Slikovni prikaz poremećaja temporomandibularnog zgloba

Complicated anatomical configuration of the temporomandibular joint was the reason for developing standardized radiographic techniques which would provide accurate anatomical images. Tomography provides excellent bony details but no in formation of the soft tissue component of the joint. This technique is useful in demonstrating suspected hypoplasia, hypertrophy or malformation of the condyles, in the case of maxillofacial trauma with fracture description, infections and tumors. Artrography is performed to determine the status of the condyle-disk-glenoid fossa and eminence relationship with rxegard to the closed and open mouth position. Computerized tomography (CT) is superior to conventional radiograšhy and conventional tomography for evaluating internal derangements of temporomandibular joint, trauma, degenerative processes and tumors. CT demonstrated good evaluation of soft tissue and excellent evaluation of bony structures. Magnetic resonance (MR) has shown exquisite soft tissue contrast and provides a view of the structures of temporomandibular joint which cannot be differentiated by conventional radiography, conventional tomography and computerized tomography. MR of temporomandibular joint can distinguish internal anatomical features of the joint to a degree that no other imaging procedure can match. An image of the articular disk without contrast media as well an image of the posterior band has made the magnetic resonance the golden standard of temporomandibular joint imaging.Složena anatomska konfiguracija temporomandibularnog zgloba razlog je razvitka standardiziranih tehnika koje omogućuju točan anatomski prikaz. Linearna tomografija omogućuje dobre koštane detalje, ali ne prikazuje mekotkivnu komponentu zgloba. Ta tehnika uspješno pokazuje hipoplaziju, hipertrofiju ili malformaciju kondila, a u slučajevima maksilofacijalne traume dobar prikaz frakture pukotine. Infekcije i tumori također su prikazivi ovom metodom. Artrografiju izvodimo radi prikaza statusa kondila, diska, zglobne jamice te zglobne kvržice s otvorenim i zatvorenim ustima. Kompjutorizirana tomografija (CT) nadmašuje konvencionalnu radiografiju i konvencionalnu tomografiju u procjeni unutarnjeg poremećaja temporomandibularnog zgloba, kod traumatskih promjena, degenerativnih procesa i tumora. CT omogućuje dobru procjenu mekih tkiva i odličnu procjenu koštanih struktura. Magnetna rezonanca (MR) pokazuje izuzetan mekotkivni kontrast i omogućuje prikaz struktura temporomandibularnog zgloba, koje se ne mogu prikazati konvencionalnom radiografijom, konvencionalnom tomografijom ili kompjutoriziranom tomografijom. MR temporomandibularnih zglobova razlikuje unutarnje anatomske strukture zgloba takvom preciznošću kakvu druge metode ne mogu dostići. Prikaz diska bez kontrastnog sredstva, kao i područja bilamilarne zone, čine magnetnu rezonancu zlatnim standardom u dijagnostici bolesti temporomandibularnog zgloba

Dental Saggital Classical Tomography and Multi-layer CT in the Planning of Implants

Uspješna implantacija zahtijeva točnu obavijest o stanju alveolarne kosti i o preciznoj lokaciji mandibularnoga kanala u donjoj čeljusti i sinusa u gornjoj čeljusti. Ozljeda neurovaskularnoga snopa unutar kanala rezultira parestezijama lica, a perforacija maksilarnoga sinusa povećava mogućnost upalnih procesa i uzrok je neuspješnih implantacija. Klinička ocjena kao jedina metoda procjene planiranja usatka nije dovoljna. Kada se planira ugraditi usadak, prijeko je potrebno znati visinu i širinu alveolarnoga grebena kako bi se izabralo odgovarajući usadak. Ortopantomografija prikazuje alveolarnu kost u dvije projekcije i ne daje odgovarajuću obavijest o anteriorno posteriornom promjeru alveolarnoga grebena. Ubrzo je shvaćeno da sagitalni slojevi daju odgovarajuću predoperativnu obavijest o stanju i anatomskim pojedinostima alveolarnoga grebena za potrebe planiranja usadaka. U našem izlaganju prikazujemo dva moguća načina prikaza sagitalnih slojeva kroz gornju i donju čeljust upotrebom specijaliziranog ortopan uređaja uz usporedbu s višeslojnim CT-om. Objema se metodama odgovarajuće prikazuju željene pojedinosti.Successful implantation requires information on the condition of the alveolar bone and precise location of the mandibular canal in the lower jaw and the sinus in the upper jaw. Injury to the neurovascular bundle in the canal results in facial paresthesia, while perforation of the maxillary sinus increases the possibility of inflammatory processes and is the cause of unsuccessful implantation. Clinical evaluation, as the only method of assessment for planning an implant is insufficient. For implant planning knowledge of the height and width of the alveolar ridge is essential for the choice of an adequate implant. Orthopantomography shows the alveolar bone in two projections and does not provide adequate information on the anterior posterior diameter of the alveolar ridge. It was soon realised that saggital layers give the relevant preoperative information on the condition and anatomic details of the alveolar ridge for implant planning. In our presentation we present two possible ways of showing saggital layers through the upper and lower jaws by the use of a specialised device and comparison with a multi-layer CT. Both methods adequately show the desired details

Magnetic resonance imaging study on temporomandibular joint morphology [Studija o morfologiji čeljusnog zgloba pomoću magnetske rezonancije]

Magnetic resonance imaging (MRI) has enabled the accomplishment of a more effective diagnostics of temporomandibular disorders (TMD). The sample included 40 patients with clinical symptoms of disc displacement (DD) of temporomandibular joint (TMJ) and 25 subjects included in our study were asymptomatic. DD were diagnosed by clinical examinations which were subsequently confirmed by MRI. DD was found in 18% of the TMJs of the asymptomatic patients. The highest prevalence of total DD without reduction was found in 44.1% of the patients' joints subsequently followed by total DD with reduction comprising 34.9% of the TMJs and by partial DD with reduction comprising 21% of the TMJs. This study may help us clarify the complicated relationship which exists between the radiographic and clinical findings of TMJ disorders

Initial Therapy by Stabilization Splint in Patients with Complete Dentures

Pacijenti često nose neprikladne potpune proteze. One postaju funkcijski neprihvatljive zbog izražene abrazije proteznih zuba i resorpcije koštanoga proteznog ležišta. Mogu se pojaviti i simptomi disfunkcije čeljusnih zglobova. Zbog nekontrolirano smanjene okomite dimenzije potpunih proteza i liječenja znakova temporomandibularne disfunkcije, koji su potvrđeni metodom magnetske rezonancije, postavlja se indikacija nošenja stabilizacijske (vertikalizacijske) udlage. Udlaga se izrađuje u artikulatoru, u kojem se provjeravaju i ispravljaju okluzijski odnosi. Tijekom liječenja prati se pacijentov subjektivni i objektivni nalaz. Uspješno inicijalno liječenje pretpostavka je uspjehu u konačnome protetskom liječenju potpunim protezama.Patients often wear inadequate complete dentures that become functionally unacceptable due to marked abrasion of the prosthetic teeth and resorption of the denture bone foundation. Symptoms of dysfunction in the temporomandibular joint may also occur. Because of the uncontrollably reduced vertical dimension of complete dentures and the treatment of the signs of temporomandibular dysfunction, as confirmed by magnetic resonance imaging, wearing of a stabilization (vertical) splint is indicated. The splint is made in an articulator where occlusal relationships are checked and corrected. During the therapy the patient’s subjective symptoms and objective findings are monitored. Successful initial therapy is a precondition for success in final prosthetic treatment by complete dentures

Vrijednost CT-a mozga u hitnoj službi: retrospektivna analiza

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist\u27s assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist\u27s assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient\u27s state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima

Magnetic Resonance Imaging Study on Temporomandibular Joint Morphology

Magnetic resonance imaging (MRI) has enabled the accomplishment of a more effective diagnostics of temporomandibular disorders (TMD). The sample included 40 patients with clinical symptoms of disc displacement (DD) of temporomandibular joint (TMJ) and 25 subjects included in our study were asymptomatic. DD were diagnosed by clinical examinations which were subsequently confirmed by MRI. DD was found in 18% of the TMJs of the asymptomatic patients. The highest prevalence of total DD without reduction was found in 44.1% of the patients’ joints subsequently followed by total DD with reduction comprising 34.9% of the TMJs and by partial DD with reduction comprising 21% of the TMJs. This study may help us clarify the complicated relationship which exists between the radiographic and clinical findings of TMJ disorders