phenylephrine-hydrochloride and Temporomandibular-Joint-Disorders

Imaging plays a role in the anatomic assessment of the airway and adjacent structures. This article discusses the use of 3-dimensional (3D) imaging (cone beam computed tomography [CBCT]) to evaluate the airway and selected regional anatomic variables that may contribute to obstructive sleep-disordered breathing (OSDB) in patients. CBCT technology uses a cone-shaped x-ray beam with a special image intensifier and a solid-state sensor or an amorphous silicon plate for capturing the image. Incorporation of 3D imaging into daily practice will allow practitioners to readily evaluate and screen patients for phenotypes associated with OSDB.

Topics: Airway Obstruction; Cone-Beam Computed Tomography; Epiglottis; Humans; Imaging, Three-Dimensional; Mandible; Maxillofacial Development; Nose; Palate, Soft; Pharynx; Sleep Apnea Syndromes; Temporomandibular Joint Disorders; Tongue

Trichorhinophalangeal syndrome type I is a rare autosomal dominant disorder characterized by cone-shaped epiphysis, sparse fine hair, pear-shaped nose and variable growth retardation. The typical craniofacial features include thin upper lip, elongated philtrum, large outstanding ears, shortened posterior facial height associated with short mandibular ramus and reduced and superiorly deflected posterior cranial base. This report describes a 17-year-old male patient with trichorhinophalangeal syndrome type I and a detailed description of the craniofacial radiographic findings, including the use of cone beam computed tomography images for determination of the airway and temporomandibular joint discrepancies.

Topics: Adolescent; Airway Obstruction; Cephalometry; Cone-Beam Computed Tomography; Facial Bones; Fingers; Hair Diseases; Humans; Langer-Giedion Syndrome; Male; Nose; Temporomandibular Joint Disorders

The purpose of this study was to evaluate soft tissue response to maxillo-mandibular counter-clockwise rotation, with TMJ reconstruction and mandibular advancement using TMJ Concepts total joint prostheses, and maxillary osteotomies in 44 females. All patients were operated at Baylor University Medical Center, Dallas TX, USA, by one surgeon (Wolford). Eighteen patients had genioplasties with either porous block hydroxyapatite or hard tissue replacement implants (Group 2) 26 had no genioplasty (Group 1). Surgically, the maxilla moved forward and upward by counter-clockwise maxillo-mandibular rotation with greater horizontal movement in Group 2. Vertically, both groups showed diversity of maxillo-mandibular mean movement. Group 1 showed a consistent 1: 0.97 ratio of hard to soft tissue advancement at pogonion; Group 2 results were less consistent, with ratios between 1: 0.84 and 1: 1.02. Horizontal changes in upper lip morphology after maxillary advancement/impaction, VY closure, and alar base cinch sutures showed greater movement in both groups, than observed in hard tissue. Counter-clockwise rotation of the maxillo-mandibular complex using TMJ Concepts total joint prostheses resulted in similar soft tissue response as previously reported for traditional maxillo-mandibular advancement without counter-clockwise rotation of the occlusal plane. The association of chin implants, in the present sample, showed higher variability of soft tissue response.

Topics: Adolescent; Adult; Arthroplasty, Replacement; Cephalometry; Chin; Face; Female; Humans; Joint Prosthesis; Linear Models; Lip; Mandibular Advancement; Maxilla; Middle Aged; Nose; Osteotomy, Le Fort; Plastic Surgery Procedures; Prosthesis Implantation; Rotation; Temporomandibular Joint Disc; Temporomandibular Joint Disorders; Young Adult

The conventional or zigzag bicoronal incision has been widely used in craniofacial surgery. Unfortunately, after the incision, the temporoparietal (TP) fascia has to be abandoned because of its vascular or structural damages.. The author describes a technique to preserve the TP fascia during the incision.. The coronal incision stopped at the subcutaneous plane. The dissection continued subcutaneously under the posterior edge of the incision as in the elevation of TP fascia. After cutting through the TP fascia, the dissection continued anteriorly in the subgaleal plane as in the coronal dissection.. A total number of 15 craniofacial patients underwent bicoronal incision with this technique. The time spent for preservation of the TP fascia was 10 to 15 minutes for both sides.. The bicoronal incision with preserved TP fascia as described provides an alternative to the patient who may need TP fascia for future uses.

Topics: Ankylosis; Craniosynostoses; Dissection; Encephalocele; Fascia; Fasciotomy; Frontal Bone; Humans; Hypertelorism; Meningocele; Muscle, Skeletal; Nose; Parietal Bone; Plastic Surgery Procedures; Subcutaneous Tissue; Surgical Flaps; Temporal Arteries; Temporal Muscle; Temporomandibular Joint Disorders; Time Factors

To assess the efficacy of blind nasal intubation technique, in cases of ankylosis of temporomandibular joint (TMJ) without the facility of fiber optic bronchoscope.. Analytical study.. Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from August 2002 to October 2003.. A total of 35 patients of ankylosis of TMJ were included in the study. Blind nasotracheal intubation technique was attempted after induction of anaesthesia and paralyzing the patients. Where blind nasotracheal intubation technique was not successful, one nasotracheal tube was passed into the esophagus and retained. Nasotracheal intubation was attempted through contralateral nares by second tube.. Out of 35 patients male to female ratio was 1:1.2. The age of the patients ranged between 5 to 35 years with a mean age of 14.5 years. Blind nasotracheal intubation technique was successful in 23 cases (65.7%), whereas in 12 patients intubation was not successful. The 12 cases of failed blind nasotracheal intubation technique were successfully intubated nasotracheally by prior placement of nasotracheal tube into the esophagus through contralateral nares, which facilitated re-intubation (34.3%).. In the selected patients blind nasotracheal intubation was facilitated by prior placement of the endotracheal tube into esophagus. This technique may be helpful in reducing the psychological trauma and complications of tracheostomy in such patients. However, to-date, fiber optic intubation remains the safest and widely accepted intubation technique in such patients.

Topics: Adolescent; Adult; Anesthetics, Intravenous; Ankylosis; Child; Child, Preschool; Female; Humans; Intubation, Intratracheal; Male; Neuromuscular Depolarizing Agents; Nose; Temporomandibular Joint Disorders

The study was carried out on 69 mentally challenged individuals. They were subjected to detailed clinical evaluation for dentofacial abnormalities and oral health status. Of the 69 mentally handicapped individuals 27 had Downs syndrome and 42 had cerebral palsy. Characteristic facial abnormalities were seen in children with Downs syndrome. In cerebral palsy, fracture maxillary anteriors were more evident. All the Downs syndrome cases had abnormal TMJ movements but in cerebral palsy only 35.7% of individuals had abnormal TMJ movements. In both the groups, submandibular lymph adenopathy was reported. Present study revealed dental caries in 56.0% of the individuals. Fair clinical level of oral hygiene in 60% of the individuals was seen.

Topics: Adolescent; Cerebral Palsy; Child; Craniofacial Abnormalities; Dental Caries; Disabled Children; Down Syndrome; Health Status; Humans; Hypertelorism; Incisor; Lymphatic Diseases; Malocclusion; Nose; Oral Health; Oral Hygiene; Palate, Hard; Persons with Mental Disabilities; Speech Disorders; Temporomandibular Joint Disorders; Tooth Abnormalities

The purpose of this study was to evaluate the effect of bilateral degenerative joint disease (BDJD) on the skeletal and dental patterns of affected individuals. There were 29 symptomatic female patients and 46 asymptomatic normal female volunteers. All study participants had bilateral high-resolution magnetic resonance scans in the sagittal (closed and open) and coronal (closed) planes to evaluate the temporomandibular joints. Linear and angular cephalometric measurements were taken to evaluate the skeletal, denture base and dental characteristics of the two groups. Analysis of variance was used to compare symptomatic subjects with control subjects. There was an overall retrusion of the maxilla and mandible with a clockwise mandibular rotation. The upper and lower denture bases were retruded. The upper incisor was more protruded, whereas the lower incisor was more retroclined in the symptomatic group. The overjet was also increased. This study suggests that subjects with BDJD may manifest altered craniofacial morphology. Clinicians should be aware of this possibility, especially for patients who are growing children and orthognathic surgery candidates.

Topics: Adult; Analysis of Variance; Cephalometry; Chin; Dental Arch; Dental Occlusion, Centric; Facial Bones; Female; Humans; Incisor; Magnetic Resonance Imaging; Mandible; Mandibular Condyle; Maxilla; Nose; Osteoarthritis; Rotation; Temporomandibular Joint; Temporomandibular Joint Disorders; Tooth

The maxillary nerve gives sensory innervation to all structures in and around the maxillary bone and the midfacial region including the skin of the midfacial regions, the lower eyelid, side of nose, and upper lip; the mucous membrane of the nasopharynx, maxillary sinus, soft palate, palatine tonsil, roof of the mouth, the maxillary gingivae, and maxillary teeth. This vast and complex division of the trigeminal nerve is intimately associated with many sources of orofacial pain, often mimicking maxillary sinus and/or temporomandibular joint involvement. For those who choose to treat patients suffering with orofacial pain and temporomandibular disorders, knowledge of this nerve must be second nature. Just providing the difficult services of a general dental practice should be stimulus enough to understand this trigeminal division, but if one hopes to correctly diagnose and treat orofacial pain disorders, dedication to understanding this nerve cannot be overstated. In this, the third of a four part series of articles concerning the trigeminal nerve, the second or maxillary division will be described and discussed in detail.

Topics: Cranial Nerve Diseases; Eyelids; Facial Pain; Gingiva; Humans; Lip; Maxilla; Maxillary Nerve; Maxillary Sinus; Nasopharynx; Neurons, Afferent; Nose; Palate, Hard; Palate, Soft; Palatine Tonsil; Skin; Temporomandibular Joint Disorders; Tooth; Trigeminal Nerve