Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss

<p>Abstract</p> <p>Background</p> <p>The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss.</p> <p>Methods</p> <p>The study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests.</p> <p>Results</p> <p>The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects.</p> <p>Conclusions</p> <p>TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.</p

Historical considerations regarding the first descriptions of pancreas’ anatomy

The descriptions of the term “pancreas” as well the macroscopic anatomy of the pancreas throughout Antiquity, Byzantium, Middle Ages and Renaissance are displayed. In particular, the original phrases of famous physicians of that period as regards the anatomy of the pancreas are presented: Hippocrates, Aristotle, Herophilus, Galen, Rufus of Efesus, Julius Pollux, Oribasius, Bartolomeo Eustachio, Andreas Vesalius, Gabriel Fallopius, Johann Georg Wirsung, Francis Glisson, Giovanni Domenico Santorini

Clinical study of the factors affecting radioulnar deviation of the wrist joint

<p>Abstract</p> <p>Background</p> <p>The radioulnar carpal joint is critical for hand and wrist function. Radioulnar deviation indicates distal radioulnar joint flexibility and reflects the structure and function of the carpal bones, ulna, radius and ligaments. The present study examined whether radioulnar deviation is affected by gender, manual labor, playing a musical instrument, playing sport, handedness, previous fracture or prior inflammation. The study used clinical findings based on anatomical landmarks</p> <p>Methods</p> <p>The ulnar, radial and total deviations for both left and right hands were measured in 300 subjects (157 men and 143 women) of mean age 21.7 years. Measurements were made with the forearm in a fixed pronated position using a novel specially designed goniometer. The gender of each subject was recorded, and information on playing of sport, playing a musical instrument, manual labor, handedness, and history of fracture or inflammation was sought. Data were analyzed using a multifactor ANOVA test.</p> <p>Results</p> <p>No statistically significant difference (p-value > 0.05) was found between those comparing groups except the total deviation of athletes' left hand versus the total deviation of non athletes' left hand (p-value 0.041 < 0.05) and the radial deviation of manual workers' left hand and non manual workers' left hand (p-value 0.002 < 0.05).</p> <p>Conclusions</p> <p>This study was based on clinical findings using anatomical landmarks. We found that manual workers and athletes showed greater left hand flexibility. This suggests that activities that place chronic stress on the radiocarpal joint can independently affect radioulnar deviation.</p

Anatomical study and analysis of the biomechanics of the forefoot's first and second ray and correlation with hallux valgus deformity

Aim. The purpose of this doctoral dissertation was the anatomical study and mechanical analysis of the foot first and second ray in patients with hallux valgus and their comparison with individuals without hallux valgus. Another aim of this doctoral dissertation was to evaluate the hallux valgus degree with respect to the severity of that deformity. Subjects and Methods. The study sample included 181 feet of 122 patients with hallux valgus and 424 feet of 212 individuals without hallux valgus deformity as a control group. The severity of the hallux valgus disorder was classified according the Manchester scale. Hallux valgus and first intermetatarsal angles were measured. The AOFAS score was determined on all individuals in the hallux valgus and the control group by a trained professional to use the instrument. Plantar loading patterns were determined on all individuals in the hallux valgus and the control group as they stood barefoot across a pressure platform which was designed by the Comex S.a. company. The measuring system (software) of the pelmatographer used in this study was the Biomec 2011. The study sample included also 12 cadaveric limbs with HV and 10 cadaveric limbs without HV deformity as a control group. Hallux valgus angle ( HVA), first to second intermetatarsal angle (IMA) and first to fifth IMA were measured. The shape of the first metatarsal head and the position - orientation of the sesamoid bones were recorded. Results. The AOFAS scores differed statistically significant between the four grades of the Manchester scale. Strong negative correlations were found between the AOFAS score, the hallux valgus angle and the first intermatatarsal angle as well. Statistically significant differences between the four grades of Manchester grading scale were present only for the mean pressures under the hallux (T1), the first (M1) and second (M2) metatarsal heads. Strong positive correlations were found between hallux valgus angle and first-second intermetatarsal angle with the pressures under the first metatarsal head, the second metatarsal head and hallux. As the value of the angle increases, the mean pressure value is higher. There was a statistically significant difference between the cadaveric material of HV feet and normal feet regarding the position of the sesamoid ossicles and the first to fifth IMA but at the same time the mean ¬value of that angle was found to be normal in both groups. Although the round shape of the first metatarsal head was in numerical predominance in HV group, there was no statistically significant difference of the first metatarsal head shape between the above two groups. Conclusions. The Manchester grading scale could be a useful clinical tool because, providing information not only about the severity of the hallux valgus, but also about the general condition of the foot, pain and gait parameters.The foot width is increased in patient with HV, however, the assessment of first to fifth IMA does not constitute a reliable and useful tool for the determination of the degree of the HV deformity.Σκοπός. Σκοπός της διδακτορικής διατριβής είναι η ανατομική μελέτη και η μηχανική ανάλυση της πρώτης και δεύτερης ακτίνας του άκρου ποδός σε ασθενείς με βλαισό μεγάλο δάκτυλο και η σύγκριση με φυσιολογικούς. Μέρος της διατριβής αποτελεί και η σταδιοποίηση της παραμόρφωσης, αλλά και η συσχέτιση με την κλινική βαρύτητα της διαταραχής. Υλικό και μέθοδοι. Το δείγμα της μελέτης αποτελείται από 181 άκρους πόδες από 122 ασθενείς με βλαισό μεγάλο δάκτυλο και 424 άκρους πόδες από 212 συμμετέχοντες χωρίς διαταραχή βλαισού μεγάλου δακτύλου. Η ταξινόμηση της βαρύτητας της διαταραχής του βλαισού μεγάλου δακτύλου έγινε με βάση την κλίμακα Manchester. Μετρήθηκαν οι γωνίες απαγωγής του μεγάλου δακτύλου και πρώτου-δεύτερου μεταταρσίου. Με τη χρήση ειδικού πελματογραφικού μηχανήματος (Comex S.a.) με εξελιγμένο λογισμικό αναλύσεων (Βiomec 2011) έγινε μέτρηση των πελματιαίων πιέσεων στους συμμετέχοντες στη μελέτη. Καθορίστηκε για τους συμμετέχοντες στη μελέτη και το σκορ της Αμερικάνικης Ορθοπαιδικής Κοινότητας Ποδιού και Αστραγάλου «American Orthopaedic Foot and Ankle Society Score, AOFASscore» από έναν ειδικά εκπαιδευμένο ορθοπαιδικό. Έγινε ανατομική μελέτη πτωματικού υλικού 12 κάτω άκρων με βλαισό μεγάλο δάκτυλο και 9 κάτω άκρων χωρίς βλαισό μεγάλο δάκτυλο. Μετρήθηκαν οι γωνίες απαγωγής μεγάλου δακτύλου, πρώτου-δεύτερου μεταταρσίου, πρώτου-πέμπτου μεταταρσίου και έγινε καταγραφή της θέσης των σησαμοειδών οστών και του σχήματος της κεφαλής του πρώτου μεταταρσίου. Αποτελέσματα. Οι μέσες τιμές του AOFAS σκορ διέφεραν στατιστικά σημαντικά στις κατηγορίες της κλίμακας Manchester. Iσχυρές αρνητικές συσχετίσεις βρέθηκαν ανάμεσα στο AOFAS σκορ και τη γωνία απαγωγής του μεγάλου δακτύλου αλλά και με τη γωνία πρώτου-δεύτερου μεταταρσίου. Στατιστικά σημαντικές διαφορές των μέσων τιμών των πελματιαίων πιέσεων κάτω από τον μεγάλο δάκτυλο, το πρώτο και δεύτερο μετατάρσιο ανευρέθηκαν ανάμεσα στις κατηγορίες της κλίμακας Manchester. Ισχυρές θετικές συσχετίσεις βρέθηκαν ανάμεσα στη γωνία απαγωγής του μεγάλου δακτύλου και στις πελματιαίες πιέσεις κάτω από το μεγάλο δάκτυλο, το πρώτο και δεύτερο μετατάρσιο. Μέσες θετικές συσχετίσεις βρέθηκαν ανάμεσα στη γωνία πρώτου-δεύτερου μεταταρσίου και στις πελματιαίες πιέσεις κάτω από το μεγάλο δάκτυλο, το πρώτο και δεύτερο μετατάρσιο. Στατιστικά σημαντική διαφορά της θέσης των σησαμοειδών οστών και της γωνίας πρώτου-πέμπτου μεταταρσίου βρέθηκε ανάμεσα στο πτωματικό υλικό με βλαισό μεγάλο δάκτυλο και στην ομάδα ελέγχου αλλά παράλληλα η μέση τιμή της γωνίας ήταν φυσιολογική και στις δύο ομάδες. Παρόλο που το σφαιρικό σχήμα της κεφαλής του πρώτου μεταταρσίου υπερτερούσε αριθμητικά στην ομάδα των κάτω άκρων με βλαισό μεγάλο δάκτυλο, δεν ανευρέθηκαν στατιστικά σημαντικές διαφορές όσον αφορά στο σχήμα της κεφαλής ανάμεσα στις δύο ομάδες. Συμπεράσματα. H κλίμακα Manchester μπορεί να αποτελέσει ένα χρήσιμο κλινικό εργαλείο, παρέχοντας πληροφορίες όχι μόνο για τη σοβαρότητα του βλαισού μεγάλου δακτύλου αλλά και για τη γενική κατάσταση του άκρου ποδός, τον πόνο και για παραμέτρους βάδισης. Το εύρος του ποδιού αυξάνει σε ασθενείς με βλαισό μεγάλο δάκτυλο αλλά η γωνία πρώτου-πέμπτου μεταταρσίου δεν αποτελεί αξιόπιστο δείκτη για την εκτίμηση της κλινικής βαρύτητας της διαταραχής

Myocardial bridge over the left anterior descending coronary artery: A case report and review of the literature

Myocardial bridging (MB) is considered as a topic of high interest since its occurrence in different studies is statistically significant, and the clinical manifestations of this phenomenon are complicated with cardiovascular diseases. Whether the MB participates in heart diseases and has a decisive effect to life-threatening situations is still under research, and many studies have been conducted to clarify the abovementioned question. A case report with a MB on the left anterior descending coronary artery is presented in the current study, and a review of the literature is provided as well. Cardiologists as well thoracic surgeons and radiologists should bear in their mind the potential presence of such variant during interpretation of angiographies and multidetector-computed tomography

Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report

Objective. In the current study a brief review is presented of the coracobrachialis muscle’s morphological variability, action, embryological development and clinical significance. Case report. We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. Conclusion. Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects

Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report

Objective. In the current study a brief review is presented of the coracobrachialis muscle’s morphological variability, action, embryological development and clinical significance. Case report. We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. Conclusion. Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects