André Luiz Ferreira Costa

Lateral pterygoid muscle volume and migraine in patients with temporomandibular disorders

Purpose Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. Materials and Methods Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fishers exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. Results Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. Conclusion In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable.

Temporomandibular disorders in patients with craniocervical dystonia

UNLABELLEDnTemporomandibular disorders are a set of musculoskeletal dysfunctions within the masticatory system, with multiple etiologies.nnnOBJECTIVEnSince craniocervical dystonia can involve the same neuromuscular structure as the temporomandibular joint, we sought to assess the correlation between temporomandibular disorders and craniocervical dystonia.nnnMETHODnWe applied the Research Diagnostic Criteria for Temporomandibular Disorders to 42 patients with craniocervical dystonia, in order to identify orofacial pain and temporomandibular characteristics on the day of botulinum toxin injection.nnnRESULTSnTwenty-two patients (52.3%) reported temporomandibular joint pain; 24 (57.1%), joint sounds; 20 (47.6%), masticatory muscle pain; and 21 (50%), diminished jaw mobility. The patients with oromandibular dystonia presented temporomandibular disorders more frequently than did patients with other types of craniocervical dystonia (p<0.001).nnnCONCLUSIONnTemporomandibular disorders occur frequently in patients with oromandibular dystonia. Further studies should address the proper treatment of temporomandibular disorders associated with dystonia.

Value of Magnetic Resonance Imaging for Diagnosis of Dentigerous Cyst

Odontogenic cysts have a high prevalence in the dental clinic population, with dentigerous cyst being one of the most frequent ones and whose aetiology involves accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. In the diagnostic process of these lesions, one should consider complementary imaging exams such as conventional radiography and computed tomography, which are commonly used for providing anatomical information on the tissues compromised by the lesion, but not on the nature of it. Magnetic resonance imaging (MRI) scans are noninvasive modalities which, due to their unique acquisition characteristics, can provide distinct information on the nature of the lesion. This study reports on a case of dentigerous cyst in the mandible of a 9-year-old patient, documented by means of different imaging modalities. MRI played an important role in both diagnosis of the lesion and differential diagnosis between neoplastic lesions presenting similar imagenological behaviour under other techniques of radiography.

Volumetric study of sphenoid sinuses: anatomical analysis in helical computed tomography

PurposeThe sphenoid sinus is the most inaccessible part of the face, being inside the sphenoid bone and closely related to numerous vital neural and vascular structures. The objective of this study was to analyze and evaluate the variation of anatomy and the volume of the sphenoid sinus using helical computed tomography and medical imaging software.Materials and methodsA total of 47 helical CT scans of sinuses of male and female individuals aged 18–86xa0years were selected. The images were formatted using ITK-SNAP software, consisting of three steps: (1) segmentation; (2) volumetric analysis and (3) 3D reconstruction. The sphenoid sinuses were also classified according to Hammer, i.e., in conchal, pre-sellar, sellar and post-sellar types. A single investigator, who is specialist in dental radiology and was trained and calibrated, performed the volume and image analysis. After 15xa0days, the segmentations were repeated.ResultsThe Dunn’s multiple comparison test revealed significant differences in the volume rankings between the right and left sides (Pxa0=xa00.0002), with the post-sellar type presenting the greatest volume on the right side compared to pre-sellar and sellar types. In the left sphenoid sinuses, the post-sellar type showed the greatest volume. The Lin’s correlation coefficient showed excellent reproducibility values.ConclusionsAccording to the applied methodology, it was found that the volume of the sphenoid sinus was influenced by neither age nor gender (Pxa0>xa00.005). There was difference in the volumes of sphenoid sinus on the right and left sides and in the anatomical classification.

Temporomandibular dysfunction post-craniotomy: Evaluation between pre- and post-operative status

OBJECTIVEnTo identify risk factors associated with post-operative temporomandibular joint dysfunction after craniotomy.nnnMETHODSnThe study sample included 24 patients, mean age of 37.3 ± 10 years; eligible for surgery for refractory epilepsy, evaluated according to RDC/TMD before and after surgery. The primary predictor was the time after the surgery. The primary outcome variable was maximal mouth opening. Other outcome variables were: disc displacement, bruxism, TMJ sound, TMJ pain, and pain associated to mandibular movements. Data analyses were performed using bivariate and multiple regression methods.nnnRESULTSnThe maximal mouth opening was significantly reduced after surgery in all patients (p = 0.03). In the multiple regression model, time of evaluation and pre-operative bruxism were significantly (p < .05) associated with an increased risk for TMD post-surgery.nnnCONCLUSIONnA significant correlation between surgery follow-up time and maximal opening mouth was found. Pre-operative bruxism was associated with increased risk for temporomandibular joint dysfunction after craniotomy.

Investigation on the relationship of dimensions of the maxillary sinus drainage system with the presence of sinusopathies: a cone beam computed tomography study

OBJECTIVEnThis study sought to assess the relationship between the dimensions of the maxillary sinus drainage system with the content of sinuses.nnnDESIGNnThree-hundred cone beam computed tomography images were selected from a database (105 males and 195 females). The images were assessed by a single investigator, trained and calibrated, performing image analysis. The length of the infundibulum and the ostium height in both maxillary sinuses were measured. The data were analyzed using Minitab 16, using 5% as a critical p-value.nnnRESULTSnA significant gender difference was also found for presence in the normal content of sinus for females and presence of antral pseudocyst for males (pu202f<u202f0.05). Subjects with normal content in the maxillary sinus present lower ostium height values. There were statistically significant with presence of and higher ostium height values and antral pseudocyst (pu202f<u202f0.01).nnnCONCLUSIONnThe current study results demonstrated that some sinusopathies were significantly related to dimensions of maxillary sinus drainage.

Three-dimensional volumetric analysis of ghost cell odontogenic carcinoma using 3-D reconstruction software: a case report

OBJECTIVEnGhost cell odontogenic carcinoma is a very rare malignant neoplasm. Tumor volume may be a more precise alternative for determining size, which is usually measured by maximum linear dimension. The purpose of this case report is to highlight the importance of obtaining 3-dimensional (3-D) images of the tumor for volumetric analysis to improve the chances of surgical success. This report presents a case of ghost cell odontogenic carcinoma infiltrating the maxillary sinus through the palate. The lesion was surgically treated and subsequently selected for volumetric reconstruction and analysis of the tumor by using InVesalius software. In this case report, we describe the use of a pictorial technique in which the tumor volume was calculated to help predict the surgical results.nnnRESULTSnThe tumor could be visualized in 3-D, with color improving the image of the segmented volume and thus increasing the perception of boundaries and depth.nnnCONCLUSIONSnRecognition of the lesion shape by volumetric analysis can provide the surgical team with clearer information, thereby helping in surgical planning and consequently increasing the chances of surgical success.

Assessment of condyle, masseter and temporal muscles volumes in patients with juvenile systemic lupus erythematosus: A cross-sectional study

AIMSnThe purpose of this study was to evaluate the effect of the corticosteroid therapy for both treatment of juvenile systemic lupus erythematosus and disease activity on two masticatory muscles and condyle of the temporomandibular joint.nnnMETHODSnA total of 21 controls and 48 juvenile systemic lupus erythematosus patients were investigated. Volumes of the temporal and masseter muscles and condyle of the subjects were assessed by using a 3D reconstruction in magnetic resonance imaging. The ITK-SNAP, a medical imaging software, was used for 3D reconstruction. A dental examination with registration of occlusion was performed in subjects. Data were statistically analyzed by means of the Dahlbergs test associated with paired t-test, Fishers exact test and Chi-square.nnnRESULTSnThere was a positive correlation between temporalis muscle and age (pxa0=xa00.032), masseter volume (pxa0=xa00.029) and condyle volume (pxa0=xa00.013). The mean volume measurements of temporal and masseter muscles and condyle were not statistically associated with juvenile systemic lupus erythematosus regarding disease activity and corticosteroid therapy (pxa0>xa00.05). There were no significant differences between malocclusion and volume of muscles and condyle.nnnCONCLUSIONnThis study suggested that volume of the target structures has no correlation with cumulative corticosteroid dose, disease activity, and malocclusion.

3D Morphology Analysis of TMJ Articular Eminence in Magnetic Resonance Imaging

Purpose The objective of this study was to evaluate the computational reconstruction of the articular eminence of the temporomandibular joint (TMJ) based on magnetic resonance imaging (MRI) and semiautomatic volumetric segmentation techniques for morphological classification of the TMJ structure. Materials and Methods A total of 36 MRI scans of TMJ individuals were selected and formatted by using the ITK-SNAP software, consisting of MRI segmentation and generation of 3D models. The TMJ articular eminences were also classified according to the morphology analysis of the articular eminence in 3D reconstructions. Two independent trained and calibrated investigators performed the image analysis, which was repeated after thirty days. Results There was no association between sex and eminence shape (p = 0.456). Fishers test revealed no statistically significant association between disc classification and eminence shape on both sides (p = 0.629). Chi-square test showed a significant statistically association between disc classification and disc displacement (p = 0.000). Intra- and interrater correlation coefficients showed excellent reproducibility values. Conclusions Anatomical variability of the sample investigated was found, with predominantly round shape and presence of correlation between this shape and normal disc position. The correlation of flattened and convex shapes with disc position reduction indicated that type of disc derangement is more prevalent.

Peripheral Calcifying Epithelial Odontogenic Tumour Mimicking a Gingival Inflammation: A Diagnostic Dilemma

The calcifying epithelial odontogenic tumour (CEOT) is an extremely rare benign neoplasia, accounting for approximately 1% of all odontogenic tumours. CEOT can have two clinical manifestations: central or intraosseous (94% of the cases) and peripheral or extraosseous (6% of the cases). Although the latter is less common, the peripheral variant has been described as an insidious lesion, since it is usually asymptomatic and may be erroneously mistaken with gingival hyperplasia, hamartomas, or even metastasis of malignant neoplasia. We report a case of a young male patient presenting with a peripheral CEOT in the mandibular posterior region, mimicking a located gingival inflammation.