RESUMEN
The gold standard for temporomandibular joint imaging is magnetic resonance imaging, although there are still pathological findings that cannot be seen in MRI but in surgery and the subsequent histological analysis only. The main goal of this investigation was to validate the MRI score used by histopathological findings as well as clinical findings. In this retrospective study 39 patients were included; 38 of which underwent unilateral and 1 underwent bilateral discectomy. MRI findings were graded according to the score by Wurm. Histopathological analysis was performed in hematoxylin-eosin staining and graded in accordance with the scores by Krenn and by Leonardi. For valuation of preoperative pain values of the temporomandibular joint operated on the numeric rating scale was utilized. Correlations were verified by Spearman-Rho. The MRI scores on average showed significantly lower scores for the discs of the operated temporomandibular joint than for the discs of the non-operated side(p<.01). No significant correlations between MRI findings, histopathological findings and pain intensities could be observed. Thus unsuspicious morphology of the TMJ and the articular disc in MRI is no guarantee for the absence of cartilage-degeneration. Further investigations utilizing T2 cartilage mapping could possibly show better correlations between the temporomandibular joint's degree of degeneration and imaging results.
Asunto(s)
Trastornos de la Articulación Temporomandibular , Humanos , Imagen por Resonancia Magnética/métodos , Dimensión del Dolor , Estudios Retrospectivos , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugíaRESUMEN
INTRODUCTION: Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option. MATERIAL AND METHODS: In this study the effects of negative pressure instillation therapy on the healing of chronic wounds in 15 patients diagnosed with impaired wound healing were investigated. These based upon infected osteoradionecrosis and osteomyelitis of the jaw. The parameters investigated as markers of the therapeutic success were serum inflammatory parameters i.e. white blood cell counts, wound smear results and wound surface reduction. RESULTS: The use of negative pressure instillation therapy lead to a reduction of the bacterial load and formation of a stabile granulation tissue in all but one case. The mean inpatient time of the patients was 13.33 ± 4.62 days. Between 2 and 8 dressing changes were needed to reach clinical sufficient wound healing results. Secondary intention wound healing could be obtained in 14 out of 15 cases. The crucial part for the successful application was a watertight enoral suturing as oro-cutaneous fistulae were present in most cases. CONCLUSION: The negative pressure instillation therapy poses a good treatment for wound healing problems and extended size soft tissue defects, even when oro-cutaneous fistulae were present. Especially in cases that contraindicate micro-vascular reconstruction, negative pressure instillation therapy could be a good alternative.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Maxilares/microbiología , Terapia de Presión Negativa para Heridas , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Infección de la Herida Quirúrgica/tratamiento farmacológico , Cicatrización de Heridas/efectos de los fármacos , Anciano , Carga Bacteriana/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare acquired inflammatory skeletal disorder of unknown origin. CRMO was first described by Gideon in 1972 and mainly affects children and young adults of female gender. The CRMO is part of the clinical picture of non-bacterial Osteomyelitis (NBO) and typically presents a relapsing recurring course with both remission and spontaneous exacerbation. CRMO is typically encountered in the limbs and the metaphysis of long bones in particular. Usually the clinical symptoms include painful swellings of the affected regions. This case report describes the rare case of a CRMO of the mandible in association with pyoderma gangraenosum. CASE PRESENTATION: A 14-year old female caucasian patient, residing in the south of Germany, presented in the oncological outpatient clinic of our Department of Paediatrics and Adolescent Medicine in June 2014 complaining of increasing neck pain and progressive swelling at her left cheek ongoing for about 6 weeks. These symptoms had been occurring quarterly for 4 years, but had never been as pronounced. Blood biochemistry showed a moderately elevated CRP (35 mg/l) and a significantly increased blood sedimentation rate (BSR 48/120 mm). The panoramic radiograph, however, revealed a bone alteration in the left mandibular region. Further investigations confirmed the diagnosis of CRMO. CONCLUSION: The present case underlines the fact that rare diseases might occasionally present with even more rare symptoms. These occasions can obviously be considered to present a considerable diagnostic challenge.
Asunto(s)
Osteomielitis/complicaciones , Piodermia/complicaciones , Adolescente , Niño , Enfermedad Crónica , Femenino , Alemania , Humanos , RecurrenciaRESUMEN
BACKGROUND: The Oral Squamous Cell Carcinoma (OSCC) frequently metastasizes lymphogenously. Haematogenous dissemination is less common. This report describes a rare case of a metastatic OSCC of the floor of the mouth to the patients' left upper arm. To our knowledge this is the first of such case described in the literature. CASE PRESENTATION: Twelve months after R0 tumor resection surgery, including microvascular reconstruction of the lower jaw followed by adjuvant radiotherapy, the patient was admitted for osteosynthesis plates removal. During clinical examination a tumor located at his left upper arm was detected. According to the patient the tumor has demonstrated rapid growth. Macroscopic appearance and conventional imaging led to the differential diagnosis of an abscess. MR-imaging could not differentiate between a tumor of soft tissue origin and a metastasis. A biopsy was taken and the pathological examination confirmed the diagnosis of an OSCC metastasis. The postoperative interdisciplinary tumor board recommended radiation therapy. CONCLUSION: Due to the fact that patients with regional lymph node metastases have a higher probability to develop distant metastasis a more detailed screening might be considered--especially when hemangiosis carcinomatosa was histologically or macroscopically found.