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OBJECTIVE: To compare postcontrast T1-weighted imaging (T1WI+) with precontrast T1-weighted (T1WI-), T2-weighted (T2WI), and proton density-weighted imaging (ProWI) in depiction of the anterior disc displacement (ADD) in temporomandibular disorders (TMDs). STUDY DESIGN: A total of 120 joints with TMD were included in this study. Qualitatively, Receiver operating characteristic analysis was performed. Quantitatively, the ratio of the intensity in the retrodiscal tissue to intensity in the disc (intensity ratio) was measured. RESULTS: One reader achieved superior performance in visualization of ADD with T1WI+ than with the other sequences. The other reader showed superiority with T1WI+ rather than T2WI or T1WI-. The intensity ratio on T1WI+ was significantly higher than the intensity ratio on other sequences. On T1WI,+ the intensity ratio in the joints with ADD was significantly higher than that in the joints without ADD. CONCLUSION: Postcontrast T1-weighted imaging can improve the visualization of ADD in TMDs.

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Sleep bruxism (SB) has been believed to be related to stress and psychosocial factors, however their implicit relationship has remained unclear. This study was conducted on patients visiting our clinic with SB and masticatory muscle disorders (MMD) for the purpose of clarifying personality and behavioral traits. This study was conducted on patients of MMD visiting our clinic. The Rosenzweig Picture-Frustration study was performed on each patient. Twenty-seven (27) patients were divided into two groups: 17 patients with SB and 10 patients without. The SB group showed a significantly lower level of E (extrapunitive) reaction than the nonSB group. SB patients showed a significantly higher level of M (impunitive) reaction than those without SB. Concerning the directions of aggression, the percentage of E-A (extraaggression) was significantly lower in SB patients than in those without. On the other hand, the percentage of I-A (intraaggression) was significantly higher in patients with SB than those without. Our study found a new aspect of the patients with MMD and SB: they are not only intraaggressive, but are also unable to be extrapunitive and extraaggressive. Consequently, they are unable to demonstrate adequate self-assertiveness in stressful situations.

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The purpose of this study was to evaluate the effectiveness and safety of combination chemotherapy with docetaxel (TXT) and nedaplatin (CDGP) for patients with oral squamous cell carcinomas. Eight patients were enrolled in this study (4 men and 4 women, with a mean age of 61.7 years). TXT and CDGP were administered at a dose of 60 mg/m(2) and 70 mg/m(2) by drip infusion for 120 minutes, respectively. Three patients received one more administration 4 weeks after the first one. The locoregional response was evaluated 4 weeks after the final administration of TXT and CDGP. As a result, the locoregional response rate after 1 course was 62.5% including 25.0% of complete response (CR). The response rate after 2 courses was 100.0% with 66.7% of CR. According to Oboshi and Shimosato's classification, histological evaluation of surgical specimens revealed that four cases were Grade IIa, two cases Grade IIb, and two cases Grade IV. The severe adverse events were neutropenia and leukopenia, which were effectively managed with granulocyte colony-stimulating factor (G-CSF). No other severe side effects were recognized. The present study suggested that the combination chemotherapy with TXT and CDGP would be an effective and safe regimen in neo-adjuvant chemotherapy for oral squamous cell carcinomas.

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To investigate the clinical significance of magnetic resonance (MR) evidence of joint effusion of the temporomandibular joint after mandibular condylar fractures, magnetic resonance imaging (MRI) was performed on 18 joints in 15 patients with either unilateral or bilateral mandibular condylar fractures using a 1.5 Tesla MRI scanner (Signa, General Electric, Milwaukee, WI). MR evidence of joint effusion was evaluated and compared with the types and the positions of the fractures. MR evidence of joint effusion was observed in 11 of 18 TMJs, which was 61% of the condylar fractures. It appeared more frequently after fractures with dislocation than those without dislocation (p < 0.05). In addition, MR evidence of effusion appeared more frequently in TMJs after high condylar fractures (head to upper neck) than low condylar fractures (lower neck to subcondylar) (p < 0.05). These findings indicate that MR evidence of joint effusion may serve as a marker for the detection of severe intra-articular damage to the TMJ after mandibular condyle fractures.

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We report here a case of vertical alveolar distraction osteogenesis with many complications that required further surgical interventions. A 54-year-old man underwent mandibular resection followed by iliac bone grafting as the result of large mandibular odontogenic keratocyst. Eleven months later, alveolar vertical distraction osteogenesis was applied to the patient for prosthetic rehabilitation. Fracture of the basal bone occurred in the consolidation period, and the fracture was fixed by the titanium miniplate system. Radiographic examination after completion of distraction osteogenesis confirmed a radiolucent area in half of the distracted area between the basal bone and the transport segment, and when the distractor was removed the radiolucent area was filled with fibrous granulation tissue. The granulation tissue was removed and endosteal implants were inserted together with a bone graft. Ultimately, all implants were osseointegrated, and adequate esthetics and function of the implant-supported prosthesis were achieved.

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OBJECTIVE: The purposes of this study were (1) to assess functional and pain outcomes after arthroscopic surgery on patients with temporomandibular joint disorders (TMD); (2) to evaluate postsurgical changes in disk position, mobility, and morphology on magnetic resonance imaging (MRI); and (3) to measure the association between changes in disk position, mobility, and morphology on MRI and clinical outcomes. STUDY DESIGN: A retrospective analysis was conducted of temporomandibular joints with internal derangement and osteoarthritis that were refractory to nonsurgical treatments and underwent arthroscopic surgery and on which MRI was performed within 1 month after the initial visit and 1 year after arthroscopic surgery. Clinical findings were assessed on the basis of mandibular range of motion and joint pain level on a visual analog scale at the initial visit and 1 year after arthroscopic surgery. The disk position, mobility, and morphology on MRI were compared with clinical findings and were statistically analyzed before and after arthroscopic surgery. The treatment outcome was judged according to our success criteria. The associations between changes in disk position, mobility, and morphology and clinical outcomes after arthroscopic surgery were statistically analyzed. RESULTS: Forty-three joints of 43 patients who underwent arthroscopic surgery were assessed in this study. After arthroscopic surgery, mandibular range of motion and visual analog scale results improved statistically. According to the criteria for clinical resolution, 32 surgeries were successful and 11 were unsuccessful. Preoperative and postoperative MRI showed that most joints had anterior disk displacement (ADD) without reduction. Postoperative MRI revealed that, statistically, the number of mobile disks had increased and deformity of the disks had progressed. In the successful group, postoperative MRI revealed that all joints had mobile disks. In both groups, most joints had ADD without reduction before and after arthroscopic surgery, and, statistically, deformity of the disks progressed after arthroscopic surgery. CONCLUSIONS: Arthroscopic surgery was an effective treatment for TMD refractory to nonsurgical treatments. This study provides important information of clinical significance. Disk position remained ADD without reduction, disk mobility increased, and deformity of the disks progressed after arthroscopic surgery.

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We used a new combination chemotherapy with nedaplatin (CDGP) and 5-fluorouracil (5-FU) in eleven fresh patients with oral squamous cell carcinomas. 5-FU was administered at a dose of 1,000 mg/body by continuous infusion for 24 hours on days 1 to 5. CDGP was administered at a dose of 80 or 100 mg/m2 by drip infusion for 120 minutes on day 5. The response rates of total (1- or 2-course) and 2-course group were 54. 5% and 83.3%, respectively. Adverse drug reactions were limited to two cases of grade 3 toxicity with anorexia. The combination chemotherapy with 5-FU and CDGP in place of cisplatin and 5-FU seemed to play an important role as neo-adjuvant chemotherapy for oral squamous cell carcinomas.

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Distraction osteogenesis with the shortening and lengthening method is a well-established procedure for repairing extremities. We used this technique for reconstruction after mandibular segmental resection. A 74-year-old woman underwent distraction osteogenesis with an intraoral device, initially shortening the mandible after a 20-mm-long segmental resection, followed by lengthening at a rate of 0.8 mm per day for 21 days. Eight weeks after the distraction, the device was removed and a dental implant was placed at the site of distraction. Radiographic observation showed new bone formation, and the implant was completely osseointegrated. Although the follow-up period is relatively short, the clinical course was uneventful. Distraction osteogenesis with the shortening and lengthening method seems to be a feasible option for reconstruction after segmental resection of the mandible.

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