Consequently, there is no comprehensive study of this lesion, nor have there been recommendations as to its management based on other than experience of single cases. Further to the diagnosis of a further case in our Unit, we have undertaken a full review of the information available. This suggests that primary oral leiomyosarcoma behaves differently from leiomyosarcoma elsewhere and there is also variation according to the site of origin within the oral cavity. The aim of this paper is to present a comprehensive review of the literature with emphasis on the presentation, behaviour, treatment, metastasis and outcome. Reconstruction of nasal defects using Branemark retained nasal prostheses. T. R. Flood & K. M. Russell. Odstock Centre for Bums,
Plastic and Maxillofacial Salisbury, UK.
Surgery, Salisbury District Hospital,
Reconstruction and rehabilitation of patients with large nasal defects can be extremelv difficult. Traditionallv. defects of this sort have been reconstructed using rotation flaps- from the forehead. However, this is not without its disadvantages. Since the advent of Branemark osseo integrated implants, there has been a resurgence of interest in utilizing implants for facial reconstruction. We present our experience gained in the management of patients with nasal defects following ablative surgery and describe the difficulties encountered with the technique and the surgical and prosthetic innovations developed in a response to a series of 15 patients. Development M. McGurk,
of a facial soft tissue mapping D. de Cunha & H. Slabbert.
system.
N. M. Girdler,
Guy’s Hospital Dental School & Newcastle University Dental School, UK. Current methods of measuring facial soft tissue changes during growth or following surgery are complex and expensive. The aim of this study was to develop a simple, non-invasive threedimensional method of facial soft tissue mapping using an optical system. The structured light technique consists of projecting a light pattern onto the subject followed by viewing from different directions by two video cameras. The images are captured and analysed to provide a three-dimensional surface image displayed as a colour coded map on a PC screen. The accuracy of the system for measuring surface depth and volume changes was validated using a mannikin head. Wax onlays of known volume were moulded onto the manikin face and volume differences were determined between asymmetric features either side of the midline. The errors in depth and volume estimation were 1.0 mm and 0.3 cm3 respectively.