Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury – Is It Safe? Radiological Simulation in a Healthy Volunteer

Introduction Cervical spine (C-spine) injury is present in up to 10% of patients with maxillofacial fractures. Uncertainty over the status of the C-spine and permitted head movements may delay maxillofacial surgical intervention, resulting in prolonged patient discomfort and return to oral nutrition, reducing quality of life. This study aimed to investigate the effects on the C-spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations – neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4–C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1–2) joints. Conclusion Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.

ADVANTAGES OF PRE-PROSTHETIC MASTICATORY SYSTEM PREPARATION WITH OCCLUSAL APPLIANCE

The aim of this literature review is to present the main advantages of pre-prosthetic preparation of the masticatory system with occlusal appliances. The possibilities for attaining muscle relaxation at the achieved centric condyle position in the temporomandibular joints are discussed. The advantages, in terms of hard dental tissue protection, the diagnostic value and the psychoprophylactic effect, are considered. The wide-ranging benefits of the use of occlusal appliances in bruxism- and bruxomania-related craniomandibular dysfunctions are indisputable and represent a current scientific interest.

Radiographic changes in the temporomandibular joint related to medication in rheumatic diseases

Objectives: The purpose of this study was to assess radiographical changes on temporomandibular joint (TMJ) in relation the autoimmune rheumatic diseases and the medicines that treat this diseases with cone beam computed tomography(CBCT). Methods: 65 people with rheumatoid diseases were included in the study and divided into five subgroups according to drugs they used. Condyle height (CH), anteroposterior dimension (APD), mesiolateral dimension (MLD) and superior joint space (SJS) were measured in order to evaluate mandibular condyle dimensions. Further, were evaluated in terms of osteoarthritic changes such as erosion, flattening, osteophyte and subchondral cyst in the mandibular condyle. TMJ measurements were compared between study-control groups and subgroups by using Student’s t-test, Mann-Whitney-U test, one-way analysis of variance (ANOVA) and Kruskal-Wallis test. The association between osteoarthritic features, rheumatoid status was tested by using χ2 test. Observers were blinded to all groups. Cohen κ values (0853–0945) and Spearman’s correlation coefficient (0.959–0.997) indicated high interexaminer reliability. Results: Condylar dimentions were significantly lower in CH and SJS in rheumatic diseases group (p < 0.001), however APD (p = 0,681) and MLD (p = 0,757) was not different significantly. Osteoarthritic changes such as erosion (p < 0.001), flattening (p = 0.005), osteophyte (p = 0.001) and subchondral cyst (p = 0.001) were significantly higher in the patient group. None of the parameters were different significantly according to subgroups determined according to drugs used(p > 0.05). Conclusions: Degenerative changes may cause decrease in condyle size and changes in condyle position. It is a process that can continue despite the use of antirheumatic or immunosuppressive drugs. All of these can become the source of possible TMJ problems.

Treatment of the mandibular shift in an adult woman and the diagnostic value of joint space index: a case report

Background Mandibular deviations are common clinical complaints. The orthodontic or orthognathic treatment of mandibular deviations is tricky because a comprehensive diagnosis, especially a functional one, is difficult to make. A inaccurate diagnosis may lead to a compromised and unstable treatment outcome. Case presentation This article describes the diagnosis and treatment of a woman with a mandibular deviation and facial skeletal asymmetry. By eliminating the disharmony of the arch form with elastics and bite turbos, her esthetic and functional outcomes improved. Cone-beam CT (CBCT) and Joint Space Index (JSI) analyses served as the diagnostic approaches and outcome evaluation methods before and after treatment. Conclusions A condyle position displacement could be an indication of functional deviation. JSI analysis is a quantitative and convenient choice to compare condyle relative positions.

Condylar position changes after three months of treatment with posterior bite turbo

Introduction: all orthodontic treatments must be safe in terms of temporomandibular joint health. No reports in the recent literature evaluate the association between the use of posterior bite turbos and condylar position changes. The aim of the present study was to evaluate condylar position changes occurring after three-month treatment with posterior bite turbo in patients from the Dental School of the Universidad del Valle. Methods: a sample of 15 hyperdivergent patients was randomly distributed into two groups: Bite Turbo and Control Group. Cone-Beam Computed Tomography (CB-CT) was used to assess the condyle position before the bite turbos bonding to first and second molars, and after three months of use of the appliances. Distances were taken from the CB-CT by a single operator, and the calibration was tested with intraclass correlation (> 0.9). Results: no statistical difference between the position of left and right condyles was detected. However, there was a significant difference in the upper space of the left condyle between the initial and final measurement. Patients reported satisfactory use of the occlusal bite turbo (85.8%) in three months of treatment. Conclusion: contrary to the expected, the simultaneous use of posterior occlusal appliances with balanced mandibular movements for 3 months did not cause significant changes in condylar position. The patients tolerate well the use of occlusal stops.

LINEAR MEASUREMENT OF THE CONDYLE POSITION IN HIV-INFECTED CHILDREN AND ADOLESCENTS

Background: The incidence of HIV had recently increased rapidly. People infected with HIV were required to take anti-viral drugs. The severity of HIV also contributes to a decrease in bone mineral density due to taking antiviral drugs. Decreased bone density in people with HIV was a chronic disease due to the long-term use of drugs. TMD in people with HIV was often associated with several factors including emotional states such as depression. Patient infected HIV was vulnerable to TMD because it triggers physical and psychological changes. TMD and decreased bone density are common in people with HIV. Researchers hope that later there will be the latest findings that can make patients infected with HIV felt safe to take drugs without worrying about the decline in bone quality. Objective: This study aimed to investigate the value of linear measurement of the condyle position in HIV- infected children and adolescents based on panoramic radiographs in Dental Hospital Padjadjaran University. Methods: This descriptive and cross-sectional method was conducted on panoramic radiographs of HIV-infected children and adolescents since was born. Condyle position was defined by linear measurement using a protractor that divides the condyle 45° of anterior, 90° of superior, and 135° of posterior joint space from a horizontal line. The distance was then measured using a digital caliper. Results: According to linear measurements of the condyle position, all samples had abnormal linear distances in children and adolescents in all gender. The standard range of anterior joint space (Ajs) was 1.3 mm, superior joint space (Sjs) was 2.1 mm, and the posterior joint space (Pjs) was 1.8 mm. The result of this research, the right women condyle sample, the standard distance of the AJS was 0%, SJS was 16%, Pjs was 18%. While the left condyle, the usual range of the AJS was 4%, SJS was 12%, Pjs was 24%. The right men condyle sample, the standard distance of the Ajs was 0%, Sjs was 17.65%, Pjs was 11.76%. While the left condyle, the usual range of the Ajs was 0%, Sjs was 11.76%, Pjs was 5.88%. Conclusions: The abnormal distance measured was found in the condyle position of children and adolescents infected with HIV.