Collagen Fiber Arrangement in Temporo-Mandibular Joint (TMJ) Disks from Human Subjects with Functional Diseases. Scanning Electron Microscopy Investigations

Twelve articular disks from patients with temporo-mandibular joint (TMJ) arthropathy were studied and compared with two normal disks. Scanning electron microscopy (SEM) examination of the surfaces and of longitudinal and cross-sections of the disks allowed the observation of the arrangement of the collagen fiber component in different parts of the disk. The superficial part of the articular disks appears to be formed by rather compact fibers. The internal portion is usually formed by bundles of collagen fibers in sheets, alternating with isolated fibers arranged in a parallel or irregular way. In some samples, blood vessels were observed. Our investigations suggested that the appearance of vascularization is the first remarkable histological change that can be observed in functionally abnormal articular disks

Variations in Function and Vocal Acoustic Characteristics After Orthognathic Surgery: Preliminary Results

Objective: To determine the effects of orthognathic surgery on oral function and vocal quality in order to assess the need for speech therapy after surgery. Material and Methods: Thirty-seven patients scheduled for mono-jaw surgery, specifically maxillary (G1:15 patients), mandibular advancement (G2:10 patients) or mandibular set-back (G3:12 patients), were recruited for this prospective cohort study. Evaluation of oral functions, video recordings of speech articulation and audio recordings of voice were obtained before surgery (T0), and at 1 (T1) and 6 months (T2) after surgery. Spectrographic analysis and self-evaluation questionnaire regarding the vocal performance (VAPP) were performed. Both qualitative and quantitative statistical analysis was performed, mainly using generalized linear models for dichotomous data (p<0.05). Results: The formant frequencies (F1 and F2) of the main vowels vary after orthognathic surgery according to the type of surgery. Before surgery, 84% of patients analyzed showed difficulties in breathing and positioning the tongue both at rest and swallowing. Thanks to surgical correction of the malocclusion, the major part of these issues were resolved within 6 months. In 25% of cases, a change in the voice and/or articulation had occurred. Conclusion: Vocality improves after orthognathic surgery and it changes in relation to the type of surgery. However, vocality did not normalize completely. Speech assessment should be considered after surgery in order to offer adequate speech therapy if necessary

Endoarticular Loose Bodies and Calcifications of the Disk of the Temporomandibular Joint: Morphological Features and Chemical Composition

We studied articular disks and endoarticular loose bodies taken from patients suffering from different types of temporomandibular joint (TMJ) pathology. The scanning electron microscopy (SEM) analysis of the disks and the endoarticular loose bodies was followed by a chemical-compositional analysis using an energy dispersive spectrometer (EDS) and by characterization of the crystalline phases by X-ray powder diffraction (XRD). The articular disks were composed of a central radio-opaque area lacking any evident structural features, surrounded by compact bundles of collagen fibers. EDS and XRD analyses showed that endodiscal radio-opaque areas were hydroxyapatite. By SEM, we observed a fibrous network only in circumscribed areas of the endoarticular loose bodies. The chemical-compositional analysis showed that the loose bodies were composed of calcite (CaCO3). The results of this investigation, along with the clinical history of the patients, allow us to formulate some hypotheses regarding the etiopathogenesis of these structural anomalies. The endodiscal calcifications could be the result of a chronic inflammatory process that produces displastic alterations of the articular disk. Moreover, an acute inflammatory process with modifications in the mechanisms of the synovial fluid turnover seems to be the event that leads to the formation of endoarticular loose bodies

EFFECTIVENESS OF SURGICAL AND ORTHODONTIC TREATMENT IN ORTHOGANTIC SURGERY: A RETROSPECTIVE STUDY

Orthognathic surgery is the surgical correction of skeletal anomalies or malformations involving the mandible or the maxilla. Therefore, an accurate objective prediction analysis of the final treatment outcome has become an important part of the consultation for any patient seeking orthognathic surgery. In the present study a case series of patients planned on tracing of cephalometric radiographs is reported in order to assess the effectiveness of planning and treatment and pertinent literature discussed. The study population was composed of 44 patients (28 females and 16 males, median age 28 years) affected by class II and III skeletal malocclusion or long face. Patients were evaluated by means of 4 teleradiograpies: one at the admission, one before surgery, one after surgery and one at the end the follow-up. Slavicek cephalometric analysis was performed. A logistic analysis was performed in order to dected those variables associated to the clinical outcome. Among the skeletal variables, the mandibular trend is the only variable that has an impact on clinical outcome. None of the teeth variables has statistical significance. Orthognathic surgery involving mobilization, repositioning, and fixation of the maxilla and mandible. The jaw is corrected to improve functional difficulties in the musculoskeletal system involving the mouth, including difficulties with mastication and pronunciation, and to treat facial appearance due to abnormal growth. It not only results in functional and cosmetic recovery, but the improved appearance also benefits the patient psychologically and socially. Our data demonstrated that patients planned on tracing of cephalometric radiographs have good clinical outcome. However, mandibular correction is the most difficult challenge to be perfectly correcte

Parosteal chondrosarcoma, a very rare condition of the mandibular condyle

We present a rare case of parosteal chondrosarcoma of the madibular condyle. The patient was referred for a functional limitation of the left temporo-mandibular joint. CT and MRI examinations demonstrated a 3.5-cm cystic mass with a peripheral rim of contrast enhancement located in the left pterygo-maxillary space. The mass had partial intraarticular spread causing deformation and focal cortical erosion of the medial aspect of the condylar head. The lesion was surgically removed; the histological diagnosis was of low-grade chondrosarcoma

3D assessment of the correlation between neonatal morphology and occlusal outcomes in 5-year-old patients with complete unilateral cleft lip and palate

Objective: To exploit 3D measurement technology to determine any correlation between neonatal palate morphology and occlusal outcomes at five years in patients receiving surgery for unilateral cleft lip and palate (CLP). Material and Methods: Twenty-nine neonatal and 5-year models treated by the same surgeon using the same protocol for CLP correction were scanned using a high-resolution structured-light scanner and stored in stl format. Dedicated software was used to make linear and surface area measurements on the neonatal models, and each digitized 5-year model was assigned a Five-Year-Old (5YO) index score on three separate occasions by the same investigator. Results: Minimum, maximum, mean, standard deviation and standard error were calculated for each variable considered, and the Pearson coefficient was used to identify any correlations between neonatal variables and 5YO scores. Linear regression analysis showed that the only variable to approach significance was the posterior width of the cleft, which showed an R2 equal to 0.111, indicating that it accounts for 11% of the variability of the 5YO index. There was no other appreciable correlation between linear measurements, surface areas, or their inter-relationships. Conclusion: There is no correlation between neonatal morphological characteristics and occlusal outcomes at 5 years in CLP patients treated via the surgical protocol considered