Isabela Maddalena Dias

Evaluation of the correlation between disc displacements and degenerative bone changes of the temporomandibular joint by means of magnetic resonance images

The aim was to evaluate the correlation between disc displacements and degenerative bone changes in magnetic resonance images (MRI) of 112 patients of both genders, with signs and symptoms of temporomandibular disorder. For this purpose, a calibrated examiner evaluated 224 MRI by assigning scores for the displacement of the disc and degenerative bone changes. Disc displacement was found in 58.42% of the temporomandibular joints (TMJs) evaluated. Anterior displacement of the disc with reduction was the most common, occurring in 67.18% cases of joints with disc displacement. Degenerative bone changes were observed in 53.94% of the TMJs analysed. There was significant correlation between disc displacement with reduction and condylar flattening, disc displacement without reduction and condylar flattening, disc displacement without reduction, and associated degenerative bone changes (flattening and erosion, flattening, osteophyte and erosion; flattening and osteophytes, erosion and sclerosis, flattening and sclerosis, flattening, osteophytes and sclerosis). The correlation between advanced cases of disc displacement and the occurrence of degenerative bone changes emphasises the importance of MRI for an accurate diagnosis and development of an appropriate treatment plan and in cases in which clinical examination is not sufficient for these purposes.

Evaluation of temporomandibular joint disc displacement as a risk factor for osteoarthrosis

Temporomandibular joint (TMJ) disc displacement is a clinical sign often found in patients with temporomandibular disorders (TMDs) and associated with TMJ osteoarthrosis. Osteoarthrosis is a degenerative joint disease that may be associated with pain and functional disability. The aim of this study was to evaluate the odds ratio (OR) of joints with disc displacement presenting osteoarthrosis via magnetic resonance imaging (MRI) analysis. In total, 224 TMJ images from patients with signs and symptoms of a TMD were evaluated. The OR, a measure of association, was used to calculate the likelihood of TMJ disc displacement (with or without reduction) with osteoarthrosis. Joints with anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) were 2.73- and 8.25-times, respectively, more likely to have osteoarthrosis. A nine-times greater likelihood of osteophyte occurrence was observed in cases of ADDwoR, whereas a lower OR for their occurrence (OR 2.96) was observed in cases of ADDwR. The significant OR of joints with disc displacement presenting osteoarthrosis, particularly in cases of ADDwoR, emphasizes the importance of accurate assessment of changes in disc position, which may be associated with other painful and functional disorders of the TMJ.

Specialists' perception and opinion about self-medication of patients with temporomandibular disorders and orofacial pain

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are considered the primary cause of chronic orofacial pain. Many patients consider self-medication a fast and adequate means to solve the pain problem and do not look for professional assistance. In spite of the considerable clinical implication of self-medication for temporomandibular disorders, the subject is poorly discussed in the literature. This study aimed at evaluating, by means of focus group, the opinion and perception of temporomandibular disorders/orofacial pain specialists about self-medication associated to temporomandibular disorders. METHODS: Focal group is a qualitative methodology technique which, by means of participants interaction, aims at collecting data as from a discussion focused on specific topics. By means of speech, subjects freely express their knowledge, beliefs, attitudes and perceptions contributing to deepen the knowledge about a core subject. Participated in the study five temporomandibular disorders/orofacial pain specialists and a moderator who led the discussion. The following topics were addressed: temporomandibular disorders, orofacial pain, used drugs, opinions/ attitudes with regard to self-medication, assistance/management of temporomandibular disorders. Speeches were recorded in audio and video for further data analysis. RESULTS: Self-medication associated to temporomandibular disorders was pointed by specialists as extremely frequent and noxious to the disease, being highlighted excessive analgesic consumption and more frequent self-medication for muscular presentations. CONCLUSION: The clinical impact of self-medication to treat temporomandibular disorders was emphasized, highlighting the influence of the practice in worsening and even chronicity of the disorder.

Prenatal detection of cardiac rhabdomyomas and cerebral lesions in a fetus with tuberous sclerosis: a case report

Tuberous sclerosis is characterized by the development of hamartomatous lesions throughout many tissues, particularly the brain, the skin, the heart and the kidneys. The authors report a case of tuberous sclerosis suspected by prenatal ultrasound detection of cardiac rhabdomyomas and brain masses. At 20 weeks the ultrasound evaluation did not reveal any cardiac or brain lesions. Later on, at 33 weeks, multiple echogenic masses in the heart, located in the ventricular walls and interventricular septum and two small cerebral echogenic masses were diagnosed. No other abnormalities were noted. There is no previous genetics history in the family. Sequential examination revealed a discrete increase in size of the tumors; no hemodynamic or arrhythmic consequences were detected. A male fetus was delivered at term, with normal weight and Apgar score. Postnatal magnetic resonance imaging confirmed the small brain tumors. The baby had some seizures that were controlled with anti‐epileptic therapy. Cardiac tumors spontaneously decreased and their regression was confirmed, a few months later, by echocardiogram. The skin of the baby showed some de‐pigmented spots. No other abnormalities were detected namely in the kidneys. At 13 months, the child had normal growth and developed appropriately. As in other cases confirmed by literature the findings of cerebral lesions on fetal ultrasound can help in the prenatal diagnosis of tuberous sclerosis, but does not necessarily indicate a poor prognosis.