James V. Manzione

Magnetic resonance imaging of the temporomandibular joint meniscus

This report describes early experience with magnetic resonance imaging (MRI) of the temporomandibular joint meniscus in which surface coil technology was used. The results suggest remarkable imaging capabilities and speed with noninvasive methods.

Arthrographically guided splint therapy for recapturing the temporomandibular joint meniscus.

Splint therapy for mandibular repositioning is an accepted method of treatment for patients with temporomandibular joint pain and dysfunction. An accurate method of registering the optimal mandibular position on the basis of meniscocondyle relationships depicted on arthrographs is described.

Improved magnetic resonance imaging of the temporomandibular joint by oblique scanning planes

This study was undertaken to investigate whether the quality of magnetic resonance images of the temporomandibular joint could be improved by scanning in oblique planes oriented according to the individual angle of the mandibular condyle (oblique images) instead of in the true anatomic sagittal and coronal planes (orthogonal images). Sagittal and coronal magnetic resonance images obtained by both methods in 21 patients were compared for image quality of the disk. In more than half the patients the oblique images demonstrated the anatomy of the disk better than the orthogonal images. Oblique images are therefore recommended.

Anatomic Findings and Management of Choanal Atresia and the Charge Association

The CHARGE association is a collection of multisystem congenital anomalies including choanal atresia. A review of the literature failed to identify any specific findings that suggested the need to alter the management of choanal atresia in these patients. Our review of 24 patients with choanal atresia managed between 1974 and 1986 identified nine patients with the CHARGE criteria. These nine patients demonstrated a higher prevalence of surgical failures than the patients without the CHARGE association. The reasons are discussed, and computed tomographic scans demonstrate the anatomic findings of a more contracted nasopharynx and narrowed posterior choanal region. Thus, successful repairs require a more radical resection of the posterior nasal septum and lateral bony walls that can be achieved only with a transpalatal approach. The preoperative airways of CHARGE association patients are also at increased risk of obstruction and may require intubation or tracheotomy during the early life of the patient.

Evaluation of arthrographically assisted splint therapy in treatment of TMJ disk displacement

Eighty-two patients with audible clicking were evaluated and treated with splints made by using arthrographic assistance. In the course of this study, it became apparent that the later the opening click, the earlier the closing click. It was not always possible to auscultate or palpate either an opening or a closing click in many patients with arthrographic findings of disk displacement with reduction. Since the opening click was the only audible sound in some patients, clinical judgment alone cannot be used to replace the displaced disk at an optimal mandibular position. The elimination of the opening click does not always signify recapture of the disk. Maxillomandibular and incisal relationships limit the amount of protrusion possible to recapture the displaced disk.

Gadolinium‐DTPA‐Enhanced magnetic resonance scanning in cerebellopontine angle tumors

Magnetic resonance (MR) imaging has quickly emerged and already replaced computerized tomography (CT) in the evaluation of cerebellopontine angle (CPA) lesions, although even MR scanning may occasionally yield equivocal results. We recently studied six patients with a new MR image‐enhancing contrast, gado‐linium‐DTPA (Gd‐DTPA). All patients were suspected of having CPA pathology, and the standard MR scan was either negative, equivocal, or left unanswered questions regarding confirmed lesions. The Gd‐DTPA‐enhanced MR scan confirmed tumors or added useful information in five of six patients.

Arthrographically assisted splint therapy

Occlusal splints are often constructed to aid in treatment of temporomandibular joint meniscus displacement. Techniques for arthrographically locating the point of meniscal displacement and for fabrication of an appropriate occlusal splint are described.

Arthrographically assisted splint therapy: A 6-month follow-up

After repositioning splint therapy, 51 patients were evaluated for a minimum of 6 months. Forty-five (88%) of the patients were considered to have been treated successfully, whereas six (12%) patients required surgery to correct meniscal displacement. A detailed analysis of signs and symptoms before and after splint treatment is in progress.

Use of TMJ arthrotomography in the diagnosis and treatment of anterior disk dislocation

Treatment of TMJ pain and dysfunction should primarily be directed at correction of a specific abnormality and the patients chief complaint. The specific approach to treatment of TMJ abnormalities is based on an accurate diagnosis. Although sound clinical judgment often suggests a tentative diagnosis, the specific diagnosis can often be confirmed radiographically. Fluoroscopic arthrotomography can effectively aid in the diagnosis and treatment needed for effective and efficient TMJ care. It is especially beneficial in the diagnosis and treatment of anterior disk dislocation. The authors conclude that (1) anterior disk dislocation is a common occurrence in TMJ intra-articular disorders; (2) standard radiographs are not diagnostic for ADD; (3) arthrotomography is an effective aid in the diagnosis and treatment of TMJ soft tissue derangements, especially ADD; (4) use of arthrotomography should be based on sound clinical judgment; (5) the causes and significance of and the optimal treatment for ADD are controversial at this time; and (6) knowledge gained from arthrotomography may clarify these controversies.

Computed tomography for internal derangements of the temporomandibular joint: A technical report

Abstract A technique for maximizing the ability to perform direct sagittal CT scanning of the TMJ with the GE 8800 CT scanner gantry is described.