J. Fernández Sanromán

Relationship between condylar position, dentofacial deformity and temporomandibular joint dysfunction: an MRI and CT prospective study

The possible relationship between the morphometric characteristics (condylar and temporomandibular joint (TMJ) disc position) of the TMJ and the TMJ clinical findings (normal versus TMJ disorders) in different types of dentofacial deformities was studied. Forty-eight patients with dentofacial deformities (96 TMJs) were investigated preoperatively and 10 patients (20 TMJs) without deformities were studied as a control group, clinically and radiographically, using computer tomography (CT) and magnetic resonance imaging (MRI), to assess the position of the mandibular condyle and the TMJ disc in the sagittal, coronal and horizontal planes. Fifteen of the 28 joints (53.6%) of patients diagnosed as class II dentofacial deformity had internal derangements and anteriorly displaced discs. The incidence of internal derangement in the class I and class III groups was lower (10%). An increased horizontal angle of the mandibular condyle and a posteriorly seated condyle were found in patients diagnosed as class II dentofacial deformity when compared with the control group. The rest of the patients studied showed no significant differences. The same results were encountered when the patients with moderate to severe TMJ pathology were studied, both clinically (using the Helkimo index modified by Athanasiou) and by MRI.

Morphometric and morphological changes in the temporomandibular joint after orthognathic surgery: a magnetic resonance imaging and computed tomography prospective study

The possible morphological and morphometric changes in the different components of the temporomandibular joint (TMJ) after orthognathic surgery were analysed using computed tomography (CT) transverse scans and sagittal and coronal magnetic resonance imaging (MRI) images. Twenty-four patients with class III dentofacial deformity were studied. Nine had isolated maxillary osteotomies and 15 had combined maxillary and mandibular subcondylar osteotomies (MSO). Ten patients were studied as a control group. The patients were studied clinically, radiographically and with CT and MRI in four different phases in order to locate the position of the mandibular condyle in relation to the glenoid fossa. No statistically significant differences were found in the group of patients who had had isolated maxillary osteotomies throughout the four phases of the study. Patients treated by bimaxillary surgery showed different condylar movements after surgery. Intra-articular effusion was evident during the early postoperative period in patients treated by bimaxillary surgery. Although different changes in the position of the bony components of the TMJ occurred after MSO, these seemed to be transient, with no major alterations in the final outcome in the patients.

Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study

The aim of this study was to evaluate the efficacy of injection of plasma rich in growth factors (PRGF) after temporomandibular joint (TMJ) arthroscopy in patients with Wilkes stage IV internal derangement. Ninety-two patients were randomized to two experimental groups: group A (42 joints) received injections of PRGF, group B (50 joints) received saline injections. Pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm) were measured before and after surgery and compared by analysis of variance (ANOVA). The mean age of patients was 35.8 years (range 17-67 years); 86 were female. Significant reductions in pain were noted in both groups after surgery: VAS 7.9 preoperative and 1.4 at 24 months postoperative. Significantly better clinical results were achieved in group A than in group B only at 6 and 12 months postoperative; no significant difference was noted at 18 or 24 months after the surgical intervention. MMO increased after surgery in both groups: 26.2mm preoperative and 36.8mm at 24 months postoperative. No significant differences in MMO were found when the two groups of patients were compared. In conclusion, the injection of PRGF does not add any significant improvement to clinical outcomes at 2 years after surgery in patients with advanced internal derangement of the TMJ.

Benign symmetrical lipomatosis with mediastinal involvement and growth retardation

Abstract Benign symmetrical lipomatosis (BSL) is a rare disease characterized by symmetrical deposition of adipose tissue in the neck and upper trunk. Deltoid region and upper arm fatty deposits are rarely found and involvement below the torso is very uncommon. 1 The disorder was first mentioned by Brodie in 1846 and Madelung published details of a series of 33 cases in 1888. 2 Launois and Bensaude established BSL as a unique clinical entity in 1898. 3 The disorder occurs in both sexes, but is most commonly found in middle-aged men. The condition has been referred to as Madelungs disease, Launois and Bensaude syndrome, Buschkes disease, lipoma diffusa symmetrica, and benign symmetrical lipomatosis. 4 The report describes a case with involvement of the upper mediastinum and growth retardation.

Tratamiento quirúrgico del granuloma central de células gigantes: estudio y seguimiento de 10 casos. Revisión de la literatura

Resumen Objetivos El granuloma central de celulas gigantes (GCCG) es una lesion benigna, no odontogenica, de origen incierto y con unas caracteristicas epidemiologicas, clinicas y radiologicas bien conocidas. El objetivo de nuestro estudio es recoger, describir y evaluar nuestra experiencia en el tratamiento quirurgico de este tipo de lesiones y su seguimiento, haciendo especial hincapie en los datos clinicos y radiologicos asi como en las complicaciones y recidivas tras el mismo. Se realiza, ademas, una revision de la literatura cientifica. Material y metodos Se trata de un estudio retrospectivo de 10 casos intervenidos en nuestro centro entre los anos 1998 y 2008. La edad media fue de 35 anos. Se describen las caracteristicas clinicas y radiologicas de cada caso, asi como la mejor opcion de tratamiento quirurgico, evaluacion del mismo, complicaciones y recidivas. Resultados Se realiza tratamiento quirurgico en los 10 casos, de los cuales 4 presentan caracteristicas clinicas y radiologicas de agresividad. El tratamiento de eleccion es la escision y curetaje hasta hueso sano en el 60%, y en el resto reseccion amplia con margenes. El periodo de seguimiento medio es de 6,7 anos, con una tasa de recidiva del 1%. Conclusion En nuestra experiencia coincidimos con la mayoria de los autores al considerar el tratamiento quirurgico de eleccion en el momento actual, senalando la importancia de realizar un adecuado diagnostico y una clara diferenciacion entre lesiones agresivas y no agresivas para determinar la radicalidad de la intervencion.

O.133 Transverse distraction osteogenesis of the maxilla and mandible using modified hyrax appliances

below 30% had an increase to more than 30% post-operatively which was considered to be indicative of hypernasality. Conclusion: Advancement of the cleft maxilla can result in either increases or decreases in nasalance in the early post-operative period for both surgical methods. The study illustrates individual differences in compensation to structural changes, as well as the need for longer-term follow-up, as planned in our study.