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Managing temporomandibular joint syndrome
1347
CURRENT LITERATURE
mous cell carcinoma of the parotid gland. Review of these 33 patients’ records showed that 21 patients had metastatic lesions from known primary sites. The histology of the tumors of the remaining 12 patients was re-examined. It was determined that 8 of the 12 had primary lesions. Two of four remaining cases were found to be high-grade mucoepidermoid carcinoma, one adenocarcinoma, and one had elements of both adenocarcinoma and squamous cell carcinoma arising from a pleomorphic adenoma. This information led the authors to conclude that primary squamous cell carcinoma of the parotid gland is a rare lesion that should be diagnosed only after squamous cell carcinoma metastatic to the parotid has been ruled out. Misdiagnosis of high grade mucoepidermoid or adenocarcinema is a common error that can be avoided by careful histologic review.-M. SCHROEDER Reprint requests to Dr Tucker: Department of Otolaryngology, The Cleveland Clinic Foundation, land. OH 441955034.
authors reviewed the literature to summarize the role of commonly used drugs in seizure activity. Drugs clearly implicated as seizure-producing include enflurane, meperidine, and ketamine. Methohexital may provoke convulsions in only in patients with preexisting psychomotor epilepsy. Seizurelike activity not mediated through epileptogenic foci has been shown to occur with morphine, fentanyl, and etomidate. Drugs clearly possessing anticonvulsant properties were halothane, isoflurane, methohexital, thiopental, etomidate, benzodiazepines, and ketamine. Local anesthetics are anticonvulsants in low doses and proconvulsants in high doses. Neither anti- nor proconvulsant activity could be identified in nitrous oxide, propofol, muscle relaxants, cholinesterase inhibitors, or anticholinergics. The authors present a critical review of the evidence to support these findings, and discuss the need for more sophisticated research to better characterize seizure activity.-J. DEMBO
9500 Euclid Avenue, Cleve-
Managing Temporomandibular Joint Syndrome. JM. Laryngoscope 10060, 1990
Hodges
Temporomandibular joint (TMJ) syndrome is a disease entity that may include ear pain, facial pain, headache, muscle tenderness, joint noise, tinnitus, and dizzyness. In this retrospective study of 448 cases, symptoms of TMJ syndrome were evaluated for effectiveness of therapy ranging from conservative to surgical Forty-eight percent of the cases studied presented with ear pain and 46% presented with complaints of headache, sinus pain, or neck pain. Almost 50% of these patients related some significant stress in their life. In this review, 75% of the cases were managed successfully with conservative therapy that consisted of patient education, heat, massage, nonnarcotic analgesics, and soft occlusal splints. Splint therapy was only used for acute muscle pain. Only partial relief of pain was obtained in 17% of the studied cases and these were all referred for occlussal problems. The remaining 6% were considered unsuccessful because conservative therapy failed for greater than 4 weeks. These patients received diagnostic radiography consisting of plain films, arthrograms, or magnetic resonance imaging. Surgical therapy was performed upon 51 joints with a success rate of 84% and 24 joints underwent arthroscopy with a success rate of 50%. In conclusion, the authors found temporomandibular joint syndrome has significant morbidity because of pain. Conservative therapy is the treatment of choice, with relief of pain being the primary objective. If the patient’s condition requires surgery, dental consultation gives the patient the best care and best surgical result. If conservative treatment fails, open surgical therapy can relieve pain in approximately 80% of cases-M. SCHROEDER Reprint requests to Dr Hodges: 1325 Eastmoreland, Memphis, TN 38119.
Reprint requests to Dr White: Department of Anesthesiology, Box 8054, Washington University School of Medicine. 660 South Euclid Ave, St Louis, MO 63110.
The Position and State of the Larynx During General Anesthesia and Muscle Paralysis. Sivarajan M, Fink BR. Anesthesiology 72:439, 1990 The authors state that visualization of the larynx may become more difficult with general anesthesia and muscle paralysis due to changes in position of the larynx. Nine human volunteers received 100% oxygen via face mask with the head extended and the neck flexed. Lateral radiographs were taken at end-tidal expiration. The subjects were then given a sleep dose of thiopental followed by a paralyzing dose of succinylcholine. Lateral radiographs were taken after administration of each drug. Manual ventilation was performed until recovery from anesthesia and paralysis. A blinded observer interpreted all radiographs and measured distances between selected anatomical structures. The onset of unconsciousness caused displacement of the larynx anteriorly with a longitudinal stretching and unfolding of the larynx. This study demonstrated that a shift of the laryngeal structures occurs with unconsciousness, possibly making intubation more difficult than anticipated. The authors suggest that performing awake laryngoscopy on patients with potentially difficult intubating conditions may give a false sense of security if the cords can be visualized because the anatomic position could change after anesthetic induction.-J. DEMBO Reprint requests to Dr Sivarajan: Department of Anesthesiology, Kasturba Medical College Manipal, Kamataka, India.
Primary Closure of the Split-Thickness Donor Site. Hagerty RC, Warm H. Plast Reconstr Surg 85:2, 1990
Suite 450,
Pro- and Anticonvulsant Effects of Anesthetics-Parts I and II. Modica PA, Tempelhoff R, White PF. Anesth Analg 70:303-305, 433-444, 1990 Many anesthetic and analgesic drugs have been reported to cause seizure activity, and many of these same drugs may also possess anticonvulsant properties. The
In this study, 31 patients had split-thickness skin grafts taken from the lower left quadrant of the abdomen. A Rees dermatome was used to obtain the graft, which allows the graft to be taken in the precise shape. After the grafts had been removed, the donor site was converted into an ellipse, excised down to the subcutaneous tissue, and closed primarily. The authors conclude that grafts of this type have fewer wound care problems, decreased pain, more aesthetic donor site scars. Additionally. large
CURRENT LITERATURE
mous cell carcinoma of the parotid gland. Review of these 33 patients’ records showed that 21 patients had metastatic lesions from known primary sites. The histology of the tumors of the remaining 12 patients was re-examined. It was determined that 8 of the 12 had primary lesions. Two of four remaining cases were found to be high-grade mucoepidermoid carcinoma, one adenocarcinoma, and one had elements of both adenocarcinoma and squamous cell carcinoma arising from a pleomorphic adenoma. This information led the authors to conclude that primary squamous cell carcinoma of the parotid gland is a rare lesion that should be diagnosed only after squamous cell carcinoma metastatic to the parotid has been ruled out. Misdiagnosis of high grade mucoepidermoid or adenocarcinema is a common error that can be avoided by careful histologic review.-M. SCHROEDER Reprint requests to Dr Tucker: Department of Otolaryngology, The Cleveland Clinic Foundation, land. OH 441955034.
authors reviewed the literature to summarize the role of commonly used drugs in seizure activity. Drugs clearly implicated as seizure-producing include enflurane, meperidine, and ketamine. Methohexital may provoke convulsions in only in patients with preexisting psychomotor epilepsy. Seizurelike activity not mediated through epileptogenic foci has been shown to occur with morphine, fentanyl, and etomidate. Drugs clearly possessing anticonvulsant properties were halothane, isoflurane, methohexital, thiopental, etomidate, benzodiazepines, and ketamine. Local anesthetics are anticonvulsants in low doses and proconvulsants in high doses. Neither anti- nor proconvulsant activity could be identified in nitrous oxide, propofol, muscle relaxants, cholinesterase inhibitors, or anticholinergics. The authors present a critical review of the evidence to support these findings, and discuss the need for more sophisticated research to better characterize seizure activity.-J. DEMBO
9500 Euclid Avenue, Cleve-
Managing Temporomandibular Joint Syndrome. JM. Laryngoscope 10060, 1990
Hodges
Temporomandibular joint (TMJ) syndrome is a disease entity that may include ear pain, facial pain, headache, muscle tenderness, joint noise, tinnitus, and dizzyness. In this retrospective study of 448 cases, symptoms of TMJ syndrome were evaluated for effectiveness of therapy ranging from conservative to surgical Forty-eight percent of the cases studied presented with ear pain and 46% presented with complaints of headache, sinus pain, or neck pain. Almost 50% of these patients related some significant stress in their life. In this review, 75% of the cases were managed successfully with conservative therapy that consisted of patient education, heat, massage, nonnarcotic analgesics, and soft occlusal splints. Splint therapy was only used for acute muscle pain. Only partial relief of pain was obtained in 17% of the studied cases and these were all referred for occlussal problems. The remaining 6% were considered unsuccessful because conservative therapy failed for greater than 4 weeks. These patients received diagnostic radiography consisting of plain films, arthrograms, or magnetic resonance imaging. Surgical therapy was performed upon 51 joints with a success rate of 84% and 24 joints underwent arthroscopy with a success rate of 50%. In conclusion, the authors found temporomandibular joint syndrome has significant morbidity because of pain. Conservative therapy is the treatment of choice, with relief of pain being the primary objective. If the patient’s condition requires surgery, dental consultation gives the patient the best care and best surgical result. If conservative treatment fails, open surgical therapy can relieve pain in approximately 80% of cases-M. SCHROEDER Reprint requests to Dr Hodges: 1325 Eastmoreland, Memphis, TN 38119.
Reprint requests to Dr White: Department of Anesthesiology, Box 8054, Washington University School of Medicine. 660 South Euclid Ave, St Louis, MO 63110.
The Position and State of the Larynx During General Anesthesia and Muscle Paralysis. Sivarajan M, Fink BR. Anesthesiology 72:439, 1990 The authors state that visualization of the larynx may become more difficult with general anesthesia and muscle paralysis due to changes in position of the larynx. Nine human volunteers received 100% oxygen via face mask with the head extended and the neck flexed. Lateral radiographs were taken at end-tidal expiration. The subjects were then given a sleep dose of thiopental followed by a paralyzing dose of succinylcholine. Lateral radiographs were taken after administration of each drug. Manual ventilation was performed until recovery from anesthesia and paralysis. A blinded observer interpreted all radiographs and measured distances between selected anatomical structures. The onset of unconsciousness caused displacement of the larynx anteriorly with a longitudinal stretching and unfolding of the larynx. This study demonstrated that a shift of the laryngeal structures occurs with unconsciousness, possibly making intubation more difficult than anticipated. The authors suggest that performing awake laryngoscopy on patients with potentially difficult intubating conditions may give a false sense of security if the cords can be visualized because the anatomic position could change after anesthetic induction.-J. DEMBO Reprint requests to Dr Sivarajan: Department of Anesthesiology, Kasturba Medical College Manipal, Kamataka, India.
Primary Closure of the Split-Thickness Donor Site. Hagerty RC, Warm H. Plast Reconstr Surg 85:2, 1990
Suite 450,
Pro- and Anticonvulsant Effects of Anesthetics-Parts I and II. Modica PA, Tempelhoff R, White PF. Anesth Analg 70:303-305, 433-444, 1990 Many anesthetic and analgesic drugs have been reported to cause seizure activity, and many of these same drugs may also possess anticonvulsant properties. The
In this study, 31 patients had split-thickness skin grafts taken from the lower left quadrant of the abdomen. A Rees dermatome was used to obtain the graft, which allows the graft to be taken in the precise shape. After the grafts had been removed, the donor site was converted into an ellipse, excised down to the subcutaneous tissue, and closed primarily. The authors conclude that grafts of this type have fewer wound care problems, decreased pain, more aesthetic donor site scars. Additionally. large