technetium-tc-99m-medronate and Facial-Pain

Temporomandibular joint (TMJ) patients with disc displacement without reduction have a misaligned disc-condyle structural relation. As the condition becomes chronic, painful osteoarthritic changes may occur. For these patients, splint therapy may help to position the condyle to a more structurally compatible and functional position and to decrease the loading force of articular surfaces. The aim of this study was (1). to evaluate osseous reactions and pain relief in patients with disc displacement without reduction after splint therapy and (2). to use single photon emission tomography (SPECT) bone imaging to compare the results with the opposite joint of the patient.. Twelve patients, who presented with pain involving the TMJ and limited mouth opening and were confirmed by soft tissue imaging as having disc displacement without reduction, were included in the study. Each patient underwent bone SPECT imaging, after which semiquantitative evaluation of transaxial images was conducted. The ratios of affected TMJ to nonaffected TMJ, affected TMJ to occipital bone, and nonaffected TMJ to occipital bone were calculated. After 6 months of splint therapy, bone SPECT examinations were repeated.. Before splint therapy, the ratios of affected TMJ to nonaffected TMJ and of affected TMJ to occipital bone were found to be significantly higher than the ratios after splint therapy (P < 0.005).. Six-month splint therapy has a positive effect on the osseous reaction and pain related to internal derangements of TMJs.

Topics: Adolescent; Adult; Facial Pain; Female; Humans; Joint Dislocations; Male; Occlusal Splints; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

The objective of this study was to evaluate the usefulness of bone scan procedures for the diagnosis of temporomandibular joint (TMJ) osteoarthritis.. From February 2009 to June 2009, 22 patients (4 males and 18 females) from Seoul National University Bundang Hospital, Republic of Korea, were diagnosed with TMJ disorder. They were examined by clinical examination, plain radiograph and bone scan and were categorized into three groups: normal, internal derangement and osteoarthritis. TMJ uptake ratios and asymmetrical indices were calculated.. There were no significant differences in uptake ratios associated with pain and bone change. However, significant results were obtained when comparing uptake ratios between the osteoarthritis and non-osteoarthritis groups.. It was concluded from this study that bone scans may help to diagnose osteoarthritis when increased uptake ratios are observed.

Topics: Adolescent; Adult; Aged; Arthralgia; Facial Pain; Female; Humans; Image Processing, Computer-Assisted; Joint Dislocations; Male; Middle Aged; Osteoarthritis; Parietal Bone; Physical Examination; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

To evaluate the association between facial pain and maxillofacial scintigraphy.. A total of 117 patients with idiopathic facial pain (IFP) (88% females; average age = 46.7 years) underwent 99mTc-MDP scans, as did 32 age-matched controls. Pearson χ(2) analysis was used to determine associations.. Of subject quadrants, 63% were painful (average duration: 5.4 years); 79% of painful quadrants had positive 99mTc-MDP scans, i.e., "hot spots," significantly different from 13% in nonpainful quadrants (P < .0001). Five percent of controls had quadrants with hot spots; the proportion of hot spots in subjects versus controls was significantly different (P < .0001). No difference was found between pain-free quadrants in subjects and controls (P = .0688).. A positive 99mTc-MDP scan is strongly correlated with the location of pain in IFP, and patients with IFP have significantly more hot spots than controls, suggesting that pain in some IFP is associated with or caused by cancellous bone disease.

Topics: Adult; Aged; Biopsy; Case-Control Studies; Chi-Square Distribution; Facial Pain; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

The purpose of this study was to investigate the potential usefulness of single photon emission computed tomography (SPECT) bone scanning with technetium-99m methylene diphosphonate (Tc-99m MDP) in the diagnosis of idiopathic jaw pain. Unlike planar bone scanning, SPECT uses tomographic technology to provide 3-dimensional images, which are more useful in localizing small lesions.. Twenty patients, each with a diagnosis of chronic idiopathic jaw pain, were compared after SPECT bone scanning with 20 age-matched and gender-matched normal controls. Uptake was identified and compared in sites with previously detected jaw pathoses and jaw pain.. Nineteen of 20 patients with jaw pain evaluated with SPECT had positive scans, in contrast with 12 of 20 control subjects (P <.04). Positive scans were correlated with painful sites in 15 of 20 patients, with the remaining 5 patients demonstrating no uptake in painful locations. Patients with jaw pain demonstrated 37 of 80 mouth quadrants with positive scans, in contrast with 21 of 80 mouth quadrants in the controls (P <.01). Nineteen of 24 painful mouth quadrants had uptake in the pain group. Of the 21 quadrants positive in the controls, 17 were correlated with previously detected jaw pathoses. The sensitivity and specificity for detecting painful sites were 0.79 and 0.68, respectively. The sensitivity and specificity for detecting previously identified pathoses in the jaws of normal controls were 0. 80 and 0.93, respectively.. Patients with idiopathic jaw pain had a significantly greater frequency of positive SPECT bone scans when compared with normal controls. However, the sensitivity and specificity of SPECT bone scans in detecting painful sites were low. These findings suggest that SPECT bone scanning with Tc-99m MDP is not indicated as a routine imaging procedure for the detection of jaw pathoses, but may be considered as a potential research tool in the future study of chronic idiopathic jaw pain.

Topics: Adult; Case-Control Studies; Chi-Square Distribution; Facial Pain; Female; Humans; Jaw Diseases; Male; Middle Aged; Osteomyelitis; Periapical Diseases; Periodontal Diseases; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Previous studies have identified focal areas of alveolar tenderness, elevated mucosal temperature, radiographic abnormality, and increased radioisotope uptake or "hot spots" within the quadrant of pain in most patients with chronic, idiopathic facial pain (phantom pain, atypical facial neuralgia, and atypical facial pain).. This retrospective investigation radiographically and microscopically evaluated intramedullary bone in a certain subset of patients with histories of endodontics, extraction, and fixed partial denture placement in an area of "idiopathic" pain.. Patients from 12 of the United States were identified through tissue samples, histories, and radiographs submitted to a national biopsy service. Imaging tests, coagulation tests, and microscopic features were reviewed. Of 38 consecutive idiopathic facial pain patients, 32 were women.. Approximately 90% of subpontic bone demonstrated either ischemic osteonecrosis (68%), chronic osteomyelitis (21%), or a combination (11%). More than 84% of the patients had abnormal radiographic changes in subpontic bone, and 5 of 9 (56%) patients who underwent radioisotope bone scan revealed hot spots in the region. Of the 14 patients who had laboratory testing for coagulation disorders, 71% were positive for thrombophilia, hypofibrinolysis, or both (normal: 2% to 7%). Ten pain-free patients with abnormal subpontic bone on radiographs were also reviewed.. Intraosseous ischemia and chronic inflammation were suggested as a pathoetiologic mechanism for at least some patients with atypical facial pain. These conditions were also offered as an explanation for poor healing of extraction sockets and positive radioisotope scans.

Topics: Adult; Aged; Biopsy; Blood Coagulation Tests; Chronic Disease; Denture, Partial, Fixed; Facial Pain; Female; Fibrinolysis; Humans; Ischemia; Male; Mandible; Mandibular Diseases; Maxilla; Maxillary Diseases; Middle Aged; Neuralgia; Osteomyelitis; Osteonecrosis; Radiography; Radiopharmaceuticals; Retrospective Studies; Root Canal Therapy; Technetium Tc 99m Medronate; Thrombophilia; Tooth Extraction; Wound Healing

Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.

Topics: Chronic Disease; Facial Pain; Humans; Male; Maxillary Diseases; Middle Aged; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate