Leslie Heffez

CT evaluation of TMJ disc replacement with a proplast-teflon laminate

A series of 12 temporomandibular joints treated by discectomy and replacement with Proplast nonporous Teflon laminates were examined retrospectively using direct sagittal and coronal computed tomography. Radiographic findings included severe condylar, glenoid fossa, and eminence remodeling changes; implant migration and fragmentation; and loss of implant adaptation to the temporal bone. The radiographic changes generally occurred in patients who were completely asymptomatic clinically.

Advances in sonography of the temporomandibular joint.

The term sonography is used to describe the technique for recording and interpreting sound. Several authors have used sonography to study the diverse sounds emitted from the temporomandibular joints of patients with facial pain and masticatory dysfunction. This article describes recent technologic advances in sonography that permit digital computerized recordings of joint sounds. In addition, a software package was developed to perform sound-power spectral analysis. Selected cases are described. The potential of this new technology is explored.

A classification of temporomandibular joint disk morphology.

Disk morphology has been recognized as an important feature of internal derangements of the temporomandibular joint and as a suspect in functional impediments. A classification of disk shapes was devised by means of corrected lateral cephalometric arthrotomograms and histopathologic sagittal sections. Five basic shapes were identified: bow tie (normal), straight, funnel, bulge, and Y. Statistical analyses were performed. The normal condyle-disk-fossa relationship and slight-to-moderate disk displacement occurred with disk shape 1 (bow tie). Severe disk displacement without reduction occurred predominantly with disk shape 4 (bulge). Beaking of dye in the anterior recess of the inferior joint space was an indicator of abnormal disk morphology and displacement.

Developmental defects of the tympanic plate: Case reports and review of the literature

A complete otoscopic examination should be performed in all patients seeking treatment of temporomandibular disorders. The presence of a bulge in the external auditory meatus that disappears with mouth opening may suggest the persistence of the foramen of Huschke. The clinician should rule out the presence or history of infection, trauma, or neoplasm before ascribing the etiology of a defect to a developmental aberration.

Arteriovenous malformation of the mandible: Report of a case with a note on the differential diagnosis

Arteriovenous malformations are extremely rare conditions that can result from congenital or acquired abnormalities in the structure of blood vessels; they are potentially fatal. Arteriovenous malformations may be asymptomatic or may show various signs and symptoms including soft tissue swelling, pain, changes in skin and mucosal color, erythematous and bleeding gingiva, bruit, and paresthesia. Radiographically, there are no pathognomonic features. The present case illustrates an arteriovenous malformation in a 16-year-old Hispanic female. The case report is unique because the malformation was previously interpreted as a pathosis of pulpal origin and was initially treated as such, although the tooth showed no gross or radiographic dental caries. A broad view of the diagnostic imaging, radiographic differential diagnosis, treatment, and histopathologic description is also presented.

Crystal methamphetamine abuse: a concern to oral and maxillofacial surgeons.

Synthetically manufactured methamphetamine (ice, crystal) appears to be undergoing a rebirth in popularity because experienced drug users are reportedly unable to distinguish between the qualities of the cocaine and methamphetamine euphoria. Like cocaine, adverse drug reactions with therapeutic drugs used in dentistry have been reported, ranging from mild intoxication to sudden death. This article discusses the pharmacology of this illicit drug and the problems associated with its use in patients undergoing oral and maxillofacial surgery.

Determination of the radiographic position of the temporomandibular joint disk

We describe a method of measuring displacement and reduction of the temporomandibular joint (TMJ) disk that makes use of reproducible geometric measurements from radiographs in the sagittal plane. This procedure leads to a simple quantitative classification scheme for condyle-disk-fossa/eminence relationships. The method was applied to microscopic sections of 12 human TMJs and then to 30 complete lateral corrected cephalometric arthotomographic studies of the TMJ. Statistical analyses of the classification scheme confirm that it is highly significant and consistent with clinical diagnoses.

The role of magnetic resonance imaging in the diagnosis and management of ameloblastoma

Magnetic resonance (MR) images of ameloblastoma are compared with computed tomographic (CT) images with the use of three parameters: artifact degradation, edge definition, and conspicuity. As a basis for comparison, MR imaging characterization of normal tissues is reviewed. The three cases studied demonstrate the importance of weighing heavily on MR for evaluation of tumor-normal tissue interface. MR generally proved to be superior to CT in the evaluation of recurrent disease because of its ability to differentiate tissues on the basis of their proton composition. CT images reflect the electron densities of tissues. Hence, interpreting inflammatory and postsurgical changes and differentiating them from neoplasm may be difficult. At the present time, familiarity with CT dictates that the MR evaluation complement and not substitute the CT evaluation.

Superficial vascularity of temporomandibular joint retrodiskal tissue: an element of the internal derangement process.

Superficial vascular changes in the retrodiskal tissue are an aspect of the remodeling process during progressive anterior displacement of the temporomandibular joint (TMJ) disk. The salient portion of the remodeled retrodiskal tissue (RRT) is contained in a 3 x 3 grid of arthroscopic fields in the superior joint space, plus the tympanic portion of the remodeled retrodiskal tissue. A four-level vascularity classification system gives a statistically significant association between superficial avascularity of the remodeled retrodiskal tissue and progressive stages of disk derangement. In particular, simultaneous avascularity in both the tympanic remodeled retrodiskal tissue and the central arthroscopic field occurs with severe disk displacement without reduction. Analyses are based on 16 microscopic studies, 25 magnetic resonance imaging and tomographic imaging studies, and 26 arthroscopic studies.

Multiple idiopathic resorption in the primary dentition: Review of the literature and case report

Resorption of primary teeth is a normal physiologic process, except when it occurs prematurely. Resorption of permanent teeth is considered abnormal, and multiple etiologic factors have been implicated. A significant number of cases are represented by idiopathic resorption. Multiple idiopathic root resorption stands as a separate physiologic entity that has been described as affecting the entire permanent dentition. Multiple idiopathic resorption of primary teeth has not been previously reported. A case is described and a differential diagnosis is provided. The specific radiographic diagnostic criteria for this condition affecting the primary dentition are outlined.