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Sample records for ankylosis

  1. Bony ankylosis following thermal and electrical injury

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    Balen, P.F.; Helms, C.A. [Dept. of Radiology, Duke University Medical Center, Durham, NC (United States)

    2001-07-01

    Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

  2. Bony ankylosis of temporomandibular joint

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    Lee, Byeong Do; Yoon, Young Nam; Um, Ki Doo; Ra, Jong Ill; Lee, Wan [School of Dentistry, Wonkwang University, Iksan (Korea, Republic of)

    2002-06-15

    Ankylosis of joint is defined as limited movement due to infection, trauma, or surgical procedure. A 59-year-old female with a chief complaint of limited movements during mouth opening had a positive history of trauma to her right TMJ area about 5 years ago. From that time, progressive mouth opening limitation and intermittent pain have occurred. At the time of admission the patient showed mandibular deviation to the right side during mouth opening, with a maximum opening limited to 5 mm. On plain radiographs, right condylar enlargement and joint space reduction by newly formed bony tissues were observed. CT scans showed right condylar enlargement, cortical sclerosis, and thickening of the condyle, articular fossa and articular eminence.

  3. Bony ankylosis of temporomandibular joint

    International Nuclear Information System (INIS)

    Lee, Byeong Do; Yoon, Young Nam; Um, Ki Doo; Ra, Jong Ill; Lee, Wan

    2002-01-01

    Ankylosis of joint is defined as limited movement due to infection, trauma, or surgical procedure. A 59-year-old female with a chief complaint of limited movements during mouth opening had a positive history of trauma to her right TMJ area about 5 years ago. From that time, progressive mouth opening limitation and intermittent pain have occurred. At the time of admission the patient showed mandibular deviation to the right side during mouth opening, with a maximum opening limited to 5 mm. On plain radiographs, right condylar enlargement and joint space reduction by newly formed bony tissues were observed. CT scans showed right condylar enlargement, cortical sclerosis, and thickening of the condyle, articular fossa and articular eminence.

  4. Ankylosis of temporomandibular joint in children

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    Das U

    2009-06-01

    Full Text Available Background: Temporomandibular joint (TMJ ankylosis or hypomobility involves fusion of the mandibular condyle to the base of the skull. It is a major clinical problem that affects many patients suffering from facial trauma, infection, or systemic disease. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Case Report: This report describes a case of a 4-year-old boy with inability to open mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty followed by vigorous physiotherapy. Conclusion: A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy can help us to restore physical, psychological, and emotional health of the child patient.

  5. Ankylosis of temporomandibular joint in children.

    Science.gov (United States)

    Das, U M; Keerthi, R; Ashwin, D P; VenkataSubramanian, R; Reddy, D; Shiggaon, N

    2009-01-01

    Temporomandibular joint (TMJ) ankylosis or hypomobility involves fusion of the mandibular condyle to the base of the skull. It is a major clinical problem that affects many patients suffering from facial trauma, infection, or systemic disease. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. This report describes a case of a 4-year-old boy with inability to open mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty followed by vigorous physiotherapy. A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy can help us to restore physical, psychological, and emotional health of the child patient.

  6. TMJ ankylosis: Management with reconstruction and interpositional ...

    African Journals Online (AJOL)

    Treatment of temporomandibular joint (TMJ) ankylosis usually requires adequate excision of the involved ankylotic 2 block (arthroplasty)or interpositional arthroplasty using autogenous or alloplastic materials. Early mobilization, 3 physiotherapy & strict follow up are essential to prevent postop adhesions. In our cases fascia ...

  7. Validity of radiographic assessment of ankylosis

    International Nuclear Information System (INIS)

    Stenvik, A.; Beyer-Olsen, E.; Aabyholm, F.; Haanaes, H.R.; Gerner, N.W.

    1990-01-01

    The accuracy and sensitivity of radiographic assessments of reactive processes in dental tissues were evaluated by comparison of radiographs and histologic sections. Experimental lesions inflicted on the roots of 10 monkey incisors had been observed by means of serially obtained radiographs over a period of 315 to 370 days. The material was used for evaluation of radiographic assessment of ankylosis. For comparative purposes, assessment of the experimental lesion penetrating to the pulp and periapical radiolucency was added. True and falsely positive or negative recordings formed the basis for calculation of the accuracy and sensitivity of the radiographic assessment. The sensitivity, or the obsevers ability to detect the actual changes, was high for pulp penetration, intermediate for inflammation, and low for ankylosis. 6 refs., 3 figs., 2 tabs

  8. [Dental ankylosis diagnosed by CT with tridimensional reconstructions].

    Science.gov (United States)

    Paris, M; Trunde, F; Bossard, D; Farges, J C; Coudert, J L

    2010-06-01

    The etiology of unerupted teeth often is difficult to establish. It may relate to abnormal orientation of the tooth bud, an anatomical obstacle, pathology of the dental sac or ankylosis. The ankylosis process and diagnosis are analyzed in this clinical series. Ankylosis and its underlying physiological process are abundantly described in the literature. Nonetheless, diagnosis remains difficult to achieve. Clinical evaluation and complementary radiographic techniques such as dental radiographs and orthopantomogram are considered by some authors as poorly reliable. These clinical examinations based on a series of subjective criteria cannot be performed on unerupted teeth. In a series of patients with unerupted or retained teeth of undetermined etiology or with traction failure, 15 were diagnosed with ankylosis. The diagnosis of ankylosis could not be achieved based on clinical or radiographic evaluation and required CT imaging. Source images along with tridimensional reconstructed images were evaluated using the MVS software (Hospices Civils of Lyon). The radicular volume involved by ankylosis could be measured and its exact location on the tooth could be demonstrated. This imaging technique with tridimensional reconstruction provided positive diagnosis of ankylosis.

  9. Management of bilateral temporomandibular joint ankylosis in children: case report.

    Science.gov (United States)

    Akama, M K; Guthua, S; Chindia, M L; Kahuho, S K

    2009-01-01

    Long standing temporomandibular joint (TMJ) ankylosis may cause severe facial deformity and growth retardation as well as psychological problems when it occurs in children. Different kinds of opinion have been advanced as regards its management. This article discusses the aetiology and management of bilateral TMJ ankylosis in form of a case report in a patient with severe facial deformity, malocclusion and retarded growth following bilateral TMJ ankylosis secondary to trauma. The patient was successfully managed by placement of costochondral grafts and interpositional arthroplasty with partial temporal myofascialflaps. Good mouth opening was achieved and subsequent follow-ups showed improved mandibular and general body growth as well as psychosocial performance. The aim of this paper is to discuss the management challenges posed by bilateral TMJ ankylosis.

  10. Ankylosing Spondylitis Associated With Bilateral TMJ Ankylosis

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    Song, Ju Seop; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Iksan (Korea, Republic of)

    2000-09-15

    A 31-year-old male with severe limitation of mouth opening was referred to our department of Chonbuk National University Hospital. The physical status of the patient was hyposthenic. Extraoral examination showed no condylar movement of the both temporomandibular joints, no pain, no faical swelling or paresthesia. Intraoral examination showed several cervical caries on the upper anterior teeth, and gingival swelling on the whole dentition. Transcranial view showed no condylar movement, and narrowing of joint spaces. Chest P-A view showed straightening of thoracic, lumbar spine, and squaring of vertebrae of the same spines. Conventional lateral radiograph of cervical spine showed calcification of the intervertebral ligament. Computed tomograph showed extensive bone formation between temporal bone and the both condylar heads. Labortory findings showed positive reaction on HLA-B27 histocompatibility antigen and increased level of IgA, IgG, ESR. Based on the clinical, radiographic, and the labortary findings, final diagnosis was made as bony ankylosis of the both temporomandibular joints secondary to ankylosing spondylitis.

  11. Temporomandibular joint ankylosis in child: A case report

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    Rahul J Hegde

    2015-01-01

    Full Text Available Background: Ankylosis of the temporomandibular joint (TMJ is an intracapsular union of the disc-condyle complex to the temporal articular surface that restricts mandibular movements, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and eminence. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and hygiene. Case Report: This report describes a case of a 12-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty with interpositional temporalis muscle flap followed by vigorous physiotherapy. Conclusion: The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Its treatment includes the orthodontist, oral and maxillofacial surgeon, pediatric dentist, and psychologist and physical therapist as part of the healthcare team.

  12. Temporomandibular joint ankylosis in child: a case report.

    Science.gov (United States)

    Hegde, Rahul J; Devrukhkar, Vishakha N; Khare, Sumedh S; Saraf, Tanvi A

    2015-01-01

    Ankylosis of the temporomandibular joint (TMJ) is an intracapsular union of the disc-condyle complex to the temporal articular surface that restricts mandibular movements, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and eminence. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and hygiene. This report describes a case of a 12-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty with interpositional temporalis muscle flap followed by vigorous physiotherapy. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Its treatment includes the orthodontist, oral and maxillofacial surgeon, pediatric dentist, and psychologist and physical therapist as part of the healthcare team.

  13. Brisement force in fibrous ankylosis: A technique revisited

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    Udupikrishna M Joshi

    2016-01-01

    Full Text Available Fibrous ankylosis is a common complication of trauma to the temporomandibular joint (TMJ in children. Proper treatment and regular follow-up is necessary for its successful management. This report highlights a case of posttraumatic fibrous ankylosis successfully managed with brisement force-gradual tractional forces applied to the TMJ under local anesthesia without any associated complications. Mouth opening increased significantly from 15 to 35 mm. The patient was advised to perform rigorous physiotherapy at home, to maintain interincisal opening of 35 mm. The case was followed up for 6 months with no decrease in mouth opening.

  14. Congenital Temporomandibular Joint Ankylosis: Case Report and Literature Review

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    Ryan Chin Taw Cheong

    2016-01-01

    Full Text Available Congenital temporomandibular joint (TMJ ankylosis is an uncommon condition that presents itself at or soon after birth in the absence of acquired factors that could have contributed to the ankylosis such as infection and trauma. The experience of managing one such case is reported in light of a review of the literature on this condition. Key management principles include adequate removal of the ankylotic mass, costochondral grafting, and post-op physiotherapy. Most patients reported in the literature with the condition experienced relapse. This echoes our own experience where there was recurrence of the ankylosis. However, after removal of the ankylotic mass, the patient maintains a satisfactory maximal incisal opening (MIO till the present day. The additional challenges faced in the congenital form in addition to the already complex management of acquired paediatric temporomandibular joint ankylosis are (1 much earlier insult to the TMJ, (2 reduced opportunity for neuromuscular development of the muscles of mastication, and (3 reduced compliance with postoperative physiotherapy programmes due to the younger age of these patients.

  15. Intubation of a neonate with glossopalatine ankylosis using a ...

    African Journals Online (AJOL)

    Glossopalatine ankylosis presents a challenge to the anaesthesiologist because of its intraoral attachment which obstructs the view of the oral cavity. When preoperative assessment by direct laryngoscopy is possible, a paraglossal approach using a straight blade can be used in such cases. We share our anaesthesia ...

  16. The management of traumatic ankylosis during orthodontics: a case report.

    LENUS (Irish Health Repository)

    McNamara, T G

    2000-01-01

    Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.

  17. Intubation of a neonate with glossopalatine ankylosis using a ...

    African Journals Online (AJOL)

    Glossopalatine ankylosis is characterised by intraoral bands that attach the tongue to the hard palate or maxillary alveolar ridge. It could be part of the group of oromandibular-limb hypogenesis syndromes that comprise anomalies like a cleft palate, an absent or underdeveloped tongue, mandibular hypoplasia, upper.

  18. Management of temporo-mandibular joint ankylosis in growing children

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    Shashikiran N

    2005-03-01

    Full Text Available Although temporo-mandibular joint (TMJ ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

  19. Cadmium-induced vertebral-column ankylosis in whitefish

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    Henschke, E.; Pesch, H.J.; Wunder, W.

    1982-01-01

    In two healthy and two diseased whitefish (Coregonus Wartmanni) taken from Lake Constance (FRG), ankylosis of the vertebral column was investigated both roentgenologically and histologically. Subsequent to the collapse and necrosis of the 'residual' spinal cord within the intervertebral spaces, the outside edges of the vertebral bodies come into direct contact. The compression and tensile forces that occur to an increased extent as a result of the instability, lead not only to a remodelling of the vertebral bodies, but also to the formation of spondylotic osteophytes at the edges of the vertebrae and, as a result of periosteal stimulation, to the development of cellular hyaline cartilage, which fills the intervertebral spaces. Finally, as a result of perichondral ossification, a bony ankylosis develops. The humping of the spine of the fish due to the stiffening and shortening of the vertebral column, is accompanied by a restriction in the animal's freedom of movement. Muscular atrophic processes and disordered food uptake give rise of poor growth and a reduction in the weight of the diseased fish. These remodelling processes in the spine resulting from instability are specific to the periosteum and may be equated with the changes seen in man in spondylosis deformans. The possible cause of this vertebral column ankylosis is cadmium poisoning. The accumulation of this heavy metal obviously leads primarily to an irreversible toxic degeneration of the cells of the chorda dorsalis.

  20. Temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet

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    G S Kalra

    2011-01-01

    Full Text Available Background: Temporomandibular joint ankylosis is a highly distressing condition in which the joint space is obliterated by scar tissue and the patient has an inability to open the mouth. Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. We have been using ultra thin silicon sheet as our preferred material for providing proper fixation and cover to the joint. We have been encouraged by good patient compliance, no implant extrusion and favourable outcome. Materials and Methods: The clinical study included 80 patients with temporomandibular joint ankylosis, treated between April 2001 and March 2009. In all patients, temporomandibular joint ankylosis had resulted following trauma. Diagnosis was based on clinical assessment supplemented by radiographic examination consisting of a panoramic radiograph, axial and coronal computer tomography. The technique of using ultra thin silicon sheet covering whole of the joint space fixed with non-absorbable nylon 3-0 suture both medially to medial pterygoid muscle and laterally to periosteum of zygomatic arch was employed in all patients. Results: A total of 80 patients were in this study (59 males and 21 females. The aetiology of temporomandibular joint ankylosis was post-traumatic in all cases. The patients′ age ranged from 5 to 45 years. The disease was unilateral in 61 cases and bilateral in 19 cases. Twelve patients, who had previous surgery done in the form of gap arthroplasty in 6 cases, costochondral graft in 4 cases and temporalis muscle in 2 cases, presented with recurrence on the same side. The pre-op inter-incisal mouth opening ranged from 4 to 12 mm. The intraoperative inter-incisal mouth opening ranged from 28 to 46 mm. An additional procedure was done in 13 patients, including placement of costochondral

  1. Modified Technique of Retrograde Intubation in TMJ Ankylosis

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    Shaila Kamat

    2008-01-01

    Full Text Available We are presenting a case report on the anaesthetic management of a case of ankylosis of temporomandibular joint for corrective surgery in a 7 year old child. Anticipated difficult airway in paediatric population has always been a perplexing problem, awake fibreoptic intubation almost impossible due to obvious difficulties with co-operation. Here we are describing a new approach to this problem, in which the patients were kept under GA with spontaneous ventilation while retrograde intubation was done quite comfortably by the conventional method.

  2. Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature

    International Nuclear Information System (INIS)

    Gulati, Ajay; Virmani, V.; Ramanathan, S.; Khandelwal, N.; Verma, L.

    2009-01-01

    Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients. (orig.)

  3. Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature

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    Gulati, Ajay; Virmani, V.; Ramanathan, S.; Khandelwal, N. [Postgraduate Institute of Medical Education and Research, PGIMER, Department of Radiodiagnosis and Imaging, Chandigarh (India); Verma, L. [Gian Sagar Dental College and Hospital, Department of Pedodontics, Patiala (India)

    2009-10-15

    Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients. (orig.)

  4. Management of temporomandibular joint ankylosis with combination of gap arthroplasty surgery and physiotherapy

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    Nurul Ramadhanty

    2017-08-01

    Full Text Available Background. Temporomandibular joint (TMJ ankylosis is a union of the articular surface of the temporal bone to the disc-condyle complex that restricts mandibular movements due to either a fibrous or bony union between the head of the condyle and the glenoid fossa. Common etiological factors are trauma, infection, and pathology in the joint or systemic diseases. The diagnosis of TMJ ankylosis is established through physical and clinical evaluation, and imaging examination. Currently, the surgical techniques used to treat TMJ ankylosis are gap arthroplasty, interpositional arthroplasty, joint reconstruction, and distraction osteogenesis. Purpose. To provide overview about management of temporomandibular joint ankylosis with gap arthroplasty combined with physiotherapy post surgery. Case. A 12-year-old female patient came to Department of Oral and Maxillofacial Surgery with complaint of opening mouth restriction, which occured since one year prior to admission. After complete physical and radiographic examination, patient then was diagnosed with TMJ ankylosis due to neglected odontogenic infection. The treatment was performed with gap arthroplasty under general anesthesia. Patient then underwent physiotherapy after the surgery, including application of heat on the affected region and exercises to open and close mouth. Discussion. Ankylosis of TMJ is an uncommon case that results in chronic and severe limited mouth opening. The critical factor of successful treatment of TMJ ankylosis is early detection, correct surgery approach, implementation of an intensive physiotherapy program, and a good post-operative conduct. Therefore on this patient, gap arthroplasty was the chosen surgery approach followed by intensive physiotherapy. Conclusion.Management goal in TMJ ankylosis is  to increase the patient’s mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis. Careful surgical technique and subsequent atten

  5. Atlantoaxial Ankylosis Detected on Neck CT Scans in a Patient with Ankylosing Spondylitis: A Case Report

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    Lee, Jeong Ah; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of); Ryu, Jeong Ah [Dept. of Radiology, Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of); Kim, Tae Hwan [Dept. of Rheynmatology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2011-07-15

    Ankylosing spondylitis is a chronic inflammatory disorder of unknown cause that principally affects the axial skeleton. The cervical spine is also vulnerable to this disease process and the characteristic feature of cervical involvement is atlantoaxial subluxation. However, only a few cases of atlantoaxial ankylosis have been reported to date. We report a case of atlantoaxial ankylosis in a patient with ankylosing spondylitis with radiologic findings incidentally detected on neck CT scans.

  6. Ankylosis Due Sequel Of Fracture Of The Mandibular Condyle: Case Report

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    Alina Alencar Ferreira Gomes

    2017-08-01

    Full Text Available The Ankylosis of the Temporomandibular joint (TMJ is a disorder of craniofacial complex that results in the merger between the condyle and the mandibular fossa, causing partial or complete immobilization of the mandible. The etiological factors are local and systemic inflammation, infection in the area of TMJ, rheumatic diseases and neoplasms, having the trauma as the main etiologic factor. The traumas are responsible for 31% to 98% of cases of ankylosis. The diagnosis is made from the anamnesis and imaging scans (computed tomography pointing to the union of joint components. The treatment of ankylosis is a big challenge due the high rate of recurrence that can be affected by factors such as type of ankylosis, surgical technique, age of the patient, post-operative physiotherapy and systematic follow-up of the patient. The various forms of treatment require careful analysis of type of ankylosis if it is intra or extra-articular, unilateral or bilateral and if it is bony or fibrous, There is no consensus in current literature regarding the best treatment. The aim of this work is to present through the report of a clinical case, a surgical treatment of Unilateral Temporomandibular joint Ankylosis, due to sequel of condylar fracture with re-establishment of the stomatognathic functions in postoperative follow-up.

  7. CT imaging in the surgical treatment of one-sided extraarticular temporomandibular joint ankylosis; Uso da tomografia computadorizada no planejamento cirurgico da anquilose temporomandibular extra-articular unilateral

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    Villamizar, Lenin A.; Ghirelli, Carolina de Oliveira; Baroni, Carina Outi; Ferro, Daniel; Pinto, Ana Carolina Brandao de Campos Fonseca, E-mail: carinaouti@yahoo.com.br [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia. Dept. de Cirurgia

    2012-07-01

    Temporomandibular joint (TMJ) ankylosis is characterized by difficulty to open the mouth. The ankylosis may be articular when TJM is involved and extra-articular when other factors lead to a restriction of chewing movements without TJM involvement. Case report of one patient with unilateral ankylosis and his surgical planning through the tomography imaging. CT imaging helps preoperative planning because it can locate the exact point of injury and can make the difference between the true and false ankylosis of the TJM. (author)

  8. Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

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    Song, Ji Young [Dept. of Oral and Maxillofacial Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of); Kim, Seong Gon; Choi, Hang Moon [School of Dentistry, Gangneung-Wonju National University, Gangneung (Korea, Republic of); Kim, Hyun Jung [Dept. of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2015-06-15

    Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.

  9. Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

    International Nuclear Information System (INIS)

    Song, Ji Young; Kim, Seong Gon; Choi, Hang Moon; Kim, Hyun Jung

    2015-01-01

    Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence

  10. Temporomandibular joint ankylosis: Case-series of two different surgical procedures

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    Gholamreza Shirani

    2014-01-01

    Full Text Available Introducation: The long-term outcome and clinical results of gaparthroplasty used for the treatment of condylar ankylosis of the mandible in children with application of postoperative activator appliances and costochondral rib graft are evaluated and compared. The purpose of this study was to compare the effect of gap arthroplasty and costochondral graft methods on reankylosis, a mount of mouth opening and growth. Materials and Methods: A non-randomized, retrospective clinical study of l0 cases (5-12 years old of condylar ankylosis of the mandible, surgically treated during a 10 year period from 2002 to 2012 was performed. Four patients were treated by condylectomy and interpositional flap, whereas six were treated by condylectomy and immediate costachondral rib grafts. The first group underwent long-term postoperative therapy using removable activator appliances. Casts, radiographs, photographs, and computed tomography (CT were used post surgically to evaluate rib graft, condylar growth and function, occlusion, facial, and condylar symmetry. Data were analyzed by SPSS 16 statistical software using Mann-Whitney, Paired T-test and Chi-square tests. Results: Children with long-standing condylar ankylosis of the mandible treated by condylectomy and interpositional flap showed more favorably when activators were used post-surgically. Conclusions: Gaparthroplasty with functional activator post-operatively can be considering for TMJ ankylosis.

  11. Simple replantation protocol to avoid ankylosis in teeth intended for orthodontic treatment

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    Yuli Nugraeni

    2009-03-01

    Full Text Available Background: Dento-alveolar trauma resulted from accidents involving the oral regions mostly affect the upper central incisors. Overjet that is beyond 5 mm and incompetent lip also contribute to increase the risk. Several literatures had already discussed different methods of replantation of avulsed teeth. However, it was not meant for further orthodontic treatment. Purpose: The objective of this review is to propose a simple replantation protocol of avulsed teeth which also prevent from ankylosis. Reviews: Protruded teeth usually need orthodontic treatment; therefore, an appropriate management should be done to avoid the development of ankylosis. Ankylosis of the periodontal ligament (PDL becomes a problem in orthodontic tooth movement in repositioned or replanted teeth. In addition, ankylosed teeth also more susceptible to root resorption. Actually, it was caused by the endodontic treatment. In particular, severely protruded or unoccluded teeth are hypofunctional, therefore have narrow PDL, thus it may facilitate to ankylosis development. Ideal management protocol such as the use of root canal sealer i.e. mineral trioxide aggregate (MTA; the using of Emdogain, and resilient wiring or semi-rigid fixation with brackets has become a solution in avulsed teeth arranged for orthodontic treatment. Nevertheless, the presence of oral surgeon, endodontist and orthodontist in the same time, and also ideal preparations after an accident was difficult to achieve. Conclusion: Considering that reducing the ongoing PDL inflammation with intracanal medicaments and maintaining the functional force during mastication is possible; it is concluded that this simple replantation protocol is likely.

  12. Cervical ankylosis following Grisel's syndrome in a 14-year-old boy with infectious mononucleosis

    International Nuclear Information System (INIS)

    Haidar, Salwa; Armstrong, Derek; Drake, James

    2005-01-01

    Non-traumatic atlanto-axial subluxation (Grisel's syndrome) is an uncommon complication of neck space infection or otolaryngologic procedures. It most frequently affects children, although it may occur in adults. We present a 14-year-old boy with Grisel's syndrome as a complication of infectious mononucleosis proceeding to cervical ankylosis. (orig.)

  13. Facial nerve injury following surgery for temporomandibular joint ankylosis: A prospective clinical study

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    S Gokkulakrishnan

    2013-01-01

    Full Text Available Objective: The purpose of this prospective study was to evaluate the incidence and degree of facial nerve damage and time taken for its recovery following surgery for temporomandibular joint (TMJ ankylosis. Materials and Methods: A total of 30 subjects with the TMJ ankylosis with or without history of previous surgery were included in this prospective study. House-Brackmann grading system was used to assess the function of the facial nerve post-operatively. Results: Most of the subjects were in the age range of 13-15 years. Eight subjects had bilateral ankylosis and remaining 22 had unilateral ankylosis. Out of 32 joints in which gap arthroplasty was performed, 4 had Grade 1 injury, 14 had Grade 2 injury, 12 had Grade 3, and 2 with the Grade 4 injury 24 h post-operatively. Whereas, out of 6 cases of interpositional arthroplasty 4 had Grade 1 injury and 2 had Grade 4 injury. According to House-Brackmann grading system, at 24 h, 78.9% patients had different grades of facial nerve injury, which gradually improved and came to normal limits within 1-3 months post-operatively. Comparison of change in the Grade of injury at 3 months follow-up as compared to baseline (24 h showed full recovery in all the cases (100% showing a statistically significant difference from baseline (P < 0.001. Conclusion: When proper care is taken during surgery for TMJ ankylosis, permanent facial nerve injury is rare. However, the incidence and degree of temporary nerve injury could be either due to the heavy retraction causing compression and or stretching of nerve fiber resulting in neuropraxia.

  14. Resection Angulation Osteotomy in Treatment of Post- septic Ankylosis of the Hip

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    DG Nabi

    2008-11-01

    Full Text Available This study evaluated the results of the resection angulation osteotomy in post-septic ankylosis of hip. We performed the procedure in 19 patients, with average age of 26 years (range, 21-32 years and followed patients postoperatively for an average of 43 months (range 20-65 months. The osteotomy united in all patients with an average union time of 16 weeks (range 12-22 weeks. Average painless movement postoperatively was: flexion, 114 degrees; extension, 18 degrees; abduction, 35 degrees; adduction , 21 degrees; external rotation, 23 degrees; and internal rotation, 22 degrees. All the patients except one were able to sit cross- legged on the floor, offer prayers and use squat-type toilets. We conclude that this procedure is a good treatment option in patients with post-septic ankylosis of the hip, who need an alternative to more sophisticated procedures like total hip arthroplasty.

  15. Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis; Report of two cases

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    Noor J. Al-Saadi

    2015-11-01

    Full Text Available Temporomandibular joint (TMJ ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with this condition. The second case was a five-year-old female who presented to the Al-Nahda Hospital, Muscat, Oman, in October 2011. Both cases presented with facial asymmetry and trismus. They subsequently underwent gap arthroplasty and interpositional temporalis muscle and fascia grafts which resulted in an immediate improvement in mouth opening. Postoperatively, the patients underwent active jaw physiotherapy which was initially successful. Both patients were followed up for a minimum of two years following their surgeries.

  16. Validity of radiographic assessment of ankylosis; Evaluation of long-term reaction in 10 monkey incisors

    Energy Technology Data Exchange (ETDEWEB)

    Stenvik, A. (Oslo Univ. (Norway)); Beyer-Olsen, E.; Aabyholm, F.; Haanaes, H.R.; Gerner, N.W. (Rikshospitalet, Oslo (Norway))

    1990-01-01

    The accuracy and sensitivity of radiographic assessments of reactive processes in dental tissues were evaluated by comparison of radiographs and histologic sections. Experimental lesions inflicted on the roots of 10 monkey incisors had been observed by means of serially obtained radiographs over a period of 315 to 370 days. The material was used for evaluation of radiographic assessment of ankylosis. For comparative purposes, assessment of the experimental lesion penetrating to the pulp and periapical radiolucency was added. True and falsely positive or negative recordings formed the basis for calculation of the accuracy and sensitivity of the radiographic assessment. The sensitivity, or the obsevers ability to detect the actual changes, was high for pulp penetration, intermediate for inflammation, and low for ankylosis. 6 refs., 3 figs., 2 tabs.

  17. Hypohidrotic ectodermal dysplasia with ankylosis of temporomandibular joint and cleft palate: A rare presentation

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    Manisha Goyal

    2015-01-01

    Full Text Available The ectodermal dysplasias are a heterogenous group of diseases, which have one or more anomalies of the hair, teeth, nails, and sweat glands. Hypohidrotic ectodermal dysplasia (HED is the most common type and is usually transmitted as an X-linked recessive trait. It is characterized by classical triad of hypotrichosis, anhidrosis/hypohidrosis, and hypodontia/anodontia. Here, we describe an Indian boy affected with HED and rare features including ankylosis of temporomandibular joint and cleft palate.

  18. Temporomandibular joint ankylosis as part of the clinical spectrum of Carey-Fineman-Ziter syndrome?

    Science.gov (United States)

    Pasetti, Martina; Mazzoleni, Fabio; Novelli, Giorgio; Iascone, Maria; Bozzetti, Alberto; Selicorni, Angelo

    2016-08-01

    The Carey-Finema-Ziter syndrome (CFZS, MIM 254940) is an apparently autosomal recessively inherited disorder consisting of the combination of non-progressive congenital myopathy with Moebius and Pierre Robin sequence, facial anomalies and growth delay. Mental development has been described as normal or delayed. Temporomandibular joint (TMJ) ankylosis is the immobility of the joint caused by ankylotic fusion of the mandible to the cranial base or zygoma. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and oral hygiene. Most often is a true ankylosis of the TMJ but other pathological mechanisms are described (i.e., the fusion of the coronoid process to temporal bone or with the zygoma, or a variety of soft tissues disorders like Fibrodysplasia Ossificans Progressiva). Here we report a 2-year-old girl fitting with a clinical diagnosis of CFZS associated with a limited mouth opening in which temporomandibular joint ankylosis was suspected. Because it has been postulated that many clinical features in CFZS may only be secondary effects of brainstem anomalies and muscle weakness during development, the limited opening of the mouth observed in our patient could represent a rare clinical feature of CFZS itself. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  19. [3D mandibular distraction planification in a case of severe temporomandibular ankylosis].

    Science.gov (United States)

    Weber, E; Meyer, C; Ernoult, C; Chatelain, B; Benassarou, M

    2015-06-01

    When occurring in childhood, temporomandibular ankylosis joint is responsible for complex maxillofacial deformities, including mandibular growth deficiency. We present a case of temporomandibular joint ankylosis associated with severe mandibular asymmetry treated by mandibular bone distraction performed under computer assistance. A 27-year-old patient presented with a severe facial asymmetry consisting in hypoplasia of the left hemi-mandible and maxilla. Mouth opening was non-existent. The CT-scan showed a left temporomandibular ankylosis. A left mandibular distraction was decided. The distraction characteristics (choice and positioning of the distractor, axis and amount of distraction) were determined preoperatively on the 3D CT-scan. The planning has been transferred to a navigation console (Kolibri®, Brainlab®). A combined intraoral and cutaneous was performed. Navigation allowed for an appropriate placement of the osteotomy line and fixation of the distractor. Distraction was started at the 5th postoperative day at the rate of 1mm per day and lasted 25 days without complication. 3D planning allows for better indication setting, better preparation of the procedure, reducing complications and operative time. It may help as an educational tool for young surgeons and for a better understanding from the patient. Navigation is an accurate method for the transfer of the planning in the operation room. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Bilaterally Primary Cementless Total Hip Arthroplasty for Severe Hip Ankylosis with Ankylosing Spondylitis.

    Science.gov (United States)

    Feng, Dong-Xu; Zhang, Kun; Zhang, Yu-Min; Nian, Yue-Wen; Zhang, Jun; Kang, Xiao-Min; Wu, Shu-Fang; Zhu, Yang-Jun

    2016-08-01

    Total hip arthroplasty is a reliable therapeutic intervention in patients with ankylosing spondylitis, in whom the aims of surgery are to reduce pain, restore hip function and improve quality of life. The current study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with hip ankylosis associated with severe ankylosing spondylitis who underwent bilateral primary total hip arthroplasty using non-cemented components. From June 2008 to May 2012, total hip arthroplasty was performed on 34 hips in 17 patients with bilateral ankylosis caused by ankylosing spondylitis. The study patients included 13 men and 4 women with a mean age of 24.2 years. The mean duration of disease was 8.3 years and the average duration of hip involvement was 7.6 years. All patients had severe hip pain and dysfunction with bilateral bony ankylosis and no range of motion preoperatively and all underwent bilateral cementless total hip arthroplasty performed by a single surgeon. Joint pain, range of motion (ROM), and Harris hip scores were assessed to evaluate the postoperative results. At a mean follow-up of 31.7 months, all patients had experienced significant clinical improvement in function, ROM, posture and ambulation. At the final follow-up, the mean postoperative flexion ROM was 134.4° compared with 0° preoperatively. Similar improvements were seen in hip abduction, adduction, internal rotation and external rotation. Postoperatively, 23 hips were completely pain-free, six had only occasional discomfort, three mild to moderate pain and two severe pain. The average Harris Hip Score improved from 23.7 preoperatively to 65.8 postoperatively. No stems had loosened at the final follow-up in any patient, nor had any revision surgery been required. Bilateral severe hip ankylosis in patients with ankylosing spondylitis can be treated with cementless bilateral synchronous total hip arthroplasty, which can greatly improve hip joint function and

  1. [Ankylosis of the temporomandibular joint: a rare manifestation of ankylosing spondylitis].

    Science.gov (United States)

    Benazzou, S; Maagoul, R; Boulaadas, M; El Kohen, A; El Quessar, A; Essakelli, L; Alaoui Rachidi, F; Benchekroun, L; Jazouli, N; Kzadri, M

    2005-11-01

    The ankylosing spondylitis is a chronic inflammatory rheumatoid disease with predilection in the axial structures. The temporomandibular joint (TMJ) is involved in 10 to 24% of cases. Ankylosis of the TMJ is exceptional, only 11 cases being reported to date. A 48-year-old patient had been followed since 1987 for severe ankylosing spondylitis. The patient, known to be positive for tissue antigen HLA B27, was admitted for limitation of mouth opening. At physical examination, mouth opening was reduced to 1cm with no mandibular movements and a stiffness of the cervical spine in flexion. Computed tomography of the TMJs highlighted a bilateral lesion with ankylosis of the left joint and of C1-C2. Surgical treatment consisted in block resection of the two TMJs using a cartilaginous rib. With a follow up of 9 months, results have been satisfactory. Complementary explorations should be undertaken in ankylosing spondylitis patients with clinical symptoms suggestive of TMJ lesions in order to establish the diagnosis and initiate treatment and avoid the development of ankylosic forms.

  2. Use of temporalis fascia flap in the treatment of temporomandibular joint ankylosis: A clinical audit of 5 years

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    Suday G Rajurkar

    2017-01-01

    Full Text Available Aim: Restoration of normal function and jaw movements in patients with temporomandibular joint (TMJ ankylosis has been a challenge. Various techniques have been provided for its treatment; but the results have been variable. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis and to decrease postoperative complications such as reankylosis. Materials and Methods: This paper is a review of surgical outcome of interposition arthroplasty with temporalis fascia in 17 patients of unilateral TMJ ankylosis who underwent the above procedure. The review is based on the pre-, intra- and post-operative evaluation of these seventeen patients who were treated between 2008 and 2013. The follow-up time was 1–5 years. Results: Reankylosis was seen in only one of the patients; the remaining patients had satisfactory mouth openings. Conclusion: Surgical treatment of TMJ ankylosis with interposition of temporal fascia is an effective and easy procedure for prevention for reankylosis. The autogeneous nature and proximity to the joint are the main advantages of the temporal fascia flap when compared with other interpositional materials.

  3. Cervical ankylosis following Grisel's syndrome in a 14-year-old boy with infectious mononucleosis

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    Haidar, Salwa; Armstrong, Derek [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, Ont. (Canada); Drake, James [Hospital for Sick Children, Department of Neurosurgery, Toronto (Canada)

    2005-03-01

    Non-traumatic atlanto-axial subluxation (Grisel's syndrome) is an uncommon complication of neck space infection or otolaryngologic procedures. It most frequently affects children, although it may occur in adults. We present a 14-year-old boy with Grisel's syndrome as a complication of infectious mononucleosis proceeding to cervical ankylosis. (orig.)

  4. Ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction in a 13-year-old male.

    Science.gov (United States)

    Mester, B; Ullerich, F; Ohmann, T; Glombitza, M; Schoepp, C

    2017-06-01

    We present the case of an adolescent male developing an ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction (ACLR). The patient was shifted to our institution with postoperative septic arthritis associated with a systemic septic condition. Before, repeated arthroscopic surgery had been conducted without any improvement. MRI showed a concomitant osteomyelitis. The infection (Gächter IV, Staphylococcus aureus) was controlled by an open surgical approach and graft removal. An increasing joint stiffness was documented. X-rays showed an ankylosis at 30° of flexion and early closure of growth plates. Functional knee scores showed significantly worse results. Early diagnosis and a stage-adapted treatment in septic arthritis following ACLR are mandatory. In advanced stages or concomitant osteomyelitis an open approach and graft removal may be appropriate. The antibiotic treatment should be adapted consistently. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis

    DEFF Research Database (Denmark)

    Maksymowych, Walter P; Wichuk, Stephanie; Chiowchanwisawakit, Praveena

    2014-01-01

    OBJECTIVE: Fat metaplasia in bone marrow on T1-weighted magnetic resonance imaging (MRI) scans may develop after resolution of inflammation in patients with ankylosing spondylitis (AS) and may predict new bone formation in the spine. Similar tissue, termed backfill, may also fill areas of excavated...... step in this pathway. METHODS: We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate...... a disease model whereby ankylosis develops following repair of erosions, and fat metaplasia and backfill are key intermediary steps in this pathway....

  6. Induced ankylosis of a primary molar for skeletal anchorage in the mandible as alternative to mini-implants.

    Science.gov (United States)

    Angelopoulou, Matina V; Koletsi, Despina; Vadiakas, George; Halazonetis, Demetrios J

    2015-01-01

    Mesial protraction of mandibular posterior teeth requires increased anchorage to avoid undesired tooth movements. Orthodontic mini-implants have become a popular and successful way to increase skeletal anchorage in such cases. However, mini-implants may cause injury to adjacent teeth or anatomical structures and may lead to tissue inflammation. Induced ankylosed primary teeth have been used in the past as abutments for the protraction of the maxilla in cases of maxillary retrognathism. However, this technique has not been described in the literature for the protraction of mandibular molars. The aim of this paper is to present, through a case report, an alternative to mini-implant devices to maximize anchorage in the mandible by inducing ankylosis on a primary molar. A 13-year-old female with class II right malocclusion, deep bite, and congenitally missing right second premolars was referred for orthodontic treatment. Treatment plan involved removal of the primary teeth and mesial protraction of the posterior. In the mandible, ankylosis was induced on the retained primary second molar by extraction, bisection, replantation of the mesial part after endodontic treatment, and bonding of a rigid splint. Ankylosis was diagnosed after 10 weeks and a closing T-loop sectional wire was inserted to move the permanent first molar mesially. At 6 months, the remaining space was closed using elastic chain on a rectangular stainless steel wire with tip-back bends, supported by class II elastics. Induced ankylosis of primary teeth can be an alternative to orthodontic mini-implants in selected cases, with minimal risks and maximum biocompatibility.

  7. Monitoring of incremental changes in maximum interincisal opening after gap arthroplasty omits the risk of Re-ankylosis.

    Science.gov (United States)

    Khalifa, Ghada Amin

    2018-01-01

    The aim of this clinical study was to prospectively measure the incremental changes in the maximum interincisal opening (MIO) after 1 cm gap arthroplasty, compare these changes between unilateral and bilateral cases, and emphasize the importance of the monitoring of the MIO for at least 24 months. This prospective study enrolled 26 patients with TMJ ankylosis either unilateral or bilateral. The fingers assessment method was used to measure the MIO preoperatively, intraoperatively, and monthly postoperatively up to 24 months. All the patients had undergone 1 cm gap arthroplasty to release the ankylosis. The changes in MIO measurements of unilateral and bilateral cases were statistically compared. The physiotherapy was performed until the measurements had normal stable values. All the cases showed a significant decrease in MIO at the first three months. At 6 months, the MIO continuously increased up to 1 year. There was no difference between the unilateral and bilateral cases. At the end of the follow-up, all measurements showed normal stable values. The monitoring of MIO is important to detect the early signs of re-ankylosis. It is the only way that can be used in which the early signs cannot be detected in radiographs. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Hydroxyapatite/collagen block with platelet rich plasma in temporomandibular joint ankylosis: a pilot study in children and adolescents.

    Science.gov (United States)

    Mehrotra, D; Kumar, S; Dhasmana, S

    2012-12-01

    The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with temporomandibular ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with temporomandibular joint ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months' follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Matthews device arthroplasty presents superior long-term mouth opening than interpositional arthroplasty in the management of temporomandibular joint ankylosis.

    Science.gov (United States)

    Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Buzzo, Celso Luiz; Raposo-Amaral, Cesar Augusto

    2016-08-01

    The aim of this study is to describe the surgical outcomes of a single-institution experience in the surgical management of temporomandibular joint ankylosis, comparing interpositional arthroplasty with autogenous tissue and Matthews device arthroplasty. A retrospective analysis of temporomandibular joint ankylosis patients (n = 15), who underwent interpositional arthroplasty or Matthews device arthroplasty, was conducted. The surgical outcomes (preoperative, recent [4-6 weeks], intermediate [1 year], and late [3 years] postoperative maximal incisal opening, hospital stay, and complication, relapse, and reoperation rates) were compared. Significant (all p  0.05) in preoperative (4.8 ± 2.9 vs. 4.9 ± 2.9 mm) and recent (35 ± 4 vs. 37 ± 4 mm) postoperative maximal incisal opening, hospital stay (3.5 ± 0.8 vs. 3.6 ± 0.8 days), and surgery-related complications (13% vs. 14%). Both surgical procedures evaluated were successful in initial management of temporomandibular joint ankylosis, but the Matthews device arthroplasty avoided postoperative relapse. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Anquilosis mandibular: una frecuente secuela por Noma Mandibular ankylosis: a Noma frequent sequel

    Directory of Open Access Journals (Sweden)

    R. Fernández García-Guilarte

    2009-12-01

    Full Text Available Conocemos poco sobre el Noma o Enfermedad Cancrum Oris. Esta entidad afecta a niños con malnutrición crónica, poca higiene oral, poco desarrollo sanitario y enfermedades concurrentes debilitantes. Existe un consenso general sobre que el Noma empieza como una gingivitis; en su fase aguda, puede haber respuesta al tratamiento antibiótico, no obstante, las secuelas tras su curación incluyen daños estéticos y funcionales variables, que pueden requerir cirugía reconstructiva. Presentamos 3 casos de anquilosis mandibular que en el examen preoperatorio presentaron dimorfismo mandibular, fusión de hueso maxilar y mandibular y anquilosis de la articulación témporomandibular. La ortopantografía y la Tomografía Axial Computerizada (TAC fueron muy útiles en la planificación de la cirugía. El tratamiento quirúrgico consistió en todos los casos en la resección del hueso anquilótico y la reconstrucción con injerto condrocostal en uno de los casos. En el postoperatorio se siguió fisioterapia intensiva. Clínicamente todos los pacientes mostraron una gran mejoría en la masticación, la alimentación y el habla, obviamente debido a una buena oclusión. El problema más común fue la baja colaboración en la rehabilitación mandibular por parte de los pacientes.Little is known about Noma or Cancrum Oris Disease. This entity affects to children with chronic malnutrition, poor oral hygiene, poor environmental sanitation and debilitating concurrent illness. There is general consensus that noma starts as gingivitis. The acute stage responds readily to antibiotic treatment. The sequelae after healing include variable functional and aesthetic impairments, which require reconstructive surgery. We report 3 cases of mandibular ankylosis. Preoperative examination revealed mandibular dismorphism, fusion of maxilla and mandible and ankylosis of the temporomandibular joint. Orthopantography and Computed Thomography scan (TCS were very useful in planning

  11. TMJ Ankylosis: Multidisciplinary Approach of Treatment for Dentofacial Enhancement—A Case Report

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    Pavankumar Janardan Vibhute

    2011-01-01

    Full Text Available This report describes the multidisciplinary phasewise treatment of a 20-year-old female patient having unilateral right TMJ bony (true ankylosis whose mouth opening was restricted to 2 mm and mandibular retrognathism; additionally, she was also suffering from speech problems, snoring, difficulty in breathing, and low level of self-esteem and self-confidence. Bilateral gap arthroplasty and temporalis myofascial graft interpositioning through preauricular approach were done in surgical phase followed by the aggressive jaw physiotherapy in postsurgical period. Oral prophylaxis and restorations were followed by the fixed orthodontic therapy to resolve bimaxillary protrusion. Advancement sliding genioplasty was performed to enhance the chin button. Speech therapy and psychological counseling were also performed from time to time to boost up the self-esteem and self-confidence. At the end of treatment, facial esthetics was improved considerably and patient got over the impact of disfigurement, impaired functions, and psychosocial stigma. Rationale to use the multidisciplinary team approach in treatment of such cases is discussed.

  12. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Kumkum Gupta

    2012-01-01

    Full Text Available Background : Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups - Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1 μg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. Results : The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Conclusion : Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway.

  13. Surgical treatment of hip ankylosis due to heterotopic ossification secondary to spinal cord injury.

    Science.gov (United States)

    Romero-Muñoz, L M; Barriga-Martín, A; DeJuan-García, J

    2018-02-21

    To expose our experience in the diagnostic and surgical treatment of neurogenic heterotopic ossification of the hip. We designed an observational retrospective descriptive study including 20 patients (30 hips) with neurogenic heterotopic ossification of the hip secondary to spinal cord injury attended in our institution in the last 10 years, with a minimum of one year follow-up. Medical files and imaging studies were reviewed. The study variables analyzed were: type and localization of neurogenic heterotopic ossification, pre-post excision range of motion, level and aetiology of spinal cord injury, ASIA score, smoking history, surgical approach and complications associated with surgery. A total of 20 patients were treated with resection of heterotopic ossification in 30 hips. 16 patients presented ASIA A spinal cord injury and 4 ASIA B spinal cord injury. Preoperatively all the patients had severe ankylosis in the hip that made sitting in a wheel chair and activities such as repositioning and hygiene difficult. The average postoperative motion at the follow-up evaluation was 90° in flexion, 20° of internal rotation and 40° of external rotation. Immediately after surgery all the patients followed a specific intensive physiotherapy regime for the hip and celecoxib 200 mg was administrated daily orally for a month to prevent recurrence of heterotopic bone formation. None of the patients reviewed suffered a recurrence of heterotopic bone formation. Surgical excision of hip ossification in order to achieve functional ROM of the hip is the best treatment for patients with neurogenic heterotopic ossification of the hip. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Improvement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia.

    Science.gov (United States)

    Zanaty, Ola; El Metainy, Shahira; Abo Alia, Doaa; Medra, Ahmed

    2016-04-01

    Temporomandibular joint (TMJ) ankylosis accompanied by mandibular micrognathia can severely obstruct a patient's upper airway. The obstructive sleep apnea and hypopnea syndrome (OSAHS) resulting from TMJ ankylosis and accompanied by mandibular micrognathia, can severely influence the patient's life. The aim of this study was to determine if there is a difference in Cormack and Lehane score before and after distraction osteogenesis in such patients, and to evaluate the airway changes and the respiratory outcome using polysomnography after mandibular distraction osteogenesis. This observational prospective study was carried out on 30 ASA II patients with micrognathia and TMJ ankylosis undergoing internal distraction osteogenesis. All patients were assessed with polysomnography before surgery and 6 month after surgery. Nasal intubation was done using a fiberoptic bronchoscope, then patients were subjected to the same anesthetic protocol. Direct laryngoscopy was attempted for the Cormack and Lehane grading after induction. The Cormack and Lehane grade was reassessed after facial symmetry was obtained on removal of the distractor. Mouth opening and Cormack and Lehane score improved significantly between the initial presentation for placement of mandibular distraction osteogenesis devices and on removal of the destructor under general anesthesia. Polysomnographic studies conducted after distraction confirmed the correction of airway obstruction in all patients: Improvement in Apnea-Hypopnea Index, mean difference (95% CI), 39.8 (38.8-40.9); the number of apneas per hour, mean difference, (95% CI) 41.1 (42.1-40.1); and oxygen-desaturation-index mean difference (95% CI) 27.6 (28.3-26.8). Mandibular distraction osteogenesis improved laryngeal view. Distraction osteogenesis can be successfully used for the treatment of obstructive sleep apnea in mandibular hypoplasia patients. © 2016 John Wiley & Sons Ltd.

  15. Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis.

    Science.gov (United States)

    Chaware, Suresh M; Bagaria, Vaibhav; Kuthe, Abhay

    2009-01-01

    Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard "one-size-fits-all" prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery.

  16. A New Method of Treatment of Temporomandibular Joint Ankylosis with Osteodistraction Using the Sh-Device: A Case Report

    Directory of Open Access Journals (Sweden)

    Gholamreza Shirani

    2018-01-01

    Full Text Available This case report presents a 16-year-old boy with bilateral temporomandibular joint (TMJ bony ankylosis due to trauma. The patient had undergone several unsuccessful therapeutic surgeries and was experiencing reduced mouth opening, difficulty in eating and speaking, poor oral hygiene, snoring, and depression. Bilateral gap arthroplasty and distraction osteogenesis (DO were performed. After the surgery, we were able to move the osteodistractors forward and prevent the upward and backward movement of the proximal mandibular segment with the use of our custom-made Sh-device, which allowed bone growth and soft-tissue matching. The mandibular deficiency was treated, and the patient's sleep quality significantly improved after three months. The physical, orthodontic and speech therapies were continued. The facial asymmetry, difficulty in sleeping, eating and speaking, and low self-esteem were completely resolved. At the 8-year follow-up, the patient's condition was satisfactory. The Sh-device can be used as a contemporary treatment modality for TMJ ankylosis.

  17. Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

    Science.gov (United States)

    Chaware, Suresh M.; Bagaria, Vaibhav; Kuthe, Abhay

    2009-01-01

    Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard “one-size-fits-all” prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery. PMID:19881026

  18. Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

    Directory of Open Access Journals (Sweden)

    Chaware Suresh

    2009-01-01

    Full Text Available Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ, successfully using a standard "one-size-fits-all" prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery.

  19. Supracondylar femoral osteotomy and knee joint replacement during the same surgical procedure in a type A haemophiliac patient with knee flexion deformity and ankylosis.

    Science.gov (United States)

    Osma Rueda, Jose Luis; Oliveros Vargas, Alejandra; Sosa, Cristian David

    2017-03-01

    Haemophilia A is the cause of diverse musculoskeletal disorders such as ankylosis, arthritis and associated angular deformity. There are few reported cases in patients with haemophilia A in which simultaneous supracondylar femoral osteotomy and knee joint replacement has been performed to treat knee angular deformity and ankylosis. Here we present the case of an 18year old male patient, with an evolution of two years, who was unable to walk due to the presence of an untreated supracondylar fracture in the left femur and ipsilateral haemophilic arthropathy which led him to develop an ankylosis in flexion close to 70°. Supracondylar osteotomy of the femur and of the left knee joint was performed in the same surgical procedure. Bleeding control was achieved with a protocol of factor VIII supply. The patient was followed up for eight years, and recovered a 0 to 90° range of motion and regained his gait pattern. This case potentially provides a new alternative approach for haemophilia patients presenting with angular deformities and complex ankylosis. We suggest that mixed lesions of intra- and extra-articular deformity in haemophiliac patients can be corrected during the same surgical intervention. In addition, interdisciplinary management including haematology for operative and immediately postoperative control of intra-bleeding using factor VIII supply and control, combined with a controlled rehabilitation plan, can yield good functional outcomes in patients with haemophilic arthropathy. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Blocking p38 signalling inhibits chondrogenesis in vitro but not ankylosis in a model of ankylosing spondylitis in vivo.

    Science.gov (United States)

    Braem, Kirsten; Luyten, Frank P; Lories, Rik J U

    2012-05-01

    To investigate p38 mitogen activated protein kinase (MAPK) signalling in an in vitro model of bone morphogenetic protein (BMP) and transforming growth factor β (TGFβ)-induced chondrogenesis and in vivo, with specific attention to its potential role in ankylosing enthesitis. Human periosteum-derived cells (hPDCs) were cultured in pellets and stimulated with BMP2 or TGFβ1 in the presence or absence of a p38 inhibitor SB203580 or proinflammatory cytokines. Chondrogenic differentiation was evaluated using quantitative PCR. Male DBA/1 mice from different litters were caged together at the age of 8 weeks and treated with SB203580 in both a preventive and therapeutic strategy. The mice were evaluated for prospective signs of arthritis and the toe joints were analysed histologically to assess disease severity. p38 inhibition by SB203580 and proinflammatory cytokines downregulated chondrogenic markers in pellet cultures stimulated by BMP2 or TGFβ1. In contrast, the in vivo experiments resulted in an increased clinical incidence of arthritis and pathology severity score, reflecting progression towards ankylosis in mice given SB203580. Inhibition of p38 inhibited chondrogenic differentiation of progenitor cells, showing that not only the SMAD signalling pathways and also alternative activation of MAPKs including p38 contribute to chondrogenesis. Such an inhibitory effect is not found in an in vivo model of joint ankylosis and spondyloarthritis. Increased incidence and severity of disease in preventive experiments and shifts in disease stages in a therapeutic experimental set-up suggest that specific inhibition of p38 may have deleterious rather than beneficial effects.

  1. Differential diagnosis of carpal and tarsal ankylosis on dry bones: Example from the catacomb of Saints Peter and Marcellinus (Rome, 1st-3rd century AD).

    Science.gov (United States)

    Kacki, S; Castex, D; Blanchard, P; Bessou, M; Giuliani, R; Dutour, O

    2013-12-01

    Bone ankylosis is a pathological feature that may occur in many chronic diseases involving joints. In paleopathology, it is therefore challenging to attribute such a change to a specific condition. Here, we illustrate the differential diagnosis by discussing the lesions observed on an incomplete skeleton from the Roman period, recovered from the catacomb of Saints Peter and Marcellinus (Rome, Italy). The skeleton exhibits several bone changes, including ankylosis on both feet and the left hand. The right tarsal fusion is accompanied by soft tissue ossifications involving the plantar aponeurosis and the tendinous structures connecting the great toe's proximal phalanx and sesamoid bones. The lesions recorded suggest that a spondyloarthropathy is the most likely cause of these extensive fusions. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Stability of interceptive/corrective orthodontic treatment for tooth ankylosis and Class II mandibular deficiency: A case report with 10 years follow-up

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Guimarães

    2015-01-01

    Full Text Available The purpose of this article is to present the treatment of a 8-year-old boy with tooth ankylosis in teeth 85 and Class II division 1 malocclusion and to report a 10-year follow-up result. The patient was initially treated with a sagittal removable appliance, followed by an eruption guidance appliance and braces. The interceptive orthodontic treatment performed to recover the space lost by ankylosis of a deciduous tooth allowed a spontaneous eruption and prevented progression of the problem. The use of an eruption-guidance appliance corrected the dentoskeletal Class II, thus improving the patient's appearance. Besides the treatment producing a good occlusal relationship with the Class I molar, the correction of the overjet and overbite was stable over a ten-year period.

  3. Tratamiento simultáneo de anquilosis temporomandibular unilateral congénita y del microlaterognatismo asociado Simultaneously treament of congenital unilateral temporomandibular ankylosis and consecutive microlatherognathism

    Directory of Open Access Journals (Sweden)

    José Felipe Basulto Varela

    2013-03-01

    Full Text Available Este artículo tiene como objetivo reportar los resultados obtenidos a corto y largo plazo, del tratamiento con enfoque multidisciplinario de una anquilosis unilateral congénita de la articulación temporomandibular asociada a un síndrome de malformación embrionaria, en un niño de 12 años de edad, en el que se utilizó un distractor externo bidimensional con un doble propósito: como fijador para mantener el espacio logrado con la artroplastia y como distractor para elongar la rama mandibular hipotrófica, activado 5 días después de la osteotomía, con el objetivo de eliminar la anquilosis y el microlaterognatismo mandíbular consecutivo de ella, simultaneamente de manera funcional y dinámica.The paper reports the short- and long-term results obtained from the multidisciplinary treatment of a congenital unilateral ankylosis of the temporomandibular joint associated to an embryonic malformation in a 12-year-old boy, using an external bidimensional distraction device with a two-fold purpose: as fixator to maintain the space achieved by arthroplasty, and as distractor to elongate the hypotrophic mandibular branch, activated 5 days after osteotomy, with the purpose of eliminating ankylosis and consecutive mandibular microlaterognatism, both functionally and dynamically.

  4. Tratamiento de anquilosis tempomandibular en la infancia mediante artroplastia y distracción de tejidos blandos Management of temporomandibular ankylosis during childhood by means of arthroplasty and soft tissue distraction

    Directory of Open Access Journals (Sweden)

    M.A. Morey Mas

    2004-08-01

    Full Text Available Los traumatismos que afectan a los cóndilos mandibulares pueden ocasionar una anquilosis de la articulación temporomandibular que, si se produce en edad de crecimiento, puede dar lugar a una deformidad facial con asimetría o retrognatia. Entre los diferentes tratamientos utilizados, la distracción osteogénica ofrece unas ventajas, entre ellas la posibilidad de aplicación en la infancia y la elongación de tejidos blandos. Presentamos un caso de anquilosis temporomandibular bilateral en una niña de 9 años, que tratamos con distracción extraoral tras resección del bloque anquilótico, pero sólo con la finalidad de elongar los tejidos blandos y mantener el espacio en la nueva cavidad glenoidea para evitar la reanquilosis y favorecer la remodelación del cóndilo.Condylar damage can produce temporomandibular joint ankylosis. If ankylosis ocurrs in early childhood can develope facial asymmetry or mandibular hypoplasia. In these cases, several therapeutic options have been used, but distraction osteogenesis offers a new excellent alternative because it allows elongation of soft tissues and can be performed in childhood. We present a bilateral temporomadibular joint ankylosis in a 9 years old girl, who was treated by means an arthroplasty and extraoral distraction devices, only for elongation of soft tissues and keeping space between skull base and mandibula to avoid reankylosis and to allow condylar remodelation.

  5. A anquilose tíbio-társica e sua importância na insuficiência venosa crônica Ankle ankylosis and its importance in chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Jorge Ribas Timi

    2009-09-01

    Full Text Available CONTEXTO: O desenvolvimento de anquilose em pacientes com insuficiência venosa crônica (IVC pode ser evidenciado em diversos estágios da patologia através de medidas da amplitude de movimento da articulação do tornozelo tomadas com a utilização de um goniômetro. OBJETIVO: Relacionar a diminuição da amplitude de movimento da articulação tíbio-társica na IVC dos membros inferiores (MMII medida por goniometria com a gravidade da IVC, utilizando-se a classificação CEAP. MÉTODOS: No período de março de 2003 a agosto de 2004, 86 pacientes (67 mulheres e 19 homens com média de idade de 50,6 anos foram submetidos à goniometria do tornozelo. Os indivíduos foram divididos conforme a gravidade da IVC de seus MMII (121 avaliados de acordo com a classificação CEAP. Quarenta membros foram caracterizados como C0 (grupo-controle, 40 como C3, e 41 como C4. As medidas obtidas nos diferentes grupos foram comparadas entre si. RESULTADOS: A média da amplitude de movimento da articulação tíbio-társica do grupo C0 foi de 42,4º (variação de 26-54; a do grupo C3 foi de 37,9º (variação de 10-61; e a do grupo C4 foi de 24,5º (variação de 8-50. A diferença das médias de C4 e C3 foi de 36%, e a de C3 comparada com o grupo-controle (C0, de 11%, caracterizando a maior diferença entre C3 e C4. CONCLUSÃO: A goniometria do tornozelo auxilia a graduar a hipertensão venosa crônica, pois demonstra a existência de correlação entre a gravidade da anquilose e a severidade da IVC.BACKGROUND: Development of ankylosis in patients with chronic venous insufficiency (CVI can be observed in different stages of the disease as the ankle range of motion is measured by a goniometer. OBJECTIVE: To relate a reduced ankle range of motion in patients with CVI of the lower limbs measured by goniometry and the severity of CVI according to the CEAP classification. METHODS: From March 2003 to August 2004, 86 patients (67 females and 19 males with a mean

  6. Ankylosis in ankylosing spondylitis: current concepts.

    Science.gov (United States)

    Haroon, Nigil

    2015-06-01

    Ankylosing spondylitis (AS) is the most common form of spondyloarthritis and is characterized by both inflammation and new bone formation. Despite many years of arduous efforts, we still do not clearly understand the pathogenesis of AS. The mechanisms behind new bone formation have been especially challenging to decipher due to the difficulty in obtaining tissue from spinal joints. The link between inflammation and bone formation looks obvious, but how inflammation drives spinal fusion is not evident. There are now two genes linked to prostaglandins (PG) that could be involved in AS pathogenesis. The first one is PTGER4 that codes for the EP4 receptor for PGE2 and the other one is PTGS1 that codes for prostaglandin-endoperoxide syntase 1 or cyclogenase 1. The bone morphogenic protein and Wnt signaling pathways could be important in signaling increased bone formation in AS. The disease-modifying potential of anti-inflammatories and tumor necrosis factor alpha inhibitors is discussed.

  7. Management Of Bilateral Temporomandibular Joint Ankylosis In ...

    African Journals Online (AJOL)

    The patient was successfully managed by placement of costochondral grafts and interpositional arthroplasty with partial temporal myofascial flaps. Good mouth opening was achieved and subsequent follow-ups showed improved mandibular and general body growth as well as psychosocial performance. The aim of this ...

  8. Anquilose intencional dos caninos decíduos como reforço de ancoragem para a tração reversa da maxila: estudo cefalométrico prospectivo Intentional ankylosis of the deciduous canines to enhance maxillary protraction: a prospective cephalometric analysis

    Directory of Open Access Journals (Sweden)

    Omar Gabriel da Silva Filho

    2006-12-01

    Full Text Available OBJETIVO: o presente trabalho de pesquisa analisou os efeitos da tração reversa da maxila associada à anquilose intencional dos caninos decíduos superiores, mediante o emprego da cefalometria. METODOLOGIA: o protocolo de tratamento incluiu: 1 anquilose intencional dos caninos decíduos superiores; 2 expansão rápida da maxila e 3 tração reversa da maxila, imediatamente após o término da fase ativa da expansão. A amostra foi composta de 18 crianças nos estágios de dentadura decídua e dentadura mista, com idade média inicial de 7 anos e 1 mês. O intervalo médio de tratamento com a tração reversa da maxila foi de 1 ano e 1 mês. As telerradiografias laterais foram obtidas na documentação inicial e após a correção da Classe III. RESULTADOS E CONCLUSÕES: os resultados demonstram que os ângulos representativos da convexidade facial, NAP e ANB, aumentaram de 0º para 6,6º e 3,5º, respectivamente. Isso significa dizer que a face transformou-se de reta ou côncava, peculiar na Classe III, para uma face convexa, característica de normalidade no estágio avaliado. Essa melhora na convexidade facial é atribuída ao avanço da maxila, registrado tanto na região alveolar (ângulo SNA e as distâncias Co-A e NPerp-A como na região basal (ângulo SN.ENA. A maxila deslocou-se para frente, enquanto a redução do ângulo SNB de 80,56º para 79,61º demonstrou um retroposicionamento mandibular. Além da mudança no sentido sagital, houve rotação da mandíbula no sentido horário, com aumento dos ângulos SN.GoGn e SN.Gn. Somado aos efeitos ortopédicos, houve inclinação vestibular dos incisivos superiores.AIM: the current article analyses the effects of maxillary protraction associated to the intentional ankylosis of the deciduous canines on the basis of cephalometric measurements. METHODS: the treatment protocol included: 1 intentional ankylosis of the upper deciduous canines; 2 rapid palatal expansion and 3 maxillary

  9. Temporomandibular joint ankylosis in ankylosing spondylitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Nishtha Gupta

    2016-01-01

    Full Text Available Ankylosing spondylitis (AS is a chronic systemic inflammatory disorder. It primarily affects the axial skeleton through involvement of the peripheral joint scan occurs. Temporomandibular joint (TMJ involvement in AS varies from 4% to 35%. Here, we present a case of a 35-year-old male, follow-up of AS from last 8 years on nonsteroidal anti-inflammatory drugs, presented with fresh complaints of painfully restricted movements of jaw during swallowing. Computer tomography of patient demonstrates articular cartilage changes with disc and joint abnormalities.

  10. Genome-wide DNA methylation profile analysis identifies differentially methylated loci associated with ankylosis spondylitis.

    Science.gov (United States)

    Hao, Jiangcan; Liu, Yang; Xu, Jiawen; Wang, Wenyu; Wen, Yan; He, Awen; Fan, Qianrui; Guo, Xiong; Zhang, Feng

    2017-07-25

    Ankylosing spondylitis (AS) is a chronic rheumatic and autoimmune disease. Little is known about the potential role of DNA methylation in the pathogenesis of AS. This study was undertaken to explore the potential role of DNA methylation in the genetic mechanism of AS. In this study, we compared the genome-wide DNA methylation profiles of peripheral blood mononuclear cells (PBMCs) between five AS patients and five healthy subjects, using the Illumina Infinium HumanMethylation450 BeadChip. Quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was performed to validate the relevance of the identified differentially methylated genes for AS, using another independent sample of five AS patients and five healthy subjects. Compared with healthy controls, we detected 1915 differentially methylated CpG sites mapped to 1214 genes. The HLA-DQB1 gene achieved the most significant signal (cg14323910, adjusted P = 1.84 × 10 -6 , β difference = 0.5634) for AS. Additionally, the CpG site cg04777551 of HLA-DQB1 presented a suggestive association with AS (adjusted P = 1.46 × 10 -3 , β difference = 0.3594). qRT-PCR observed that the mRNA expression level of HLA-DQB1 in AS PBMCs was significantly lower than that in healthy control PBMCs (ratio = 0.48 ± 0.10, P pathway enrichment analysis of differentially methylated genes identified four GO terms and 10 pathways for AS, functionally related to antigen dynamics and function. Our results demonstrated the altered DNA methylation profile of AS and implicated HLA-DQB1 in the development of AS.

  11. Pathologic thoracic spine fracture in presence of Parkinson's disease and diffuse ankylosis: successful management of a challenging condition.

    Science.gov (United States)

    Aoki, Yasuchika; Nakajima, Arata; Sakakibara, Ryuji; Ohtori, Seiji; Takahashi, Kazuhisa; Nakagawa, Koichi

    2013-02-11

    Patients with Parkinson's disease have higher risk of complications and revision surgery following spine surgery. Spinal fracture in an ankylosed spine is also difficult to treat. We recently treated a case of thoracic spine fracture in a patient with Parkinson's disease complicating a severely ankylosed spine. There is no report describing surgical treatment of spine fracture in such a difficult condition, thus, we firstly report the case and discuss the reasons for a successful result. A 68-year-old man with Parkinson's disease had a pathologic thoracic spine fracture at T11. Four days after onset, he was referred to a local hospital because of gradually increasing back pain, but no spinal fracture was pointed out at that time. Because he developed lower extremity bilateral numbness and weakness, he was transported to our hospital, eight days after onset. When referred to our hospital, he exhibited severe back pain and paralysis of the lower extremities due to spinal cord involvement. Emergency surgery was performed. Decompression of T10-11 was performed followed by instrumented spinal fusion from T8 to L2. A dramatic neurological improvement was observed following surgery, and complete bony fusion was achieved. At the final two-year postoperative follow-up, the patient had no pathological symptoms related to spinal fracture and no instrument failure was observed. This patient had Parkinson's disease and a severely ankylosed spine, both of which may lead to unsatisfactory surgical results from spinal surgery. Generally, patients with Parkinson's disease have an increased risk for adjacent segment disease and instrument failure. In this patient, fusion surgery did not change the number of fused segments because operated segments were already ankylosed. Because no stress force exists between adjacent vertebral bodies, a severely ankylosed spine may help prevent screw pullout. Thus, treatment of a spinal fracture in an ankylosed spinal segment is a less adverse condition for patients with Parkinson's disease. Our experience led us to think that a combination of Parkinson's disease with severely ankylosed spine does not necessarily suggest unsatisfactory outcomes after surgical treatment of spinal fracture.

  12. Pathologic thoracic spine fracture in presence of Parkinson’s disease and diffuse ankylosis: successful management of a challenging condition

    Directory of Open Access Journals (Sweden)

    Aoki Yasuchika

    2013-02-01

    Full Text Available Abstract Background Patients with Parkinson’s disease have higher risk of complications and revision surgery following spine surgery. Spinal fracture in an ankylosed spine is also difficult to treat. We recently treated a case of thoracic spine fracture in a patient with Parkinson’s disease complicating a severely ankylosed spine. There is no report describing surgical treatment of spine fracture in such a difficult condition, thus, we firstly report the case and discuss the reasons for a successful result. Case presentations A 68-year-old man with Parkinson’s disease had a pathologic thoracic spine fracture at T11. Four days after onset, he was referred to a local hospital because of gradually increasing back pain, but no spinal fracture was pointed out at that time. Because he developed lower extremity bilateral numbness and weakness, he was transported to our hospital, eight days after onset. When referred to our hospital, he exhibited severe back pain and paralysis of the lower extremities due to spinal cord involvement. Emergency surgery was performed. Decompression of T10-11 was performed followed by instrumented spinal fusion from T8 to L2. A dramatic neurological improvement was observed following surgery, and complete bony fusion was achieved. At the final two-year postoperative follow-up, the patient had no pathological symptoms related to spinal fracture and no instrument failure was observed. Conclusion This patient had Parkinson’s disease and a severely ankylosed spine, both of which may lead to unsatisfactory surgical results from spinal surgery. Generally, patients with Parkinson’s disease have an increased risk for adjacent segment disease and instrument failure. In this patient, fusion surgery did not change the number of fused segments because operated segments were already ankylosed. Because no stress force exists between adjacent vertebral bodies, a severely ankylosed spine may help prevent screw pullout. Thus, treatment of a spinal fracture in an ankylosed spinal segment is a less adverse condition for patients with Parkinson’s disease. Our experience led us to think that a combination of Parkinson’s disease with severely ankylosed spine does not necessarily suggest unsatisfactory outcomes after surgical treatment of spinal fracture.

  13. Axial involvement with facet joint arthropathy and bony ankylosis in a case of camptodactyly, arthropathy, coxa vara, pericarditis (CACP) syndrome

    NARCIS (Netherlands)

    Emad, Yasser; Ragab, Yasser; Khalifa, Maher; Bassyouni, Iman; El Shaarawy, Nashwa; Rasker, Johannes J.

    2013-01-01

    Familial arthropathy associated with congenital camptodactyly has been previously recognized as a definite clinical entity in the literature. The clinical spectrum of this disease seems to be variable. The typical features of congenital camptodactyly, arthropathy, coxa vara and pericarditis (CACP

  14. Ankylosis of the hips and knees due to sickle cell disease [v1; ref status: indexed, http://f1000r.es/S7w2Gz

    Directory of Open Access Journals (Sweden)

    Saad Saleh Abdullah Al Elayan

    2012-10-01

    Full Text Available This is a case report of a 29-year-old Saudi male with sickle cell disease (SCD with severe stiffness of his joints, mainly both knees and hips, secondary to complications of SCD. He was severely crippled: unable to sit, stand or walk, and was bedridden for 8 years when he was presented to us. Radiographs showed fusion of both knees and hips. There was no evidence of active osteomyelitis by Gallium scan. The patient’s hemoglobin S decreased to levels below 30% by exchange transfusion. Bilateral total hip replacement, as well as unilateral total knee replacement, was carried out to improve his level of function. There is only one reported case of such severe and multiple joint complications in a single patient suffering from SCD. The increased life expectancy that medical advances have offered to the sickle-cell patients has led to the appearance of sickle-cell-related complications, which were previously only seen rarely. These complications were successfully managed and the patient was able to move and transfer using a wheel chair.

  15. EAMJ Jan. Managements.indd

    African Journals Online (AJOL)

    2009-01-01

    . One of the goals of the treatment of ankylosis is to prevent re-ankylosis. Topazian's (11) review of gap arthroplasty without interposition reported a recurrence rate as high as 53%.To reduce the chance of re-ankylosis, some ...

  16. Use of oral mucoperiosteal and Pterygo-masseteric muscle flaps as ...

    African Journals Online (AJOL)

    Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re‑ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as ...

  17. KONDILEKTOMI PADA PENDERITA DEWASA DENGAN ANKILOSIS SENDI TEMPOROMANDIBULA

    Directory of Open Access Journals (Sweden)

    Bambang Aries Purbawanto

    2015-08-01

    Full Text Available Ankylosis of the temporomandibular joint is a fusion of the glenoid fossa and capsular surface of the joint that involved condyle and discus as a result of the formation of fibrous tissue or bone formation. This condition caused the mandible could not translate from the fossa. This condition reduced mouth opening that range from partial to complete immobility of the jaw. Ankylosis can be divided into two types, intracapsular and extracapsular ankylosis. This case reported a condylectomy of an adult patient with ankylosis for eight years. It resulted maximum opening mouth approximately 32 mm.

  18. Disease: H00868 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H00868 Stapes ankylosis with broad thumb and toes This syndrome is characterized b...Hall CM, Baraitser M ... TITLE ... The autosomal dominant syndrome with congenital stapes ankylosis, broad thumbs and hyperopia. ... JOURNAL ... Clin Dysmorphol 6:195-203 (1997) ...

  19. Treatment of replacement resorption by intentional replantation, resection of the ankylosed sites, and Emdogain--results of a 6-year survey.

    Science.gov (United States)

    Filippi, Andreas; Pohl, Yango; von Arx, Thomas

    2006-12-01

    The present clinical study investigated the outcome of intentional replantation using resection of the ankylosed sites of the root, extraoral endodontic treatment using titanium posts and Emdogain for periodontal healing following trauma-related ankylosis. During an evaluation period of 6 years, 16 ankylosed teeth affected by replacement resorption were treated as described. Evaluation parameters before treatment and during the follow-up period included Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. In a second accident, one tooth was lost after 7 months and was excluded as a dropout. Ankylosis did not recur in seven replanted teeth, which were observed for an average of 52.3 months (range: 24-68 months). Ankylosis recurred in eight teeth after an average period of 12 months (range: 4-26 months). An infraocclusion, normal or only slightly reduced Periotest scores and normal percussion sound were preoperatively found in six of seven successfully replanted teeth, which corresponded to a relatively small area of ankylosis. The majority of the teeth showing recurrent ankylosis preoperatively presented with normal position, negative Periotest scores and a high percussion sound which corresponded to an extended area of ankylosis. Statistically significant relationship between preoperative findings and the treatment outcome (P = 0.031) have become apparent. The results indicate that the treatment of minor areas of ankylosis by intentional replantation, resection of the ankylosed sites and Emdogain appeared to prevent or delay the recurrence of ankylosis in 7 of 15 teeth.

  20. Autotransplantation of maxillary second premolars to mandibular recipient sites where the primary second molars were impacted, predisposes for complications

    DEFF Research Database (Denmark)

    Bokelund, Mette; Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg

    2013-01-01

    The aim of the study was to elucidate whether ankylosis of a transplanted permanent tooth can be predicted based on an evaluation of the primary and permanent dentitions.......The aim of the study was to elucidate whether ankylosis of a transplanted permanent tooth can be predicted based on an evaluation of the primary and permanent dentitions....

  1. Emdogain does not prevent progressive root resorption after replantation of avulsed teeth: a clinical study.

    Science.gov (United States)

    Schjøtt, M; Andreasen, J O

    2005-02-01

    Emdogain has been shown in clinical and experimental studies to promote regeneration of all periodontal tissues: cementum with anchoring fibres, a functional, periodontal ligament and alveolar bone in connection with treatment of marginal periodontitis. The intention of this study was to analyse whether this regenerative capacity upon the periodontal ligament also worked in a trauma situation where a significant number of PDL cells have been eliminated because of unphysiologic storage or actual damage during avulsion or replantation. Furthermore if ankylosis sites already established because of earlier replantation after avulsion could be surgical removed and application of Emdogain could revert the ankylosis stage to a normal PDL situation. The first treatment situation was tested in seven patients with a total of 16 avulsed teeth with varying time of extra oral storage. The teeth were extra-orally endodontically treated and the root and socket covered with Emdogain before replantation. All teeth demonstrated subsequent ankylosis, primarily diagnosed by a percussion test. The second treatment situation where an ankylosis was already established constituted of seven patients with a total of 11 teeth because of previous replantation after avulsion. These teeth were all extracted, the ankylosis sites removed and the root and socket treated with Emdogain. After 6 months all teeth showed recurrence of ankylosis. It is concluded that Emdogain was not able to prevent or cure ankylosis.

  2. AcEST: BP921008 [AcEST

    Lifescience Database Archive (English)

    Full Text Available RAJU Cysteine synthase OS=Brassica juncea PE=2 ... 30 4.3 sp|P58366|ANKH_RAT Progressive ankylosis protein h...omolog OS=Ratt... 30 4.3 sp|Q9JHZ2|ANKH_MOUSE Progressive ankylosis protein OS=Mu...s muscul... 30 4.3 sp|Q9HCJ1|ANKH_HUMAN Progressive ankylosis protein homolog OS=Ho... 30 4.3 sp|Q9W7R4|TEN3...1_ARATH Cysteine synthase OS=Arabidopsis thaliana ... 30 5.6 sp|P58367|ANKH_XENLA Progressive ankylosis prot...K 345 P IWK GK+DG I G T+ A K +K Sbjct: 165 PEIWKGTEGKIDGFISGIGTGGTITGAGKYLK 196 >sp|P58366|ANKH_RAT Progressive ankylos

  3. Combination of Root Surface Modification with BMP-2 and Collagen Hydrogel Scaffold Implantation for Periodontal Healing in Beagle Dogs

    OpenAIRE

    Kato, Akihito; Miyaji, Hirofumi; Ishizuka, Ryosuke; Tokunaga, Keisuke; Inoue, Kana; Kosen, Yuta; Yokoyama, Hiroyuki; Sugaya, Tsutomu; Tanaka, Saori; Sakagami, Ryuji; Kawanami, Masamitsu

    2015-01-01

    Objective : Biomodification of the root surface plays a major role in periodontal wound healing. Root surface modification with bone morphogenetic protein (BMP) stimulates bone and cementum-like tissue formation; however, severe ankylosis is simultaneously observed. Bio-safe collagen hydrogel scaffolds may therefore be useful for supplying periodontal ligament cells and preventing ankylosis. We examined the effects of BMP modification in conjunction with collagen hydrogel scaffold implantatio...

  4. A case of perosomus elumbis in a Holstein calf

    International Nuclear Information System (INIS)

    Son, J.M.; Yong, H.Y.; Lee, D.S.; Choi, H.J.; Jeong, S.M.; Lee, Y.W.; Cho, S.W.; Shin, S.T.; Cho, J.K.

    2008-01-01

    Perosomus elumbis is an occasionally found congenital anomaly of unknown etiology and is characterized by partial or complete agenesis of lumbar, sacral and coccygeal vertebrae and ankylosis of the hindlimbs. A 2-day-old female Holstein calf presented nearly normal forelimbs but flexure and ankylosis of the hindlimbs. The vertebrae and pelvic malformations and agenesis were radiographed and then necropsied. Mild ankylosis of the hindlimbs, absence of cauda equina, left scoliosis in state of fusion of T11 and T12 and complete fusion of L4 and L5, narrowed pelvic canal and misshapen ilium were confirmed. However, abnormal development or agenesis was not observed in the urogenital and intestinal system in this calf

  5. Untitled

    African Journals Online (AJOL)

    The lamb which was delivered alive was found al., 1984; Ibrahim et al., 1987; Ate and Allam, to have significantly enlarged head relative to 2002). Although there exists various reports of body size with ankylosis of the limbs. The lamb dystocia caused by congenital malformations, died few minutes following delivery.

  6. 2018-04-22T12:30:44Z https://www.ajol.info/index.php/all/oai oai:ojs ...

    African Journals Online (AJOL)

    Other complications were chronic joint dislocation, ankylosis, joint stiffness, arthrosis/arthritis, chronic osteomyelitis, Volkmann's ischaemic contracture, osteonecrosis, neuropathy, limb gangrene, delayed union and pressure ulcer. The most frequent intervention was open reduction and internal fixation (60.56%) and most of ...

  7. Early hypercementosis and arrested dental eruption: heritable multiple ankylodontia.

    Science.gov (United States)

    Israel, H

    1984-01-01

    This study describes arrested posterior permanent tooth eruption in association with hypercementosis, reduction of the periodontal ligamental space, and bony ankylosis. The severe dental malocclusion occurred in four members of the same family and it appears to have an autosomal dominant mode of inheritance.

  8. A Study of the Association of Polymorphism rs5860110 and its ...

    African Journals Online (AJOL)

    HP

    subsequent ankylosis [1]. Most patients develop first symptoms of AS younger than 30 years of age [2]. More recent studies have shown that structural damage at initial ..... prognosis of ischemic stroke in Chinese patients.Cell. Physiol Biochem 2013; 32:1798-1807. 23. Karamizadeh Z, Kamali Sarvestani E, Saki F, Karamifar.

  9. Browse Title Index

    African Journals Online (AJOL)

    Items 251 - 300 of 522 ... Vol 18, No 2 (2012), Intrathecal fentanyl with 0.5% bupivacaine heavy in chronic opium abusers, Abstract PDF. S Gupta, K Dev, S Katyal, S Kathuria. Vol 20, No 5 (2014), Intubation of a neonate with glossopalatine ankylosis using a paraglossal approach and a laryngoscope with a straight blade ...

  10. Pattern of Maxillofacial Surgical Conditions in North Central Nigeria ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... relative contributions of each surgical condition to the average workload of the oral and maxillofacial surgeon. However, the few hospital-based studies complimented by the present one could give a fair idea of the present workload pattern in Nigeria. Figure 3: A group of TMJ ankylosis patients presenting ...

  11. Browse Title Index

    African Journals Online (AJOL)

    Items 751 - 800 of 813 ... Vol 17, No 1 (2008), Tinnitus and the prevalence of co-morbid psychological stress, Abstract. A A Adoga, A S Adoga, J T Obindo. Vol 24, No 4 (2015), TMJ ankylosis: Management with reconstruction and interpositional arthroplasty, Abstract. Madhumati Singh, R Shruthi, Sojitra Mitul, Karan Abhishek, ...

  12. PICTORIAL ESSAY Bamboo spine – X-ray findings of ankylosing ...

    African Journals Online (AJOL)

    Early lumbar axial ankylosis and spinal involvement is more marked in male patients than female, with early radiographic signs of hip involvement.2-4. Classic joint involvement includes: bilateral sacro-iliac, thoraco- lumbar and lumbo-sacral joints (early) and cervical spine (late).5 The peripheral skeleton is involved in 10 ...

  13. Download this PDF file

    African Journals Online (AJOL)

    2004-03-02

    Mar 2, 2004 ... fering trauma to the chin in order to prevent this condition is emphasized. The difficulties encoun- .... scopy. In one (3.3%) other case of unilateral in- complete ankylosis, a laryngeal mask was success~ .... surgical emphysema, pneumothorax, and air em- bolism have been associated with tracheostomy?

  14. The importance of the occipitocervical area in patients with ankylosing spondylitis analysis of a cohort of 86 cervical fractures in surgically treated patients

    Directory of Open Access Journals (Sweden)

    Augusto Atilio Covaro

    2017-01-01

    Conclusions: X-angle is a reliable measure for joint integrity C0–C1–C2 in patients with AS. Total cervical ankylosis including the C0-C1-C2 segments is not related to poorer QOL and disability in these patients.

  15. Bamboo spine – X-ray findings of ankylosing spondylitis revisited ...

    African Journals Online (AJOL)

    Ankylosing spondylitis is a debilitating disease that is one of the seronegative spondylarthropathies, affecting more males than females in the proportion of about 6:1 in the age group 15 - 35 years of age. Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray ...

  16. Causes of maxillofacial patient mortality in a Nigerian tertiary hospital

    African Journals Online (AJOL)

    patients. Discussion. A literature search found few mortality studies carried out in maxillofacial surgery units, (Fahad et al. [2]). Although Verco et al [10] studied only .... immobilization. 1 (2.2). Aggressive jaw tumors. Jaw resection and reconstruction. 5 (10.9). Assymetric face ±. TMJ ankylosis. Placement of distractors. 1 (2.2).

  17. MR signal in the sacroiliac joint space in spondyloarthritis: a new sign

    Energy Technology Data Exchange (ETDEWEB)

    Laloo, Frederiek; Herregods, N.; Verstraete, K.; Jans, L. [Ghent University Hospital, Department of Radiology and Medical Imaging, Gent (Belgium); Varkas, G.; Elewaut, D.; Bosch, F. van den [Ghent University Hospital, Department of Rheumatology, Gent (Belgium); Jaremko, J.L. [University of Alberta Hospital, Department of Radiology and Diagnostic Imaging, Edmonton, Alberta (Canada); Baraliakos, X. [Ruhr-University Bochum, Rheumazentrum Ruhrgebiet, Herne (Germany)

    2017-05-15

    To determine the diagnostic value of MR signal within the sacroiliac (SI) joint space in spondyloarthritis (SpA). A retrospective analysis of MRIs of SI joints was performed in 363 patients, aged 16-45 years, clinically suspected of sacroiliitis. Intra-articular SI joint MR signals were categorized as normal, high T1 signal, fluid signal, ankylosis or vacuum phenomenon (VP). These MRI findings were correlated with the final diagnosis, according to the ASAS criteria. Sensitivity, specificity, and positive and negative likelihood ratios (LR) and predictive values were calculated. Presence of intra-articular high T1 signal, fluid signal and ankylosis had a specificity of 95.8 %, 95.3 % and 99.5 % for SpA. High T1 signal, fluid signal and ankylosis were present in 38.4 %, 19.2 % and 17.9 % of SpA patients and in 4.2 %, 4.7 % and 0.5 % of patients without SpA, resulting in LR+ of 9.0, 4.1 and 37.9, respectively. VP was present in 13.2 % of SpA patients and in 20.8 % of patients without SpA, resulting in an LR+ of 0.6. Presence of high T1 signal, fluid signal and ankylosis within the SI joint on MRI have high specificity for SpA. High T1 signal is the most sensitive MRI feature within the SI joint for SpA. (orig.)

  18. Ankylosing spondylitis in a 50-year-old man: a case report | Kawu ...

    African Journals Online (AJOL)

    Ankylosing spondylitis (AS) is a distinct disease entity characterized by inflammation of multiple articular and paraarticular structures especially of the spine, sacroiliac joints and large peripheral joints such as the hips, shoulders and rarely the knees frequently resulting in bony ankylosis. This is a case report of a 50 year old ...

  19. The role of bone morphogenetic proteins in ankylosing spondylitis.

    Science.gov (United States)

    Carter, Shea; Braem, Kirsten; Lories, Rik J

    2012-08-01

    Ankylosing spondylitis (AS), the best-known form of spondyloarthritis (SpA), is a remodelling arthritis characterized by chronic inflammation and bone formation. Ankylosis of the axial skeleton and sacroiliac joints leads to an impairment of spinal mobility, progressive spinal fusion and an increased risk of spinal fractures. The nature of the relationship between inflammation and new bone formation in AS has been controversial and questions remain as to whether there is a direct relationship between inflammation and new bone formation. Like others, we have hypothesized that the molecular pathways underlying ankylosis recapitulate the process of endochondral bone formation and that bone morphogenetic proteins (BMPs) play a key role in this process in AS. Furthermore, we discuss the entheseal stress hypothesis, which proposes that inflammation and ankylosis are linked but largely independent processes, and consider observations from mouse models and other human diseases which also imply that biomechanical factors contribute to the pathogenesis of AS. As current therapeutics, such as tumour necrosis factor inhibitors do not impede disease progression and ankylosis in AS, it is the pathways discussed in this review that are the now the focus for the identification of future drug targets.

  20. Author Details

    African Journals Online (AJOL)

    Onoyom-Ita, V.I. Vol 8, No 1 (2009) - Articles Ankylosis of the mandible: a study of 32 cases. Abstract. ISSN: 1597-1260. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL · News.

  1. PATTERNS OF SEVEN AND COMPLICATED MALARIA IN CHILDREN

    African Journals Online (AJOL)

    GB

    2017-01-01

    Jan 1, 2017 ... syndrome is a variant of HFM, which includes vertebral anomalies and epibulbar ... zygomatic arch and external and middle ear, which includes the incus, ... syndrome, hypoplasia of the condyle on the right side and congenital unilateral ankylosis on the right side. Orthopantomograph examination revealed.

  2. Schistosomus Reflexus Causing Dystocia in a Red Sokoto Doe: A ...

    African Journals Online (AJOL)

    ... malpositioned kidney and heart, spinal inversion and limb ankylosis. The digestive, respiratory, cardiovascular, urogenital and skeletal systems anomalies were observed in this report. Many of the malformations and malpositioning have been previously reported. The above clinical findings suggest Schistosomus reflexus ...

  3. Outcome of treatment of cervical spine tuberculosis at the King ...

    African Journals Online (AJOL)

    Pancervical ankylosis was seen in three cases (9%) and was symptomatic in one (3%) of these cases. Other complications included esophageal injury, graft fracture, screw loosening, screw malposition and plate fixation failure (2.5% in each case). Conclusion: The results of treatment of cervical spine tuberculosis are good.

  4. Browse Title Index

    African Journals Online (AJOL)

    B.K. Mukaara, L.J. Ngenzi, R.J. Daniels. Vol 76, No 12 (1999), Temporomandibular joint ankylosis in south western Nigeria, Abstract. AE Obiechina, IT Arotiba, AO Fasola. Vol 87, No 1 (2010), Temporomandibular joint dislocation in Nairobi, Abstract PDF. LK Sang, E Mulupi, MK Akama, JM Muriithi, FG Macigo, ML Chindia.

  5. A simplified staging system based on the radiological findings in different stages of ochronotic spondyloarthropathy

    International Nuclear Information System (INIS)

    Jebaraj, Isaac; Chacko, Binita Riya; Chiramel, George Koshy; Matthai, Thomas; Parameswaran, Apurve

    2013-01-01

    This study describes a group of 26 patients with ochronotic spondyloarthropathy who were on regular treatment and follow-up at a tertiary level hospital and proposes a simplified staging system for ochronotic spondyloarthropathy based on radiographic findings seen in the thoracolumbar spine. This proposed classification makes it easy to identify the stage of the disease and start the appropriate management at an early stage. Four progressive stages are described: an inflammatory stage (stage 1), the stage of early discal calcification (stage 2), the stage of fibrous ankylosis (stage 3), and the stage of bony ankylosis (stage 4). To our knowledge, this is the largest reported series of radiological description of spinal ochronosis, and emphasizes the contribution of the spine radiograph in the diagnosis and staging of the disease

  6. Inherited knee disorders in the Medici family.

    Science.gov (United States)

    Lippi, Donatella; Matucci-Cerinic, Marco; Alburyc, W R; Weisz, George M

    2014-01-01

    Reconstructing a medical condition which was existent centuries ago is limited by the lack of contemporaneous evidence-based descriptions in the accounts given by physicians and other observers. Despite these limitations modern paleopathological evidence, supplemented by techniques of historical investigation, have led to the conclusion that males in the Medici family typically suffered from a complex clinical entity with a triple pathology of stenotic spinal ankylosis, recurrent peripheral joint disease and erythematous skin disease; the Medici Syndrome. Examination of the knee joint is illustrative of recurrent joint disease both in the primary and secondary lines of the family. Pictorial and sculptural representations, if used cautiously, can assist in this retrospective process. The six cases presented here illustrate the involvement of the knee joint where the joint destruction ultimately led to an ankylosis. Copyright © 2013. Published by Elsevier B.V.

  7. Cementable implant-supported prosthesis, serial extraction, and serial implant installation: case report.

    Science.gov (United States)

    Rosen, Harry; Gornitsky, Mervyn

    2004-12-01

    Cement-retained implant-supported prostheses are particularly indicated where access for screw placement is limited or impossible like in posterior locations or where there is limited jaw opening. The patient in this case report suffered from limited jaw opening as a result of a long history of temporomandibular joint ankylosis related to hemophilia. Cement-retained implant-supported prostheses coupled with serial extraction, serial implant installations, and chairside provisional restorations made uneventful treatment possible.

  8. Orthodontic and pediatric dental treatment approach in patient with multiple dental anomalies

    OpenAIRE

    SOUZA, Ricardo Alves; CARVALHO, Alberic Costa; BARRETTO, Larissa Passos; SIMÕES, Francisco Xavier Paranhos Coêlho

    2014-01-01

    The purpose of this clinical case report is to discuss the approach to oral rehabilitation of a patient with severe dental alterations such as enamel hypoplasia, change in shape, supernumerary tooth, dental ankylosis, agnesia and crowing in the incisor region. All of these problems compromised not only the esthetical and functional aspects of this patient, but his social relationships as well. Thus integrated planning between Pediatric Dentistry and Orthodontics made it possible to provide th...

  9. Espondilitis anquilopoyética: una reflexión y una interrogante

    Directory of Open Access Journals (Sweden)

    Annia Deysi Hernández Martín

    2014-07-01

    Full Text Available Ankylosing spondylitis is a chronic inflammatory disease that affects the synovial membrane, joint entheses and para-articular structures of the spine, including the sacroiliac joints and limbs. We present a case of ankylosing spondylitis that had evolved for 12 years despite the relatively early diagnosis and treatment, showing flexion deformity and limitation of spinal movements. On radiological examination an early evolution to ankylosis was observed, which motivated us to make a reflection and a question.

  10. Uma forma rara de ocorrencia de Schistosomus reflexus em bovino: relato de caso

    OpenAIRE

    Prestes, Nereu Carlos [UNESP; Megid, Jane [UNESP

    2010-01-01

    The Schistosomus reflexus (SR) is a fatal congenital and rare aberration, found primarily in ruminants, gestating a fetus with folding of the backbone, exposure of the abdominal and thoracic viscera, ankylosis of the limbs, diaphragm and liver hypoplasia, scoliosis and abnormalities of the digestive and genitourinary systems. A deformed congenital aberration removed by forced traction in dystocia of a crossbred cow, belonging to a breeder of Lençóis Paulista/ SP city was attended in Veterinar...

  11. Effect of periodontal ligament removal with gauze prior to delayed replantation in rabbit incisors on rate of replacement resorption.

    Science.gov (United States)

    Maslamani, Manal; Joseph, Bobby; Gabato, Severino; Andersson, Lars

    2018-03-23

    Delayed (dry storage > 60 minutes) replantation results in ankylosis and replacement resorption. It has been suggested to remove the non-viable periodontal ligament before replantation to possibly reduce the rate of replacement resorption. However there has been no study on the rate of replacement resorption after such measures. The aim of this study was to investigate if there was any difference in the rate of replacement resorption by either removing the periodontal ligament (PDL) with gauze or not removing PDL in teeth subjected to delayed replantation followed by healing for 2 or 6 weeks. Maxillary central incisors were extracted in 8 rabbits. In the right central incisors, the necrotic PDL was removed by dry gauze over the root surface. In the left eight extracted teeth PDL was left on the root surface. All extracted teeth were left to dry for 60 minutes. Extra-oral root canal treatment was performed before replantation. The rabbits were sacrificed after 2 weeks and 6 weeks respectively. Histologic processing and evaluation was done. In the 2 weeks group, all teeth showed ankylosis. The cementum was intact, and fusion of the bone and root was generally seen without resorption of the root, whereas in the 6 weeks group regardless of whether PDL had been kept or not, ankylosis and osseous replacement of the dentin was seen. There was no evidence of inflammatory infiltrate in the sections examined. Removal of PDL prior to delayed replantation may result in some initial protection of the cementum during the first few weeks. However, over longer times there seems to be neither protection of the dentin from ankylosis and osseous replacement, nor any influence on the rate of replacement resorption. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Forecasting the Supply of Women Available to the Navy.

    Science.gov (United States)

    1980-08-01

    Intervertebral Disc Dis- placement 725 Ankylosis of Joints 727 Sacroiliac Joint , Affection 726 Other Musculoskeletal Diseases and Defects Curvature...High School Graduates (HSGs) and Non High School Graduates (NHSGs)... 6 5. FY79 Distribution of Navy Nonprior Service Male Accessions Broken Down by...Mental Grade . .. .. .. .. .. .. .. .. .. .. . .. 6 6. Distribution of School Year 76-77, 77-78, 78-79 Test Takers by ASVAB Mental Categories

  13. Ankylosing Spondylitis: a Reflection and a Question

    Directory of Open Access Journals (Sweden)

    Annia Deysi Hernández Martín

    2014-07-01

    Full Text Available Ankylosing spondylitis is a chronic inflammatory disease that affects the synovial membrane, joint entheses and para-articular structures of the spine, including the sacroiliac joints and limbs. We present a case of ankylosing spondylitis that had evolved for 12 years despite the relatively early diagnosis and treatment, showing flexion deformity and limitation of spinal movements. On radiological examination an early evolution to ankylosis was observed, which motivated us to make a reflection and a question.

  14. Permasalahan-permasalahan Yang Menyertai Erupsi Gigi

    OpenAIRE

    Kurniasih, Indri

    2008-01-01

    Tooth eruption process is an normal physiological process. It may become abnormal there disturbances intervered within the process. Several disturbances such as trauma, hereditary factors, and pathological disorders can cause some problems which may leads to dental disorders if it were remain untreated. These matters have to become a serious concern of the dentists. There are several problems which are frequently associated with tooth eruption process such as ankylosis, eruption cyst, eruptio...

  15. Classification of Champus Professional Services to Ambulatory Patient Groups and Assignment of Resource-Based Relative Values. Champus Professional Services Classification Study (CPSCS).

    Science.gov (United States)

    1992-01-10

    OBSTRUCTION BY ABNORMAL PELVIC SOFT TISSUES DURING LABO 6603 66031 DEEP TRANSVERSE ARREST AND PERSISTENT OCCIPITOPOSTERIOR 6604 66041 SHOULDER (GIRDLE... DYSTOCIA , WITH DELIVERY 6605 66051 LOCKED TWINS, WITH DELIVERY 6606 66061 UNSPECIFIED FAILED TRIAL OF LABOR, WITH DELIVERY 6607 66071 UNSPECIFIED FAILED...OF JOINT, SITE UNSPECIFIED 7183 71831 RECURRENT DISLOCATION OF JOINT OF SHOULDER REGION 7184 71844 CONTRACTURE OF HAND JOINT 7185 71850 ANKYLOSIS OF

  16. Multidisciplinary approach in the management of absolute trismus with bilateral temporomandibular joint replacements for a patient with juvenile idiopathic arthritis.

    Science.gov (United States)

    Fanaras, Nikolaos; Parry, Nicholas S; Matthews, N Shaun

    2014-11-01

    Juvenile idiopathic arthritis (JIA) is an exclusion diagnosis that gathers together all forms of arthritis that begin before the age of 16 years, persist for more than 6 weeks and are of unknown origin. We present the case of a 42 year old woman with a 20 year history of absolute trismus, secondary to bilateral temporomandibular joint (TMJ) ankylosis caused by JIA. The trismus resulted in grossly compromised oral hygiene and limited the patient to a semi-solid diet. JIA also affected her neck leading to a severe cervico-thoracic kyphosis. The patient who had been wheelchair bound developed severe lymphoedema of both lower limbs, complicating the pre-operative work up further. This particularly challenging case required input from specialists in anaesthetics, neurosurgery, special care dentistry, intensive care and maxillofacial surgery. Treatment consisted of ankylosis release, dental clearance and bilateral alloplastic replacement of her TMJs with custom implants. A full range of hinge movement and good functional outcome was achieved. This case presents the multidisciplinary approach to a severely compromised patient and illustrates the pre-, intra- and postoperative management of bilateral TMJ ankylosis with bespoke implants. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Bone pathology inpsoriatic arthritis

    Directory of Open Access Journals (Sweden)

    V. V. Badokin

    2007-01-01

    Full Text Available Objective. To study different variants of osteolysis in pts with psoriatic arthritis (PA and to reveal their relationship with other clinico-radiological features of joint damage. Material and methods. 370 pts with definite PA having different variants of joint damage were included. Radiological examination of bones and joints (in some cases large picture frame was performed. Morphological evaluation of synovial biopsies was done in 34 pts with PA and 10 pts with rheumatoid arthritis (RA. Results. Different types of osteolysis were revealed in 80 (21,6% pts. Osteolytic variant of joint damage was present in 29 pts. 33 pts had acral, 48 — intra-articular osteolysis and 16 - true bone atrophy. Frequency and intensity of bone resorption were associated with severity of PA. Acral osteolysis correlated with arthritis of distal interphalangeal joints and onychodystrophy. Intra-articular osteolysis was most often present in distal interphalangeal joints of hands and metacarpophalangeal joints (39,6% and 41,7% respectively. Characteristic feature of PA was combination of prominent resorption with formation of bone ankylosis and periosteal reaction. Ankylosis was present in 33,3% of pts with intra-articular osteolysis and in 60% of pts with combination of different osteolysis variants. Systemic reaction of microcirculation in synovial biopsies was most prominent in osteolytic variant: marked thickening of capillary and venule basal membrane with high level of acid phosphatase, increased capillary and precapillary blood flow with stasis features, vascular lymphocyte and macrophage infiltration, productive vasculitis with annular wall thickening, thrombovasculitis and villi deep layer sclerosis. Conclusion. Different variants of osteolysis show bone involvement in PA. Acral and intra- articular osteolysis association with bone ankylosis and periostitis proves their common pathogenetic entity.

  18. Age-related changes in the tooth-bone interface area of acrodont dentition in the chameleon.

    Science.gov (United States)

    Dosedělová, Hana; Štěpánková, Kateřina; Zikmund, Tomáš; Lesot, Herve; Kaiser, Jozef; Novotný, Karel; Štembírek, Jan; Knotek, Zdeněk; Zahradníček, Oldřich; Buchtová, Marcela

    2016-09-01

    Chameleon teeth develop as individual structures at a distance from the developing jaw bone during the pre-hatching period and also partially during the post-hatching period. However, in the adult, all teeth are fused together and tightly attached to the jaw bone by mineralized attachment tissue to form one functional unit. Tooth to bone as well as tooth to tooth attachments are so firm that if injury to the oral cavity occurs, several neighbouring teeth and pieces of jaw can be broken off. We analysed age-related changes in chameleon acrodont dentition, where ankylosis represents a physiological condition, whereas in mammals, ankylosis only occurs in a pathological context. The changes in hard-tissue morphology and mineral composition leading to this fusion were analysed. For this purpose, the lower jaws of chameleons were investigated using X-ray micro-computed tomography, laser-induced breakdown spectroscopy and microprobe analysis. For a long time, the dental pulp cavity remained connected with neighbouring teeth and also to the underlying bone marrow cavity. Then, a progressive filling of the dental pulp cavity by a mineralized matrix occurred, and a complex network of non-mineralized channels remained. The size of these unmineralized channels progressively decreased until they completely disappeared, and the dental pulp cavity was filled by a mineralized matrix over time. Moreover, the distribution of calcium, phosphorus and magnesium showed distinct patterns in the different regions of the tooth-bone interface, with a significant progression of mineralization in dentin as well as in the supporting bone. In conclusion, tooth-bone fusion in chameleons results from an enhanced production of mineralized tissue during post-hatching development. Uncovering the developmental processes underlying these outcomes and performing comparative studies is necessary to better understand physiological ankylosis; for that purpose, the chameleon can serve as a useful model

  19. Radiography of the spine and sacro-iliac joints in ankylosing spondylitis and psoriasis

    International Nuclear Information System (INIS)

    Dale, K.; Vinje, O.

    1985-01-01

    A grading system involving six stages of arthritis from grade O=normal joints to grade V=extensive bony ankylosis in the sacro-iliac joints and a scheme applicable for quantitative registration of the radiographic findings of the spine in ankylosing spondylitis (AS) are detailed. These radiographic grading systems were used in a study comprising 48 patients with psoriasis (group A), 19 patients with AS and psoriasis (group B), 103 patients with AS (group C) and 231 first-degree relatives of the patients belonging to groups B and C (group D). Radiographic abnormalities of the spine were found totally in 80 per cent of the patients belonging to groups B and C. In these groups sclerotic anterior borders of vertebrae (SABS) and/or straightened anterior surfaces of vertebrae were seen totally in 66 per cent. SABS were earlier findings than syndesmophyte formation which was found in 60 per cent of the patients belonging to groups B and C. Except for ankylosis of the apophyseal joints and ossified interspinous ligament most frequently found in the lower lumbar region in patients with duration of disease more than 20 years, all abnormalities of the spine were most frequent in the dorsolumbar junction. Grade V sacro-iliitis was associated with ankylosis of two or more segments of the spine. Such spinal changes were infrequently seen in patients with grade IV sacro-iliitis. This finding supports the previous notion that among patients fulfilling the criteria for AS, there is a group with a non-ankylosing disease. Thus two different subgroups of AS could be identified. Except for frequent unilateral sacro-iliitis and slight changes of the spine in group A no radiographic differences were found between the groups A, B and C. Sacro-iliitis was found in 22(9%) in group D, and 11 of those with sacro-iliitis had abnormalities of the spine compatible with AS. (orig.)

  20. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-01-01

    AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify.......3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. CONCLUSION: Teeth involved in alveolar process fractures appear...

  1. Resection arthroplasty of the hip in paralytic dislocations.

    Science.gov (United States)

    Kalen, V; Gamble, J G

    1984-06-01

    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  2. Post-traumatic bifid mandibular condyle: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Min Ho; Yoon, Kyu Ho; Park, Kwan Soo; Park, Jae An [Dept. of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul (Korea, Republic of)

    2016-09-15

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC.

  3. Post-traumatic bifid mandibular condyle: A case report and literature review

    International Nuclear Information System (INIS)

    Woo, Min Ho; Yoon, Kyu Ho; Park, Kwan Soo; Park, Jae An

    2016-01-01

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC

  4. THE RHEUMATOID HAND (Part I

    Directory of Open Access Journals (Sweden)

    Yuri Aleksandrovich Olyunin

    2009-01-01

    Progression of RA leads to articular cartilage and bone destruction and ligament and tendon damage over time. Incompetence of the ligamentous apparatus may cause dorsal subluxation of the radius. In late RA, bone erosions are detectable in practically all patients. This is the most characteristic X-ray symptom of polyarthritis. Extensive and multiple destructive changes in the joints are accompanied by the development of their multiple subluxations, dislocations, and contractures. In addition to destructive changes in the joints, most deformities are associated with their tendinous and liga-mentous looseness and ruptures and with the rearrangement of normal muscle tension around one joint or more. Articular ankylosis occurs in late RA

  5. Sacroiliac joint involvement in classical or definite rheumatoid arthritis

    International Nuclear Information System (INIS)

    Carvalho, A. de; Graudal, H.

    1980-01-01

    In 188 patients with rheumatoid arthritis 564 radiologic examinations of the sacroiliac joints were performed. Severe blurring of the joint space or ankylosis were uncommon. The involvement was related to an age > 40 years at the onset, high values of the ESR and involvement of most joint groups in the limbs and cervical spine. Sex, presence or high titres of the rheumatoid factor and antinuclear antibodies were unrelated to lesions of the sacroiliac joints. A relation to the severity of rheumatoid arthritis rather than to the immunologic condition is suggested. (Auth.)

  6. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas

    2016-01-01

    Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed...... for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine...

  7. Severe heterotopic ossification and stiffness after revision knee surgery for a periprosthetic fracture

    Directory of Open Access Journals (Sweden)

    Maher Baroudi, MD

    2017-09-01

    Full Text Available Although heterotopic ossification (HO after total hip arthroplasty has been very well described as a cause of disability, much less was written on clinical dysfunction of HO after total knee arthroplasty (TKA. To the extent of our knowledge, there has been no published case of complete bony ankylosis, secondary to severe generalized HO, after a TKA. We present the case of a 67-year-old female treated successfully, with surgical excision of ossification and TKA revision surgery, using a rotating hinge system.

  8. Thoracic sinuses in HIV a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pai V

    2003-01-01

    Full Text Available A male aged 57 years with multiple discharging sinuses on both sides of chest, multiple ulcers on the back, painful ankylosis of right shoulder since 2 months. Chest examination showed reduced expansion and decreased breath sounds on right side. Large boggy swelling on right hemithorax with multiple discharging sinuses was seen. VDRL was reactive in high dilutions and he was also ELISA - HIV positive. X-ray of chest showed few opacities in right lung field. A provisional diagnosis of Gumma - Syphilis/Tuberculous was considered. Sensorineural deafness was also present.

  9. Thoracic sinuses in HIV a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pai V

    2003-03-01

    Full Text Available A male aged 57 years with multiple discharging sinuses on both sides of chest, multiple ulcers on the back, painful ankylosis of right shoulder since 2 months. Chest examination showed reduced expansion and decreased breath sounds on right side. Large boggy swelling on right hemithorax with multiple discharging sinuses was seen. VDRL was reactive in high dilutions and he was also ELISA - HIV positive. X-ray of chest showed few opacities in right lung field. A provisional diagnosis of Gumma - Syphilis/Tuberculous was considered. Sensorineural deafness was also present.

  10. Tooth morphology, implantation and replacement system of Hoplias malabaricus (Teleostei, Characiformes, Erythrinidae

    Directory of Open Access Journals (Sweden)

    RM. Hassunuma

    Full Text Available The oropharyngeal cavity of Hoplias malabaricus, an ichthyophagous freshwater fish, is anatomically adapted to predation. Macroscopic and microscopic analyses were conducted in order to study the morphology and system of implantation and replacement of teeth. The results showed that this teleost has conical and caniniform teeth, with an orthodentin crown covered by an enameloid cap and a vascularised orthodentin in the root. With regard to the implantation system, there is a junction between the tooth and the bone tissue, as a typical physiological dental ankylosis. The teeth are replaced by a resorption process of multinucleated giant cells that actively eliminate the dentin and bone tissue.

  11. Experimental joint immobilization in guinea pigs. Effects on the knee joint

    Science.gov (United States)

    Marcondesdesouza, J. P.; Machado, F. F.; Sesso, A.; Valeri, V.

    1980-01-01

    In young and adult guinea pigs, the aftermath experimentally induced by the immobilization of the knee joint in hyperextended forced position was studied. Joint immobilization which varied from one to nine weeks was attained by plaster. Eighty knee joints were examined macro and microscopically. Findings included: (1) muscular hypotrophy and joint stiffness in all animals, directly proportional to the length of immobilization; (2) haemoarthrosis in the first week; (3) intra-articular fibrous tissue proliferation ending up with fibrous ankylosis; (4) hyaline articular cartilage erosions; (5) various degrees of destructive menisci changes. A tentative explanation of the fibrous tissue proliferation and of the cartilage changes is offered.

  12. [Dysfunctional pathology from "true" and "de facto" mutilation of the dental arches].

    Science.gov (United States)

    Garino, G B; Capurso, U

    1989-01-01

    The mutilations of the dental arches for agenesia, extractions or trauma and because of ankylosis, caries can be the cause of the disorders of the stomatognatic system. These problems are in relation with the time of the disfunction, the skeletal type and the interarches relationship. The pathogenetic factors are secondary to the amount and the direction of the dislocations or the entrapment of the lower jaw. The treatment planning can provide the closure of the spaces or the reopening. These procedures are demonstrated by two treated cases with TMJ disorders.

  13. Anesthesia in a child with fibrodysplasia ossificans progressiva.

    Science.gov (United States)

    Vashisht, Rita; Prosser, Dylan

    2006-06-01

    We describe the anesthesia management of a 12-year-old girl, diagnosed with fibrodysplasia ossificans progressiva (FOP), who presented with a submandibular abscess. FOP is a rare, inherited disorder with heterotopic bone formation and progressive musculoskeletal disability. This disability ultimately confines patients to a wheelchair. Minor trauma following dental treatment may lead to ankylosis of the jaw. Subsequent to this disability, which resulted in poor dental hygiene, our patient developed a dental abscess. This spread along the mandibular margin and under the tongue. She presented with an impending airway compromise in an already difficult situation. The options for airway management in a child with limited mouth opening are discussed.

  14. Temporomandibular Joint Reconstruction in the Growing Child.

    Science.gov (United States)

    Resnick, Cory M

    2018-02-01

    Indications and considerations for reconstruction of the temporomandibular joint (TMJ) differ between growing and skeletally mature patients. Osteoarthritis, which is the most common cause of TMJ destruction in adults, is comparatively rare in children. The most common indications in young patients are congenital deformities, pathology, ankylosis and progressive resorptive processes. Options for reconstruction include distraction osteogenesis, autologous reconstruction (ie, costochondral graft, free fibula flap), and total alloplastic joint replacement. The choice of the ideal reconstruction is based on multiple factors, which include extent and laterality of the deformity, patient age, jaw growth pattern, and potential for progressive destruction. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. DENTAL SPLINTS: TYPES AND TIME OF IMMOBILIZATION POST TOOTH AVULSION

    Directory of Open Access Journals (Sweden)

    Samuel Rodrigo de Andrade VERAS

    2017-12-01

    Full Text Available Avulsion is defined as the complete displacement of the tooth out of its socket with disruption of the fibers of periodontal ligament, remaining some of them adhered to the cementum and the rest to the alveolar bone. This condition is more frequent in young permanent teeth, because the root development is still incomplete. Splints are used to immobilize traumatized teeth that suffered damage in their structures of support, preventing their constant movement. The literature has shown that after replantation, it is necessary to use splints in order to immobilize the teeth during the initial period, which is essential for the repair of periodontal ligament; the use of semi-rigid splint is more indicated than the rigid one, and long periods of splinting showed that substitutive resorption or ankylosis is an expected complication. Thus, the aim of this review is to describe the different types of splints; their time of permanency, and its influence on the process of healing and reparation on the occurrence of substitutive resorption or ankylosis. It is very important to keep gathering knowledge about this content, since it has been proved that the approaches and the protocols keep changing over time.

  16. Vertebral deformities in hatchery-reared and wild-caught juvenile Japanese flounder, Paralichthys olivaceus

    Science.gov (United States)

    Lü, Hongjian; Zhang, Xiumei; Fu, Mei; Xi, Dan; Su, Shengqi; Yao, Weizhi

    2015-01-01

    The present study compared vertebral deformities of hatchery-reared and wild-caught juvenile Japanese flounder, Paralichthys olivaceus. A total of 362 hatchery-reared flounder (total length 122.5-155.8 mm) were collected from three commercial hatcheries located in Yantai, East China, and 89 wild fish (total length 124.7-161.3 mm) were caught off Yangma Island near Yantai City (37°27'N, 121°36'E). All the fish were dissected, photographed, and images of the axial skeleton were examined for vertebral deformities. Compared with wild-caught flounder in which no deformed vertebrae were detected, 48 (13.3%) hatcheryreared fish had deformed vertebrae. The deformities were classified as compression, compression-ankylosis, and dislocation-ankylosis. The vertebral deformities were mainly localized between post-cranial vertebra 1 and 3, with vertebrae number 1 as the most commonly deformed. The causative factors leading to vertebral deformities in reared Japanese flounder may be related to unfavorable temperature conditions, inflammation, damage, or rupture to the intervertebral ligaments under rearing conditions. Furthermore, no significant difference in the total number of vertebral bodies was observed between wild-caught (38.8±0.4) and hatchery-reared flounder (38.1±0.9) ( P>0.05). However, the number of vertebral bodies of hatchery-reared and wild-caught flounder ranged from 35 to 39 and from 38 to 39, respectively.

  17. [Superolateral dislocation of the temporomadibular joint: Case report].

    Science.gov (United States)

    Debelmas, A; Bertoïa, C; Moreau, A; Khonsari, R H

    2015-06-01

    Superolateral disclocations of the temporomandibular joint are rare. They mostly occur after high-energy trauma and are frequently associated with fractures of the mandibular body. A 35-year-old man was admitted for the management of a high-energy craniofacial trauma due to a road accident. The initial assessment revealed bilateral superolateral temporomandibular joint disclocations, with bilateral sagittal fractures of the condyle head and a fracture of the right parasymphysis. The treatment consisted in an external reduction of both condyles, followed by open reduction and internal fixation of the parasymphysis. The patient quickly started physiotherapy after the procedure and recovered a normal mouth opening after a month of follow-up. For most authors, a quick management of superolateral dislocations is necessary in order to achieve a proper reduction of the temporomandibular joint dislocation and avoid surgical reduction. Temporomandibular joint ankylosis is the main complication of such lesions. Early physiotherapy is indicated in order to prevent ankylosis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. A device for temporomandibular joint exercise and trismus correction: design and clinical application.

    Science.gov (United States)

    Lo, Lun-Jou; Lin, Chun-Li; Chen, Yu-Ray

    2008-01-01

    Temporomandibular joint (TMJ) hypomobility and trismus is a frequently seen clinical condition, and rehabilitation with mouth-opening exercises is mandatory for fast and successful recovery. As conventional methods and available devices are not without disadvantages, a new TMJ exerciser has been developed and clinically tested. The new device was designed and made using a computer-aided design/computer-aided manufacture program. The mouthpiece is opened using a power screw technique. The device was revised until it became acceptable for clinical trials. Nineteen patients with TMJ hypomobility or trismus used the new device: five after surgical release of TMJ ankylosis, five after facial fracture reduction and intermaxillary fixation, three after blunt facial trauma, five following orthognathic surgery, and one following facial bone-contouring surgery. The outcome was evaluated. The new TMJ exercise appliance was convenient, durable and easy to use. The maximal incisor opening was 16.3+/-7.1 mm before use of the device, and 34.2+/-6.3 mm after the treatment period (P<0.05). Fourteen patients (74%), i.e. all except the five with release of ankylosis, recovered to normal range of mouth opening at longitudinal follow up. There was no mechanical failure and no complications from using the device, and the patients were satisfied. The new exerciser is a satisfactory device for physiotherapy of TMJ hypomobility and trismus.

  19. Insights into the pathophysiology of ankylosing spondylitis: contributions from animal models.

    Science.gov (United States)

    Braem, Kirsten; Lories, Rik J

    2012-05-01

    The introduction of anti-tumor necrosis factor strategies has significantly changed the perspective and outcome of patients with ankylosing spondylitis and related spondyloarthritides. This breakthrough has also boosted further research efforts into the mechanisms of disease. As human tissue specimens of the spine and sacroiliac joints are very difficult to obtain and rarely allow mechanistic studies, most of the new concepts have emerged from different animal models of disease. In this review, we summarize insights into the role of HLA-B27 based on transgenic rat and mouse models, efforts into the identification of cell populations stimulating inflammation and molecular studies of pathological bone formation leading to ankylosis. Important progress has been made and novel hypotheses were put forward. These include the impact of HLA-B27 on endoplasmic reticulum stress and the unfolded protein response, the role of stromal cells in inflammation, the entheseal stress hypothesis and the identification of the bone morphogenetic protein and WNT signaling pathways as therapeutic targets for ankylosis. Copyright © 2011 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  20. Treatment of a Vertical Root Fracture Using Dual-Curing Resin Cement: A Case Report

    Directory of Open Access Journals (Sweden)

    Nima Moradi Majd

    2012-01-01

    Full Text Available Introduction. Vertical root fracture (VRF is one of the most frustrating complications of root canal treatment. The prognosis of the root with VRF is poor therefore tooth extraction and root amputation are usually the only treatment options. However, bonding of the fracture line with adhesive resin cement during the intentional replantation procedure was recently suggested as an alternative to tooth extraction. Methods. A vertically fractured left maxillary incisor was carefully extracted, fracture line was treated with adhesive resin cement, a retrograde cavity was produced and filled with calcium-enriched mixture (CEM cement, and tooth was replanted. Results. After 12 months the tooth was asymptomatic. The size of periapical radiolucency was noticeably reduced and there was no clinical sign of ankylosis. Conclusion. Using adhesive resin cement to bond the fracture lines extraorally in roots with VRF and intentional replantation of the reconstructed teeth could be considered as an alternative to tooth extraction, especially for anterior teeth.

  1. Orthodontic treatment for oral rehabilitation after multiple maxillofacial bone fractures.

    Science.gov (United States)

    Nakamura, Yoshiki; Ogino, Tomoko Kuroiwa; Hirashita, Ayao

    2008-09-01

    We present the orthodontic treatment of a patient with occlusal dysfunction after plastic surgery for multiple maxillofacial bone fractures caused by a traffic accident. The patient had mandibular deviation to the right because of inappropriate repositioning and fixation of the fractured bone and complete avulsion of both mandibular central incisors. The bilateral mandibular incisors, canines, and premolars were also suspected of partial avulsion or alveolar bone fracture. Several tests, including percussion and dental computed tomography, were performed on these teeth to rule out ankylosis and confirm tooth movement. Camouflage orthodontic treatment was carried out with expansion of the maxillary arch, alignment of both arches, and space closure between the mandibular lateral incisors to improve the occlusion. Good occlusion and interdigitation were obtained. Orthodontic treatment is useful for the rehabilitation of occlusal dysfunction caused by multiple maxillofacial bone fractures.

  2. Treatment of inflammatory root resorption using mineral trioxide aggregate: A case report

    Directory of Open Access Journals (Sweden)

    Roohollah Sharifi

    2014-01-01

    Full Text Available Introduction: This report presents a case to show inflammatory root resorption can be successfully treated by using mineral trioxide aggregate (MTA. Case Report: A central maxillary incisor of an eight-year-old boy was avulsed associated with crown fracture secondary to a fall. The tooth was stored in ice. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful. To stop inflammatory root resorption, long-term calcium hydroxide therapy was employed. Despite the use of calcium hydroxide, resorption continued. Subsequent to the failure of that treatment, MTA was used as a root canal filling material. At 20-month follow-up, the tooth was asymptomatic and had clinical signs of ankylosis but external inflammatory root resorption had stopped. Discussion: MTA may be considered as an alternative option for the treatment of continuous external inflammatory root resorption.

  3. Intentional replantation of periodontally compromised hopeless tooth

    Science.gov (United States)

    Nagappa, G.; Aspalli, Shivanand; Devanoorkar, Archana; Shetty, Sudhir; Parab, Prachi

    2013-01-01

    Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. Even single tooth mal-alignment makes the patient to approach a dentist. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors agree that it should be reserved as the last resort to save a tooth after other procedures have failed or would likely to fail. The main reason of failure in replanted teeth is root resorption, specifically ankylosis or replacement resorption. Although the success rate is not always high, intentional replantation may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Here is case report of a patient desiring alignment of malpositioned periodontally involved anterior single tooth due to various causes treated by intentional replantation. PMID:24174765

  4. Intentional replantation of periodontally compromised hopeless tooth

    Directory of Open Access Journals (Sweden)

    G Nagappa

    2013-01-01

    Full Text Available Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. Even single tooth mal-alignment makes the patient to approach a dentist. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors agree that it should be reserved as the last resort to save a tooth after other procedures have failed or would likely to fail. The main reason of failure in replanted teeth is root resorption, specifically ankylosis or replacement resorption. Although the success rate is not always high, intentional replantation may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Here is case report of a patient desiring alignment of malpositioned periodontally involved anterior single tooth due to various causes treated by intentional replantation.

  5. Impacted incisors associated with supernumerary teeth treated with a modified Haas appliance.

    Science.gov (United States)

    Sant'Anna, Eduardo Franzotti; Marquezan, Mariana; Sant'Anna, Claudia Franzotti

    2012-12-01

    Tooth impaction involves factors such as lack of space in the alveolar process, trauma, ankylosis, and mechanical barriers such as abnormal frenum, supernumerary teeth, tumors, and local cysts. When impaction occurs in the anterior region, esthetics are compromised. This report describes the successful approach to treatment for a young boy who had 2 supernumerary teeth associated with impaction of the left central and lateral permanent incisors. Treatment consisted of extracting the supernumerary teeth and performing maxillary expansion with a modified Haas appliance to guide the left central incisor into its appropriate position. The teeth erupted spontaneously after maxillary expansion and an increase in space. A fixed edgewise appliance was placed incrementally to correct the maxillary anterior tooth positions and finish the treatment. Adequate esthetics and function were achieved. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  6. Intentional replantation of periodontally compromised hopeless tooth.

    Science.gov (United States)

    Nagappa, G; Aspalli, Shivanand; Devanoorkar, Archana; Shetty, Sudhir; Parab, Prachi

    2013-09-01

    Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. Even single tooth mal-alignment makes the patient to approach a dentist. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors agree that it should be reserved as the last resort to save a tooth after other procedures have failed or would likely to fail. The main reason of failure in replanted teeth is root resorption, specifically ankylosis or replacement resorption. Although the success rate is not always high, intentional replantation may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Here is case report of a patient desiring alignment of malpositioned periodontally involved anterior single tooth due to various causes treated by intentional replantation.

  7. Jaw locking after maxillofacial trauma

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja

    2007-09-01

    Full Text Available The purpose of this report is to present two cases of jaw locking with two different etiologies. In case #1, jaw locking occured 5.5 months after a surgical reduction and internal fixation on the fractured maxilla and mandible. Some plain radiographic x-ray were made but failed to give adequate information in establishing the cause of trismus. The three dimensional computed tomography (3D-CT was finally made and able to help guide the pre-operative diagnosis and treatment. Two-steps gap arthroplasty were done comprising a gap arthroplasty leading to acceptable outcome. An adult patient in case #2 with a history of trauma at his childhood and bird-like face apprearance clinically, was unable to open the mouth since the time of accident. The patient was diagnosed with bilateral ankylosis of temporomandibular joints. One side (right gap arthroplasty was done and resulted in normal mouth opening.

  8. The radiological residua of healed diabetic arthropathies

    International Nuclear Information System (INIS)

    Reinhardt, K.

    1981-01-01

    Diabetic arthropathy is a relatively rare manifestation of neuropathic disease, occurring in fewer than 5% of cases. Abnormalities of this type are confined largely to the small joints of the feet, although the larger joints of the lower limbs and the spine occasionally are affected. Some lesions, particularly in the feet, repair spontaneously, leaving radiological residua sufficiently characteristic to prompt suspicion of an unrecognised diabetic state. These include deformity of the head of the second metatarsal (akin to a Freiberg lesion), shortening of the great toe, painless deforming arthrosis of the knee, and ankylosis of interphalangeal joints. In the presence of these signs the patient should be interrogated concerning diabetes and blood sugar estimates, with provocation if necessary, obtained. Should such a diagnosis be sustained, appropriate protective measures may be undertaken to avoid a relapse of the arthropathy. (orig.)

  9. Radiological residua of healed diabetic arthropathies

    Energy Technology Data Exchange (ETDEWEB)

    Reinhardt, K.

    1981-12-01

    Diabetic arthropathy is a relatively rare manifestation of neuropathic disease, occurring in fewer than 5% of cases. Abnormalities of this type are confined largely to the small joints of the feet, although the larger joints of the lower limbs and the spine occasionally are affected. Some lesions, particularly in the feet, repair spontaneously, leaving radiological residua sufficiently characteristic to prompt suspicion of an unrecognised diabetic state. These include deformity of the head of the second metatarsal (akin to a Freiberg lesion), shortening of the great toe, painless deforming arthrosis of the knee, and ankylosis of interphalangeal joints. In the presence of these signs the patient should be interrogated concerning diabetes and blood sugar estimates, with provocation if necessary, obtained. Should such a diagnosis be sustained, appropriate protective measures may be undertaken to avoid a relapse of the arthropathy.

  10. Tumor necrosis factor inhibitor therapy but not standard therapy is associated with resolution of erosion in the sacroiliac joints of patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Wichuk, Stephanie; Chiowchanwisawakit, Praveena

    2014-01-01

    INTRODUCTION: Radiography is an unreliable and insensitive tool for the assessment of structural lesions in the sacroiliac joints (SIJ). Magnetic resonance imaging (MRI) detects a wider spectrum of structural lesions but has undergone minimal validation in prospective studies. The Spondyloarthritis...... Research Consortium of Canada (SPARCC) MRI Sacroiliac Joint (SIJ) Structural Score (SSS) assesses a spectrum of structural lesions (erosion, fat metaplasia, backfill, ankylosis) and its potential to discriminate between therapies requires evaluation. METHODS: The SSS score assesses five consecutive coronal......). Two readers independently scored 147 pairs (baseline, 2 years) of scans from a prospective cohort of patients with SpA who received either standard (n = 69) or tumor necrosis factor alpha (TNFα) inhibitor (n = 78) therapy. Smallest detectable change (SDC) was calculated using analysis of variance...

  11. Ankylosing spondylitis is indigenous to Mesoamerica.

    Science.gov (United States)

    Martínez-Lavín, M; Mansilla, J; Pineda, C; Pijoán, C

    1995-12-01

    Paleopathology helps to define the origin and the migration of diseases. It has been established that genetic and environmental factors play a role in the pathogenesis of ankylosing spondylitis (AS). We investigated whether AS was present in Mesoamerica before contact with the European civilization. We studied the collection of Mesoamerican human skeletal remains preserved at the National Museum of Anthropology of Mexico, searching for features of AS. We found one incomplete specimen of a man of the Postclassic period (900-1521 AD). It showed fusion of the vertebral column from T8 to L5 due to ankylosis of the apophyseal joints and of the spinal processes. The pelvis was not preserved. Radiographs demonstrated ossification of both supraspinous and interspinous ligaments. Our findings suggest AS was present in Mesoamerica before the arrival of Europeans.

  12. Reimplantation of Accidentally Avulsed Permanent Maxillary Anterior Teeth in a 10-Year-Old Girl

    Directory of Open Access Journals (Sweden)

    Md Abdul Hannan Sheikh

    2017-09-01

    Full Text Available Accidental tooth avulsion is a grievous injury and common among the children. Management of avulsed tooth within alveolar socket by reimplantation becomes a challenge for the clinician due to extraoral time and media of transportation. Although the long-term prognosis of reimplantation is poor, the time during which the tooth remain within the arch will guide the development of alveolar bone completely. Moreover, reimplantation will maintain anatomical, functional and esthetic rehabilitation of the patient. In this case report, we present a case of accidental avulsion where teeth were gently rinsed of any debris and placed in normal saline during the examination and preparation of the reimplantation sockets. The teeth were then reimplanted, functionally splinted followed by endodontical treatment. After 12 months follow-up the periodontal space was healed perfectly without any resorption or ankylosis.

  13. The unerupted maxillary canine - a post-surgical review.

    LENUS (Irish Health Repository)

    O'Dowling, Ian

    2009-10-01

    The orthodontic records of 685 patients referred for surgical exposure of an unerupted impacted maxillary canine tooth were examined. The condition was more common among females than males, slightly less than 2:1. The impacted teeth had a palatal-labial ratio of 3:1. All of the teeth were exposed using the open surgical technique and in 98% of cases the tooth erupted and was orthodontically aligned. In 2% of cases ankylosis occurred and the teeth were subsequently extracted. The presence of peg-shaped lateral incisors associated with the impacted maxillary canine tooth was 3.4% of the total number of impacted teeth and congenital absence was found in 1.7% of impacted teeth.

  14. Hearing loss in the Saethre-Chotzen syndrome.

    Science.gov (United States)

    Ensink, R J; Marres, H A; Brunner, H G; Cremers, C W

    1996-10-01

    A three-generation family with Saethre-Chotzen syndrome and an isolated case are presented. The proband presented with conductive hearing loss. His mother and grandmother showed minor features of the syndrome including conductive hearing loss. Symptoms of the craniosynostosis syndromes can include stapes ankylosis, a fixed ossicular chain in a too small epitympanum, and small or even absent mastoids. The proband was treated with a bone-anchored hearing aid (BAHA) instead of reconstructive middle ear surgery. Current literature on the results of ear surgery is reviewed. In general, reconstructive middle ear surgery should be considered if congenital anomalies of the middle ear are the only presenting symptom. In cases with additional anomalies such as atresia of the ear canal or damage due to chronic ear infections, the outcome of reconstructive surgery to correct the anomalous ossicular chain is unsatisfactory. In such cases of the BAHA is probably the best solution.

  15. Bilateral Mandibular Torus and an Ankylosed Third Molar: A Case Report

    Directory of Open Access Journals (Sweden)

    Hasan Onur Şimşek

    2016-04-01

    Full Text Available Environmental factors, genetic heritage, increased biting function and nutrition are some of the reason for intraoral exostosis to get developed. Torus mandibularis is one of the types of exostosis in the oral region, which is unilaterally or bilaterally located in the lingual aspect of the body of the mandible above the mylohyoid line. There is usually no need for biopsy for the diagnosis of tori. In symptomatic cases, excision is the treatment of choice. In this paper, a 65-year-old man with a wide bilateral mandibular torus and an ankylosed mandibular right third molar tooth with mucosal retention is presented and general information was given about tori. In relation with this case, it was thought that dental ankylosis and tori may occur together because of similar etiological factors.

  16. [Inflammatory spinal diseases: axial spondyloarthritis : Central importance of imaging].

    Science.gov (United States)

    Baraliakos, X; Fruth, M; Kiltz, U; Braun, J

    2017-03-01

    The diagnosis of axial spondyloarthritis (axSpA) includes classical ankylosing spondylitis (AS) as well as earlier stages and abortive courses of the disease, in which structural alterations have not yet occurred. These are classified as non-radiographic axSpA (nr-axSpa). Inflammatory changes in the entire axial skeleton are characteristic for axSpA and can be visualized by magnetic resonance imaging (MRI), while in most patients structural alterations, such as new bone formation with syndesmophytes and ankylosis develop in the later course of the disease. These bony alterations can best be visualized by conventional radiography and by computed tomography. Certain MRI sequences are nowadays considered as the standard method for depiction of inflammatory changes in axSpA. The introduction of MRI has led to a paradigm shift for this disease because the inflammatory lesions characteristic for the disease can be visualized at an early stage using appropriate MRI sequences.

  17. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score

    DEFF Research Database (Denmark)

    Maksymowych, Walter P; Wichuk, Stephanie; Chiowchanwisawakit, Praveena

    2015-01-01

    to excellent for ankylosis (ICC 0.79-0.98), consistently good for fat metaplasia (ICC 0.71-0.78), moderate to good for erosion (ICC 0.58-0.62), and fair to good for backfill (ICC 0.35-0.66). Reliability for change scores was moderate to good for all structural lesions despite the relatively small changes...... in scores, and was highest for fat metaplasia when both ICC and SDC values were compared. CONCLUSION: The new SPARCC MRI SSS method can detect structural changes in the SIJ with acceptable reliability over a 1-2-year timeframe, and should be further validated in patients with SpA......., and either 2-year (exercises 1 and 2) or 1-year (exercise 3) scans from 147 patients with SpA assessed blinded to timepoint. Interobserver reliability was assessed by intraclass correlation coefficient (ICC) and smallest detectable change (SDC). RESULTS: Interobserver reliability for status score was good...

  18. The Medici syndrome: a medico-historical puzzle.

    Science.gov (United States)

    Weisz, George M; Matucci-Cerinic, Marco; Albury, William R; Lippi, Donatella

    2010-05-01

    The historical significance of the Medici family of Florence is widely recognised, but the diseases which afflicted leading members of this family have only been scientifically studied in recent decades. Paleopathological findings on exhumed skeletons, supplemented by medical descriptions in historical documents, have permitted a retrospective diagnosis of a triple pathological syndrome in the senior branch of the Medici family. Peripheral joint and spinal conditions, with the presence of skin disease, are identified in several generations of the family in the 15th century and are presented as the 'Medici syndrome'. Radiological findings are compared with macro- and microscopical descriptions in the diagnosis of the peripheral joint disease and spinal ankylosis/stenosis within the syndrome.

  19. Structural Disease Progression in Axial Spondyloarthritis: Still a Cause for Concern?

    Science.gov (United States)

    Neerinckx, Barbara; Lories, Rik J

    2017-03-01

    Progressive ankylosis is a feared consequence of long-standing axial spondyloarthritis. We aim to critically review current insights into the effect of therapy, the molecular pathways involved in this process, and to present a model explaining the sequence of events. Long-term follow-up data suggest that successful control of inflammation may slow down radiographic progression of disease in axial spondyloarthritis. Structural effects of new therapies such as interleukin-17 targeting need to be further studied. Bone loss and architectural changes could act as driver for the tissue remodeling process trying to maintain spinal stability in the presence of inflammation. Despite some progress, the nature and mechanisms of new bone formation in axial spondyloarthritis still remain incompletely understood. However, long-term control of inflammation appears critical to avoid progressive disability due to structural damage.

  20. Mechanisms and Treatments of Heterotopic Ossification Following Spinal Cord Injuries

    Science.gov (United States)

    2016-10-01

    manifests as abnormal ossification of soft tissues near joints. NHO is debilitating, causing pain, joint deformation, ankylosis and vascular and nerve...SCI.  NHO  occurs  in  15‐29%  of  patients  suffering  SCI,  often  young  men  in  car/sport  accidents .  In  the  case  of  US  soldiers...in traumatic  brain  spinal cord injured patients (Citak MD et al,  Spine 2012;37:1953‐57; Dizdar D et al,  Brain   Inj 2013;27:807‐11), we hypothesize

  1. Refinement of facial reconstructive surgery by stereo-model planning.

    Science.gov (United States)

    Cheung, L K; Wong, M C M; Wong, L L S

    2002-10-01

    The development of rapid prototyping has evolved from crude milled models to laser polymerized stereolithographic models of excellent accuracy. The technology was advanced further with the recent introduction of fused deposition modelling and a three-dimensional ink-jet printing technique in stereo-model fabrication. The concept of using a three-dimensional model in planning the operation has amazed maxillofacial surgeons since its first application in grafting a skull defect in 1995. It was followed by many bright ideas for applications in the field of facial reconstructive surgery. Stereo-models may assist in diagnosis of facial fractures, joint ankylosis and even impacted teeth. The surgery can be simulated prior the operation of complex craniofacial syndromes, facial asymmetry and distraction osteogenesis. The stereo-model can be used for preparation of reconstructive plate or joint prostheses. It is of enormous value for educational teaching and as a patient information tool when obtaining the consent for surgery.

  2. The unerupted maxillary canine--a post-surgical review.

    Science.gov (United States)

    O'Dowling, Ian

    2009-01-01

    The orthodontic records of 685 patients referred for surgical exposure of an unerupted impacted maxillary canine tooth were examined. The condition was more common among females than males, slightly less than 2:1. The impacted teeth had a palatal-labial ratio of 3:1. All of the teeth were exposed using the open surgical technique and in 98% of cases the tooth erupted and was orthodontically aligned. In 2% of cases ankylosis occurred and the teeth were subsequently extracted. The presence of peg-shaped lateral incisors associated with the impacted maxillary canine tooth was 3.4% of the total number of impacted teeth and congenital absence was found in 1.7% of impacted teeth.

  3. Pierre Robin sequence and obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Rubens Reimão

    1994-12-01

    Full Text Available The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT perfomed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.

  4. Temporomandibular Joint Septic Arthritis and Mandibular Osteomyelitis Arising From an Odontogenic Infection: A Case Report and Review of the Literature.

    Science.gov (United States)

    Gams, Kevin; Freeman, Phillip

    2016-04-01

    Septic arthritis of the temporomandibular joint (TMJ) has been infrequently reported in the literature. Some investigators believe that this condition is under-reported because it is underdiagnosed. Misdiagnosis or late diagnosis of this condition can lead to serious morbidity, including fistula formation, intracranial abscess, fibrous or bony ankylosis, temporal bone or condylar osteomyelitis, growth alteration, and several others. This report describes a case of septic TMJ arthritis arising from direct spread of an odontogenic infection with subsequent development of mandibular osteomyelitis. The purpose of this case report is to 1) increase awareness of an underdiagnosed condition, 2) establish the seriousness of this infection, 3) for the first time report on a case of TMJ septic arthritis caused by Bacteroides infection, and 4) provide a review of the relevant literature. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Radium-226-induced dental disease in Beagles: a radiographic study

    International Nuclear Information System (INIS)

    Morgan, J.P.; Miyabayashi, T.; Goldman, M.; Soo, S.

    1987-01-01

    Evaluation of dental radiographs made at necropsy and during the life of the dogs clearly shows age dependent changes within the control dogs. Periodontal diseases, loss of lamina dura, root ankylosis, and loss of pulp cavity were all commonly noted. Tooth loss and dental caries were rare in the control dogs. In injected Beagles loss of lamina dura was noted earlier and was dose dependent. Tooth loss and dental carried increased with dose level and appeared earlier. Tooth loss was common by 1600-1800 days of age while dental caries were common in almost all dogs by 1600-1800 days of age in the R40 level. Dental caries was the most accurate indication of the level of 226 Ra toxicity. 18 reference, 1 table

  6. Osteological alterations in the tucuxi Sotalia fluviatilis (cetacea, delphinidae

    Directory of Open Access Journals (Sweden)

    Daniela de C. Fettuccia

    2013-09-01

    Full Text Available We present a description of osteological alterations observed in the tucuxi, Sotalia fluviatilis (Gervais, 1853 from a sample of 43 specimens. Fractures were the most frequent alterations in the sample (16%, occurring in various regions of the skeleton such as the ribs, hyoid apparatus, transverse and neural processes of vertebrae and scapula. We observed three individuals with ankylosis between the cervical vertebrae and two individuals with morphological changes (cranio-caudally elongated hemal arch and flattened cranial margin of the scapula. The only observed pathology was a case of osteomyelitis in the left dentary, which caused the loss of teeth, deformation of the associated alveoli and the formation of a medial fistula (lingual for drainage of purulent material. This represents the first record of osteomyelitis in S. fluviatilis.

  7. The natural history of ankylosing spondylitis in the 21st century

    Directory of Open Access Journals (Sweden)

    C. Campana

    2011-06-01

    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease that affects the axial skeleton and evolves in stiffnes followed by ankylosis and disability. However, it may be difficult to exactly establish the natural history of the disease and the influence of risk factors of progression, since most patients are treated with various pharmacologic or non-pharmacologic agents, which may potentially influence the natural progression of the disease. In this context, we report here a very interesting case of a 40 year old man, presented to our outpatient clinic, 28 years after the onset of AS. Previously for personal reasons, did not choose not to undergo any treatment. This case allows us to evaluate the natural radiological progression of the disease and the influence of predictive risk factors.

  8. Complications associated with cheek tooth extraction in the horse.

    Science.gov (United States)

    Earley, Edward T; Rawlinson, Jennifer E; Baratt, Robert M

    2013-01-01

    Common indications for cheek tooth extraction in the horse include dental fracture, periodontal disease, severe decay/ caries, mandibular fracture with alveolar/tooth involvement, and periapical abscess. Complications secondary to extraction of cheek teeth are prevalent. Typical complications may include retained root tip(s), collateral damage of neighboring teeth and alveolar bone, mandibular fracture non-union or delayed union, cemental ankylosis, dilacerated root(s), oroantral/oronasal fistula, palatal deviation of cheek teeth, bone sequestration, sinus involvement, alveolar plug failure, and palatine artery laceration. This paper presents a series of cases that had complications following cheek tooth extraction. Anticipation of problematic extractions, recognition of complications, and appropriate treatment will aid the clinician in managing the inevitable cheek tooth extraction complication.

  9. [A descriptive clinical study of a type of arthritis in beekeepers of the Badajoz area of La Siberia Extremeña].

    Science.gov (United States)

    Peña, J; Salazar, J M; Ortega, R; Alvarez, J L; Campillo, J E; Torres, M D

    1995-07-01

    The appearance of episodes of arthritis has been detected in beekeepers in the Siberia Extremadura (Spain) related to working with the hives. This present work describes the clinical features of such arthritic syndrome. Sixty cases were selected at random from a previous epidemiological study to undergo a clinical protocol that included, anamnesis, physical signs, haematological, biochemical and immunological analyses, and radiological exploration of hands, wrists, feet, and pelvis. The picture is characterized by episodes of oligoarthritis associated with bee-stings in the affected joints or nearby. The most frequent radiologic lesions are pinched articular lines, sclerosis, and the presence of geodes. Analytically, there was frequent eosinophilia, abnormalities in haemostasis tests, and a rise in serum alkaline phosphatase. An acute inflammatory oligoarthritis of unknown cause has been described which affects the hands asymmetrically, and which is found in beekeepers in relation to their work with the hives. It occasionally involves into a chronic localized arthropathy capable of provoking ankylosis and permanent articular disability.

  10. On the biology of the bony otic capsule and the pathogenesis of otosclerosis

    DEFF Research Database (Denmark)

    Bloch, Sune Land

    2012-01-01

    In human otosclerosis, focal pathological bone remodeling occurs in significant amounts inside the normally anti-resorptive perilabyrinthine domain of the bony otic capsule. Otosclerosis causes hearing loss in 0.2-0.5% of the population by ankylosis of the footplate. The disease cannot be predicted......, avoided or medically reversed as the pathogenesis remains unknown. Previously genetic research has failed to identify a specific otosclerosis-gene and earlier theories of virus infections, autoimmunity or association to generalized bone diseases have been unable to explain why otosclerosis only occurs...... in the bony otic capsule while the rest of the skeleton remains completely normal. Studies from the otopathological laboratory (RH) have revealed how the bone turnover rates increase centrifugally from a sub-normal 0.1% adjacent to the inner ear space towards a normal 10% per year at the capsular periphery...

  11. Regenerative wound healing in acute degree III mandibular defects in dogs.

    Science.gov (United States)

    Mardas, Nikos; Kraehenmann, Michael; Dard, Michel

    2012-05-01

    To evaluate the healing events in degree III furcation defects in dogs following the application of the combination of an enamel matrix derivative with a biphasic calcium phosphate (Emdogain Plus). Seventeen degree III furcation defects, 5 mm high and 4 mm wide, were created in 9 dogs. In both groups, the defects were conditioned with EDTA. One defect was treated with Emdogain Plus (n = 9), while the contralateral defect serving as control remained empty (n = 8). The defects in both groups were fully covered by coronally repositioned flaps. After 5 months of healing, histologic and histometric analysis was preformed. A significant amount of new attachment and bone formation was observed in both control and test specimens. However, in a number of control specimens, ankylosis was also observed. In the control and test groups, respectively, the mean new cementum length was 10.8 ± 2.1 mm and 8.6 ± 3.2 mm; the mean periodontal ligament length was 7.6 ± 3.8 mm and 8.1 ± 4.0 mm. The mean new bone height was 4.4 ± 1.3 mm and 4.3 ± 1.6 mm in the control and test groups, respectively. No statistical differences were found between the two groups in terms of amount of cementum, periodontal ligament, and alveolar bone regeneration. The present study failed to show higher amounts of newly formed cementum and bone following treatment of acute degree III mandibular furcation defects following use of Emdogain Plus compared with a coronally advanced flap. Emdogain Plus seems to have a protective role against ankylosis in this type of defect.

  12. Effect of fibroblast growth factor and enamel matrix derivative treatment on root resorption after delayed replantation.

    Science.gov (United States)

    Tuna, Elif Bahar; Arai, Kiyoshi; Tekkesin, Merva Soluk; Seymen, Figen; Gencay, Koray; Kuboyama, Noboru; Maeda, Takahide

    2015-02-01

    Periodontal ligament (PDL) healing and long term prognosis of replanted avulsed teeth should rely on several factors including length of extra-oral dry time and type of the storage medium. The status of periodontal ligament is critical for the healing of replanted teeth. Different substances have been used for root surface treatment to promote formation of PDL and increase the survival of avulsed teeth submitted to replantation. The purpose of this study was to assess the effect of recombinant basic fibroblast growth factor 2 (bFGF) and enamel matrix derivative (EMD) on root resorption after delayed replantation. 18 freshly extracted single-rooted incisor and premolar teeth were extracted from the beagle dogs and immersed in whole bovine milk for 45 and 60 min (n = 3 each). Following storage period, sockets washed and teeth were treated with bFGF and EMD and replanted into the sockets. After 8 weeks, dogs were sacrificed, specimens processed to 4-μm thick serial sections for histopathologic examination and morphometric assessments. Thus, the proportions of the roots that exhibited signs of surface resorption, inflammatory resorption, and replacement resorption, that is, ankylosis and normal PDL were noted. The percentage of root resorption was in the following order: EMD>milk>bFGF for 45 min and milk>EMD>bFGF for 60 min. For all groups, teeth stored 60 min showed significantly higher incidence of PDL resorption than those stored for 45 min (P replacement resorption was observed in teeth treated with EMD for 60 min. After 8 weeks, the least resorption was found in bFGF-treated group (P replacement resorption, which may turn to ankylosis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Radiographic damage and progression of the cervical spine in ankylosing spondylitis patients treated with TNF-α inhibitors: Facet joints vs. vertebral bodies.

    Science.gov (United States)

    Maas, Fiona; Spoorenberg, Anneke; Brouwer, Elisabeth; van der Veer, Eveline; Bootsma, Hendrika; Bos, Reinhard; Wink, Freke R; Arends, Suzanne

    2017-04-01

    To investigate radiographic damage and 4-year progression of the cervical facet joints in a prospective observational cohort of AS patients treated with TNF-α inhibitors, to compare this with damage and progression of the cervical vertebral bodies, and to study the relation with patient characteristics and clinical outcome. Patients from the Groningen Leeuwarden AS (GLAS) cohort starting TNF-α inhibitors with baseline and 4-year radiographs were included. Cervical facet joints and vertebral bodies were scored by two independent readers according to the method of de Vlam and mSASSS, respectively. At baseline, 25 of 99 (25%) AS patients had partial or complete ankylosis of the cervical facet joints, whereas 51 (52%) patients had non-bridging or bridging syndesmophytes of cervical vertebral bodies. During 4 years, 13 (13%) patients developed new (partial) ankylosis of the facet joints, whereas 26 (26%) developed new (bridging) syndesmophytes. Facet joint damage and progression without involvement of the vertebral bodies were seen in 5 (5%) and 8 (8%) patients, respectively. Damage of facet joints was associated with longer disease duration, history of IBD/uveitis/psoriasis, higher disease activity, larger occiput-to-wall distance, higher mSASSS, and presence of syndesmophytes. Progression of the facet joints was associated with larger occiput-to-wall distance and more facet joint damage at baseline. Cervical facet joints were frequently involved in AS. During 4 years of TNF-α blocking therapy, 13% of the patients showed radiographic progression of cervical facet joints of which the majority did not show progression of vertebral bodies. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

    Directory of Open Access Journals (Sweden)

    Rex Chadrabose

    2011-12-01

    Full Text Available Abstract Background Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Materials Our case series includes 9 patients (seven males and two females with the mean age of 34 years (13-56 years. Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. Results The average duration of follow up is 65 months (45 months-80 months. The mean Mayo's elbow performance score (MEPS preoperatively was 48 (35-70. The MEPS at final follow up was 80 (60-95. With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°. The mean post operative range of motion at final follow up was 27°of extension (20-500, 116°of flexion (1100-1300, and the arc of motion was 88°(800-1000. One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. Conclusion We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

  15. Achondroplasia manifesting as enchondromatosis and ossification of the spinal ligaments: a case report

    Directory of Open Access Journals (Sweden)

    Al Kaissi Ali

    2008-08-01

    Full Text Available Abstract Introduction A girl presented with achondroplasia manifested as mild knee pain associated with stiffness of her back. A skeletal survey showed enchondroma-like metaphyseal dysplasia and ossification of the spinal ligaments. Magnetic resonance imaging of the spine further clarified the pathological composites. Case presentation A 7-year-old girl presented with the classical phenotypic features of achondroplasia. Radiographic documentation showed the co-existence of metaphyseal enchondromatosis and development of spinal bony ankylosis. Magnetic resonance imaging showed extensive ossification of the anterior and posterior spinal ligaments. Additional features revealed by magnetic resonance imaging included calcification of the peripheral vertebral bodies associated with anterior end-plate irregularities. Conclusion Enchondromas are metabolically active and may continue to grow and evolve throughout the patient's lifetime; thus, progressive calcification over a period of years is not unusual. Ossification of the spinal ligaments has a specific site of predilection and often occurs in combination with senile ankylosing vertebral hyperostosis. Nevertheless, ossification of the spinal ligaments has been encountered in children with syndromic malformation complex. It is a multifactorial disease in which complex genetic and environmental factors interact, potentially leading to chronic pressure on the spinal cord and nerve roots with subsequent development of myeloradiculopathy. Our patient presented with a combination of achondroplasia, enchondroma-like metaphyseal dysplasia and calcification of the spinal ligaments. We suggest that the development of heterotopic bone formation along the spinal ligaments had occurred through an abnormal ossified enchondral mechanism. We postulate that ossification of the spinal ligaments and metaphyseal enchondromatous changes are related to each other and represent impaired terminal differentiation of

  16. Multi-response model for rheumatoid arthritis based on delay differential equations in collagen-induced arthritic mice treated with an anti-GM-CSF antibody.

    Science.gov (United States)

    Koch, Gilbert; Wagner, Thomas; Plater-Zyberk, Christine; Lahu, Gezim; Schropp, Johannes

    2012-02-01

    Collagen-induced arthritis (CIA) in mice is an experimental model for rheumatoid arthritis, a human chronic inflammatory destructive disease. The therapeutic effect of neutralizing the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) by an antibody was examined in the mouse disease in a view of deriving a pharmacokinetic/pharmacodynamic (PKPD) model. In CIA mice the development of disease is measured by a total arthritic score (TAS) and an ankylosis score (AKS). We present a multi-response PKPD model which describes the time course of the unperturbed and perturbed TAS and AKS. The antibody acts directly on GM-CSF by binding to it. Therefore, a compartment for the cytokine GM-CSF is an essential component of the mathematical model. This compartment drives the disease development in the PKPD model. Different known properties of arthritis development in the CIA model are included in the PKPD model. Firstly, the inflammation, driven by GM-CSF, dominates at the beginning of the disease and decreases after some time. Secondly, a destructive (ankylosis) part evolves in the TAS that is delayed in time. In order to model these two properties a delay differential equation was used. The PKPD model was applied to different experiments with doses ranging from 0.1 to 100 mg/kg. The influence of the drug was modeled by a non-linear approach. The final mathematical model consists of three differential equations representing the compartments for GM-CSF, inflammation and destruction. Our mathematical model described well all available dosing schedules by a simultaneous fit. We also present an equivalent and easy reformulation as ordinary differential equation which grants the use of standard PKPD software.

  17. Influence of enamel matrix derivative (Emdogain) and sodium fluoride on the healing process in delayed tooth replantation: histologic and histometric analysis in rats.

    Science.gov (United States)

    Poi, Wilson Roberto; Carvalho, Roberta Martinelli; Panzarini, Sônia Regina; Sonoda, Celso Koogi; Manfrin, Thais Mara; Rodrigues, Thais da Silveira

    2007-02-01

    Although it has already been shown that enamel matrix derivative (Emdogain) promotes periodontal regeneration in the treatment of intrabony periodontal defects, there is little information concerning its regenerative capacity in cases of delayed tooth replantation. To evaluate the alterations in the periodontal healing of replanted teeth after use of Emdogain, the central incisors of 24 Wistar rats (Rattus norvegicus albinus) were extracted and left on the bench for 6 h. Thereafter, the dental papilla and the enamel organ of each tooth were sectioned for pulp removal by a retrograde way and the canal was irrigated with 1% sodium hypochlorite. The teeth were assigned to two groups: in group I, root surface was treated with 1% sodium hypochlorite for 10 min (changing the solution every 5 min), rinsed with saline for 10 min and immersed in 2% acidulated-phosphate sodium fluoride for 10 min; in group II, root surfaces were treated in the same way as described above, except for the application of Emdogain instead of sodium fluoride. The teeth were filled with calcium hydroxide (in group II right before Emdogain was applied) and replanted. All animals received antibiotic therapy. The rats were killed by anesthetic overdose 10 and 60 days after replantation. The pieces containing the replanted teeth were removed, fixated, decalcified and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The use of 2% acidulated-phosphate sodium fluoride provided more areas of replacement resorption. The use of Emdogain resulted in more areas of ankylosis and was therefore not able to avoid dentoalveolar ankylosis. It may be concluded that neither 2% acidulated-phosphate sodium fluoride nor Emdogain were able to prevent root resorption in delayed tooth replantation in rats.

  18. Radiologic Changes in the Symphysis Pubis of Male Patients with Ankylosing Spondylitis.

    Science.gov (United States)

    Koo, Bon San; Song, Yoonah; Joo, Kyung Bin; Lee, Seunghun; Kim, Tae-Hwan

    2016-02-01

    We aimed to evaluate the involvement of the symphysis pubis in patients with ankylosing spondylitis (AS), and to assess the correlations between symphysis pubis changes and clinical findings. We retrospectively evaluated a total of 222 male patients with AS who underwent pelvic and cervical/lumbar spine radiography at the Hanyang University Hospital for Rheumatic Diseases from August 2004 to February 2014. Radiographs were examined by 2 experienced radiologists, and radiographic damage was scored as follows: 0 (no damage), 1 (subtle irregularity and/or subchondral sclerosis), 2 (erosion), 3 (partial ankylosis), and 4 (total ankylosis). We evaluated the patients' clinical characteristics and analyzed their correlations with radiographic symphysis pubis changes. The mean patient age was 30.5 ± 8.3 years and mean disease duration was 7.1 ± 4.6 years; 105 patients (47.3%) exhibited radiologic damage in the symphysis pubis. Moreover, 75, 28, 0, and 2 patients had scores of 1, 2, 3, and 4, respectively. When comparing the normal (score 0) and abnormal (score 1-4) symphysis pubis groups, the latter had a longer symptom duration (10.1 ± 7.0 vs 7.6 ± 5.8 yrs, p = 0.004) and higher modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; 18.6 ± 17.0 vs. 14.3 ± 13.4, p = 0.038). Moreover, a significant correlation was noted between the radiographic symphysis pubis damage score and mSASSS (r(2) = 0.147, p = 0.029). Among male patients with AS, 47.3% exhibited symphysis pubis involvement. Moreover, a correlation was observed between the radiographic symphysis pubis and spine changes.

  19. Primary failure of eruption (PFE): a systematic review.

    Science.gov (United States)

    Hanisch, Marcel; Hanisch, Lale; Kleinheinz, Johannes; Jung, Susanne

    2018-03-15

    Primary failure of eruption (PFE) is a rare disease defined as incomplete tooth eruption despite the presence of a clear eruption pathway. Orthodontic extrusion is not feasible in this case because it results in ankylosis of teeth. To the best of our knowledge, besides the study of Ahmad et al. (Eur J Orthod 28:535-540, 2006), no study has systematically analysed the clinical features of and factors associated with PFE. Therefore, the aim of this study was to systematically evaluate the current literature (from 2006 to 2017) for new insights and developments on the aetiology, diagnosis, genetics, and treatment options of PFE. Following the PRISMA guidelines, a systematic search was performed using the PubMed/Medline database for studies reporting on PFE. The following terms were used: "primary failure of tooth eruption", "primary failure of eruption", "tooth eruption failure", and "PFE". Overall, 17 articles reporting clinical data of 314 patients were identified. In all patients, the molars were affected. In 81 reported cases, both the molars and the premolars were affected by PFE. Further, 38 patients' primary teeth were also affected. In 27 patients, no family members were affected. Additional dental anomalies were observed in 39 patients. A total of 51 different variants of the PTH1R gene associated with PFE were recorded. Infraocclusion of the posterior teeth, especially if both sides are affected, is the hallmark of PFE. If a patient is affected by PFE, all teeth distal to the most mesial tooth are also affected by PFE. Primary teeth can also be impacted; however, this may not necessarily occur. If a patient is suspected of having PFE, a genetic test for mutation in the PTH1R gene should be recommended prior to any orthodontic treatment to avoid ankylosis. Treatment options depend on the patient's age and the clinical situation, and they must be evaluated individually.

  20. Optimizing the MRI protocol of the sacroiliac joints in Spondyloarthritis: which para-axial sequence should be used?

    Energy Technology Data Exchange (ETDEWEB)

    Giraudo, Chiara; Weber, Michael; Platzgummer, Hannes; Kainberger, Franz; Schueller-Weidekamm, Claudia [Medical University of Vienna, Vienna General Hospital, Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Vienna (Austria); Magnaldi, Silvia [Fondazione Poliambulanza Istituto Ospedaliero, Dipartimento di Radiologia e Diagnostica per Immagini, Brescia (Italy); Puchner, Antonia [Medical University of Vienna, Vienna General Hospital, Division of Rheumatology, Department of Internal Medicine III, Vienna (Austria)

    2016-01-15

    To assess the diagnostic value of para-axial T2w-TSE (paT2) and fat-suppressed proton density (paPD-FS) MRI sequences for the evaluation of the sacroiliac joint (SIJ) of patients with axial Spondylarthritis (SpA). One hundred and six patients with clinical findings suggestive of SpA underwent an MR protocol of the SIJ with additional paPD-FS (41 patients) and paT2 (105 patients). Acute (bone marrow oedema [BME], enthesitis, capsulitis, synovitis) and chronic findings (erosions, ankylosis) were assessed by paPD-FS and compared with the gold standard post-contrast sequences, whereas chronic features (because of the lack of fat suppression) were evaluated on paT2 and compared with pcT1. paPD-FS demonstrated high sensitivity (98.9 %) and specificity (99.1 %) for BME; sensitivity and specificity for synovitis and enthesitis were 100 %; 85.7 % and 100 %, respectively, for capsulitis. paPD-FS and paT2 showed 100 % sensitivity and specificity for ankylosis; for erosions, paT2 demonstrated 85.3 % sensitivity and 100 % specificity, whereas paPD-FS, respectively, 98 % and 100 %. PaT2 and paPD-FS provided precious information enabling an accurate interpretation of the heterogeneous findings of SpA. paPD-FS showed good results in detecting acute and chronic lesions and its inclusion in a routine MR examination of the SIJ could increase the diagnostic performance of a pre-contrast protocol. (orig.)

  1. Patterns of radiographic damage to cervical spine in polyarticular juvenile idiopathic arthritis patients presenting to tertiary care hospital in pakistan

    International Nuclear Information System (INIS)

    Khyzer, E.; Aftab, T.

    2015-01-01

    Objective: To see the radiographic cervical spine damage in polyarticular juvenile idiopathic arthritis (PJIA) coming to a tertiary care hospital in Islamabad, Pakistan. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The study was conducted in department of Rheumatology at Pakistan Institute of Medical Sciences from Jun 2013 to Dec 2013. Subjects and Methods: A total of 50 patients of PJIA coming to Rheumatology Outpatient Department were recruited in the study after informed consent. Radiographs of cervical spine were performed for each patient in antero-posterior, lateral with flexion and extension and open-mouth views. Radiographs were reviewed for the following eatures: loss of cervical lordosis, odontoid process erosion, anterior atlantoaxial subluxation, C1-C2 arthritis, atlantoaxial impaction, inflammation of disc, apophyseal joint arthritis, anterior ankylosis, apophyseal joint ankylosis, anterior and posterior subaxial subluxation and growth disturbances. Data was analysed using SPSS version 18. Results: Out of the total 50 patients, 28 (56%) were females while 22 (44%) were males. The mean duration of pJIA was 5.54 +- 3.28 years. Radiological cervical spine involvement was seen in 52% patients. The most common structural lesions were anterior atlantoaxial subluxation (30%), C1-C2 arthritis (22%) erosion of the odontoid process (18%), and apophyseal joint arthritis (16%). Loss of cervical lordosis was found in 7(14%) patients. There was no growth disturbances observed in vertebra. Conclusion: Cervical spine involvement is common in patients of PJIA. It is mostly asymptomatic, so routine cervical spine radiographs in all patients suffering from PJIA is recommended. (author)

  2. Destructive arthritis in Behçet's disease: a report of eight cases and literature review.

    Science.gov (United States)

    Frikha, F; Marzouk, S; Kaddour, N; Frigui, M; Bahloul, Z

    2009-09-01

    Behçet's disease (BD) is a multisystemic disease with typically non-erosive and non-deforming joint manifestations. The occurrence of destructive arthritis in Behçet's disease has rarely been reported. Here we attempt to define the epidemiological, clinical and radiological features of this unusual type of osteoarticular manifestation of BD. We retrospectively reviewed the medical records of 553 patients with Behçet's disease seen over 25-year period in our department of Internal Medicine (Sfax-Tunisia). All the patients fulfilled The International Study Group of Behçet's Disease criteria. Patients with destructive arthritis (defined by radiological changes: erosions and/or geodes and/or global narrowing of the joint space and/or ankylosis) were included in this study. Rheumatologic manifestations were observed in 71.1% patients. Eight patients (1.4% overall, 2% among patients with rheumatologic manifestations) had presented with destructive arthritis. The joint symptoms involved the knee in two cases, the wrist in one case, the elbow (one case), the sternoclavicular joint in two cases, the foot in one case and the tarsal scaphoïd in one case. There was recurrent arthritis at the same joint in the majority of cases. X-ray examinations revealed radiological changes: global narrowing of the joint in one case (knee), narrowing of the joint with geodes in three cases (knee, sternoclavicular), isolated geodes in two cases (tarsal scaphoid, foot) and severe lesions with ankylosis in two cases (two elbows, right wrist). Joint manifestations are common in patients with BD, but destructive arthritis is rare.

  3. Avaliação radiográfica e de função de vôo após fixação de osteotomias distais do úmero em pombas (Columba livia, com modelo de fixador externo articulado Radiologic and flight function evaluation after fixation of distal humeral osteotomies in pigeons, with model of articulated external fixator

    Directory of Open Access Journals (Sweden)

    Vanessa C.M. Ferraz

    2008-08-01

    viabilidade de músculos e tendões, e assim, garantindo a capacidade de vôo das aves tratadas, sendo um método adequado para a reparação de fraturas distais de úmero em aves quando se pretende a reabilitação destes animais.The treatment of distal humeral fractures in birds is very difficult, technically and for consolidation and maintenance of normal function of the wing, because theses bones are pneumatic, and its cortices very thin. The ankylosis of the humerus-radius-ulnar joint with external fixator is unviable for birds intended for rehabilitation and release. In all animals, the experimental fixator was placed over the humerus, with its articulation over the humerus-radial-ulnar joint e the extension of the fixator was placed over the ulna. The animals were divided in two groups: bilateral surgeries with ankylosis in one wing (static wing and maintenance of the joint function in the other (dynamic wing (Group 1, and unilateral surgery, with maintenance of the joint function (dynamic wing (Group 2. The bonny callus was evaluated with radiographs: post-surgical, at 3, 6 and 9 weeks. The birds in Group 2 were evaluated as of their flight abilities between 11 and 15 weeks after surgery. The wing amplitude and humeral length was evaluated in all animals, after euthanasia. At 6 weeks, all the animals in Group 2, that underwent unilateral surgery, without ankylosis, and four animals in Group 1, that underwent bilateral surgeries: ankylosis of one elbow (static wing and not of the other (dynamic wing, presented radiographic and clinical consolidation of the fractures. Two animals in Group 1 only presented consolidation of the dynamic wing at 9 weeks and of the static wing at 12 weeks. All the animals in Group 2 presented adequate flight capacity, in at least 13 weeks after surgery. There are few published papers on bird osteosynthesis, and therefore we studied the use of articulated external fixator for the stabilization of distal humeral fractures, avoiding ankylosis

  4. Hypercementosis Associated with ENPP1 Mutations and GACI.

    Science.gov (United States)

    Thumbigere-Math, V; Alqadi, A; Chalmers, N I; Chavez, M B; Chu, E Y; Collins, M T; Ferreira, C R; FitzGerald, K; Gafni, R I; Gahl, W A; Hsu, K S; Ramnitz, M S; Somerman, M J; Ziegler, S G; Foster, B L

    2018-04-01

    Mineralization of bones and teeth is tightly regulated by levels of extracellular inorganic phosphate (P i ) and pyrophosphate (PP i ). Three regulators that control pericellular concentrations of P i and PP i include tissue-nonspecific alkaline phosphatase (TNAP), progressive ankylosis protein (ANK), and ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1). Inactivation of these factors results in mineralization disorders affecting teeth and their supporting structures. This study for the first time analyzed the effect of decreased PP i on dental development in individuals with generalized arterial calcification of infancy (GACI) due to loss-of-function mutations in the ENPP1 gene. Four of the 5 subjects reported a history of infraocclusion, overretained primary teeth, ankylosis, and/or slow orthodontic tooth movement, suggesting altered mineral metabolism contributing to disrupted tooth movement and exfoliation. All subjects had radiographic evidence of unusually protruding cervical root morphology in primary and/or secondary dentitions. High-resolution micro-computed tomography (micro-CT) analyses of extracted primary teeth from 3 GACI subjects revealed 4-fold increased cervical cementum thickness ( P = 0.00007) and a 23% increase in cementum density ( P = 0.009) compared to age-matched healthy control teeth. There were no differences in enamel and dentin densities between GACI and control teeth. Histology revealed dramatically expanded cervical cementum in GACI teeth, including cementocyte-like cells and unusual patterns of cementum resorption and repair. Micro-CT analysis of Enpp1 mutant mouse molars revealed 4-fold increased acellular cementum thickness ( P = 0.002) and 5-fold increased cementum volume ( P = 0.002), with no changes in enamel or dentin. Immunohistochemistry identified elevated ENPP1 expression in cementoblasts of human and mouse control teeth. Collectively, these findings reveal a novel dental phenotype in GACI and identify ENPP1 genetic

  5. MR imaging features of foot involvement in ankylosing spondylitis

    International Nuclear Information System (INIS)

    Erdem, C. Zuhal; Sarikaya, Selda; Erdem, L. Oktay; Ozdolap, Senay; Gundogdu, Sadi

    2005-01-01

    Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22

  6. MR imaging features of foot involvement in ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Erdem, C. Zuhal E-mail: sunarerdem@yahoo.com; Sarikaya, Selda; Erdem, L. Oktay; Ozdolap, Senay; Gundogdu, Sadi

    2005-01-01

    Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22

  7. Effect of enamel matrix proteins (Emdogain') on healing after re-implantation of "periodontally compromised" roots. An experimental study in the dog.

    Science.gov (United States)

    Araújo, M; Hayacibara, R; Sonohara, M; Cardaropoli, G; Lindhe, J

    2003-10-01

    The present experiment was performed to assess whether Emdogain applied on the root surface of extracted teeth or teeth previously exposed to root planning can protect the tooth from ankylosis following re-implantation. The experiment included two groups of dogs, including five animals each. The root canals of all mandibular third premolars (3 P 3) were reamed and filled with gutta-percha. A crestal incision was placed from the area of the second to the fourth premolar. Buccal and lingual full thickness flaps were elevated. With the use of a fissure bur, the crown and furcation area of 3 P 3 were severed in an apico-coronal cut. The distal and mesial tooth segments were luxated with an elevator and extracted with forceps. Group A: The mesial and distal segments of 3 P 3 were air dried on a glass surface for 60 min. The roots from the right side were conditioned and exposed to Emdogain application. The roots from the left side received the same treatment with the exception of Emdogain application. The mesial and distal tooth segments were re-implanted and the crown portions were severed with a horizontal cut and removed. The buccal and lingual flaps were mobilized and sutured to obtain complete coverage of the submerged roots. Group B: A notch was prepared in each root, 4-5 mm apical of the cemento-enamel junction. The area of the root that was located coronal to the notch was scaled and planned. The roots in the right side of the mandible were treated with Emdogain, while the roots in the left side served as controls. After 6 months of healing, the dogs were killed and blocks containing one root with surrounding tissues were harvested, and prepared for histological examination, which also included morphometric assessments. Thus, the proportions of the roots that exhibited signs of (i) replacement (ii) inflammatory and (iii) surface resorption were calculated. It was demonstrated that healing of a re-implanted root that had been extracted and deprived of vital

  8. Primary total elbow arthroplasty

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    Suresh Kumar

    2013-01-01

    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  9. Management of traumatically intruded permanent maxillary lateral incisor - Case report and review of literature

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    Deepak Sharma

    2016-01-01

    Full Text Available Primary etiologic factors of trauma in the permanent dentition are bicycle accidents, sports accidents, falls, and fights. From the standpoint of therapy, anatomy, and prognosis, five different types of luxation lesions are recognized: Concussion, subluxation, extrusive luxation, lateral luxation, and intrusive luxation. Intrusive luxation is apical displacement of tooth into the alveolar bone. The tooth is driven into the socket, compressing the periodontal ligament, and commonly causes a crushing fracture of the alveolar socket. It is considered one of the most severe luxation injuries to affect permanent teeth. Intrusion injuries are often associated with severe damage to the tooth, periodontium, and pulpal tissue. The rare occurrence of this injury, 0.3–1.9% in the permanent dentition, has resulted in limited studies to support suggested treatment regimens. Clinical treatment for intrusion is especially difficult because of the severe complications accompanying it. These complications include pulp necrosis or obliteration, inflammatory root resorption, ankylosis, replacement root resorption, and loss of marginal bone support. Hence, the aim of presenting this case report of intrusive luxation is to highlight the importance of prompt care and root canal dressing and discuss the several treatments proposed to reposition the intruded teeth.

  10. Transtendinous wiring of mallet finger fractures presenting late.

    Science.gov (United States)

    Lee, Hyun-Joo; Jeon, In-Ho; Kim, Poong-Taek; Oh, Chang-Wug; Deslivia, Maria Florencia; Lee, Suk-Joong

    2014-12-01

    To determine if transtendinous wiring was an effective late treatment for bony mallet injuries. Between 2005 and 2011, 19 consecutive patients (13 men, 6 women) with a mean age of 29 years (range, 13-52 y) were treated late for mallet finger fractures. The mean interval from injury to initial operation was 57 days (range, 28-141 d). Fifteen of 18 mallet fractures demonstrated evidence of radiographic healing after an average of 6 weeks (range, 5-10 wk). One patient developed ankylosis, and 3 patients failed to achieve bone union at the final follow-up. The mean motion of the distal interphalangeal joint was 73° (range, 35°-95°), and the mean extension lag was 7° (range, 0°-25°). Transtendinous wiring was an effective late treatment for mallet fractures, demonstrating satisfactory fixation, allowing early mobilization, and showing good functional results while avoiding salvage operations. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. Clinical aspects and conservative dental management of a patient with fibrodysplasia ossificans progressiva.

    Science.gov (United States)

    Oliveira, Francisco Artur Forte; Fernandes, Clarissa Pessoa; Araujo, Kenia Samara Barbosa; Alves, Ana Paula Negreiros Nunes; Sousa, Fabrício Bitu; Mota, Mário Rogério Lima

    2014-01-01

    T o present the clinical findings of a patient with fibrodysplasia ossificans progressiva (FOP), highlighting peculiarities of dental treatment in patients with this condition. FOP is a rare genetic disease characterized by skeletal malformations and ectopic ossifications in skeletal muscles, tendons, ligaments and aponeurosis. Exacerbation of these ossifications can be caused by dental treatment, resulting in disease progression. A 26-year-old male patient with a diagnosis of FOP was referred to our service for dental treatment. The patient presented decreased mobility in peripheral joints (knees and elbows), postural disability (ankylosis of the vertebral column), lateral deviation and shortness of the hallux, as well as heterotopic ossifications on the hands and back. The implementation of conservative dental procedures, such as oral hygiene instructions and recurrent topical fluoride applications, were performed in addition to endodontic and restorative treatments. Brief dental appointments were conducted without using regional anesthesia or dental dam clamps. The dental chair was positioned at 45° to provide more comfort and to avoid exacerbating the disease. The patient has now completed 6 months of follow-up and is free of heterotopic ossifications resulting from dental treatment. The dental treatment modifications implemented for the present case were sufficient to establish good oral health and to prevent the formation of heterotopic ossifications in the maxillofacial region. FOP is a rare disease dentists must familiarize themselves with to provide adequate, personalized treatment, which minimizes traumas that may exacerbate the disease.

  12. Decoronation for the management of an ankylosed young permanent tooth.

    Science.gov (United States)

    Sapir, Shabtai; Shapira, Joseph

    2008-02-01

    Replacement resorption rate is a variable process, and is dependent on age, basal metabolic rate, extra-alveolar time, treatment prior to replantation, amount of root dentin, severity of trauma, and extent of periodontal ligament necrosis. In patients 7-16 years old a tooth is lost 3-7 years after the onset of root resorption. The complications that may develop as a consequence of ankylosis of a permanent incisor in children are due to the inevitable early loss of the traumatized tooth and local arrest of alveolar bone development. An ankylosed tooth should be removed before the changes become so pronounced that they compromise future prosthetic treatment. The treatment options may involve: interceptive regenerative treatment, early extraction of the ankylosed tooth, orthodontic space closure, intentional replantation, extraction of the ankylosed tooth followed with immediate ridge augmentation/preservation, auto-transplantation, single tooth dento-osseous osteotomy, and decoronation. The purpose of this article was to review the considerations involved in the decision-making concerning the use of the decoronation technique for the treatment of a permanent incisor diagnosed as ankylosed.

  13. Temporomandibular Joint Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Gianfranco Frojo, MD

    2018-01-01

    Full Text Available Summary:. Infection of the temporomandibular joint (TMJ is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.

  14. Pfeiffer syndrome

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    Fryns Jean-Pierre

    2006-06-01

    Full Text Available Abstract Pfeiffer syndrome is a rare autosomal dominantly inherited disorder that associates craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Hydrocephaly may be found occasionally, along with severe ocular proptosis, ankylosed elbows, abnormal viscera, and slow development. Based on the severity of the phenotype, Pfeiffer syndrome is divided into three clinical subtypes. Type 1 "classic" Pfeiffer syndrome involves individuals with mild manifestations including brachycephaly, midface hypoplasia and finger and toe abnormalities; it is associated with normal intelligence and generally good outcome. Type 2 consists of cloverleaf skull, extreme proptosis, finger and toe abnormalities, elbow ankylosis or synostosis, developmental delay and neurological complications. Type 3 is similar to type 2 but without a cloverleaf skull. Clinical overlap between the three types may occur. Pfeiffer syndrome affects about 1 in 100,000 individuals. The disorder can be caused by mutations in the fibroblast growth factor receptor genes FGFR-1 or FGFR-2. Pfeiffer syndrome can be diagnosed prenatally by sonography showing craniosynostosis, hypertelorism with proptosis, and broad thumb, or molecularly if it concerns a recurrence and the causative mutation was found. Molecular genetic testing is important to confirm the diagnosis. Management includes multiple-staged surgery of craniosynostosis. Midfacial surgery is performed to reduce the exophthalmos and the midfacial hypoplasia.

  15. Type 2 Pfeiffer syndrome. Report of a case and review of the literature

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    Roldán Arce Jorge

    2014-07-01

    Full Text Available Pfeiffer syndrome is a rare autosomal dominant disease that affects almost 1 out of every 100,000 live newborns, and it is associated with craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly in hands and feet. Three types of this syndrome have been described based on the presence of other abnormalities and the severity of the condition. “Classic” type 1 consists of mild severity with normal to near-normal intelligence and generally a good prognosis. Type 2 is characterized by a cloverleaf skull, severe proptosis, elbow ankylosis or synostosis, growth retardation and life-threatening neurological and respiratory complications. Type 3 is similar to type 2 but without the cloverleaf cranium. This syndrome is genetically heterogeneous, it is caused by mutations in the fibroblast growth factor receptor genes FGFR- 1 or FGFR-2. Occasionally Pfeiffer syndrome can be diagnosed prenatally by sonography or molecularly if the causative mutation is known. Management must be multidisciplinary and it includes multiple-staged surgery. In this report we present the clinical and radiographic findings in female newborn, whose clinical features were consistent with Pfeiffer syndrome type 2. A brief updated review of the literature is included.

  16. Inadequate Dietary Phosphorus Levels Cause Skeletal Anomalies and Alter Osteocalcin Gene Expression in Zebrafish

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    Juliana M. Costa

    2018-01-01

    Full Text Available Phosphorus (P is an essential mineral for the development and maintenance of the vertebrate skeletal system. Modulation of P levels is believed to influence metabolism and the physiological responses of gene expression. In this study, we investigated the influence of dietary P on skeletal deformities and osteocalcin gene expression in zebrafish (Danio rerio, and sought to determine appropriate levels in a diet. We analyzed a total of 450 zebrafish within 31 days of hatching. Animals were distributed in a completely randomized experimental design that consisted of five replications. After an eight-week experiment, fish were diaphanized to evaluate cranial and spinal bone deformities. Increases in dietary phosphorus were inversely proportional to the occurrence of partial spine fusions, the absence of spine fusions, absence of parallelism between spines, intervertebral spacing, vertebral compression, scoliosis, lordosis, ankylosis, fin caudal insertion, and craniofacial deformities. Additionally, osteocalcin expression was inversely correlated to P levels, suggesting a physiological recovery response for bone mineralization deficiency. Our data showed that dietary P concentration was a critical factor in the occurrence of zebrafish skeletal abnormalities. We concluded that 1.55% P in the diet significantly reduces the appearance of skeletal deformities and favors adequate bone mineralization through the adjustment of osteocalcin expression.

  17. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

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    Sandén Bengt

    2009-07-01

    Full Text Available Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI. Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.

  18. Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006-2011).

    Science.gov (United States)

    Arzi, Boaz; Cissell, Derek D; Verstraete, Frank J M; Kass, Philip H; DuRaine, Grayson D; Athanasiou, Kyriacos A

    2013-01-01

    To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Retrospective case series. 41 dogs and 17 cats. Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Results indicated that TMJ disorders were frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and signs of pain. (J Am Vet Med Assoc 2013;242:69-75).

  19. Donor's age and replicative senescence favour the in-vitro mineralization potential of human fibroblasts.

    Science.gov (United States)

    Boraldi, Federica; Bartolomeo, Angelica; Di Bari, Caterina; Cocconi, Andrea; Quaglino, Daniela

    2015-12-01

    Aberrant mineralization of soft connective tissues (ectopic calcification) may occur as a frequent age-related complication. Still, it remains unclear the role of mesenchymal cell donor's age and of replicative senescence on ectopic calcification. Therefore, the ability of cells to deposit in-vitro hydroxyapatite crystals and the expression of progressive ankylosis protein homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), tissue non specific alkaline phosphatase (TNAP) and osteopontin (OPN) have been evaluated in human dermal fibroblasts derived from neonatal (nHDF) and adult (aHDF) donors (ex-vivo ageing model) or at low and high cumulative population doublings (CPD) up to replicative senescence (in-vitro ageing model). This study demonstrates that: 1) replicative senescence favours hydroxyapatite formation in cultured fibroblasts; 2) donor's age acts as a major modulator of the mineralizing potential of HDF, since nHDF are less prone than aHDF to induce calcification; 3) donor's age and replicative senescence play in concert synergistically increasing the calcification process; 4) the ANKH+ENPP1/TNAP ratio, being crucial for pyrophosphate/inorganic phosphate balance, is greatly influenced by donor's age, as well as by replicative senescence, and regulates mineral deposition; 5) OPN is only modulated by replicative senescence. Copyright © 2015. Published by Elsevier Inc.

  20. Diagnostic imaging of sacroiliac joints and the spine in the course of spondyloarthropathies

    International Nuclear Information System (INIS)

    Sudoł-Szopinska, Iwona; Urbanik, Andrzej

    2013-01-01

    Spondyloarthropathies belong to a group of rheumatic diseases, in which inflammatory changes affect mainly the sacroiliac joints, spine, peripheral joints, tendon, ligaments and capsule attachments (entheses). This group includes 6 entities: ankylosing spondylitis, arthritis associated with inflammatory bowel disease, reactive arthritis, undifferentiated spondyloarthropathy, psoriatic arthritis and juvenile spondyloarthropathy. In 2009, ASAS (Assessment in SpondyloArthritis international Society) association, published classification criteria for spondyloarthropathies, which propose standardization of clinical-diagnostic approach in the case of sacroiliitis, spondylitis and arthritis. Radiological diagnosis of inflammatory changes of sacroiliac joints is based on a 4 step radiographic grading method from 1966. According to modified New York criteria, the diagnosis of ankylosing spondylitis is made based on the presence of advanced lesions, sacroiliitis of at least 2 grade bilaterally or 3–4 unilaterally. In case of other types of spondyloarthropathies diagnosis is made based on presence of at least grade 1 changes. In MRI, active inflammation of sacroiliac joints is indicated by the presence of subchondral bone marrow edema, synovitis, bursitis, or enthesitis. ASAS discusses only the classic form of axial spondyloarthropathies, which is ankylosing spondylitis. To quantify radiological inflammatory changes in the course of the disease, Stoke Ankylosing spondylitis classification Spinal Score (SASSS) is recommended. The signs of inflammation and scarrying of the spinal cord in the course of ankylosing spondylitis, present in MRI include: bone marrow edema, sclerosis, fat metaplasia, formation of syndesmophytes, and ankylosis

  1. [Treatment of distraction osteogenesis in the patients of obstructive sleep apnea-hypopnea syndrome with micrognathia].

    Science.gov (United States)

    Lu, Xiao-feng; Tang, You-sheng; Shen, Guo-fang; Zhu, Min; Li, Qing-yun; Qiu, Wei-liu

    2003-06-01

    To apply the treatment of distraction osteogenesis(DO) to obstructive sleep apnea-hypopnea syndrome(OSAHS) patients with croniomaxillofacial deformities. All 46 OSAHS patients with micrognathia are had polysomnography(PSG) study and cephalometric analysis. Their age from 4 to 18 years old, the mean age is 11.4. The number of temporal mandibular joint (TMJ) ankylosis with micrognathia, micrognathia; 1st & 2nd bronchial arch syndrome and crouzon syndrome patients were 32, 9, 2 and 3 respectively. All were treated with DO. Maxilla or mandible was advanced from 5 to 35 micrometers; the mean advanced distance is 18.34 mm. They were all revaluated by PSG and cephalometric analysis postoperatively. All patients have good respond to the treatment. They have a better appearance and the narrow upper airway was enlarged remarkably, their AHI drop from 66.31 +/- 14.74 pre-operately to 3.16 +/- 1.70 pro-operately, and minimal posterior airway space(PAS) from (5.48 +/- 2.76) mm to (9.97 +/- 2.05) mm. There is remarkable difference (P < 0.001). DO is a good method for the patients of OSAHS with micrognathia.

  2. Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report

    Directory of Open Access Journals (Sweden)

    Haghpanah Babak

    2010-06-01

    Full Text Available Abstract Spinal cord injury is a well-known predisposing factor for development of heterotopic ossification around the joints especially hip and elbow. Heterotopic ossification about the knee is usually located medially, laterally or anteriorly; besides, the knee is generally fixed in flexion. There are only a few reports of heterotopic bone formation at the posterior aspect of the knee (popliteal space and fixation of both knees in extension; so, there is little experience in operative management of such a problem. Here, we present a 39-years old paraplegic man who was referred to us five years after trauma with a request of above knee amputation due to sever impairment of his life style and adaptive capacity for daily living because of difficulties in using wheelchair. The principle reason for the impairment was fixed full extension of both knees as the result of bilateral large heterotopic ossification masses in popliteal fossae. The bony masses were surgically resected with acceptable outcome. The anatomic position of the ossified masses as well as ankylosis of both knees in full extension, and the acceptable functional outcome of surgery which was done after a long period of five years following injury makes this case unique.

  3. Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment

    Directory of Open Access Journals (Sweden)

    Daniela Atili Brandini

    2018-03-01

    Full Text Available Abstract The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8 - endodontic treatment was performed before the extraction and replantation; Group II (n = 10 - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10 - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%. In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

  4. Occult radiological effects of lipomatosis of the lumbosacral plexus

    Energy Technology Data Exchange (ETDEWEB)

    Mahan, Mark A. [Barrow Neurological Institute, Phoenix, AZ (United States); Howe, B.M.; Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Spinner, Robert J. [Mayo Clinic, Department of Neurosurgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States)

    2014-07-15

    Lipomatosis of nerve (LN) is a condition of massive peripheral nerve enlargement frequently associated with hypertrophy within the distribution of the nerve, and most commonly affecting the distal limbs. We sought to understand if LN of the lumbosacral plexus would be associated with the trophic effects of LN on surrounding tissue within the pelvis, which may be clinically occult, but present on MRI. Fifty-one cases of LN, confirmed by pathology or pathognomonic appearance on MRI, were reviewed. Patients with LN of the sciatic nerve were investigated for radiological signs suggestive of overgrowth. Five patients had involvement of the sciatic nerve, 4 of whom had MR imaging of the pelvis. Three patients had LN involving the lumbosacral plexus, and one patient had isolated involvement of the sciatic nerve. All patients with involvement of the lumbosacral plexus demonstrated previously unrecognized evidence of nerve territory overgrowth in the pelvis, including: LN, profound adipose proliferation, muscle atrophy and fatty infiltration, and bone hypertrophy and ankylosis. The patient with LN involving the intrapelvic sciatic nerve, but not the lumbosacral plexus did not demonstrate any radiological evidence of pelvic overgrowth. LN is broader in anatomical reach than previously understood. Proximal plexal innervation may be involved, with a consequent effect on axial skeleton and intrapelvic structures. (orig.)

  5. Retention and Healing Outcomes after Intentional Replantation.

    Science.gov (United States)

    Cho, Sin-Yeon; Lee, Yoon; Shin, Su-Jung; Kim, Euiseong; Jung, Il-Young; Friedman, Shimon; Lee, Seung-Jong

    2016-06-01

    Intentional replantation is an alternative to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This study assessed tooth retention and healing after intentional replantation and explored predictors of these outcomes. Data of intentional replantation procedures performed between March 2000 and December 2010 were collected prospectively, excluding teeth with preoperative periodontal and root defects. A cohort of 159 teeth was followed up for 0.5-12 years. Retention and healed status without complications (periapical radiolucency, external root resorption, ankylosis, signs/symptoms, probing ≥6 mm) was recorded and analyzed with Kaplan-Meier survival analysis and Cox proportional hazard regression model (P regression identified extraoral time ≤15 minutes as predictor of complication-free healing (P < .04; hazard ratio, 2.767; 95% confidence interval, 1.053-7.272). This prospective cohort study of contemporary intentional replantation suggested a cumulative 12-year retention rate of 93% and healed rate of 77% after 3 years. Healing occurred 1.7 times more frequently in teeth replanted within 15 minutes. Although most complications occurred within 1 year after replantation, follow-up should extend for at least 3 years to capture late complications. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  6. Treatment of Necrotic Calcified Tooth Using Intentional Replantation Procedure

    Directory of Open Access Journals (Sweden)

    Nima Moradi Majd

    2014-01-01

    Full Text Available Introduction. If the teeth are impacted by a chronic irritant, the pulp space possibly will undergo calcific changes that may impede access opening during root canal treatment. In such cases that conventional endodontic treatment is impossible or impractical, intentional replantation may be considered as a last solution to preserve the tooth. Methods. After failing to perform conventional root canal therapy for a necrotic calcified right mandibular second premolar, the tooth was gently extracted. The root apex was resected and the root end cavity was prepared and filled with calcium enriched mixture (CEM cement. Then, the extracted tooth was replanted in its original position. Results. After a year the tooth was asymptomatic, and the size of periapical radiolucency was remarkably reduced and no clinical sign of ankylosis was observed. Conclusion. Intentional replantation of the necrotic calcified teeth could be considered as an alternative to teeth extraction, especially for the single-rooted teeth and when nonsurgical and surgical endodontic procedures seem impossible.

  7. Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC) and Metallic Retainers

    Science.gov (United States)

    Gandini, Paola; Tessera, Paola; Vallittu, Pekka K.; Lassila, Lippo; Sfondrini, Maria Francesca

    2017-01-01

    Fiber reinforced Composite (FRC) retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot-) resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis. PMID:28976936

  8. Retrograde intubation through nasal route in patients with limited mouth opening undergoing oral and maxillofacial surgery.

    Science.gov (United States)

    Vadepally, Ashwant Kumar; Sinha, Ramen; Kumar, A V S S Subramanya

    2018-01-01

    Patients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrograde intubation through nasal route in patients with LMO less than 2 cm. The procedure was performed with some modification with regard to retrograde guide on 18 patients requiring maxillofacial surgical procedures to increase mouth opening. Indications for this technique were mandibular fracture (n = 6), oral submucous fibrosis (OSMF; n = 6), temporomandibular joint (TMJ) ankylosis (n = 4) and internal derangement of TMJ (n = 2). All patients were assessed for preoperative interincisal opening; during intubation through specific parameters and; also postoperative findings were observed. Mean time taken for successful intubation was 5.6 min ± 1.66. One patient had subcutaneous emphysema which was managed conservatively. Postoperatively, four patients had sore throat which resolved in few days. No other complications were encountered. In conclusion, retrograde nasotracheal intubation is an effective and useful technique for airway control in patients with LMO and with only a small risk potential.

  9. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis: correlation with anatomy and histology.

    Science.gov (United States)

    Hermann, K-G A; Bollow, M

    2014-03-01

    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis. Correlation with anatomy and histology

    Energy Technology Data Exchange (ETDEWEB)

    Hermann, K.G.A. [Charite Medical School, Campus Mitte, Berlin (Germany). Dept. of Radiology; Bollow, M. [Augusta Hospital, Bochum (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclear Medicine

    2014-03-15

    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. (orig.)

  11. [Progress of temporomandibular joint prosthesis].

    Science.gov (United States)

    Sun, Quan; Li, Kaide; Liu, Lei

    2014-08-01

    The anatomically and functionally complex nature of the temporomandibularjoint (TMJ) makes its reconstruction one of the most challenging tasks faced by surgeons who operate in the head and neck. TMJ prosthesis is one of the important techniques in the reconstruction of TMJ. The main indications for TMJ prosthesis include ankylosis, fractures of condylar that can't be fixed, trauma or tumor, end-stage TMJ disturbance, and TMJ dysplasia caused by Hallermann-Streiff syndrome. TMJ replacement aims to enhance the function of TMJ, alleviate pain, and prevent serious complications. TMJ prosthesis is advantageous in oral and maxillofacial surgery because it can imitate normal anatomic morphology and adhere to the host. Moreover, the use of other materials is no longer necessary and functional training can be started postoperatively at once, among others. Prosthetic materials have leading and promoting functions in the development of joint prosthesis. Good design, fit shape, and fixation are the necessary conditions for prosthesis to serve its function. Investigation of joint biomechanics is also necessary. With the rapid developments in material science, joint biomechanics, and other related subjects, TMJ prosthesis has been significantly improved in terms of its materials, design, fit shape, and fixation techniques. In addition, the development of TMJ prosthesis would expand its applications. This review intends to provide an overview about the progress and clinical application of TMJ prosthesis.

  12. A functional variant in ERAP1 predisposes to multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Franca Rosa Guerini

    Full Text Available The ERAP1 gene encodes an aminopeptidase involved in antigen processing. A functional polymorphism in the gene (rs30187, Arg528Lys associates with susceptibility to ankylosying spondylitis (AS, whereas a SNP in the interacting ERAP2 gene increases susceptibility to another inflammatory autoimmune disorder, Crohn's disease (CD. We analysed rs30187 in 572 Italian patients with CD and in 517 subjects suffering from multiple sclerosis (MS; for each cohort, an independent sex- and age-matched control group was genotyped. The frequency of the 528Arg allele was significantly higher in both disease cohorts compared to the respective control population (for CD, OR = 1.20 95%CI: 1.01-1.43, p = 0.036; for RRMS, OR = 1.26; 95%CI: 1.04-1.51, p = 0.01. Meta-analysis with the Wellcome Trust Cases Control Consortium GWAS data confirmed the association with MS (p(meta = 0.005, but not with CD. In AS, the rs30187 variant has a predisposing effect only in an HLA-B27 allelic background. It remains to be evaluated whether interaction between ERAP1 and distinct HLA class I alleles also affects the predisposition to MS, and explains the failure to provide definitive evidence for a role of rs30187 in CD. Results herein support the emerging concept that a subset of master-regulatory genes underlay the pathogenesis of autoimmunity.

  13. Effect of extracorporeal shock waves on subcondylar mandibular fractures.

    Science.gov (United States)

    Altuntaş, Emine Elif; Oztemur, Zekeriya; Ozer, Hatice; Müderris, Suphi

    2012-11-01

    The purpose of this pilot study was to evaluate the effects of extracorporeal shock wave therapy on healing of subcondylar mandibular fracture in rats. Unilateral subcondylar fracture in 20 Wistar albino rats was used as a fracture model. Each rat was anesthetized 1 day after surgery, and extracorporeal shock wave therapy was performed. On the 21st day after surgery, animals were killed. Mandibles were dissected, all soft tissues were removed after sacrifice, and fractured and nonfractured hemimandibles were obtained from each rat. Histologic analyses were performed by a single pathologist blinded to the samples. The specimens' mean score in bone fracture healing was 7 (1.09) (range, 6-9) in group 1 and 2.57 (1.62) (range, 1-6) in group 2. With respect to the specimens' bone fracture healing score, there was a statistically significant difference between the 2 groups. As a result, our study showed that extracorporeal shock wave therapy accelerated the improvement of fractures in experimentally induced subcondylar mandibular fracture in the rat mandible. We believe that reducing the duration of improvement in subcondylar mandibular fractures by intermaxillary fixation along with extracorporeal shock wave theraphy would contribute to preventing complications such as ankylosis, fibrosis, and hypomobility occuring because of prolonged fixation.

  14. [About a case of laryngeal location of SAPHO].

    Science.gov (United States)

    Vatin, L; Jean, E; Rivière, D; Montava, M; Giovanni, A; Dessi, P; Lagier, A

    2017-10-01

    Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) is a syndrome that combines dermatological, articular and osseous inflammatory manifestations. Bilateral laryngeal immobility relative to cricoarytenoid joint origin is very uncommon. This article presents a case of bilateral cricoarytenoid joint ankylosis in a SAPHO syndrome context. A 53-year-old patient presenting with a two year history of intermittent bouts of dyspnea. A SAPHO syndrome was discussed on repeated thoracic CT-scan. The link between dyspnea and SAPHO syndrome had not been made immediately given the absence of any known anteriority. However, having ruled out other etiologies and after having had to perform a tracheotomy due a worsening of the respiratory condition, this diagnosis was considered. Treatment by corticosteroids and infliximab permitted a clinical improvement of the patient. This clinical case report should increase awareness of possible cricoarytenoid joint involvement in SAPHO. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  15. Clinical and histopathological evaluation of MDP/collagen induced arthritis rat model (MCIA) after treatment with Urtica dioica, plantago major and Hypericum perforatum L herbal mixture.

    Science.gov (United States)

    Khalifeh, Mohammad S; Hananeh, Wael; Al-Rukibat, Raida; Okour, Omar; Boumezrag, Assia

    2008-04-01

    This study was done to assess the effects of Urtica dioica, Plantago major and Hypericum perforatum L herbal mixture in the MCIA rat model. In addition, a new pathological and clinical arthritis lesion assessment was developed. Sprague-Dawley (SD) rats were immunized with bovine type II collagen and muramyl dipeptide (MDP). Commercial herbal extracts were administered daily to the rats after the immunization for the course of experiment (90 days). Rats were boosted with a second collagen-MDP emulsion 60 days after the first immunization. Paws were daily evaluated macroscopically for redness, swelling, distortion, or ankylosis of the joints. On the day of sacrifice, rat paws were assessed for histopathologic changes. Herbal mixture administration decreased the clinical lesion manifestation in the MCIA rat model and led to development of similar or slightly more severe histopathological lesions compared to rats that did not receive the treatment. The clinical arthritis signs appeared as early as 13 days after the first MDP/collagen injection and with peak incidence at 20 days post-immunization. Histopathologically, animals showed changes ranging from mild to very severe. Administration of the herbal mixture used in this study had a clinical therapeutic effect on the course of the clinical manifestations in the MCIA model, but the herbal treatment had no such effect on the histopathological lesion development and even led to slightly more severe lesions. Rats in the MCIA model developed prominent clinical and histopathological changes that were comparable to rheumatoid arthritis (RA) lesions in humans.

  16. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Arendse, Regan [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); University of Cape Town, Division of Rheumatology, Groote Schuur Hospital, Cape Town (South Africa); Brink, Paul [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); Beighton, Peter [University of Cape Town, Division of Human Genetics, Faculty of Health Sciences, Cape Town (South Africa)

    2009-12-15

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  17. Unusual radiographic changes of a gout patient

    International Nuclear Information System (INIS)

    Markota, J.

    2004-01-01

    Background. Gout is a metabolic disorder that results in hyperuricemia and accumulation of uric acid crystals (urats) in tissues, especially joint cartilage. The gouty arthritis presents as acute attacks of arthritis leading eventually to chronic gouty arthritis. In 80% of cases it first occurs in the matatarsophalangeal (MTP) joint of the great toe and is more frequent in male population. Case report. We present a case of unusual radiographic changes accompanying gouty arthritis. A 63 year old female complained about swelling of the first MTP joint on the right, right knee, about stiffness of feet and hands' digits and about backache. First symptoms started to appear 30 years ago. In the time of examination radiographs displayed degenerative changes of the majority of presented joints, bilateral sacroiliitis and osseous ankylosis of both insteps. Microscopic examination showed urate crystals in the samples of the synovial fluid aspirated from the knee. The histological findings of the synovial tissue after the synovectomy were also in favour of gouty arthritis. Conclusions. Radiographs are the most important imaging modality in the diagnostic process of gout. However, radiographic differential diagnosis can be difficult, since the findings overlap with other conditions which cause arthritis and osteoarthritis especially in longstanding gout, elderly patients and females. The diagnosis must be often confirmed with the help of laboratory and histological findings. (author)

  18. Histology of tooth attachment tissues and plicidentine in Varanus (Reptilia: Squamata), and a discussion of the evolution of amniote tooth attachment.

    Science.gov (United States)

    Maxwell, Erin E; Caldwell, Michael W; Lamoureux, Denis O; Budney, Lisa A

    2011-10-01

    Few recent studies have examined the histological basis for tooth attachment in squamates. In the past few years, a surge of interest in this topic has led to the intriguing suggestion that the major tissues derived from the tooth germ (enamel, dentine, cementum and alveolar bone), are conservative and are present in all amniotes. In this study, we describe the histology and development of the tooth attachment complex in Varanus rudicollis, the rough-neck monitor. We provide the first published evidence for the role of cementum and alveolar bone in tooth attachment in varanoid lizards. In Varanus, cementum is deposited on the external surface of the tooth root as well as at the base of the tooth, where it plays a role in the attachment of the tooth to the jawbone. Alveolar bone is also involved in tooth ankylosis. Our results support the hypothesis that the major tooth germ tissues are found in all amniotes. We provide insights into the structure and development of plicidentine, defined as infolding of the dentine around the tooth base. This feature is unique to varanoids among extant tetrapods and is the third tissue implicated in tooth attachment in Varanus. Plicidentine develops asymmetrically along the labial-lingual axis of a tooth. Varanus is characterized by the presence of both primary and higher-order lamellae, which anastomose to form a honeycomb-like surface that then interacts with the more basal attachment tissues. Copyright © 2011 Wiley-Liss, Inc.

  19. The application of 3-dimensional printing for preoperative planning in oral and maxillofacial surgery in dogs and cats.

    Science.gov (United States)

    Winer, Jenna N; Verstraete, Frank J M; Cissell, Derek D; Lucero, Steven; Athanasiou, Kyriacos A; Arzi, Boaz

    2017-10-01

    To describe the application of 3-dimensional (3D) printing in advanced oral and maxillofacial surgery (OMFS) and to discuss the benefits of this modality in surgical planning, student and resident training, and client education. Retrospective case series. Client-owned dogs (n = 28) and cats (n = 4) with 3D printing models of the skulls. The medical records of 32 cases with 3D printing prior to major OMFS were reviewed. Indications for 3D printing included preoperative planning for mandibular reconstruction after mandibulectomy (n = 12 dogs) or defect nonunion fracture (n = 6 dogs, 2 cats), mapping of ostectomy location for temporomandibular joint ankylosis or pseudoankylosis (n = 4 dogs), assessment of palatal defects (n = 2 dogs, 1 cat), improved understanding of complex anatomy in cases of neoplasia located in challenging locations (n = 2 dogs, 1 cat), and in cases of altered anatomy secondary to trauma (n = 2 dogs). In the authors' experience, 3D printed models serve as excellent tools for OMFS planning and resident training. Furthermore, 3D printed models are a valuable resource to improve clients' understanding of the pet's disorder and the recommended treatment. Three-dimensional printed models should be considered viable tools for surgical planning, resident training, and client education in candidates for complex OMFS. © 2017 The American College of Veterinary Surgeons.

  20. Analysis of the healing process in delayed tooth replantation after root canal filling with calcium hydroxide, Sealapex and Endofill: a microscopic study in rats.

    Science.gov (United States)

    Negri, Márcia Regina; Panzarini, Sônia Regina; Poi, Wilson Roberto; Sonoda, Celso Koogi; Gulinelli, Jéssica Lemos; Saito, Célia Tomiko Matida Hamata

    2008-12-01

    The major concern in the therapeutics of tooth replantation refers to the occurrence of root resorption and different approaches have been proposed to prevent or treat these complications. The purpose of this study was to evaluate tissue response to delayed replantation of anterior rat teeth treated endodontically using calcium hydroxide, Sealapex, and Endofill without the placement of gutta-percha cones. Thirty rats had their right upper incisor extracted and maintained in dry storage for 60 min. After removal of the dental papilla, enamel organ, pulp tissue, and periodontal ligament remnants, the teeth were immersed in 2% sodium fluoride phosphate acidulated, pH 5.5, for 10 min. The root canals were dried with absorbent paper points and the teeth were assigned to three groups (n = 10) according to the filling material. Group I - calcium hydroxide and propyleneglycol paste, Group II - Sealapex, and Group III - Endofill. The sockets were irrigated with saline and the teeth were replanted. Replacement resorption, inflammatory resorption and ankylosis were observed in all groups. Although the occurrence of inflammatory resorption was less frequent in Group I, there were no statistically significant differences among the groups. It may be concluded that compared to the paste, filling the root canals with Sealapex and Endofill sealers without the placement of gutta-percha cones did not provide better results.

  1. Clinical and radiographic changes of carpi, tarsi and interphalangeal joints of beef zebu bulls on semen collection regimen

    Directory of Open Access Journals (Sweden)

    G.A. Motta

    Full Text Available ABSTRACT Osteoarthritis and osteochondrosis are highly correlated to reproductive failure in bulls. This study aimed to evaluate the carpal, tarsal and interphalangeal lesions in beef zebu bulls on semen collection regimen. Twenty-one beef cattle bulls, in a total of forty-one animals, were split into three age-based groups: animals from two to four years old (GI, from more than four to eight years old (GII and above eight years old (GIII. The clinical findings were conformational changes of limbs, synovial effusion, peripheral venous engorgement of joints and prolonged decubitus. The total population showed moderate clinical manifestation and radiographic score. The GIII presented more severe joint lesions. Carpi and tarsi regions had discrete to difuse osteophytosis, subchondral cysts, cartilaginous flaps, bone incongruence and fragmentation, osteitis, and ankylosis. Interphalangeal joints presented osteophytosis, distal phalanx osteitis and enthesophytosis. The digital radiographic examination allowed full identification of articular lesions and their clinical correspondences, besides the positive correlation between age, body weight and radiographic score.

  2. Schistosomus Reflexus Syndrome in Olive Ridley Sea Turtles ( Lepidochelys olivacea).

    Science.gov (United States)

    Bárcenas-Ibarra, A; Rojas-Lleonart, I; Lozano-Guzmán, R I; García-Gasca, A

    2017-01-01

    The olive ridley sea turtle ( Lepidochelys olivacea), considered the most abundant sea turtle species, is listed as vulnerable on the International Union for Conservation of Nature Red List. The most important nesting areas are located in the Eastern Pacific, and congenital malformations have been previously reported in this species. The present study was conducted in a single population at El Verde beach, one of the most important nesting beaches for the species in the northwestern Mexican Pacific. The study was based on embryos that had been incubated in a controlled environment. Schistosomus reflexus syndrome (SRS) was observed in 124 of 20 257 olive ridley embryos (0.6%), comprising 124 of 400 (31%) cases of congenital malformations over a 7-month period. Affected embryos had malformations of the carapace, bridge, or plastron, resulting in exposure of the abdominal or thoracic viscera, as well as spinal malformation and abnormal positioning of limbs adjacent to the head with subsequent ankylosis. SRS phenotypes (although lethal) varied from mild to severe, although most cases were severe. SRS was mostly associated with congenital malformations in the neck (short neck, 80%), tail (anury, 38%), and flippers (different types of dysmelias, 53%). In most cases of severe SRS, ankyloses were present. Documenting these findings could be important to identify the cause of the developmental defects, and identification of the cause of the defects may be of significance to the population and to our efforts to manage this and other populations at risk.

  3. Inadequate Dietary Phosphorus Levels Cause Skeletal Anomalies and Alter Osteocalcin Gene Expression in Zebrafish.

    Science.gov (United States)

    Costa, Juliana M; Sartori, Maria M P; Nascimento, Nivaldo F do; Kadri, Samir M; Ribolla, Paulo E M; Pinhal, Danillo; Pezzato, Luiz E

    2018-01-25

    Phosphorus (P) is an essential mineral for the development and maintenance of the vertebrate skeletal system. Modulation of P levels is believed to influence metabolism and the physiological responses of gene expression. In this study, we investigated the influence of dietary P on skeletal deformities and osteocalcin gene expression in zebrafish ( Danio rerio ), and sought to determine appropriate levels in a diet. We analyzed a total of 450 zebrafish within 31 days of hatching. Animals were distributed in a completely randomized experimental design that consisted of five replications. After an eight-week experiment, fish were diaphanized to evaluate cranial and spinal bone deformities. Increases in dietary phosphorus were inversely proportional to the occurrence of partial spine fusions, the absence of spine fusions, absence of parallelism between spines, intervertebral spacing, vertebral compression, scoliosis, lordosis, ankylosis, fin caudal insertion, and craniofacial deformities. Additionally, osteocalcin expression was inversely correlated to P levels, suggesting a physiological recovery response for bone mineralization deficiency. Our data showed that dietary P concentration was a critical factor in the occurrence of zebrafish skeletal abnormalities. We concluded that 1.55% P in the diet significantly reduces the appearance of skeletal deformities and favors adequate bone mineralization through the adjustment of osteocalcin expression.

  4. [Does coexistant fractures impair the results of treatment of elbow dislocations in children?].

    Science.gov (United States)

    Lejman, Tadeusz; Kowalczyk, Bartłomiej; Feluś, Jarosław

    2006-01-01

    We present 33 children with 34 elbow dislocations. In 22 cases concomittant fractures around the elbowe were noted: 13 displaced medial epicondyle fractures, 5 radial neck fractures, 2 radial head fractures, 2 coronoid process fractures, 1 olecranon fracture, 1 lateral condyle fracture, 1 medial condyle fracture. In 5 children more than one concomittant fracture were noted. The mean age during dislocation was 11 years (from 4 to 15), the mean follow up period was 3.5 years (from 2 to 5). On follow up a clinical examination of the elbow was performed including axis assesment and elbow ROM. X-ray were taken in all children in AP and lateral view. All children had a satisfying function of the extremity and no pain was noted. No difference in ROM was noted in children with isolated elbow dislocation or with concomittant medial epicondyle fractures however in 3 of those children a persistent flexion contracture was observed. Among children with other fractures poorer results occured in 3 patients, specially after displaced radial neck fractures. In one of them there was slight supination and pronation restriction, in second a complete ankylosis of proximal radioulnar joint occured in neutral forearm position. In one child after elbow dislocation and medial condyle fracture a late radial dislocation occured. We think that concomitant medial epicondyle fracture does not impare good results of elbow dislocation treatment if well recognised and treated. Other fractures, specially radial neck fractures, increase the risk of complications.

  5. Overexpression of Shox2 Leads to Congenital Dysplasia of the Temporomandibular Joint in Mice

    Directory of Open Access Journals (Sweden)

    Xihai Li

    2014-07-01

    Full Text Available Our previous study reported that inactivation of Shox2 led to dysplasia and ankylosis of the temporomandibular joint (TMJ, and that replacing Shox2 with human Shox partially rescued the phenotype with a prematurely worn out articular disc. However, the mechanisms of Shox2 activity in TMJ development remain to be elucidated. In this study, we investigated the molecular and cellular basis for the congenital dysplasia of TMJ in Wnt1-Cre; pMes-stop Shox2 mice. We found that condyle and glenoid fossa dysplasia occurs primarily in the second week after the birth. The dysplastic TMJ of Wnt1-Cre; pMes-stop Shox2 mice exhibits a loss of Collagen type I, Collagen type II, Ihh and Gli2. In situ zymography and immunohistochemistry further demonstrate an up-regulation of matrix metalloproteinases (MMPs, MMP9 and MMP13, accompanied by a significantly increased cell apoptosis. In addition, the cell proliferation and expressions of Sox9, Runx2 and Ihh are no different in the embryonic TMJ between the wild type and mutant mice. Our results show that overexpression of Shox2 leads to the loss of extracellular matrix and the increase of cell apoptosis in TMJ dysplasia by up-regulating MMPs and down-regulating the Ihh signaling pathway.

  6. Implant-supported prosthesis misalignment related to the dental arch: a 14-year clinical follow-up.

    Science.gov (United States)

    das Neves, Flávio Domingues; Coró, Vitor; da Silva Neto, João Paulo; de Mattias Sartori, Ivete Aparecida; do Prado, Ricardo Alves

    2012-08-01

    The purpose of this study was to warn the dental community about a possible problem in function with partial implant-supported prostheses used for long periods. The misalignment between natural teeth and the implant-supported prosthesis on teeth 11 and 12, observed in a 14-year clinical follow-up, illustrates the fact. The metal-ceramic crowns were placed in 1995 after a rigorous occlusal adjustment. Evaluations were made at 4, 6, 9, and 14 years, when it was noticed that the restorations were positioned palatally and extruded in comparison with the natural teeth. After 9 years, a greater discrepancy was noticed, with anterior occlusion and esthetic changes. The possible causes have been discussed: occlusal problems, parafunctional habits, and natural movement. The first 2 options were discarded after clinical analysis and diagnosis. Therefore, the natural movement probably deriving from an interaction of mechanical and genetic factors might have been the cause. The implants do not have periodontal ligaments but rather ankylosis, so they do not suffer those movements. This case emphasizes the need to inform patients that implants can last more than 10 years in function, but this is not the case with restorations, which lose function and esthetics and must be replaced.

  7. Replantation of permanent incisors in children using Emdogain.

    Science.gov (United States)

    Barrett, Edward J; Kenny, David J; Tenenbaum, Howard C; Sigal, Michael J; Johnston, Douglas H

    2005-10-01

    The aim of this study was to determine whether application of an enamel matrix protein derivative, Emdogain (Biora AB Malmo, Sweden) to the root surface of avulsed permanent incisors would improve postreplantation outcomes in a pediatric population. Between June 1999 and May 2002, 25 avulsed permanent maxillary incisors (22 centrals and three laterals) were treated with Emdogain and followed for up to 32 months, mean duration 20.6 months (range: 6.9-32.5 months). Mean patient age at the time of treatment was 12.0 years (range: 7.7-17.6 years) and mean extra-alveolar duration was 185 min (range: 100-300 min). At the end of their follow-up each of the replanted incisors demonstrated radiographic evidence of replacement root resorption and clinical evidence of ankylosis. None of the replanted teeth were affected by inflammatory root resorption and there was no evidence of infection. When compared with the control samples from Barrett and Kenny (Endod Dent Traumatol 1997;15:269-72.) and Andersson et al. (Endod Dent Traumatol 1989;5:38-47.) this sample treated with the Emdogain protocol demonstrated significantly less root resorption than either of the control samples (anova, P Emdogain protocol did not produce periodontal regeneration, it did eliminate inflammatory resorption and infection and led to significantly less root resorption compared with the two historical controls.

  8. The ossification diathesis in the Medici family: DISH and other features.

    Science.gov (United States)

    Weisz, George M; Matucci-Cerinic, Marco; Lippi, Donatella; Albury, William R

    2011-12-01

    The Medici family ruled Florence for most of the period from the 1430s to the 1730s, with the senior (primogenito) branch predominating until the line ended in the 1530s and the cadet (secondogenito) branch predominating thereafter. Recent studies have identified a familial syndrome consisting of cutaneous symptoms, peripheral arthropathy and spinal ankylosis in the primogenito branch of the family, and the presence of diffuse idiopathic skeletal hyperostosis (DISH) in two members of the secondogenito branch. These findings raise the question of whether DISH was also a component of the primogenito familial syndrome. The present study provides a further specification of the ossification diathesis in the familial syndrome of the primogenito branch of the Medici family. Recently discovered photographs of exhumed Medici skeletons from the primogenito line are examined, with a focus on spinal, sacro-iliac and peripheral ossifications. These observations are supplemented with published reports of radiological, histological and macroscopic studies of the skeletons. Our interpretations of the ossification data relating to the primogenito branch of the Medici family are supportive of a diagnosis of DISH. DISH was one component of the triple pathology identified as a syndrome in the fifteenth century primogenito Medici line. As a diagnosis of DISH has recently been proposed for two sixteenth century members of the secondogenito branch of the family, it appears that the same condition affected both branches of the Medici lineage, without excluding other forms of undifferentiated joint and spondylarthropathies.

  9. The Paradox of Bone Formation and Bone Loss in Ankylosing Spondylitis: Evolving New Concepts of Bone Formation and Future Trends in Management.

    Science.gov (United States)

    Magrey, Marina N; Khan, Muhammad A

    2017-04-01

    The purpose of the study is to briefly review the molecular mechanisms that leads to structural damage in ankylosing spondylitis (AS), defined as new bone formation resulting in complete or incomplete ankylosis of the spine, and the impact of treatment with biologics to retard this process. The understanding of molecular mechanisms leading to new bone formation in AS has significantly improved but is still incomplete. Availability of biologics has greatly enhanced the treatment of patients with AS, but its impact on slowing the structural damage is still a matter of debate, although a few observational studies have shown that long term use of TNF-α blockers may slow radiographic progression. The availability of newer biologics targeting IL-17/1L23 has shown some promising results in slowing radiographic progression in AS. Although the availability of TNF-inhibitors has greatly enhanced the treatment options for patients with AS, their impact on slowing the structural damage is still not clearly established. However, preliminary results using newer biologics targeting IL-17/1L23 axis are more encouraging but longer follow-up is needed.

  10. The genetic basis of ankylosing spondylitis: new insights into disease pathogenesis

    Science.gov (United States)

    Tsui, Florence WL; Tsui, Hing Wo; Akram, Ali; Haroon, Nigil; Inman, Robert D

    2014-01-01

    Ankylosing spondylitis (AS) is a complex disease involving multiple risk factors, both genetic and environmental. AS patients are predominantly young men, and the disease is characterized by inflammation and ankylosis, mainly at the cartilage–bone interface and enthesis. HLA-B27 has been known to be the major AS-susceptibility gene for more than 40 years. Despite advances made in the past few years, progress in the search for non-human leukocyte antigen susceptibility genes has been hampered by the heterogeneity of the disease. Compared to other complex diseases, such as inflammatory bowel disease (IBD), fewer susceptibility loci have been identified in AS. Furthermore, non-major histocompatibility-complex susceptibility loci discovered, such as ERAP1 and IL23R, are likely contributors to joint inflammation. Identification and confirmation of functional variants remains a significant challenge of investigations involving genome-wide association studies (GWAS). It remains unclear why none of the AS-susceptibility genes identified in GWAS appear to be directly involved in the ankylosing process. Numerous reviews have recently been published on the genetics of AS. Therefore, aside from a brief summary of what AS GWAS has successfully achieved thus far, this review will focus on directions that could address unanswered questions raised by GWAS. PMID:24971029

  11. The Role of MicroRNAS in Ankylosing Spondylitis

    Science.gov (United States)

    Li, Zheng; Wong, Sunny H.; Shen, Jianxiong; Chan, Matthew T.V.; Wu, William Ka Kei

    2016-01-01

    Abstract Ankylosing spondylitis (AS) is a common and genetically heterozygous inflammatory rheumatic disease characterized by new bone formation, ankylosis and inflammation of hip, sacroiliac joints and spine. Until now, there is no method for early diagnosis of AS and the effective treatment available for AS patients remain largely undefined. We searched articles indexed in PubMed (MEDLINE) database using Medical Subject Heading (MeSH) or Title/Abstract words (“microRNA” and “ankylosing spondylitis”) from inception up to November 2015. Genetic polymorphisms of miRNAs and their targets might alter the risk of AS development whereas certain miRNAs exhibit correlation with inflammatory index. Let-7i and miR-124 were upregulated whereas miR-130a was downregulated in circulating immune cells of AS patients. These deregulated miRNAs could modulate key immune cell functions, such as cytokine response and T-cell survival. miRNA deregulation is key to AS pathogenesis. However, clinical utilization of miRNAs for management of AS patients requires further support from future translational studies. PMID:27057910

  12. Therapy of ankylosing spondylitis and other spondyloarthritides: established medical treatment, anti-TNF-α therapy and other novel approaches

    Science.gov (United States)

    Braun, Juergen; Sieper, Joachim

    2002-01-01

    Therapeutic options for patients with more severe forms of spondyloarthritis (SpA) have been rather limited in recent decades. There is accumulating evidence that anti-tumor-necrosis-factor (anti-TNF) therapy is highly effective in SpA, especially in ankylosing spondylitis and psoriatic arthritis. The major anti-TNF-α agents currently available, infliximab (Remicade®) and etanercept (Enbrel®), are approved for the treatment of rheumatoid arthritis (RA) in many countries. In ankylosing spondylitis there is an unmet medical need, since there are almost no disease-modifying antirheumatic drugs (DMARDs) available for severely affected patients, especially those with spinal manifestations. Judging from recent data from more than 300 patients with SpA, anti-TNF therapy seems to be even more effective in SpA than in rheumatoid arthritis. However, it remains to be shown whether patients benefit from long-term treatment, whether radiological progression and ankylosis can be stopped and whether long-term biologic therapy is safe. PMID:12223105

  13. Transcriptome network analysis reveals potential candidate genes for ankylosing spondylitis.

    Science.gov (United States)

    Zhu, Z-Q; Tang, J-S; Cao, X-J

    2013-12-01

    Ankylosing spondylitis (AS) is a chronic, inflammatory arthritis and autoimmune disease. The main symptom of AS is inflammatory spinal pain; with time, some patients develop ankylosis and spinal immobility. We aim to find cure available for ankylosing spondylitis. We used the GSE11886 series to identify potential genes that related to AS to construct a regulation network. In the network, some of TFs and target genes have been proved related with AS in previous study, such as NFKB1, STAT1, STAT4, TNFSF10, IL2RA, and IL2RB. We also found some new TFs (Franscription Factors) and target genes response to AS, such as BXDC5, and EGFR. Further analysis indicated some significant pathways are associated with AS, including antigen processing and presentation and cytokine-cytokine receptor interaction, etc.; although not significant, there was evident that they play an important role in AS progression, such as apoptosis and systemic lupus erythematosus. Therefore, it is demonstrated that transcriptome network analysis is useful in identification of the candidate genes in AS.

  14. Radiologic comparison of erosive polyarthritis with prominent interphalangeal involvement

    International Nuclear Information System (INIS)

    Gold, R.H.; Bassett, L.W.; Theros, E.G.

    1982-01-01

    Psoriatic arthritis, Reiter's disease, and multicentric reticulohistiocytosis may manifest prominent interphalangeal joint and cutaneous involvement. All three disorders may also affect the sacroiliac joints and spine. Despite these similarities, there are basic radiologic differences enabling distinction between the three disorders. Erosive osteoarthritis must also be considered in the differential diagnosis of interphalangeal erosive arthritis. Psoriatic erosions are characteristically ill defined, often bilaterally asymmetrical, usually unaccompanied by significant osteoporosis, and frequently associated with florid proliferation of subperiosteal new bone. An unilateral polyarticular pattern, which often occurs in a single ray, is the most prevalent of several patterns of involvement. Reiter's disease exhibits many clinical and radiologic similarities to psoriatic arthritis, but in the former there tends to be selective involvement of the joints of the lower limbs and particularly the feet, with relative sparing of the hands and wrists, while in the latter the joints of the upper and lower limbs tend to be involved to an equal extent. Multicentric reticulohistiocytosis (MR). Lesions predominate in skin and synovium and result in sharply circumscribed, rapidly progressive, strikingly bilaterally symmetrical erosions spreading from joint margins to articular surfaces. Most or all of the diarthrodial joints may be affected, but interphalangeal joint predominance and early and severe atlanto-axial involvement are characteristic. Erosive osteoarthritis is characterized by interphalangeal subchondral erosions, accompanying periosteal new bone that is more subtle than that of psoriatic arthritis, and interphalangeal bony ankylosis that occurs with the same frequency as that of psoriatic arthritis. (orig.)

  15. CT and MR Imagings of Semicircular Canal Aplasia

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Chung Hee; Hong, Hyun Sook; Yi, Beom Ha; Cha, Jang Gyu; Park, Seong Jin; Kim, Dae Ho; Lee, Hae Kyung; Kim, Shi Chan [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2009-07-15

    To evaluate the clinical, CT and MR imaging findings of semicircular canal (SCC) aplasia and to evaluate if a correlation exists between these findings and the associated anomalies or syndromes. This study retrospectively reviewed the CT and MRI findings of five patients with SCC aplasia. The CT and MR findings were analyzed for SCC, direction of facial nerve canal, cochlea, vestibule, oval or round window, middle ear ossicles, and internal auditory canal (IAC). The subjects included three boys and two girls ranging in age from one to 120 months (mean age; 51 months). Four of the subjects had the CHARGE syndrome, and one had the Goldenhar syndrome. Moreover, four subjects had sensorineural hearing loss and one had combined hearing loss. The course of the facial nerve canal was abnormal in all five cases. Moreover, trapped cochlea and dysplastic modiolus were each observed in one case. Four subjects had atresia of the oval window; whereas ankylosis of the ossicles was present in three subjects. IAC stenosis was present in one patient with the CHARGE syndrome. The aberrant course of the facial nerve canal, atresia of the oval window, and abnormal ossicles were frequently associated in patients with SCC aplasia. In addition, the Goldenhar and CHARGE syndromes were also commonly associated syndromes.

  16. Class II malocclusion with accentuated occlusal plane inclination corrected with miniplate: a case report

    Science.gov (United States)

    Farret, Marcel Marchiori; Farret, Milton M. Benitez

    2016-01-01

    ABSTRACT Introduction: A canted occlusal plane presents an unesthetic element of the smile. The correction of this asymmetry has been typically considered difficult by orthodontists, as it requires complex mechanics and may sometimes even require orthognathic surgery. Objective: This paper outlines the case of a 29-year-old woman with Class II malocclusion, pronounced midline deviation and accentuated occlusal plane inclination caused by mandibular deciduous molar ankylosis. Methods: The patient was treated with a miniplate used to provide anchorage in order to intrude maxillary teeth and extrude mandibular teeth on one side, thus eliminating asymmetry. Class II was corrected on the left side by means of distalization, anchored in the miniplate as well. On the right side, maxillary first premolar was extracted and molar relationship was kept in Class II, while canines were moved to Class I relationship. The patient received implant-prosthetic rehabilitation for maxillary left lateral incisor and mandibular left second premolar. Results: At the end of treatment, Class II was corrected, midlines were matched and the canted occlusal plane was totally corrected, thereby improving smile function and esthetics. PMID:27409658

  17. Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC and Metallic Retainers

    Directory of Open Access Journals (Sweden)

    Andrea Scribante

    2017-10-01

    Full Text Available Fiber reinforced Composite (FRC retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot- resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis.

  18. Spot-Bonding and Full-Bonding Techniques for Fiber Reinforced Composite (FRC) and Metallic Retainers.

    Science.gov (United States)

    Scribante, Andrea; Gandini, Paola; Tessera, Paola; Vallittu, Pekka K; Lassila, Lippo; Sfondrini, Maria Francesca

    2017-10-04

    Fiber reinforced Composite (FRC) retainers have been introduced as an aesthetic alternative to conventional metallic splints, but present high rigidity. The purpose of the present investigation was to evaluate bending and fracture loads of FRC splints bonded with conventional full-coverage of the FRC with a composite compared with an experimental bonding technique with a partial (spot-) resin composite cover. Stainless steel rectangular flat, stainless steel round, and FRC retainers were tested at 0.2 and 0.3 mm deflections and at a maximum load. Both at 0.2 and 0.3 mm deflections, the lowest load required to bend the retainer was recorded for spot-bonded stainless steel flat and round wires and for spot-bonded FRCs, and no significant differences were identified among them. Higher force levels were reported for full-bonded metallic flat and round splints and the highest loads were recorded for full-bonded FRCs. At the maximum load, no significant differences were reported among spot- and full-bonded metallic splints and spot-bonded FRCs. The highest loads were reported for full bonded FRCs. The significant decrease in the rigidity of spot-bonded FRC splints if compared with full-bonded retainers suggests further tests in order to propose this technique for clinical use, as they allow physiologic tooth movement, thus presumably reducing the risk of ankylosis.

  19. Effects of near-infrared LED therapy on experimental tooth replantation in rats.

    Science.gov (United States)

    Pigatto Mitihiro, Débora; de Paula Ramos, Solange; Corazza Montero, Janaína; Alves Campos, Aline; de Oliveira Toginho Filho, Dari; Dezan Garbelini, Cassia Cilene

    2017-02-01

    Dental avulsion damages periodontal tissues and may induce dentoalveolar ankylosis and root resorption after replantation. The aim of this work was to evaluate the effects of light-emitting diode (LED) therapy after tooth replantation. The upper right incisors of 36 male Wistar rats were extracted and replanted after 15 min. The control group (Co, n = 18) was submitted to replantation and the LED group (n = 18) was submitted to replantation and LED therapy (940 nm, 4 J cm -2 ) for three consecutive days (0, 24, and 48 h). Six animals from each group were euthanized at 7, 14, and 21 days for histological analysis. The upper left incisors were used as a negative control. Data were compared using the Fisher exact test, considering P LED (72.2%) groups presented areas of periodontal ligament necrosis. However, periodontal ligament necrosis was more frequent in the LED group at 14 (70%, P LED group (24.4%, P LED group after 21 days (83.3%, P LED group after 14 (79%, P LED therapy up to 48 h after tooth replantation may delay periodontal ligament repair. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Roentgenographic study of the temporomandibular joint in rheumatoid arthritis

    International Nuclear Information System (INIS)

    Yun, Ho Jung; You, Dong Soo

    1984-01-01

    For the study of the temporomandibular joint in rheumatoid arthritis 30 patients were selected who were diagnosis as rheumatoid arthritis through the clinical, radiographic examination and laboratory finding. Temporoman dibular joint involvement was evaluated through the clinical, radiographic examination. The results were as follows; 1. TMJ was involved in 15 patients of 30 patients with rheumatoid arthritis. (50% involvement). 2. Duration of rheumatoid arthritis was more longer in patients with TMJ involvement than in patients without TMJ involvement. 3. Osseous changes in TMJ were in order of frequency erosion, flattening, osteophyte, sclerosis, deformity, and most common involved site was mandibular condyle. 4. Most common positional change of condyle was forward position in centric occlusion, and restricted movement of condyle in 1 inch mouth opening. 5. TMJ involvement of rheumatoid arthritis was almost bilateral. 6. Main symptoms of TMJ were pain, stiffness, tenderness, limitation of mouth opening, crepitation. 7. There was not the case of ankylosis. 8. There was statistically insignificant correlation between mandibular deviation and TMJ involvement, but some cases showed severe deviation on mouth opening.

  1. Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006–2011)

    Science.gov (United States)

    Arzi, Boaz; Cissell, Derek D.; Verstraete, Frank J. M.; Kass, Philip H.; DuRaine, Grayson D.; Athanasiou, Kyriacos A.

    2013-01-01

    Objective To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Design Retrospective case-series. Animals 41 dogs and 17 cats. Procedures Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Results Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Conclusions and Clinical Relevance Results indicated that TMJ disorders are frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and pain. PMID:23234284

  2. Skeletal abnormalities in humpback whales Megaptera novaeangliae stranded in the Brazilian breeding ground.

    Science.gov (United States)

    Groch, Kátia R; Marcondes, Milton C C; Colosio, Adriana C; Catão-Dias, José Luiz

    2012-11-08

    Skeletal tissues of 49 humpback whales Megaptera novaeangliae that stranded between 2002 and 2011 along the Abrolhos Bank seashore and its adjacent waters in Brazil were studied. Twelve (24.5%) animals presented pathological changes in one or more bones. Degenerative changes and developmental malformations were most frequent (10.2% each), followed by inflammatory/infectious and traumatic lesions (8.2% each). Infectious diseases led to severe lesions of the caudal vertebrae of 2 whales. In one of these individuals, the lesions involved 6 caudal vertebrae, leading to ankylosis of 3 vertebrae. Degenerative changes were observed in the vertebral columns of 3 animals, involving the joints of 13 ribs of 1 individual, and in the humerus of 1 whale. Traumatic lesions, such as osseous callus in the ribs, were observed in 4 animals. In 1 whale, the rib showed severe osteomyelitis, possibly resulting from the infection of multiple fractures. Developmental abnormalities such as spina bifida on 3 cervical vertebrae of 1 whale, fusion of spinal processes on thoracic vertebrae of 1 individual and fusion of the first 2 ribs unilaterally or bilaterally in 4 animals were found. Chronic infectious conditions found in the axial skeleton may have restrained spinal mobility and had detrimental effects on the general health of the animals, contributing to stranding and death. To our knowledge, this is the first systematic study on skeletal lesions in stranded humpback whales.

  3. Twenty-year follow-up of a familial case of PTH1R-associated primary failure of tooth eruption.

    Science.gov (United States)

    Kanno, Cláudia Misue; de Oliveira, José Américo; Garcia, José Fernando; Roth, Helmut; Weber, Bernhard H F

    2017-03-01

    Nonsyndromic primary failure of eruption (PFE) is a rare autosomal dominant disorder of dental eruption with no obvious dental or soft tissue interference. The purposes of this study were to genetically and clinically characterize a family with many members affected by PFE and to describe the natural evolution of the disorder. Three generations of a family with 18 members, 10 of them clinically affected by PFE, were evaluated periodically during 20 years of clinical follow-up. PFE was observed in varying degrees of severity in both sexes. Clinical presentation became more severe in adulthood. One patient had spontaneous reeruption of 2 posterior teeth. Cervical root resorptions were observed in 3 members. Genetic analysis showed a deleterious heterozygous mutation in intron 9 of the PTH1R gene (c.639-2A>G) and diagnosed an additional affected member. The long-term follow-up of PFE cases in this family permitted the following observations: (1) the onset occurred from the preemergence to the postemergence phases, (2) PFE appeared to be closely related to ankylosis, (3) affected teeth maintained the eruptive potential even in adulthood, (4) the earlier the onset the more severe the open bite, and (5) cervical root resorptions occurred in 3 affected members. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  4. Administration of the bisphosphonate zoledronic acid during tooth development inhibits tooth eruption and formation and induces dental abnormalities in rats.

    Science.gov (United States)

    Hiraga, Toru; Ninomiya, Tadashi; Hosoya, Akihiro; Nakamura, Hiroaki

    2010-06-01

    Bisphosphonates (BPs) are potent inhibitors of osteoclastic bone resorption and widely used for the treatment of osteoporosis and metastatic bone diseases. Recently, BPs have also been shown to benefit children with primary and secondary osteoporosis, including osteogenesis imperfecta; however, their long-term safety has not been established yet. Clinical and experimental studies have demonstrated that BPs delay or inhibit tooth eruption. The failure of tooth eruption causes several dental abnormalities. In this study, to determine the effects of BPs on tooth formation, the BP zoledronic acid (ZOL) was injected into 7- and 14-day-old rats, and the development of the mandibular teeth was examined. X-ray analysis demonstrated that ZOL inhibited the eruption of both incisors and molars and their formation, especially in the molar roots. Histological examination showed that, in ZOL-treated animals, alveolar bone remained unresorbed around tooth crowns, which injured ameloblasts and enamel matrix, leading to defects of the enamel. Furthermore, haphazard proliferation of odontogenic epithelium and mesenchyme associated with primitive tooth structures, which resembles human odontomas, was induced at the basal end of incisors but not around the molars. Tooth ankylosis to alveolar bone was occasionally observed in molars. These results suggest that administration of BPs during tooth development has the potential to inhibit tooth eruption and formation and to induce several types of dental abnormalities, which may be attributed to the altered osteoclastic activities.

  5. New treatment option for an incomplete vertical root fracture–a preliminary case report

    Science.gov (United States)

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option. PMID:24670232

  6. Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

    Directory of Open Access Journals (Sweden)

    Souza, José Celso Rodriques de

    2015-11-01

    Full Text Available Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2% underwent unilateral surgery and 47 (28.8% underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air–bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6% ears had a residual air–bone gap <10 dB, and 196 (93.3% had a residual air–bone gap ≤15 dB. Two patients (0.95% had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgery may be performed in educational institutions with the supervision of experienced surgeons.

  7. Spondylolysis and End Plate Arthrosis at L5-S1: A Cadaveric Study.

    Science.gov (United States)

    McCunniff, Peter T; Yoo, Hojun; Yu, Charles; Bajwa, Navkirat S; Toy, Jason O; Ahn, Uri M; Ahn, Nicholas

    2017-01-01

    This study examined the effect of bilateral and unilateral L5 pars defects on the degree of disk degeneration at the L5-S1 level in cadaveric specimens. An observational study was performed of 690 cadaveric specimens selected at random. These specimens represent individuals who died between 1893 and 1938. The study included 558 male and 132 female cadavers. Of the 120 specimens with L5 spondylolysis, 95 cases were bilateral and 25 were unilateral. The remaining 544 specimens were used as the control cohort. Degenerative disk disease was measured by the classification of Eubanks et al. According to this classification, degenerative disk disease was graded from no arthrosis (grade 0) to complete ankylosis (grade IV). Linear regression analysis corrected for age, sex, and race showed that subjects with bilateral spondylolysis at L5 had a statistically significant increase in the amount of disk degeneration (P=.02) compared with those with unilateral lesions. Student's t tests showed significant differences (Pspondylolysis above what would be predicted in the normal control population. A positive correlation was found between the number of pars defects at L5 and the degree of disk degeneration at L5-S1. These results support the idea that individuals with spondylolysis at these levels may be at increased risk for development of low back pain and reduced quality of life. [Orthopedics. 2017; 40(1):e59-e64.]. Copyright 2016, SLACK Incorporated.

  8. Management of temporomandibular joint degenerative disorders with human amniotic membrane: Hypothesis of action.

    Science.gov (United States)

    Guarda-Nardini, Luca; Trojan, Diletta; Paolin, Adolfo; Manfredini, Daniele

    2017-07-01

    Approaches providing the positioning of human amniotic membrane (HAM) within the intra-articular space of arthritic TMJs have never been investigated. This contrasts with the increasing amount of evidence suggesting the potential positive effects of HAM on a number of surgical conditions, even included the interpositional arthroplasty for TMJ ankylosis. Thus, the possible usefulness of HAM to restore joint functions in severely damaged TMJs could be hypothesized. Based on these premises, the clinical research question "Is human amniotic membrane positioning effective to reduce symptoms and restore jaw function in patients with severe inflammatory-degenerative disorders of the temporomandibular joint?" has been addressed by performing a systematic review of the literature. Out of potential 11988 and 8883 citations in the PubMed and Scopus databases, respectively, only five were of possible interest for inclusion in the review, but none of them addressed specifically the clinical research question. Thus, the hypothetical background for usefulness was discussed. The benefits of HAM positioning in TMJs with severe inflammatory-degenerative disorders could be related with its anti-inflammatory and anti-microbial and analgesic properties as well as its low immunogenicity. Studies in which HAM is positioned within the joint space of patients with severe TMJ degeneration, either as a disc-replacing film during major surgeries for discectomy and arthroplasty or as an injectable solution that can be needle-inserted after an arthrocentesis procedure, should be designed to test the hypothesis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Treatment of an avulsed maxillary permanent central incisor by autotransplantation of a primary canine tooth.

    Science.gov (United States)

    Sönmez, D; Dalci, K; Tunç, E Sen

    2008-07-01

    To present a case in which an avulsed permanent maxillary central incisor was replaced by autotransplantation of a primary canine tooth. The present case describes transplantation of a primary canine tooth into the space left by an avulsed permanent maxillary central incisor after a delay of several days. After root canal treatment, the primary canine tooth was extracted and placed into the prepared socket. To provide better adaptation of the donor tooth, the recipient alveolar site was remodeled using surgical burs. Semi-rigid splinting was maintained for 15 days. The crown of the primary canine was reshaped with composite resin and with an interim prosthesis, preventing movement of the lateral incisor tooth into the space of the transplanted canine. After 24-month follow-up the autotransplanted primary canine showed ankylosis but the tooth was in an acceptable state. The use of permanent tooth autotransplantation has been well documented. However a literature search revealed only one case report on the autotransplantation of primary teeth. Long term results of primary tooth autotransplantation are scarce but the procedure in this case report could be considered as a temporary space maintainer for the treatment of a patient with a lost permanent incisor under 10 years of age. Success of primary tooth autotransplantation may be affected by several factors, such as case selection, extra oral time, surgical and endodontic procedures.

  10. Diagnosis and Managment of Maxillary Incisor with Vertical Root Fracture: A Clinical Report with Three-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Ines Kallel

    2018-01-01

    Full Text Available According to the American Association of Endodontists, “a ‘true’ vertical root fracture is defined as a complete or incomplete fracture initiated from the root at any level, usually directed buccolingually.” Vertical root fracture (VRF usually starts from an internal dentinal crack and develops over time, due to masticatory forces and occlusal loads. When they occur in teeth, those types of fractures can present difficulties in diagnosis, and there are however many clinic and radiographical signs which can guide clinicians to the existence of the fracture. Prognosis, most often, is hopeless, and differential diagnosis from other etiologies may be difficult sometimes. In this paper, we present a case of VRF diagnosed after surgical exploration; the enlarged fracture line was filled with a fluid resin. A 36-month clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depth from 7 mm prior to treatment to 4 mm with no signs of ankylosis. In this work, the diagnosis and treatment alternatives of vertical root fracture were discussed through the presented clinical case.

  11. The risk of healing complications in primary teeth with concussion and subluxation injury

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Blanche, Paul; Amaloo, Catherina

    2017-01-01

    (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR) and premature tooth loss (PTL) in primary teeth following concussion and subluxation injuries, and to identify possible risk factors for PN, PCO and PTL following subluxation. MATERIAL AND METHODS: The study...... was a retrospective analysis of a cohort comprising 31 patients (36 teeth) with concussion injury and 174 patients (241 teeth) with subluxation injury. No treatment was performed. The follow-up program included examination after 4 weeks, 8 weeks, 6 months, 1 year, and when the patients were 6 years of age. Minimum...... - 13.4). Subluxation: PCO 23.2% (95% CI: 17.8 - 28.6), PN 8.3% (95% CI: 4.8 - 11.8), IRR 2.6% (95% CI: 0.5-4.6%), PTL 9.5% (95% CI: 5.0 -14.1). Most complications (95%) were diagnosed within the first year. Most cases of PN (65%) and PTL (85%) were seen in patients aged four years or more. CONCLUSION...

  12. Identification of early response genes to roughness and fluoride modification of titanium implants in human osteoblasts.

    Science.gov (United States)

    Ramis, Joana Maria; Taxt-Lamolle, Sébastien Francis; Lyngstadaas, Staale Petter; Reseland, Janne Elin; Ellingsen, Jan Eirik; Monjo, Marta

    2012-04-01

    Tissue response after implantation determines the success of the healing process. This response is not only dependent on the chemical properties of the implant surface but also by the surface topography or its roughness. Although in vitro and in vivo studies show improved results with rough- and fluoride-modified implants, the mechanisms behind these findings are still unknown. Here, we have used a two-step procedure to identify novel genes related to the early response of primary human osteoblasts to roughness and fluoride-modified titanium implants. Two hundred seventeen genes responding to roughness were identified by microarray analysis and 198 genes responding to fluoride, 33 genes were common. Those identified genes related to bone and mineralization were further investigated by real-time reverse-transcriptase polymerase chain reaction. After 1 day of culture, toll-like receptor 3, ankylosis-progressive homolog, decorin, osteocalcin, and runt-related transcription factor-2 were classified as responsive genes to roughness; Distal-less homeobox-2 and Tuftelin-1 as responsive genes to fluoride treatment. Responsive genes to both treatments were collagen type I, parathyroid hormone-like hormone, hairy and enhancer of split-1, follistatin, ectonucleotide pyrophosphatase/phosphodiesterase-1, and thyroid hormone receptor-alpha. Our strategy was useful for identifying novel genes that might be involved in the early response of osteoblasts to rough and fluoride-modified titanium implants.

  13. [Chronic prostatitis and Bechterew's disease].

    Science.gov (United States)

    Kohlicek, J; Svec, V

    1977-11-01

    A group of patients between 35 and 65 years old with chronic prostatitis were examined for the presence of Becherew's disease. In this connection the New York and Roman criterions for morbus Bechterew were applied. There were found one ankyosing spondylarthritis, one ankylosis of the sacroiliac joint, and 11 times a tentative sacroileitis were stated. Altogether the proved and tentative findings were only 3.68 per cent of all examinations. In our countries the morbus Bechterew is found in 0,21 per cent of the normal population. So the protion of the Bechterew's disease in patients with chronic prostatitis is indeed a little higher than average, but not so frequent as often pretended in recent times. After a second series 58 patients being treated because of Bechterew's disease of different stages and different terms were examined for the possibility of a simultaneously elapsing chronic prostatitis. A chronic prostatitis was found in 38 per cent of these patients which correspondents to the incidence published in literature for the medium-age manhood. Nobody of the test persons had complaints on the part of the urologenital tract.

  14. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis. Correlation with anatomy and histology

    International Nuclear Information System (INIS)

    Hermann, K.G.A.; Bollow, M.

    2014-01-01

    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. (orig.)

  15. Talonavicular joint abnormalities and walking ability of patients with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Miyamoto, Noriyoshi; Senda, Masuo; Hamada, Masanori; Katayama, Yoshimi; Kinosita, Atsushi; Uchida, Kensuke; Inoue, Hajime

    2004-01-01

    Rheumatoid arthritis (RA) is often associated with deformities of the feet, and foot pain often arises in the talonavicular joint of patients with RA. The object of this study was to assess the relationship between magnetic resonance imaging (MRI) findings of the talonavicular joint and walking ability. The subjects were 35 RA patients (10 feet in 5 males and 56 feet in 30 females) aged 34-87 years (mean: 70 years±12.1), with a disease duration from 1-54 years (mean: 14 years±12.1). MRI findings were classified as follows: Grade 1, almost normal; Grade 2, early articular destruction; Grade 3, moderate articular destruction; Grade 4, severe articular destruction; and Grade 5, bony ankylosis dislocation. Walking ability was classified into one of 9 categories ranging from normal gait to bedridden status according to the system of Fujibayashi. As the grade of MRI images became higher the walking ability decreased, and these parameters showed a correlation by Spearman's rank correlation coefficient analysis (P=0.003). Thus, in the present cohort group of patients with RA, the deterioration of walking ability increased with the severity of destruction of the talonavicular joint. (author)

  16. Description of spinal findings and determining the MR positive spondylitis

    International Nuclear Information System (INIS)

    Penkov, M.

    2015-01-01

    Full text: Spondyloarthritis (SpA) is an umbrella term applied to a family of rheumatic diseases that have both features in common with, as well as being distinct from, other inflammatory arthritides, particularly rheumatoid arthritis (RA). Recently, the ASAS working group established classification criteria to distinguish 2 broad categories of SpA: peripheral SpA and axSpA (Rudwaleit, 2011; Rudwaleit, 2010; Rudwaleit, 2009c). This division is based on the body part predominantly involved in the inflammatory process and those areas of the body that may respond similarly well to medication. Therefore, peripheral SpA includes diseases affecting mainly peripheral joints, such as reactive arthritis and psoriatic arthritis (PsA), whereas axSpA comprises those diseases with mainly axial involvement (sacroiliac joints and spine), including ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA). Patients with AS have definitive evidence of structural changes in the sacroiliac joint (sacroiliitis) on x-ray, fulfilling the Modified New York classification criteria (mNY-positive) (van der linden, 1984), whereas in those with nr-axSpA structural changes on conventional radiographs do not meet the mNy criteria (mNY-negative) (Rudwaleit, 2005; Dougados, 1991). Axial SpA is a chronic inflammatory disease that impacts a substantial proportion of the population. Limited evidence exists regarding the exact prevalence of axSpA. In the US, however, recent data suggest that the prevalence is similar to that of RA (axSpA: 0.7% to 1.4%; RA: 0.5% to 1.0%) (Reveille; 2012; Myasoedova, 2010; Helmick, 2008). In patients with axSpA, the disease typically originates in the sacroiliac joints, then progresses to the spine. In the sacroiliac joints and the spine, active inflammation results in erosions, sclerosis, and fatty lesions. However, the most characteristic feature is new bone formation leading to ankylosis of the sacroiliac joints and syndesmophytes attached to the vertebral

  17. Evaluation of an injectable rhGDF-5/PLGA construct for minimally invasive periodontal regenerative procedures: a histological study in the dog.

    Science.gov (United States)

    Kwon, David H; Bennett, William; Herberg, Samuel; Bastone, Patrizia; Pippig, Susanne; Rodriguez, Nancy A; Susin, Cristiano; Wikesjö, Ulf M E

    2010-04-01

    To evaluate the injectability, biocompatibility, safety, and periodontal wound healing/regeneration following application of a novel bioresorbable recombinant human growth/differentiation factor-5 (rhGDF-5)/poly(lactic-co-glycolic acid) (PLGA) construct. Periodontal pockets (3 x 6 mm, width x depth) were surgically created over the buccal roots of the second and fourth mandibular pre-molars in eight adult Hound Labrador mongrel dogs. Surgeries including injection of the rhGDF-5/PLGA construct into the pockets were sequenced that four animals provided 2-/4-week and four animals 6-/8-week observations of sites receiving rhGDF-5/PLGA or serving as sham-surgery control. The rhGDF-5/PLGA construct was easy to prepare and apply. Approximately 0.2 ml (93 microg rhGDF-5)/tooth was used. Clinical and radiographic healing was exemplary without adverse events. Healing was characterized by a non-specific connective tissue attachment, acellular/cellular cementum, periodontal ligament (PDL), bone regeneration, and a junctional epithelium. PLGA fragments were observed in 4/7, 2/8, and 1/8 sites at 2, 4, and 6 weeks, respectively. Associated inflammatory reactions exhibited no limiting effect on periodontal wound healing/regeneration. Root resorption/ankylosis was not observed. Bone formation showed apparent increased maturity (lamellar bone) at 6 weeks in sites receiving rhGDF-5/PLGA compared with the control. Both protocols exhibited significant increases in PDL, cementum, and bone regeneration over time, without significant differences between treatments. In time, PDL and cementum regeneration was twofold greater for the control at 4 weeks (p=0.04) while increased bone formation was observed at sites receiving rhGDF-5/PLGA (pperiodontal wound healing/regeneration. Additional work to optimize the polymer carrier and rhGDF-5 release kinetics/dose might be required before evaluating the efficacy of this technology in clinical settings using minimally invasive approaches.

  18. Evaluation of the topical effect of alendronate on the root surface of extracted and replanted teeth. Microscopic analysis on rats' teeth.

    Science.gov (United States)

    Lustosa-Pereira, Adriana; Garcia, Roberto Brandão; de Moraes, Ivaldo Gomes; Bernardineli, Norberti; Bramante, Clovis Monteiro; Bortoluzzi, Eduardo Antunes

    2006-02-01

    The treatment of choice for tooth avulsion is replantation. The ideal replantation should be realized as quickly as possible, or at least, the avulsed tooth should be kept in an adequate solution to preserve the periodontal ligament attached to the root. If that is not possible, treatment of the radicular surface should be done in order to prevent radicular resorption. The purpose of this study was to test sodium alendronate as a substance for topical treatment of the radicular surface of avulsed teeth in an attempt to prevent the occurrence of dental resorptions. Fifty-four rat maxillary right central incisors were extracted and replanted. Group I--extra-alveolar dry period of 15 min, intracanal dressing with calcium hydroxide (CALEN, S.S. White, Artigos Dentários LTDA, Rio de Janeiro, Brazil) and replantation; Groups II and III - extra-alveolar dry periods of 30 and 60 min, respectively, immersion in 1% sodium hypochlorite for 30 min for removal of the periodontal ligament, washing in saline solution for 5 min, and treatment of the radicular surface with 3.2 mg/l sodium alendronate solution for 10 min. Intracanal dressing with calcium hydroxide and replantation followed. At 15, 60, and 90 days post-reimplantation, the animals were killed and the samples obtained and processed for microscopic analysis. The results indicated that sodium alendronate was able to reduce the incidence of radicular resorption, but not of dental ankylosis. No significant differences were observed regarding variations in the extra-alveolar periods among the groups.

  19. The influence of root surface distance to alveolar bone and periodontal ligament on periodontal wound healing.

    Science.gov (United States)

    Montevecchi, Marco; Parrilli, Annapaola; Fini, Milena; Gatto, Maria Rosaria; Muttini, Aurelio; Checchi, Luigi

    2016-10-01

    The purpose of this animal study was to perform a 3-dimensional micro-computed tomography (micro-CT) analysis in order to investigate the influence of root surface distance to the alveolar bone and the periodontal ligament on periodontal wound healing after a guided tissue regeneration (GTR) procedure. Three adult Sus scrofa domesticus specimens were used. The study sample included 6 teeth, corresponding to 2 third mandibular incisors from each animal. After coronectomy, a circumferential bone defect was created in each tooth by means of calibrated piezoelectric inserts. The experimental defects had depths of 3 mm, 5 mm, 7 mm, 9 mm, and 11 mm, with a constant width of 2 mm. One tooth with no defect was used as a control. The defects were covered with a bioresorbable membrane and protected with a flap. After 6 months, the animals were euthanised and tissue blocks were harvested and preserved for micro-CT analysis. New alveolar bone was consistently present in all experimental defects. Signs of root resorption were observed in all samples, with the extent of resorption directly correlated to the vertical extent of the defect; the medial third of the root was the most commonly affected area. Signs of ankylosis were recorded in the defects that were 3 mm and 7 mm in depth. Density and other indicators of bone quality decreased with increasing defect depth. After a GTR procedure, the periodontal ligament and the alveolar bone appeared to compete in periodontal wound healing. Moreover, the observed decrease in bone quality indicators suggests that intrabony defects beyond a critical size cannot be regenerated. This finding may be relevant for the clinical application of periodontal regeneration, since it implies that GTR has a dimensional limit.

  20. Septic arthritis of the temporomandibular joint: case reports and review of the literature.

    Science.gov (United States)

    Gayle, Eryka A; Young, Sean M; McKenna, Samuel J; McNaughton, Candace D

    2013-11-01

    Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity. We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency physicians. In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned 1 mL of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharged home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than 3 weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later she underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; 20 months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint. Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever. Copyright © 2013. Published by Elsevier Inc.

  1. Impacted maxillary canines and root resorption of adjacent teeth: A retrospective observational study.

    Science.gov (United States)

    Guarnieri, R; Cavallini, C; Vernucci, R; Vichi, M; Leonardi, R; Barbato, E

    2016-11-01

    The prevalence of impacted maxillary canine is reported to be between 1% and 3%. The lack of monitoring and the delay in the treatment of the impacted canine can cause different complications such as: displacement of adjacent teeth, loss of vitality of neighbouring teeth, shortening of the dental arch, follicular cysts, canine ankylosis, recurrent infections, recurrent pain, internal resorption of the canine and the adjacent teeth, external resorption of the canine and the adjacent teeth, combination of these factors. An appropriate diagnosis, accurate predictive analysis and early intervention are likely to prevent such undesirable effects. The objective is to evaluate, by means of a retrospective observational study, the possibility of carrying out a predictive analysis of root resorption adjacent to the impacted canines by means of orthopantomographs, so as to limit the prescription of additional 3D radiography. 120 subjects with unilateral or bilateral maxillary impacted canine were examined and 50 patients with 69 impacted maxillary canine (22 male, 28 female; mean age: 11.7 years) satisfied the inclusion criteria of the study. These patients were subjected to a basic clinical and radiographic investigation (orthopantomographs and computerized tomography). All panoramic films were viewed under standardized conditions for the evaluation of two main variables: maxillary canine angulations (a, b, g angles) and the overlapping between the impacted teeth and the lateral incisor (Analysis of Lindauer). Binary logistic regression was used to estimate the likelihood of resorbed lateral incisors depending on sector location and angle measurements. Results indicated that b angle has the greatest influence on the prediction of root resorption (predictive value of b angle = 76%). If β angle <18° and Lindauer = I, the probability of resorption is 0.06. Evaluation of b angle and superimposition lateral incisor/impacted canine analysed on orthopantomographs could be one of

  2. Tooth alterations in areas of bisphosphonate-induced osteonecrosis.

    Science.gov (United States)

    de Camargo Moraes, Paulo; Silva, Carolina Amália Barcellos; Soares, Andresa Borges; Passador-Santos, Fabrício; Corrêa, Maria Elvira Pizzigatti; de Araújo, Ney Soares; de Araújo, Vera Cavalcanti

    2015-03-01

    Osteonecrosis of the jaw is a potential side effect when using bisphosphonates. Most studies on the effects of bisphosphonates on teeth have been conducted in vitro or in animal models of tooth development. Therefore, the aim of this study was to describe alterations found in human teeth extracted from areas of bisphosphonate-induced osteonecrosis. Using a retrospective study design, 16 teeth from 13 patients were extracted from areas of bisphosphonate-induced osteonecrosis during surgical debridement. The specimens were decalcified and embedded in paraffin. A series of 5-μm sections were prepared, stained with hematoxylin and eosin (H&E) and observed under a light microscope. The majority of the patients were female (53.85 %), with a mean age of 60.23 ± 13.18 years. Zoledronate (IV) was the most common bisphosphonate used (92.3 %), over a mean period of 2 years. The commonest alteration observed was hypercementosis (87.5 %), followed by pulpar necrosis (81.25 %), pulp stones attached to the dentine and loose pulp stones in the pulp chamber and root canals in addition to linear calcifications (68.75 %), dentinoid/osteoid material formation (18.75 %), and dental ankylosis (6.25 %). Patients undergoing bisphosphonate therapy present diverse tooth alterations, which should be closely monitored by clinicians to prevent complications. It is paramount that the teeth involved in oral lesions are always examined. Attention should be drawn to the need to establish preventive measures, in terms of dental treatment, for patients prior to starting bisphosphonate therapy.

  3. Effects of concomitant use of fibroblast growth factor (FGF)-2 with beta-tricalcium phosphate (β-TCP) on the beagle dog 1-wall periodontal defect model

    International Nuclear Information System (INIS)

    Anzai, Jun; Kitamura, Masahiro; Nozaki, Takenori; Nagayasu, Toshie; Terashima, Akio; Asano, Taiji; Murakami, Shinya

    2010-01-01

    Research highlights: → Concomitant use of FGF-2 and β-TCP (an osteo-conductive scaffold) significantly promotes periodontal regeneration in the severe periodontitis model (1-wall defect model) of beagle dog. → FGF-2 enhanced new bone formation via β-TCP at the defects. → In particular, FGF-2 dramatically regenerated new periodontal ligament and cementum formations at the defects, that is one of the most important healing outcomes during the process of periodontal regeneration. → Epithelial downgrowth (undesirable wound healing) was decreased by administration of FGF-2. → This manuscript indicates for the first time that concomitant use of FGF-2 and β-TCP is efficacious in regenerating periodontal tissue following severe destruction of the tissue by progression of periodontitis. -- Abstract: The effects of concomitant use of fibroblast growth factor-2 (FGF-2) and beta-tricalcium phosphate (β-TCP) on periodontal regeneration were investigated in the beagle dog 1-wall periodontal defect model. One-wall periodontal defects were created in the mesial portion of both sides of the mandibular first molars, and 0.3% FGF-2 plus β-TCP or β-TCP alone was administered. Radiographic evaluation was performed at 0, 3, and 6 weeks. At 6 weeks, the periodontium with the defect site was removed and histologically analyzed. Radiographic findings showed that co-administration of FGF-2 significantly increased bone mineral contents of the defect sites compared with β-TCP alone. Histologic analysis revealed that the length of the regenerated periodontal ligament, the cementum, distance to the junctional epithelium, new bone height, and area of newly formed bone were significantly increased in the FGF-2 group. No abnormal inflammatory response or ankylosis was observed in either group. These findings indicate the efficacy of concomitant use of FGF-2 and β-TCP as an osteoconductive material for periodontal regeneration following severe destruction by progressive

  4. What is the reliability of non-trained investigators in recognising structural MRI lesions of sacroiliac joints in patients with recent inflammatory back pain? Results of the DESIR cohort.

    Science.gov (United States)

    Jacquemin, Charlotte; Rubio Vargas, Roxana; van den Berg, Rosaline; Thévenin, Fabrice; Lenczner, Gregory; Reijnierse, Monique; Ferkal, Salah; Le Corvoisier, Philippe; Rahmouni, Alain; Loeuille, Damien; Feydy, Antoine; Dougados, Maxime; van der Heijde, Désirée; Claudepierre, Pascal

    2016-01-01

    The objective of this study was to evaluate the reliability of recognising structural lesions on MRI (erosions, fatty lesions, ankylosis) of the sacroiliac joints (MRI-SIJ) in clinical practice compared to a central reading in patients with a possible recent axial spondyloarthritis (axSpA). Patients aged 18-50 years, with recent (DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort. MRI-SIJ structural lesions were scored by non-trained local readers, and by two trained central readers. Local readers scored each SIJ as normal, doubtful or definite lesions. Central readers scored separately each type of lesion. The central reading (mean of the two central readers' scores) was the external standard. Agreement (κ) was calculated first between local (3 definitions of a positive MRI-SIJ) and central readings (9 definitions), and then between the two central readers. 664/708 patients with complete available images were included. Agreements between local and central readings were overall 'fair', except when considering at least 2 or 3 fatty lesions and at least 3 erosions and/or fatty lesions where agreement was 'moderate'. Agreement between central readers was similar. MRI-SIJ was positive for 52.6% of patients according to central reading (at least 1 structural lesion) and for 35.4% of patients according to local reading (at least unilateral 'doubtful' or 'definite' structural lesions). Agreement on a positive structural MRI-SIJ was fair to moderate between local and central readings, as well as between central readers. The reliability improved when fatty lesions were considered. NCTO 164 8907.

  5. It costs to be clean and fit: energetics of comfort behavior in breeding-fasting penguins.

    Directory of Open Access Journals (Sweden)

    Vincent A Viblanc

    Full Text Available Birds may allocate a significant part of time to comfort behavior (e.g., preening, stretching, shaking, etc. in order to eliminate parasites, maintain plumage integrity, and possibly reduce muscular ankylosis. Understanding the adaptive value of comfort behavior would benefit from knowledge on the energy costs animals are willing to pay to maintain it, particularly under situations of energy constraints, e.g., during fasting. We determined time and energy devoted to comfort activities in freely breeding king penguins (Aptenodytes patagonicus, seabirds known to fast for up to one month during incubation shifts ashore.A time budget was estimated from focal and scan sampling field observations and the energy cost of comfort activities was calculated from the associated increase in heart rate (HR during comfort episodes, using previously determined equations relating HR to energy expenditure. We show that incubating birds spent 22% of their daily time budget in comfort behavior (with no differences between day and night mainly devoted to preening (73% and head/body shaking (16%. During comfort behavior, energy expenditure averaged 1.24 times resting metabolic rate (RMR and the corresponding energy cost (i.e., energy expended in excess to RMR was 58 kJ/hr. Energy expenditure varied greatly among various types of comfort behavior, ranging from 1.03 (yawning to 1.78 (stretching times RMR. Comfort behavior contributed 8.8-9.3% to total daily energy expenditure and 69.4-73.5% to energy expended daily for activity. About half of this energy was expended caring for plumage.This study is the first to estimate the contribution of comfort behavior to overall energy budget in a free-living animal. It shows that although breeding on a tight energy budget, king penguins devote a substantial amount of time and energy to comfort behavior. Such findings underline the importance of comfort behavior for the fitness of colonial seabirds.

  6. Host tissue reactions of non-demineralized autogenic and xenogenic dentin blocks implanted in a non-osteogenic environment. An experimental study in rabbits.

    Science.gov (United States)

    Al-Asfour, Adel; Farzad, Payam; Andersson, Lars; Joseph, Bobby; Dahlin, Christer

    2014-06-01

    Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Osseointegration at implants placed into delayed reimplanted roots: an experimental study in dogs.

    Science.gov (United States)

    de Carvalho Cardoso, Leandro; Poi, Wilson Roberto; Botticelli, Daniele; Junior, Idelmo Rangel Garcia; Pantani, Fabio; Pereira, Cassiano Costa Silva

    2014-05-01

    To evaluate peri-implant bone repair of implants placed into the roots of delayed reimplanted teeth, in a process of ankylosis and external replacement resorption. The third and fourth mandibular premolars of four (4) beagle dogs were used as experimental sites. The study was divided into three stages: stage 1 - endodontic and extraction/reimplantation session, stage 2 - decrowning session and stage 3 - implant placement. Two groups were identified: (I) immediate implants, including implants installed in fresh extraction sockets of the distal roots, and (II) experimental implants, including implants installed into the retained ankylotic mesial roots. In each group, 16 implants were planned to be inserted, but only 9 immediate implants and 12 experimental implants were used for analyses. Implants were intended to heal in a submerged mode. After 4 months of healing, the animals were sacrificed and ground sections were obtained for histomorphometric evaluation. Eleven of the twelve implants in the experimental group were found successful regarding clinical and radiographic aspects. For immediate implants, a lower BIC% was found at the coronal portion (BIC% 1 = 42.2%) compared with the three most coronal threads portion (BIC% 2 = 55.1). Also, experimental implants presented a lower BIC% at the coronal portion (BIC% 1 = 36.9%) compared with the three most coronal threads portion (BIC% 2 = 45.3). Comparison between groups showed a higher degree of BIC% and mineralization in immediate group compared with experimental group. The differences, however, did not yield statistical significance. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  8. Progressive, generalized, apical idiopathic root resorption and hypercementosis.

    Science.gov (United States)

    Schätzle, Marc; Tanner, Sandro D; Bosshardt, Dieter D

    2005-11-01

    Root resorption is a multifactorial process that results in loss of tooth structure. The causes of root resorption may vary, leading to several types of resorptions. Some factors have been identified and may be categorized into physiological resorption, local factors, systemic conditions, and idiopathic resorptions. The objective of this report was to present a case of a 17-year-old white female with progressive, generalized, apical idiopathic root resorption followed up for 34 months. Two panoramic radiographs, 14 and 34 months after initial clinical and radiological examinations, showed the rapid progression of apical root resorption. Two molars, teeth #15 and #16, which had to be extracted, and a bone sample from the distal aspect of tooth #15 were processed for histologic analysis. Two millimeters apical to the cemento-enamel junction, an abrupt increase in the cementum thickness was noted, amounting to 300 and 800 microm in teeth #15 and #16, respectively. The thickening of the cementum layer was due to an accelerated deposition of cellular intrinsic fiber cementum. An unusually high number of mineralization foci were observed in association with acellular extrinsic fiber cementum, and both free and fused cementicles were seen. In contrast to tooth #16, tooth #15 revealed extensive dentin replacement by a bone-like and a cementum-like tissue. Furthermore, ankylosis was demonstrated in tooth #15 and confirmed in the bone sample. At present, there is no preventive or therapeutic regimen for the type of root resorption seen in this case report. Treatment usually consists of the extraction of teeth with advanced lesions.

  9. Histological assessment of pulp condition after apical vital root transection in one root of multirooted teeth in dogs: a preliminary study.

    Science.gov (United States)

    Yaghmaiee, Massoud; Yavari, Amir Saeed; Mashhadiabbas, Fatemeh; Bahrami, Afshin; Farnia, Pupak; Sharifi, Davoud; Ghanavi, Jalaledin; Eslami, Behnan

    2007-09-01

    One of the most important aspects in surgery is the healing process after the periapical surgery. Past studies have shown occasional encounters with vital root resection and have noted varying degrees of pulpal response after root resection in periodontal disease. The purpose of this investigation was to observe the pulpal and periapical responses to intentional apical vital root transection in one root of multirooted teeth of German-Canadian dogs over a 6-month postoperative period. This is an experimental study performed on left maxillary and mandibular quadrants of four adult German-Canadian dogs after a 3- and 6-month period. Four teeth were assessed in each interval. One of the roots of multirooted teeth in the left quadrant of both maxillary and mandibular jaws was surgically transected. Tissue blocks were prepared by routine histological methods after 12 and 24 weeks after the surgery. The results showed a disruption of the normal pulpal architecture, with initial pulpal degeneration and subsequent early replacement by the periodontal ligament tissue after 24 weeks. Hypercementosis was seen around the apical portion of the root in all specimens. Pulpal regeneration was seen in the both upper and lower molars (p = 0.03). Resorption took place only in two specimens (p = 0.46). The inflammation in the 12th week was more than the 24th week. The pulp of multirooted teeth remains vital after transection of the apical part of the root in dogs. Longer follow-up periods are recommended because root canal therapy or extraction is indicated if resorption, necrosis, or ankylosis is seen.

  10. Inhibition of osteoblast mineralization by phosphorylated phage-derived apatite-specific peptide

    Science.gov (United States)

    Ramaswamy, Janani; Nam, Hwa Kyung; Ramaraju, Harsha; Hatch, Nan E.; Kohn, David H.

    2015-01-01

    Functionalization of biomaterials with material- and cell-specific peptide sequences allows for better control of their surface properties and communication with the surrounding environment. Using a combinatorial phage display approach, we previously identified the peptide VTKHLNQISQSY (VTK) with specific affinity to biomimetic apatite. Phosphorylation of the serine residues of the peptide (pVTK) caused a significant increase in binding to apatite, as well as a dose-dependent inhibition of osteoblast mineralization. In this study, we investigated the mechanisms behind pVTK mediated inhibition of mineralization using MC3T3 cells and testing the hypothesis that mineralization is inhibited via alteration of the Enpp1-TNAP-Ank axis. Inhibition of mineralization was not due to disruption of collagen deposition or calcium chelation by the negatively charged pVTK. The timing of peptide administration was important in inhibiting mineralization - pVTK had a greater effect at later stages of osteogenic differentiation (days 7–12 of culture corresponding to matrix maturation and mineralization), and could prevent progression of mineralization once it had started. pVTK treatment resulted in a significant decrease in ectonucleotide pyrophosphatase/phosphodiesterase 1 (Enpp1) enzyme activity and gene expression. The expression of ankylosis protein (Ank) and osteopontin (OPN) and Pit-1 genes was also significantly reduced with peptide treatment, while tissue non-specific alkaline phosphatase (TNAP), bone sialoprotein (BSP), and Runx2 gene expression was significantly higher. The ability of pVTK to inhibit mineralization can potentially be translated into therapeutics against pathological calcification seen in cardiovascular disease, osteoarthritis or craniosynostosis, or be used to prevent failure of biomaterials due to calcification, such as bioprosthetic heart valves. PMID:26406452

  11. Identification of the Inorganic Pyrophosphate Metabolizing, ATP Substituting Pathway in Mammalian Spermatozoa

    Science.gov (United States)

    Yi, Young-Joo; Sutovsky, Miriam; Kennedy, Chelsey; Sutovsky, Peter

    2012-01-01

    Inorganic pyrophosphate (PPi) is generated by ATP hydrolysis in the cells and also present in extracellular matrix, cartilage and bodily fluids. Fueling an alternative pathway for energy production in cells, PPi is hydrolyzed by inorganic pyrophosphatase (PPA1) in a highly exergonic reaction that can under certain conditions substitute for ATP-derived energy. Recombinant PPA1 is used for energy-regeneration in the cell-free systems used to study the zymology of ATP-dependent ubiquitin-proteasome system, including the role of sperm-borne proteasomes in mammalian fertilization. Inspired by an observation of reduced in vitro fertilization (IVF) rates in the presence of external, recombinant PPA1, this study reveals, for the first time, the presence of PPi, PPA1 and PPi transporter, progressive ankylosis protein ANKH in mammalian spermatozoa. Addition of PPi during porcine IVF increased fertilization rates significantly and in a dose-dependent manner. Fluorometric assay detected high levels of PPi in porcine seminal plasma, oviductal fluid and spermatozoa. Immunofluorescence detected PPA1 in the postacrosomal sheath (PAS) and connecting piece of boar spermatozoa; ANKH was present in the sperm head PAS and equatorial segment. Both ANKH and PPA1 were also detected in human and mouse spermatozoa, and in porcine spermatids. Higher proteasomal-proteolytic activity, indispensable for fertilization, was measured in spermatozoa preserved with PPi. The identification of an alternative, PPi dependent pathway for ATP production in spermatozoa elevates our understanding of sperm physiology and sets the stage for the improvement of semen extenders, storage media and IVF media for animal biotechnology and human assisted reproductive therapies. PMID:22485177

  12. Arthrogryposis Multiplex: A Case Report La artrogriposis múltiple: a propósito de un caso

    Directory of Open Access Journals (Sweden)

    Diego Alexis Blanco Manso

    2012-11-01

    Full Text Available Congenital muscular dystrophies appear from birth or early infancy with hypotonia and loss of proximal or generalized muscle strength. Contractures at birth are called arthrogryposis. Arthrogryposis multiplex is a disorder that is identified by congenital stiffness of one or more joints, caused by hypoplasia of the muscles in the region and also by an incomplete fibrous ankylosis. Some experts have attributed the disease to a prolonged intrauterine compression, but others propose that it is more likely that the syndrome originates from an early period of embryonic life. We report a case of arthrogryposis multiplex with walking impossibility due to a broken kneecap. Through rehabilitation in the Specialized Outpatient Center, the patient achieves locomotion.Las distrofias musculares congénitas se presentan desde el nacimiento o los primeros meses de vida con hipotonía y pérdida de la fuerza muscular proximal o generalizada. A las contracturas presentes al nacer se les denomina artrogriposis. La artrogriposis múltiple es un trastorno que se identifica por la rigidez congénita de una o más articulaciones, causada por la hipoplasia de los músculos ubicados en la región y también por una anquilosis fibrosa incompleta. Algunos especialistas han atribuido esta enfermedad a una compresión intrauterina prolongada, en cambio otros plantean, que es mucho más viable que el síndrome se origine en un periodo temprano de la vida embrionaria. Se presenta un caso de artrogriposis múltiple con imposibilidad para la marcha producto de una fractura de rótula que a por medio de la rehabilitación en el Centro Especializado Ambulatorio logra la locomoción.

  13. Avoiding unfavorable results in postburn contracture hand

    Science.gov (United States)

    Bhattacharya, Sameek

    2013-01-01

    Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation. PMID:24501479

  14. Curcumin: an orally bioavailable blocker of TNF and other pro-inflammatory biomarkers

    Science.gov (United States)

    Aggarwal, Bharat B; Gupta, Subash C; Sung, Bokyung

    2013-01-01

    TNFs are major mediators of inflammation and inflammation-related diseases, hence, the United States Food and Drug Administration (FDA) has approved the use of blockers of the cytokine, TNF-α, for the treatment of osteoarthritis, inflammatory bowel disease, psoriasis and ankylosis. These drugs include the chimeric TNF antibody (infliximab), humanized TNF-α antibody (Humira) and soluble TNF receptor-II (Enbrel) and are associated with a total cumulative market value of more than $20 billion a year. As well as being expensive ($15 000–20 000 per person per year), these drugs have to be injected and have enough adverse effects to be given a black label warning by the FDA. In the current report, we describe an alternative, curcumin (diferuloylmethane), a component of turmeric (Curcuma longa) that is very inexpensive, orally bioavailable and highly safe in humans, yet can block TNF-α action and production in in vitro models, in animal models and in humans. In addition, we provide evidence for curcumin's activities against all of the diseases for which TNF blockers are currently being used. Mechanisms by which curcumin inhibits the production and the cell signalling pathways activated by this cytokine are also discussed. With health-care costs and safety being major issues today, this golden spice may help provide the solution. Linked Articles This article is part of a themed section on Emerging Therapeutic Aspects in Oncology. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2013.169.issue-8 PMID:23425071

  15. Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation.

    Science.gov (United States)

    Maksymowych, Walter P; Chiowchanwisawakit, Praveena; Clare, Tracey; Pedersen, Susanne J; Østergaard, Mikkel; Lambert, Robert G W

    2009-01-01

    To determine whether a vertebral corner that demonstrates an active corner inflammatory lesion (CIL) on magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) is more likely to evolve into a de novo syndesmophyte visible on plain radiography than is a vertebral corner that demonstrates no active inflammation on MRI. MRI scans and plain radiographs were obtained for 29 patients recruited into randomized placebo-controlled trials of anti-tumor necrosis factor alpha (anti-TNFalpha) therapy. MRI was conducted at baseline, 12 or 24 weeks (n=29), and 2 years (n=22), while radiography was conducted at baseline and 2 years. A persistent CIL was defined as a CIL that was found on all available scans. A resolved CIL was defined as having completely disappeared on either the second or third scan. A validation cohort consisted of 41 AS patients followed up prospectively. Anonymized MRIs were assessed independently by 3 readers who were blinded with regard to radiographic findings. New syndesmophytes developed significantly more frequently in vertebral corners with inflammation (20%) than in those without inflammation (5.1%) seen on baseline MRI (Pankylosis.

  16. Avoiding unfavorable results in postburn contracture hand

    Directory of Open Access Journals (Sweden)

    Sameek Bhattacharya

    2013-01-01

    Full Text Available Deformities of the hands are a fairly common sequel of burn especially in the developing world. This is because of high incidence of burns, limited access to standard treatment and rehabilitation. The best outcome of a burnt hand is when deformities are prevented from developing. A good functional result is possible when due consideration is paid to hands during resuscitation, excisional surgery, reconstructive surgery and physiotherapy. The post-burns deformities of hand develop due direct thermal damage or secondary to intrinsic minus position due to oedema or vascular insufficiency. During the acute phase the concerns are, maintenance circulation minimize oedema prevent unphysiological positioning and wound closure with autogenous tissue as soon as possible. The rehabilitation program during the acute phase starts from day one and goes on till the hand has healed and has regained full range of motion. Full blown hand contractures are challenging to correct and become more difficult as time passes. Long-standing cases often land up with attenuation of extensor apparatus leading to swan neck and boutonniere deformity, muscle shortening and bony ankylosis. The major and most common pitfall after contracture release is relapse. The treatment protocol of contracture is solely directed towards countering this tendency. This article aims to guide a surgeon in obtaining optimal hand function and avoid pit falls at different stages of management of hand burns. The reasons of an unfavourable outcome of a burnt hand are possible lack of optimal care in the acute phase, while planning and performing reconstructive procedure and during aftercare and rehabilitation.

  17. Periodontal ligament, cementum, and alveolar bone in the oldest herbivorous tetrapods, and their evolutionary significance.

    Directory of Open Access Journals (Sweden)

    Aaron R H LeBlanc

    Full Text Available Tooth implantation provides important phylogenetic and functional information about the dentitions of amniotes. Traditionally, only mammals and crocodilians have been considered truly thecodont, because their tooth roots are coated in layers of cementum for anchorage of the periodontal ligament, which is in turn attached to the bone lining the alveolus, the alveolar bone. The histological properties and developmental origins of these three periodontal tissues have been studied extensively in mammals and crocodilians, but the identities of the periodontal tissues in other amniotes remain poorly studied. Early work on dental histology of basal amniotes concluded that most possess a simplified tooth attachment in which the tooth root is ankylosed to a pedestal composed of "bone of attachment", which is in turn fused to the jaw. More recent studies have concluded that stereotypically thecodont tissues are also present in non-mammalian, non-crocodilian amniotes, but these studies were limited to crown groups or secondarily aquatic reptiles. As the sister group to Amniota, and the first tetrapods to exhibit dental occlusion, diadectids are the ideal candidates for studies of dental evolution among terrestrial vertebrates because they can be used to test hypotheses of development and homology in deep time. Our study of Permo-Carboniferous diadectid tetrapod teeth and dental tissues reveal the presence of two types of cementum, periodontal ligament, and alveolar bone, and therefore the earliest record of true thecodonty in a tetrapod. These discoveries in a stem amniote allow us to hypothesize that the ability to produce the tissues that characterize thecodonty in mammals and crocodilians is very ancient and plesiomorphic for Amniota. Consequently, all other forms of tooth implantation in crown amniotes are derived arrangements of one or more of these periodontal tissues and not simply ankylosis of teeth to the jaw by plesiomorphically retaining "bone

  18. Atlantoaxial instability: An exceptional complication of ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Zeineb Alaya

    2018-04-01

    Full Text Available Background: Atlantoaxial instability (AAI and more rarely odontoid pannus formation, similar to the one observed in Rheumatoid Arthritis, are seldom reported in ankylosing spondylitis (AS. We report a new case of a patient with AS with a pannus in the atlanto-axial region and cervical C1-C2 instability. Case presentation: The patient, now aged 41, was diagnosed with AS in 2010. She was put on different non steroidal anti inflammatory treatments with persistent spinal pain. She was referred to our department in 2015 with severe cervical pain and stiffness since 3 months. On examination, the patient had severely limited cervical spine movements. Lumbar spine movements were moderately affected. There was no neurological deficit. Her Bath Ankylosing Spondylitis Disease Activity Index (BASDAI was 4.9/10 and Bath Ankylosing Spondylitis Functional Index (BASFI was 5/10. Plain Radiographs of the pelvis showed bilateral grade 4 sacroilitis and bilateral coxitis. Dorsal and lumbar spine plain radiographs showed squaring of vertebral bodies. Cervical spine radiographs showed an increased atlanto-axial distance. Spinal MRI confirmed the atlantoaxial subluxation with an anterior distance of 8 mm, with marked intraspinal pannus formation and synovitis around the odontoid peg. Synovial thickening exerted an anterior mark on the bulbo-medullary junction with no evidence of oedema signs. Posterior zygapophysial ankylosis involving all cervical levels was also observed. The patient had a cervical collar with anti-tumor necrosis factor-α (cerolizumab-pegol prescription with favorable outcome. Conclusion: Odontoid pannus formation is rare in AS. Clinical and radiological follow-up are important to assess the impact on the cervical spine. Keywords: Ankylosing spondylitis, Atlantoaxial instability, MRI, Cerolizumab-pegol

  19. The value of {sup 99m}Tc-HDP scan in the diagnosis of tibial avascular necrosis caused by thermal injury: a case with multi-image correlation analysis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae General Hospital, Seoul (Korea, Republic of)

    2007-10-15

    Basic pathology in thermal injury is coagulative soft tissue necorsis that may occasionally be complicated by infection and later by scarring and vascular changes. Radiological features were discussed in detail by Resnick. The early changes consist of soft tissue defect, porosis and periostitis and the late changes include osteophytosis, periarticular calcification or ossification and arthropathy with ankylosis. Acromutilation can occur when small bones of the hand and foot are burned and scarred. This communication describes {sup 99m}Tc-HDP pnhole bone scan manifestations of thermal bone injuries observed in a case of skin-bone burns of the mid-tibial shaft that was complicated by infection, soft tissue scarring and osteonecrosis. Patient was a 49-year-old female thermal burn involving a mid-tibial shaft segment along with overlying skin. The injury was accidental to medullary rimming to fit intramedullary nail to fix fracture. The heat produced during drilling spread to burn the pretibial skin that is sparse in subcutaneous buffer tissue and vessels. The soft tissue burn was infected and healed by repeated skin grafts and scar over a period of 2 years. Concomitantly, the underlying bone was infected locally and treated but ensued in osteonecrosis that was accompanied by osteolysis. Indeed. pinhole {sup 99m}Tc-HDP scan played a unique role in this case in detecting that live lateral cortex had sustained the large dead bone that involved the main volume of the mid-tibial shaft. Importantly, the scan could confirm live cortex to have sustained dead bone uncollapsed. Anatomical and metabolic data gained from bone scanning prompted us to systematically scrutinize radiograph and CT to specifically identify the preserved lateral cortex. As mentioned the existence of healthy cortex is biomechanically and tactically vital to surgically replace and restore the devitalized bone.

  20. Granulation Tissue Eroding the Subchondral Bone Also Promotes New Bone Formation in Ankylosing Spondylitis.

    Science.gov (United States)

    Bleil, Janine; Maier, Rene; Hempfing, Axel; Sieper, Joachim; Appel, Heiner; Syrbe, Uta

    2016-10-01

    We previously suggested that fibroblast-rich granulation tissue eroding the subchondral bone is instrumental in the joint remodeling that occurs in ankylosing spondylitis (AS). The purpose of this study was to determine if this granulation tissue also carries bone-forming capabilities, which we approached by searching for bone-forming cells (hypertrophic chondrocytes, osteoblasts) in its vicinity. We also assessed adipogenic tissue transformation, which has been suggested to be an intermediate feature in AS bone formation based on imaging studies. The facet joints of AS patients, osteoarthritis (OA) patients, and autopsy subjects (controls) were screened for subchondral granulation tissue. We searched for hypertrophic chondrocytes by assessing RUNX-2, type X collagen, and matrix metalloproteinase 13 (MMP-13) expression, for osteoblasts by analyzing RUNX-2, CD56, and type I collagen expression, as well as for signs of new bone formation. Adipocytes and lipid accumulation were assessed in Safranin O-stained sections. In the joints of AS and OA patients, RUNX-2-positive cells were found to be lining the granulation tissue. These cells coexpressed type I collagen but lacked type X collagen and MMP-13 expression, confirming their osteoblastic nature. In 91% of AS joints and in 20% of OA joints (P granulation tissue and the cartilage. Joints containing bony spots showed greater replacement of the adjacent bone marrow by granulation tissue than did joints without bone formation (P granulation tissue often contained adipocytes and lipid accumulations. Replacement of the subchondral bone marrow by fat tissue was also frequently found but was not associated with new bone formation. The subchondral granulation tissue carries osteoblasts, which promote new bone formation, leading to intraarticular ankylosis of the facet joints in AS. © 2016, American College of Rheumatology.

  1. Conservative orthodontic fixed appliance management of pediatric mandibular bilateral condylar fracture.

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    Xu, Yanhua; Gong, Siew-Ging; Zhu, Fangyong; Li, Ming; Biao, Xu

    2016-07-01

    Management of mandibular condylar fractures is difficult in children with their inherently dynamic and unstable deciduous and mixed dentitions. We present a variation of the conservative fixed orthodontic approach that was used as an adjunct to aid in the reduction of a bilateral condylar fracture in a pediatric patient. A boy, aged 10 years 9 months, came with clinical signs and symptoms of mandibular fracture after being involved in a motor vehicle accident. A computed tomography scan showed a vertical fracture on the left condylar head, a displaced fracture of the right condylar neck, and a mandibular symphysis fracture. The patient was treated with an orthodontic fixed appliance instead of an arch bar splint, followed by elastic traction to achieve a proper occlusion and condylar remodeling. Follow-up appointments were made 2 weeks and 1, 2, 20, 37, and 49 months after treatment. Clinical recovery was observed 2 months after treatment. At the follow-up appointments at 20, 37, and 49 months, jaw function and occlusal relationship remained stable, and no ankylosis was observed. The computed tomography scans showed that the right condyle had remodeled, and the left condyle exhibited a slight curve in the head at 49 months posttreatment. The patient's satisfaction with these treatment results was high. Conservative treatment of a mandibular fracture by fixed orthodontic means is a viable treatment option that is relatively straightforward and cost-effective and has a high level of patient acceptance and comfort. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  2. Early anti-inflammatory intervention ameliorates axial disease in the proteoglycan-induced spondylitis mouse model of ankylosing spondylitis.

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    Tseng, Hsu-Wen; Glant, Tibor T; Brown, Matthew A; Kenna, Tony J; Thomas, Gethin P; Pettit, Allison R

    2017-05-30

    Ankylosing spondylitis (AS) is characterised by immune-mediated arthritis and osteoproliferation, ultimately leading to joint ankylosis. Whether inflammation is necessary for osteoproliferation is controversial, fuelled by the unclear efficacy of anti-inflammatory treatments on radiographic progression. In proteoglycan-induced spondylitis (PGISp), a mouse model of AS, inflammation is the prerequisite for osteoproliferation as osteoproliferation was only observed following inflammation-driven intervertebral disc (IVD) destruction. We hypothesised that early intervention with a potent anti-inflammatory therapy would protect IVD integrity and consequently alter disease progression. PGISp mice received vehicle or a combination of etanercept (ETN) plus prednisolone (PRD) therapy for 2 or 6 weeks initiated at an early disease stage. Peripheral arthritis was scored longitudinally. Spinal disease was assessed using a semi-quantitative histological scoring regimen including inflammation, joint destruction and excessive tissue formation. ETN + PRD therapy significantly delayed the onset of peripheral arthritis. IVD integrity was significantly protected when treatment was commenced in early disease. Six-weeks of treatment resulted in trends towards reductions in intervertebral joint damage and excessive tissue formation. IVD score distribution was dichotomized, likely reflecting the extent of axial disease at initiation of therapy. In the sub-group of mice with high IVD destruction scores, ETN + PRD treatment significantly reduced IVD destruction severity, inflammation and bone erosion and reduced cartilage damage and excessive tissue formation. Early intervention with anti-inflammatory treatment not only improved inflammatory symptoms but also ameliorated structural damage of spine in PGISp mice. This preclinical observation suggests that early anti-inflammatory intervention may slow radiographic progression in AS patients.

  3. Etanercept Increases Bone Mineral Density in Ankylosing Spondylitis, but Does Not Prevent Vertebral Fractures: Results of a Prospective Observational Cohort Study.

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    van der Weijden, Maria A C; van Denderen, J Christiaan; Lems, Willem F; Nurmohamed, Michael T; Dijkmans, Ben A C; van der Horst-Bruinsma, Irene E

    2016-04-01

    Ankylosing spondylitis (AS) is characterized by chronic inflammation leading to ankylosis, but also to low bone mineral density (BMD) and vertebral fractures (VFx). Treatment with tumor necrosis factor-α blockers decreases inflammation and has shown to be effective in increasing BMD. We studied the effects of etanercept (ETN) on BMD and VFx in patients with AS after 2 years of treatment. Further, we studied changes in bone turnover markers and radiological damage. Patients with active AS, treated with ETN for 2 years, were included. BMD lumbar spine and hip were measured at baseline and after 2 years, as well as radiological damage (modified Stoke Ankylosing Spondylitis Spinal Score with the addition of the thoracic spine), VFx (Genant method), and change in bone turnover markers. Forty-nine patients with AS were included. After 2 years of ETN, hip BMD increased by 2.2% (p = 0.014) and lumbar spine BMD by 7.0% (p Ankylosing Spondylitis Disease Activity Index decreased significantly (p < 0.001), as well as C-reactive protein and erythrocyte sedimentation rate (p < 0.001). Despite ETN therapy, the number of patients with VFx more than doubled (from 6 to 15 patients, p = 0.003). Also, the radiological damage increased significantly over time (from 12.1 to 18.5, p < 0.001); however, no significant change in bone turnover markers was found. This prospective longitudinal observational cohort study showed that after 2 years of ETN, BMD of the hip and spine increased significantly, but the number of patients with VFx and the severity of VFx increased as well. Besides that, radiological progression, including the thoracic spine, increased significantly. Thus, the favorable bone-preserving effect is accompanied by unfavorable outcomes on VFx and radiological damage.

  4. Bone formation in axial spondyloarthritis.

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    Lories, Rik J; Haroon, Nigil

    2014-10-01

    The success of targeted therapies directed against tumor necrosis factor for patients with spondyloarthritis has shifted the focus of physicians and scientists towards the prevention of structural damage to the involved structures, in particular the sacroiliac joints and the spine, to avoid loss of function and disability. Structural damage to the skeleton as witnessed by radiography mainly consists of new bone formation potentially progressively leading to spine or joint ankylosis. This important long-term outcome parameter has been difficult to study, not alone because the time window for change may be long but also because human tissues with direct translational relevance are rarely available. Data from rodent models have identified growth factor signaling pathways as relevant targets. Both human and animal studies have tried to understand the link between inflammation and new bone formation. At the current moment, most evidence points towards a strong link between both but with the question still lingering about the sequence of events, disease triggers, and the interdependence of both features of disease. New discoveries such as a masterswitch T cell population that carries the IL23 receptor and the analysis of auto-antibodies directed again noggin and sclerostin are contributing to innovative insights into the pathophysiology of disease. Long-term data with tumor necrosis factor (TNF) inhibitors also suggest that some window of opportunity may exist to inhibit structural disease progression. All these data provide support for a further critical analysis of the available datasets and boost research in the field. The introduction of novel disease definitions, in particular the characterization of non-radiographic axial spondyloarthritis patients, will likely be instrumental in our further understanding of structural damage. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Portland cement induces human periodontal ligament cells to differentiate by upregulating miR-146a

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    Min-Ching Wang

    2018-04-01

    Full Text Available Background/Purpose: Bioaggregates such as Portland cement (PC can be an economical alternative for mineral trioxide aggregate (MTA with additional benefit of less discoloration. MTA has been known to induce differentiations of several dental cells. MicroRNAs are important regulators of biological processes, including differentiation, physiologic homeostasis, and disease progression. This study is to explore how PC enhances the differentiation of periodontal ligament (PDL cells in microRNAs level. Methods: PDL cells were cultured in a regular PC- or MTA-conditioned medium or an osteoinduction medium (OIM. Alizarin red staining was used to evaluate the extent of mineralization. Transfection of microRNA mimics induced exogenous miR-31 and miR-146a expression. The expression of microRNAs and differentiation markers was assayed using reverse-transcriptase polymerase chain reaction. Results: PC enhanced the mineralization of PDL cells in a dose-dependent manner in the OIM. Exogenous miR-31 and miR-146a expression upregulated alkaline phosphatase (ALP, bone morphogenic protein (BMP, and dentin matrix protein 1 (DMP1 expression. However, miR-31 and miR-146a modulates cementum protein 1 (CEMP1 expression in different ways. PC also enhanced ALP and BMP but attenuated CEMP1 in the OIM. Although the OIM or PC treatment upregulated miR-21, miR-29b, and miR-146a, only miR-146a was able to be induced by PC in combination with OIM. Conclusion: This study demonstrated that PC enhances the differentiation of PDL cells, especially osteogenic through miR-146a upregulation. In order to control the ankylosis after regenerative endodontics with the usage of bioaggregates, further investigations to explore these differentiation mechanisms in the miRNA level may be needed. Keywords: Portland cement, Bioaggregate, miR-146a, Osteogenic differentiation, Periodontal ligament (PDL

  6. An atypical presentation of mechanical failure of eruption of a mandibular permanent molar: diagnosis and treatment case report.

    Science.gov (United States)

    Smith, C P; Al-Awadhi, E A; Garvey, M T

    2012-06-01

    Failure of eruption of mandibular permanent molars occurs infrequently but is a difficult clinical problem. It can be due to local or systemic factors or failure of the eruption process. Primary failure of eruption (PFE) is a rare condition that can result in severe posterior open bite, requires complex treatment strategies and has unfavourable outcomes. Mechanical failure of eruption (MFE) is more unusual but can respond positively to treatment. Differentiating between the two is crucial in making the correct diagnosis and managing the case successfully. A 10-year-old girl presented with a partially erupted mandibular right first permanent molar, 46. She had no relevant medical or dental history and no family history of tooth eruption failure. 46 was monitored for 6 months to allow spontaneous eruption. Local and systemic factors were eliminated. Progress radiographs and longitudinal clinical data were collected. Attempted eruption of 46 was completed by surgical luxation and elevation by orthodontic force. Surgical luxation and elevation of 46 was repeated with the removal of the mandibular right second permanent molar, 47, which was mechanically obstructing the eruption of 46. With continued orthodontic force the tooth was righted up and brought into occlusion with no complication of ankylosis. The mandibular right third molar continues to erupt and migrate mesially. The patient now exhibits a bilateral functioning posterior bite three years after the treatment was commenced. Through a combination of sequential monitoring with treatment including surgical luxation and orthodontic force, a therapeutic diagnosis of MFE was made. The appropriate treatment was carried out and the tooth erupted into occlusion.

  7. Central role of pyrophosphate in acellular cementum formation.

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    Brian L Foster

    Full Text Available Inorganic pyrophosphate (PP(i is a physiologic inhibitor of hydroxyapatite mineral precipitation involved in regulating mineralized tissue development and pathologic calcification. Local levels of PP(i are controlled by antagonistic functions of factors that decrease PP(i and promote mineralization (tissue-nonspecific alkaline phosphatase, Alpl/TNAP, and those that increase local PP(i and restrict mineralization (progressive ankylosis protein, ANK; ectonucleotide pyrophosphatase phosphodiesterase-1, NPP1. The cementum enveloping the tooth root is essential for tooth function by providing attachment to the surrounding bone via the nonmineralized periodontal ligament. At present, the developmental regulation of cementum remains poorly understood, hampering efforts for regeneration. To elucidate the role of PP(i in cementum formation, we analyzed root development in knock-out ((-/- mice featuring PP(i dysregulation.Excess PP(i in the Alpl(-/- mouse inhibited cementum formation, causing root detachment consistent with premature tooth loss in the human condition hypophosphatasia, though cementoblast phenotype was unperturbed. Deficient PP(i in both Ank and Enpp1(-/- mice significantly increased cementum apposition and overall thickness more than 12-fold vs. controls, while dentin and cellular cementum were unaltered. Though PP(i regulators are widely expressed, cementoblasts selectively expressed greater ANK and NPP1 along the root surface, and dramatically increased ANK or NPP1 in models of reduced PP(i output, in compensatory fashion. In vitro mechanistic studies confirmed that under low PP(i mineralizing conditions, cementoblasts increased Ank (5-fold and Enpp1 (20-fold, while increasing PP(i inhibited mineralization and associated increases in Ank and Enpp1 mRNA.Results from these studies demonstrate a novel developmental regulation of acellular cementum, wherein cementoblasts tune cementogenesis by modulating local levels of PP(i, directing and

  8. Analysis of meniscal degeneration and meniscal gene expression

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    Norton James H

    2010-01-01

    Full Text Available Abstract Background Menisci play a vital role in load transmission, shock absorption and joint stability. There is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1 to determine the prevalence of meniscal degeneration in OA patients, and 2 to examine gene expression in OA meniscal cells compared to normal meniscal cells. Methods Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients and lower limb amputation surgery for osteosarcoma patients (normal control specimens, and graded. Meniscal cells were prepared from these meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal meniscal cells was examined using Affymetrix microarray and real time RT-PCR. Results The grades of meniscal degeneration correlated with the grades of articular cartilage degeneration (r = 0.672; P HLA-DPA1, integrin, beta 2 (ITGB2, ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1, ankylosis, progressive homolog (ANKH and fibroblast growth factor 7 (FGF7, were expressed at significantly higher levels in OA meniscal cells compared to normal meniscal cells. Importantly, many of the genes that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS5 and prostaglandin E synthase (PTGES, were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that many of the genes detected in our study are disease-specific. Conclusion Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel

  9. Adverse events of surgical extrusion in treatment for crown-root and cervical root fractures: a systematic review of case series/reports.

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    Elkhadem, Ahmed; Mickan, Sharon; Richards, Derek

    2014-02-01

    Crown-root and cervical root fractures constitute a restorative challenge due to sub-gingival position of the fracture margin. Surgical tooth extrusion is one of the treatment options. There is uncertainty regarding the prognosis of such treatment modality. To assess adverse events of surgical tooth extrusion in the treatment for crown-root and cervical root fractures in permanent teeth. PubMed, Embase, and Google Scholar were searched through 15th of June 2012. Search was limited to English and Arabic languages. Reference list of relevant studies were hand-searched. Grey literature was searched using Open Grey. Two review authors independently extracted data, while only one assessed trial quality using 8-point methodological index for non-randomized studies (MINORS) scale. A sensitivity analysis was performed to exclude studies with suspected patients' duplicates. Eleven case reports and eight case series involving 226 patients with 243 teeth were identified. No randomized controlled trials were found. The mean quality score for all case series was 9 suggesting a fair quality, while that of all case reports was 5 suggesting poor quality. Non-progressive root resorption is the most common finding following surgical extrusion with an event rate of 30% (95% CI 24.6-36.7%). This is followed by low event rates of tooth loss (5%), slight mobility (4.6%), marginal bone loss (3.7%), and progressive root resorption (3.3%). No ankylosis occurred to any extruded tooth, while severe tooth mobility showed negligible overall event rate of 0.4%. The available evidence suggests that surgical tooth extrusion is a valid technique in management of crown-root and cervical root fracture of permanent teeth. Minimal adverse events and good prognosis are expected. Further, surgical extrusion can be considered as a treatment option in teeth suffering sub-gingival decay. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Magnetic resonance imaging for ankylosing spondylitis

    International Nuclear Information System (INIS)

    Bollow, M.

    2002-01-01

    Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2% is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99% of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5-9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchrondritis of the public symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called 'biologicals' are employed. (orig.) [de

  11. Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

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    Y. Ragab

    2015-09-01

    Full Text Available Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6% and 32 females (44.4] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3% cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%, septic arthritis in 10 (13.9%, tuberculous arthritis in 4 (5.6%, sickle-cell disease in 7 (9.7%, complicated with septic arthritis in 3 (4.2%, transient bone marrow edema (BME in 3 (4.2%, osteomyelitis in 2 (2.8%, osteosarcoma in 2 (2.8%, sciatic nerve injury in 1 (1.4%, leukemia with BME in 1 (1.4%, coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%, and a benign bone cyst in 1 (1.4%. MRI studies showed hip effusion in a total of 51 patients (70.8%, joint space narrowing in 9 (12.5%, and BME in 15(20.8%. MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.

  12. Histological characterization of denticulate palatal plates in an Early Permian dissorophoid

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    Bryan M. Gee

    2017-08-01

    Full Text Available Denticles are small, tooth-like protrusions that are commonly found on the palate of early tetrapods. Despite their widespread taxonomic occurrence and similar external morphology to marginal teeth, it has not been rigorously tested whether denticles are structurally homologous to true teeth with features such as a pulp cavity, dentine, and enamel, or if they are bony, tooth-like protrusions. Additionally, the denticles are known to occur not only on the palatal bones but also on a mosaic of small palatal plates that is thought to have covered the interpterygoid vacuities of temnospondyls through implantation in a soft tissue covering; however, these plates have never been examined beyond a simple description of their position and external morphology. Accordingly, we performed a histological analysis of these denticulate palatal plates in a dissorophoid temnospondyl in order to characterize their microanatomy and histology. The dentition on these palatal plates has been found to be homologous with true teeth on the basis of both external morphology and histological data through the identification of features such as enamel and a pulp cavity surrounded by dentine. In addition, patterns of tooth replacement and ankylosis support the hypothesis of structural homology between these tiny teeth on the palatal plates and the much larger marginal dentition. We also provide the first histological characterization of the palatal plates, including documentation of abundant Sharpey’s fibres that provide a direct line of evidence to support the hypothesis of soft tissue implantation. Finally, we conducted a survey of the literature to determine the taxonomic distribution of these plates within Temnospondyli, providing a broader context for the presence of palatal plates and illustrating the importance of maintaining consistency in nomenclature.

  13. Fixity of vocal cords and laryngocele in acromegaly.

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    Motta, S; Ferone, D; Colao, A; Merola, B; Motta, G; Lombardi, G

    1997-12-01

    Acromegalic patients have a reduced life expectancy mainly due to cardio-, cerebrovascular and respiratory disorders and increased prevalence of neoplasias. Particularly, the pathogenesis of respiratory disorders in acromegalics is debated. Laryngeal abnormalities are not yet well clarified even if they are frequently involved in the occurrence of respiratory insufficiency. In this study, we report on a 65 year-old acromegalic male suffering from frequent and severe dyspnea attacks and clinical findings of respiratory upperway obstruction, besides the common acromegalic features. At the external examination of the larynx, a bilateral painless and soft mass, located in the laterocervical region under the hyoid bone, was detected. Fiberoptic laryngoscopy, showed bilateral swelling between the aryepiglottic fold and the false vocal cords, whose size increased during the expiration and the phonation, fixity of the vocal cords in paramedian position, with a marked reduction of the respiratory space and increase in arytenoid cartilage size and mucosal edema. Neck and mediastinum CT scan showed the presence of an air containing bilateral swelling, crossing the thyrohyoid membrane. Bilateral cricoarytenoidal joint chondrocalcification, associated to a mixed-type bilateral laryngocele, was diagnosed. Laryngoceles were both surgically removed and a left monolateral arytenoidectomy was performed, using fiberoptic microlaryngoscopy with CO2 laser. The clinical evaluation, one month later, confirmed the complete disappearance of dyspnea and a partial improvement of phonation. Three months later, laryngoscopy showed the bilateral restoration of vocal cords motility and a significant improvement of phonation. This case presents an uncommon and severe respiratory problem in acromegaly such as the fixity of vocal cords associated to laryngocele. Circulating GH and IGF-I hypersecretion caused edema and laxity of laryngeal mucosa as well as bilateral ankylosis of cricoarytenoidal

  14. Effects of concomitant use of fibroblast growth factor (FGF)-2 with beta-tricalcium phosphate ({beta}-TCP) on the beagle dog 1-wall periodontal defect model

    Energy Technology Data Exchange (ETDEWEB)

    Anzai, Jun, E-mail: anzai_jun@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Kitamura, Masahiro, E-mail: kitamura@dent.osaka-u.ac.jp [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Nozaki, Takenori, E-mail: tnozaki@dent.osaka-u.ac.jp [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Nagayasu, Toshie, E-mail: nagayasu_toshie@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Terashima, Akio, E-mail: terashima_akio@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Asano, Taiji, E-mail: asano_taiji@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Murakami, Shinya, E-mail: ipshinya@dent.osaka-u.ac.jp [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan)

    2010-12-17

    Research highlights: {yields} Concomitant use of FGF-2 and {beta}-TCP (an osteo-conductive scaffold) significantly promotes periodontal regeneration in the severe periodontitis model (1-wall defect model) of beagle dog. {yields} FGF-2 enhanced new bone formation via {beta}-TCP at the defects. {yields} In particular, FGF-2 dramatically regenerated new periodontal ligament and cementum formations at the defects, that is one of the most important healing outcomes during the process of periodontal regeneration. {yields} Epithelial downgrowth (undesirable wound healing) was decreased by administration of FGF-2. {yields} This manuscript indicates for the first time that concomitant use of FGF-2 and {beta}-TCP is efficacious in regenerating periodontal tissue following severe destruction of the tissue by progression of periodontitis. -- Abstract: The effects of concomitant use of fibroblast growth factor-2 (FGF-2) and beta-tricalcium phosphate ({beta}-TCP) on periodontal regeneration were investigated in the beagle dog 1-wall periodontal defect model. One-wall periodontal defects were created in the mesial portion of both sides of the mandibular first molars, and 0.3% FGF-2 plus {beta}-TCP or {beta}-TCP alone was administered. Radiographic evaluation was performed at 0, 3, and 6 weeks. At 6 weeks, the periodontium with the defect site was removed and histologically analyzed. Radiographic findings showed that co-administration of FGF-2 significantly increased bone mineral contents of the defect sites compared with {beta}-TCP alone. Histologic analysis revealed that the length of the regenerated periodontal ligament, the cementum, distance to the junctional epithelium, new bone height, and area of newly formed bone were significantly increased in the FGF-2 group. No abnormal inflammatory response or ankylosis was observed in either group. These findings indicate the efficacy of concomitant use of FGF-2 and {beta}-TCP as an osteoconductive material for periodontal

  15. [A historic case of Wegener's granulomatosis: the physicist who discovered the electromagnetic waves: Heinrich Hertz].

    Science.gov (United States)

    Feldmann, H

    2005-06-01

    A diary and an extensive correspondence of Heinrich Hertz and his family provide a meticulous documentation of his life, made available by Albrecht Folsing in 1997 through a carefully investigated biography, which permit the conclusion that H. Hertz died of Wegener's granulomatosis, 45 years before this disease had been explored. WEGENER'S GRANULOMATOSIS: The symptoms of the granulomatosis, that was first described by Friedrich Wegener in 1936 and 1939 are presented in short with literal quotations of the author: It begins with a refractory cold that will last until the end, then follow involvement of the paranasal sinuses, ears, mucous lining of mouth and pharynx, slight fever, weakness, in the final phase dissemination with nephritis, septic fever, arthritis, myalgia, paralyses leading to total immobility, exitus. The etiology is not fully understood but probably based on immunoreaction. H. HERTZ: CURRICULUM VITAE: Born in Hamburg, Germany, in 1857: after secondary school academic training in physics at Dresden, Munic and Berlin. 1885 professor of physics in Karlsruhe, then starting in 1889 at Bonn. 1887/88 exploration of the electromagnetic waves, now the basis for all radio communication, and exploration of the photoelectric effect, the basis of solar techniques. Numerous highranking distinctions. H. HERTZ: The case history is presented in detail based on numerous literal quotations from personal letters and the diary. After a few banal affections involving the teeth and toes the systemic disease became manifest in summer 1892 with a refractory cold which remained the focus of treatment until death. Granulation tissue in the nose that was excised several times: no tuberculosis, no carcinoma. Otitis with purulent mastoiditis, in October 1892 mastoidectomy, persistent purulence. Early in 1893 diagnosis of nephritis. Extraction of a superior tooth, punturing of the maxillary sinus, then twice radical opening of the maxillary sinus. Painful ankylosis and paralyses

  16. A histological and micro-CT investigation in to the effect of NGF and EGF on the periodontal, alveolar bone, root and pulpal healing of replanted molars in a rat model - a pilot study.

    Science.gov (United States)

    Furfaro, Francesco; Ang, Estabelle S M; Lareu, Ricky R; Murray, Kevin; Goonewardene, Mithran

    2014-01-06

    This study aims to investigate, utilising micro-computed tomography (micro-CT) and histology, whether the topical application of nerve growth factor (NGF) and/or epidermal growth factor (EGF) can enhance periodontal, alveolar bone, root and pulpal tissue regeneration while minimising the risk of pulpal necrosis, root resorption and ankylosis of replanted molars in a rat model. Twelve four-week-old male Sprague-Dawley rats were divided into four groups: sham, collagen, EGF and NGF. The maxillary right first molar was elevated and replanted with or without a collagen membrane impregnated with either the growth factors EGF or NGF, or a saline solution. Four weeks after replantation, the animals were sacrificed and the posterior maxilla was assessed using histological and micro-CT analysis. The maxillary left first molar served as the control for the corresponding right first molar. Micro-CT analysis revealed a tendency for all replanted molars to have reduced root length, root volume, alveolar bone height and inter-radicular alveolar bone volume. It appears that the use of the collagen membrane had a negative effect while no positive effect was noted with the incorporation of EGF or NGF. Histologically, the incorporation of the collagen membrane was found to negatively affect pulpal, root, periodontal and alveolar bone healing with pulpal inflammation and hard tissue formation, extensive root resorption and alveolar bone fragmentation. The incorporation of EGF and NGF did not improve root, periodontal or alveolar bone healing. However, EGF was found to improve pulp vascularisation while NGF-improved pulpal architecture and cell organisation, although not to the level of the control group. Results indicate a possible benefit on pulpal vascularisation and pulpal cell organisation following the incorporation of EGF and NGF, respectively, into the alveolar socket of replanted molars in the rat model. No potential benefit of EGF and NGF was detected in periodontal or root

  17. Periodontal wound healing/regeneration following the application of rhGDF-5 in a beta-TCP/PLGA carrier in critical-size supra-alveolar periodontal defects in dogs.

    Science.gov (United States)

    Kwon, David H; Bisch, Frederick C; Herold, Robert W; Pompe, Cornelius; Bastone, Patrizia; Rodriguez, Nancy A; Susin, Cristiano; Wikesjö, Ulf M E

    2010-07-01

    The objective of this study was to evaluate the effect of a novel recombinant human GDF-5 (rhGDF-5) construct intended for onlay and inlay indications on periodontal wound healing/regeneration. Contralateral, surgically created, critical-size, 6-mm, supra-alveolar periodontal defects in five adult Hound Labrador mongrel dogs received rhGDF-5 coated onto beta-tricalcium phosphate (beta-TCP) particles and immersed in a bioresorbable poly(lactic-co-glycolic acid) (PLGA) composite or the beta-TCP/PLGA carrier alone (control). The rhGDF-5 and control constructs were moulded around the teeth and allowed to set. The gingival flaps were then advanced; flap margins were adapted 3-4 mm coronal to the teeth and sutured. The animals were euthanized at 8 weeks post-surgery when block biopsies were collected for histometric analysis. Healing was generally uneventful. A few sites exhibited minor exposures. Three control sites and one rhGDF-5 site (in separate animals) experienced more extensive wound dehiscencies. The rhGDF-5 and control constructs were easy to apply and exhibited adequate structural integrity to support the mucoperiosteal flaps in this challenging onlay model. Limited residual beta-TCP particles were observed at 8 weeks for both rhGDF-5/beta-TCP/PLGA and beta-TCP/PLGA control sites. The rhGDF-5/beta-TCP/PLGA sites showed significantly greater cementum (2.34 +/- 0.44 versus 1.13 +/- 0.25 mm, p=0.02) and bone (2.92 +/- 0.66 versus 1.21 +/- 0.30 mm, p=0.02) formation compared with the carrier control. Limited ankylosis was observed in four of five rhGDF-5/beta-TCP/PLGA sites but not in control sites. Within the limitations of this study, the results suggest that rhGDF-5 is a promising candidate technology in support of periodontal wound healing/regeneration. Carrier and rhGDF-5 dose optimization are necessary before further advancement of the technology towards clinical evaluation.

  18. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture.

    Science.gov (United States)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2016-04-01

    To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors. A total of 91 patients with 223 traumatized teeth. The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%. Immature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1-63.9), IRR: 2.5% (95% CI: 0-5.1), ARR: 2.1% (95% CI: 0.1-4.1), MBL: 2.4% (95% CI: 0.3-4.4), and TL: 7.8% (95% CI: 0-15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 - 5.7), P = 0.01), displacement in the horizontal part of the fracture >2 mm (HR: 1.8; 95% CI: 1.1-3.2, P = 0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3-3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1-4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN. Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. The clinical and radiological evaluation of pyogenic arthritis

    International Nuclear Information System (INIS)

    Cho, Young Jun; Kim, Kyung Joo; Yoo, Jung Keun; Kim, Young Chul; Hur, Don

    1984-01-01

    swelling and the others are include in order of frequency: joint space widening, small erosions in articular cortex, subchondral osteoporosis. The common radiological findings of symptom duration more than 31 days in 6 cases were lost of entire cortex, ankylosis and joint space narrowing.

  20. Osteopontin regulates dentin and alveolar bone development and mineralization.

    Science.gov (United States)

    Foster, B L; Ao, M; Salmon, C R; Chavez, M B; Kolli, T N; Tran, A B; Chu, E Y; Kantovitz, K R; Yadav, M; Narisawa, S; Millán, J L; Nociti, F H; Somerman, M J

    2018-02-01

    The periodontal complex is essential for tooth attachment and function and includes the mineralized tissues, cementum and alveolar bone, separated by the unmineralized periodontal ligament (PDL). To gain insights into factors regulating cementum-PDL and bone-PDL borders and protecting against ectopic calcification within the PDL, we employed a proteomic approach to analyze PDL tissue from progressive ankylosis knock-out (Ank -/- ) mice, featuring reduced PP i , rapid cementogenesis, and excessive acellular cementum. Using this approach, we identified the matrix protein osteopontin (Spp1/OPN) as an elevated factor of interest in Ank -/- mouse molar PDL. We studied the role of OPN in dental and periodontal development and function. During tooth development in wild-type (WT) mice, Spp1 mRNA was transiently expressed by cementoblasts and strongly by alveolar bone osteoblasts. Developmental analysis from 14 to 240days postnatal (dpn) indicated normal histological structures in Spp1 -/- comparable to WT control mice. Microcomputed tomography (micro-CT) analysis at 30 and 90dpn revealed significantly increased volumes and tissue mineral densities of Spp1 -/- mouse dentin and alveolar bone, while pulp and PDL volumes were decreased and tissue densities were increased. However, acellular cementum growth was unaltered in Spp1 -/- mice. Quantitative PCR of periodontal-derived mRNA failed to identify potential local compensators influencing cementum in Spp1 -/- vs. WT mice at 26dpn. We genetically deleted Spp1 on the Ank -/- mouse background to determine whether increased Spp1/OPN was regulating periodontal tissues when the PDL space is challenged by hypercementosis in Ank -/- mice. Ank -/- ; Spp1 -/- double deficient mice did not exhibit greater hypercementosis than that in Ank -/- mice. Based on these data, we conclude that OPN has a non-redundant role regulating formation and mineralization of dentin and bone, influences tissue properties of PDL and pulp, but does not

  1. Hemophilic arthropathy. A scoring system for magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Soler, R.; Rodriguez, E.; Marini, M. [Department of Radiology, Hospital Juan Canalejo, Coruna (Spain); Lopez-Fernandez, F. [Department of Hematology, Hospital Juan Canalejo, Coruna (Spain)

    2002-04-01

    The aim of this study was to define a system for scoring hemophilic arthropathy (HA) based on MR findings, providing for objective evaluation of the degree of joint involvement and evolution after on-demand administration of FVIII substitutional therapy or prophylactic treatment. A total of 133 MR examinations (89 basal and 44 during follow-up) were performed in 25 patients. Patients were divided in two groups depending on the therapy received and the length of time that the disease had been evolving at the start of the study. Group I was composed of 10 patients with secondary prophylaxis and group II was composed by 15 treated on demand. T1-weighted and T2*-weighted images performed on a 0.5-T unit were prospectively evaluated. The joint involvement was established on a scale of 0 (no abnormalities), I (minimal amount of hemosiderin), II (large amount of hemosiderin and isolated cartilaginous erosion), III (cartilage destruction, bone erosions, and subchondral cysts) to IV (large internal joint derangement, secondary osteoarthritis and/or ankylosis). At basal MR examination, patients of group I showed no abnormalities (n=28, 75.6%), grade I (n=3), and grade II (n=6) of HA. Patients of group II corresponded to MR grades III (n=21) and IV (n=11) of HA. The MR follow-up showed improvement in three joints of group I and worsening in 5 joints in group I and 2 joints in group II. Early signs of HA were detected in 10 joints with MR imaging but were underestimated on plain radiographs. Advanced degrees of HA were classified as severe under both imaging techniques. Magnetic resonance is the preferred imaging technique to assess HA. The earliest signs of joint damage, detected by MR, are overlooked by plain radiography. The MR scoring system can be used for evaluating HA. Follow-up MR should be performed to evaluate regression or worsening of the abnormalities, primarily in the case of patients with prophylaxis who usually suffer normal or early joint involvement not

  2. [Clinical-functional evolution of patients with ankylosing spondylitis following physio-kinetotheraphy].

    Science.gov (United States)

    Roşu, Mihaela Oana; Ancuţa, Codrina; Chirieac, Rodica

    2012-01-01

    Ankylosing spondylitis enigmatic from the etiologic point of view, appears with subjects who are still in school or involved in a productive activity. If detected in its early stages, under complex, constant and long-term treatment, patients have a good evolution. The objectives of the study are to describe the clinical and functional profile of patients with AS, sacroiliitis stage, and the evol ution of physical and functional parameters under traditional physio-kinetotherapy. This retrospective study was performed on 40 patients with ankylosing spondylitis (AS), who were hospitalized in the Clinic of Rheumatology Iaşi, during 2008-1010, who satisfied the amended New York criteria for this. Subjects underwent an initial evaluation (first admission) and another one at the end of the study (second admission), after approximately 6 months. The demographic characteristics, the clinical and functional elements of the study sample have indicated: the average age of 24.83 +/- 3.948, predominantly male (82.5%) and 62.5% were from rural areas. Most cases occurred at the age of 19-25 (57.5%), beginning at 18-25 (77.5%), with an average of 19.60 +/- 2.318. Following the radiological changes in the various stages of sacroiliitis, stage II prevailed (40%), then stage III (32.5%) and IV (15%). The evaluation of ASAS (Assessment of Spondylo Arthritis International Society) parameters and the respiratory system showed significant improvements of: BASDAI score with 31.53%, BASFI with 37.62%, BASMI with 20.66%, DIE % with 27.53 and of CV with 5.08% as well as a decrease in pain perception measured by VAS scale (p = 0.017). In the early stages of the disease, as far as the sample involved in the study is concerned, when the spine and vertebrae joints were not blocked by the evolution of the disease, corrective gymnastics and respiratory exercises, stretching and a good posture are very important, along with other therapies used to prevent axial ankylosis.

  3. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

  4. Reemplazo articular temporomandibular debido a queratoquiste odontogénico Temporomandibular joint replacement because of odontogenic keratocyst

    Directory of Open Access Journals (Sweden)

    Pedro Angel Peñón Vivas

    2013-03-01

    Full Text Available Existen disímiles condiciones que hacen necesario el reemplazo articular temporomandibular; dentro de las más frecuentes se encuentran la anquilosis, la osteoatrosis, estadíos avanzados del Síndrome de disfunción temporomandibular, daño articular postrauma y procesos neoplásicos o tumorales. Los queratoquistes odontógenos que se agrupan para su estudio dentro de los quistes odontogénicos del desarrollo, representan cerca del 7 al 10 por ciento de todos los quistes maxilo-mandibulares. Se dice que tienen dos picos de incidencia entre la segunda y tercera década de vida y entre los 50 y 60 años de edad, con una ligera predilección por el sexo masculino. Aparece más frecuentemente en la región del tercer molar de la mandíbula con extensión a la rama ascendente El presente trabajo tuvo como objetivo mostrar el caso de un paciente masculino de 57 años de edad en el que fue necesario el reemplazo articular temporomandibular debido a un queratoquiste odontogénico que involucraba la totalidad de la rama mandibular derecha, incluyendo el proceso condíleo y coronoideo, así como el ángulo hasta el tercio posterior del cuerpo mandibular. Tras un año de realizada la intervención quirúrgica la evolución del paciente fue satisfactoria.Temporomandibular joint replacement is required in a variety of conditions. Among the most frequent are ankylosis, osteoarthrosis, advanced stages of the temporomandibular dysfunction syndrome, post-traumatic joint damage, and neoplastic or tumoral processes. Odontogenic keratocysts, which are classified as developmental odontogenic cysts for study purposes, constitute 7-10 per cent of all maxillomandibular cysts. Two peaks have been identified in their incidence: between the second and third decades of life, and between 50 and 60 years of age, with a slight predominance of the male sex. They are most common in the third molar area of the mandibule, with expansion to the ascending branch. A case is

  5. PLAP-1: A novel molecule regulating homeostasis of periodontal tissues

    Directory of Open Access Journals (Sweden)

    Satoru Yamada

    2008-10-01

    specific role(s in the periodontal ligament as a negative regulator of cytodifferentiation and mineralization, probably by regulating BMP-2 activity to prevent the periodontal ligament from developing non-physiological mineralization, such as ankylosis.

  6. Assessment of radiographic factors affecting surgical exposure and orthodontic alignment of impacted canines of the palate: a 15-year retrospective study.

    Science.gov (United States)

    Motamedi, Mohammad Hosein Kalantar; Tabatabaie, Fataneh Alavi; Navi, Fina; Shafeie, Hasan Ali; Fard, Behnam Khosravani; Hayati, Zahra

    2009-06-01

    Impacted canines require a combination of both surgical and orthodontic management. In this study, patients treated for bone-impacted canines of the hard palatal were evaluated to assess which radiographic factors influenced the feasibility to move impacted maxillary permanent canines from the hard palate into the alveolar arch. Eighty patients aged 12 to 24 (average 16 years) were treated surgically and orthodontically to align 146 bone-impacted canines of the hard palate (from 1994 to 2008). Factors such as age, sex, angulation of the canine to the midline (CAM), anomaly of the canine root (RA), overlap of the adjacent lateral incisor root (OALIR), and ratio of root formation (RRF) upon treatment were documented. Radiographic records and demographic data were assessed. The following radiographic measurements of canine position were made from the orthopantomogram (OPG): (1) angulation to the midline, (2) anteroposterior position of the root, (3) overlap of the adjacent incisor. RA or dilaceration was assessed from the OPG, maxillary occlusal (MO), and periapical (PA) radiographs. Whether the impacted canine had responded to surgical exposure and was orthodontically aligned, or surgically removed and discarded was also recorded. The data were analyzed to assess and correlate significance. Eighty patients aged 12 to 24 (19 males and 61 females) with 146 bone-impacted permanent canines of the hard palatal were treated. One hundred and three teeth (70.54%) had responded to surgical exposure and orthodontic alignment within 9 to 12 months. Forty-three impacted canine teeth (29.46%) had to be surgically removed because of ankylosis and no movement after 8 to 9 months using 50 to 60 g of traction force via elastic chains. Data analysis via chi-square and Pearson correlation tests showed that as the CAM increased (> 45 degrees), the canine was more likely to be unresponsive to treatment (P half the root) of the adjacent lateral incisor root (OALIR) via the canine crown

  7. Role of the epithelial cell rests of Malassez in the development, maintenance and regeneration of periodontal ligament tissues.

    Science.gov (United States)

    Xiong, Jimin; Gronthos, Stan; Bartold, P Mark

    2013-10-01

    Periodontitis is a highly prevalent inflammatory disease that results in damage to the tooth-supporting tissues, potentially leading to tooth loss. Periodontal tissue regeneration is a complex process that involves the collaboration of two hard tissues (cementum and alveolar bone) and two soft tissues (gingiva and periodontal ligament). To date, no periodontal-regenerative procedures provide predictable clinical outcomes. To understand the rational basis of regenerative procedures, a better understanding of the events associated with the formation of periodontal components will help to establish reliable strategies for clinical practice. An important aspect of this is the role of the Hertwig's epithelial root sheath in periodontal development and that of its descendants, the epithelial cell rests of Malassez, in the maintenance of the periodontium. An important structure during tooth root development, the Hertwig's epithelial root sheath is not only a barrier between the dental follicle and dental papilla cells but is also involved in determining the shape, size and number of roots and in the development of dentin and cementum, and may act as a source of mesenchymal progenitor cells for cementoblasts. In adulthood, the epithelial cell rests of Malassez are the only odontogenic epithelial population in the periodontal ligament. Although there is no general agreement on the functions of the epithelial cell rests of Malassez, accumulating evidence suggests that the putative roles of the epithelial cell rests of Malassez in adult periodontal ligament include maintaining periodontal ligament homeostasis to prevent ankylosis and maintain periodontal ligament space, to prevent root resorption, to serve as a target during periodontal ligament innervation and to contribute to cementum repair. Recently, ovine epithelial cell rests of Malassez cells have been shown to harbor clonogenic epithelial stem-cell populations that demonstrate similar properties to mesenchymal stromal

  8. The VEGF and BMP-2 levels in patients with ankylosing spondylitis and the relationship to treatment with tumour necrosis factor alpha inhibitors.

    Science.gov (United States)

    Tošovský, Marian; Bradna, Petr; Andrýs, Ctirad; Andrýsová, Kateřina; Cermáková, Eva; Soukup, Tomáš

    2014-01-01

    Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by the development of osteoproductive changes in the spine which could possibly result in ankylosis. Treatment with tumour necrosis factor alpha (TNFα) inhibitors has proved to be an important step forward in the treatment of this disease, but for the time being it is not clear whether it favourably influences radiographic progression of the disease. Vascular endothelial growth factor most probably plays a role in the development of osteoproductive changes and recently its predictive influence on radiographic progression has been demonstrated. Bone morphogenic protein 2 (BMP-2) participates in the regulation of bone proliferation and its increased serum level has been demonstrated in patients with advanced AS and correlated with the degree of radiographic changes. The study aims to evaluate the VEGF and BMP-2 levels in patients with ankylosing spondylitis and how these levels relate to the concurrent treatment with TNFα inhibitors. Sera were evaluated from patients at the Rheumatologic Clinic of the Hradec Králové Faculty Hospital who fulfilled the modified New York Criteria for AS (n = 55). In these patients, the parameters of the activity of the disease (BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, CRP = C-reactive protein) and the concurrent therapy (TNFα inhibitors, n = 21, vs. non-anti TNFα, n = 34) were recorded. The levels of VEGF and BMP-2 were analyzed using the ELISA method. In patients treated with TNFα inhibitors, a significantly lower VEGF level was found when compared to untreated patients (140.3 (109.4; 262.2) vs. 261 (172.4; 396.6) pg/ml; p = 0.02). No difference was found between BMP-2 levels in both groups (treated vs. untreated patients) (254.8 (2301; 267.3) vs. 261.1 (248.6; 273.5) pg/ml; p = 0.24). A correlation analysis did not reveal any relationship between VEG F and BMP-2 (r = 0.057; p = 0.68). Serum levels of VEGF correlated with serum

  9. Inflammation-driven bone formation in a mouse model of ankylosing spondylitis: sequential not parallel processes.

    Science.gov (United States)

    Tseng, Hsu-Wen; Pitt, Miranda E; Glant, Tibor T; McRae, Allan F; Kenna, Tony J; Brown, Matthew A; Pettit, Allison R; Thomas, Gethin P

    2016-01-29

    Ankylosing spondylitis (AS) is an immune-mediated arthritis particularly targeting the spine and pelvis and is characterised by inflammation, osteoproliferation and frequently ankylosis. Current treatments that predominately target inflammatory pathways have disappointing efficacy in slowing disease progression. Thus, a better understanding of the causal association and pathological progression from inflammation to bone formation, particularly whether inflammation directly initiates osteoproliferation, is required. The proteoglycan-induced spondylitis (PGISp) mouse model of AS was used to histopathologically map the progressive axial disease events, assess molecular changes during disease progression and define disease progression using unbiased clustering of semi-quantitative histology. PGISp mice were followed over a 24-week time course. Spinal disease was assessed using a novel semi-quantitative histological scoring system that independently evaluated the breadth of pathological features associated with PGISp axial disease, including inflammation, joint destruction and excessive tissue formation (osteoproliferation). Matrix components were identified using immunohistochemistry. Disease initiated with inflammation at the periphery of the intervertebral disc (IVD) adjacent to the longitudinal ligament, reminiscent of enthesitis, and was associated with upregulated tumor necrosis factor and metalloproteinases. After a lag phase, established inflammation was temporospatially associated with destruction of IVDs, cartilage and bone. At later time points, advanced disease was characterised by substantially reduced inflammation, excessive tissue formation and ectopic chondrocyte expansion. These distinct features differentiated affected mice into early, intermediate and advanced disease stages. Excessive tissue formation was observed in vertebral joints only if the IVD was destroyed as a consequence of the early inflammation. Ectopic excessive tissue was predominantly

  10. Hemophilic arthropathy. A scoring system for magnetic resonance imaging

    International Nuclear Information System (INIS)

    Soler, R.; Rodriguez, E.; Marini, M.; Lopez-Fernandez, F.

    2002-01-01

    The aim of this study was to define a system for scoring hemophilic arthropathy (HA) based on MR findings, providing for objective evaluation of the degree of joint involvement and evolution after on-demand administration of FVIII substitutional therapy or prophylactic treatment. A total of 133 MR examinations (89 basal and 44 during follow-up) were performed in 25 patients. Patients were divided in two groups depending on the therapy received and the length of time that the disease had been evolving at the start of the study. Group I was composed of 10 patients with secondary prophylaxis and group II was composed by 15 treated on demand. T1-weighted and T2*-weighted images performed on a 0.5-T unit were prospectively evaluated. The joint involvement was established on a scale of 0 (no abnormalities), I (minimal amount of hemosiderin), II (large amount of hemosiderin and isolated cartilaginous erosion), III (cartilage destruction, bone erosions, and subchondral cysts) to IV (large internal joint derangement, secondary osteoarthritis and/or ankylosis). At basal MR examination, patients of group I showed no abnormalities (n=28, 75.6%), grade I (n=3), and grade II (n=6) of HA. Patients of group II corresponded to MR grades III (n=21) and IV (n=11) of HA. The MR follow-up showed improvement in three joints of group I and worsening in 5 joints in group I and 2 joints in group II. Early signs of HA were detected in 10 joints with MR imaging but were underestimated on plain radiographs. Advanced degrees of HA were classified as severe under both imaging techniques. Magnetic resonance is the preferred imaging technique to assess HA. The earliest signs of joint damage, detected by MR, are overlooked by plain radiography. The MR scoring system can be used for evaluating HA. Follow-up MR should be performed to evaluate regression or worsening of the abnormalities, primarily in the case of patients with prophylaxis who usually suffer normal or early joint involvement not

  11. Osteogénesis por distracción esquelética maxilomandibular: Análisis de esta novedosa terapéutica OSTEOGENESIS BY MAXILLOMANDIBULAR SKELETAL DISTRACTION: ANALYSIS OF THIS NOVEL THERAPEUTICS

    Directory of Open Access Journals (Sweden)

    Dadonim Vila Morales

    2005-04-01

    Full Text Available El proceso de generación de nuevo hueso por estiramiento del callo óseo se denomina osteogénesis por distracción. Este proceso se aplica también a los huesos del macizo craneofacial, y en especial a la mandíbula, para tratar defectos mandibulares que aparecen en diferentes síndromes, como el Treacher Collins, microsomía hemifacial, Pierre Robins, apnea obstructiva del sueño y otras deformidades secundarias a anquilosis de la articulación temporomandibular y traumas. Se realizó una revisión bibliográfica del tema. Nuestro estudio de 45 series publicadas arrojó que el tipo de distractor más usado es el extraoral, que el hueso más tratado es la mandíbula, que solo el 4,4 % de los autores realizan estudios cefalométricos para la evaluación de los resultados y que las complicaciones más frecuentes son la avulsión parcial de los pines, dolor en la ATM y limitación de la apertura bucal.The process of generation of a new bone by lengthening the osteal callus is called osteogenesis by distraction. This process is also applied to bones of the craniofacial skeleton and, specially, to the mandible to treat mandibular defects appearing in different syndromes, such as Treacher Collins, hemifacial microsomy, Pierre Robins, obstructive sleeping apnea, and other deformities secondary to ankylosis of the temporomandibular joint and traumas. A bibliographic review of the topic was made. Our study of 45 series published showed that the extraoral was the most used type of distractor, that the mandible was the most treated bone, that only 4.4 % of the authors conduct cephalometric studies to evaluate the results, and that partial avulsion of the pins, pain in the TMA and limitation to open the mouth were the most frequent complications.

  12. OTOSCLEROSI S - AN EVALUATION OF CLINICAL AND AUDIOLOGIC FINDINGS; OUTCOME AND COMPLICATIONS OF SMALL FENESTRA STAPEDOTOMY

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    Sunil Kumar

    2015-05-01

    Full Text Available INTRODUCTION: Otosclerosis is one of the commonest non infective causes of acquired deafness in adults’. ‘Otosclerosis’ literally means hardening of the ear. It is a primary and exclusive disease of otic capsule of human temporal bone. Otosclerosis is characterised by alternate phases of bone resorption and formation. If the location of bony changes produces evident clinical manifestations term “C linical Otosclerosis” is used. If bony changes are not translated into clinical manifestations, the term used is “histologica l Otosclerosis”. Antonio Valsalva in 1735 gave first description of ankylosis of stapes to margins of oval window. Von Troltsch in 1881 coined the term ‘Otosclerosis’. Politzer in 1893 first described Otosclerosis as a primary disease of otic capsule. Alth ough the clinical course of the disease is well documented, its aetiology remains unclear; thus, multiple theories are available. But none of them has established a definite cause. Otosclerosis usually manifests as a progressive conductive or mixed hearing loss occurring clinically to varying degrees in 0.5% - 1% of the general population. The clinical diagnosis of Otosclerosis, as clarified by Bezold in 1908, requires a careful history, physical examination, tuning fork evaluation and audiometric testing. Radiographic examinations can be done as adjuncts when needed. Therapeutic options for Otosclerosis include medical, surgical and use of hearing aids, alone or in combination. Stapes surgery is an effective treatment for hearing loss and tinnitus of Otoscl erosis and stapedectomy is the current treatment of choice for conductive component of Otosclerosis. The first stapes mobilization was employed by Kessel in 1878. The procedure of extracting the stapes for Otosclerosis was first performed by Jack of Boston in 1892 but was beset with obvious difficulties because he lacked proper magnification and antibiotic coverage. In 1956 Dr. John Shea revived the

  13. The risk of healing complications in primary teeth with concussion or subluxation injury-A retrospective cohort study.

    Science.gov (United States)

    Lauridsen, Eva; Blanche, Paul; Amaloo, Catharina; Andreasen, Jens O

    2017-10-01

    Traumatic dental injuries in the primary dentition occur frequently. Long-term complications may potentially cause damage to the permanent successor. The aim of this study was to report the risk of pulp necrosis (PN), pulp canal obliteration (PCO), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), and premature tooth loss (PTL) in primary teeth following concussion and subluxation injuries, and to identify possible risk factors for PN, PCO, and PTL following subluxation. The study was a retrospective analysis of a cohort comprising 31 patients (36 teeth) with concussion injury and 174 patients (241 teeth) with subluxation injury. No treatment was performed. The follow-up program included examination after 4 weeks, 8 weeks, 6 months, 1 year, and when the patients were 6 years of age. Minimum follow up was 1 year or until the time of tooth loss. Kaplan-Meier and Aalen-Johansen methods and Cox regression analysis. Level of significance was set at 5%. Risk estimated after one year. Concussion: PCO 8.6% (95% CI: 0-17.9), PN 5.7% (95% CI: 0-13.4), PTL 5.6% (95% CI: 0-13.4). Subluxation: PCO 23.2% (95% CI: 17.8-28.6), PN 8.3% (95% CI: 4.8-11.8), IRR 2.6% (95% CI: 0.5-4.6), PTL 9.5% (95% CI: 5.0-14.1). Most complications (95%) were diagnosed within the first year. Most cases of PN (65%) and PTL (85%) were seen in patients aged 4 years or more. Primary teeth with concussion or subluxation injury carry a low risk of PN and infection with periapical inflammation, root resorption, and PTL. Nearly all complications were diagnosed within the first year after the injury. The risk of PTL was highest in patients more than 4 years of age at the time of injury. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. The Results of Fetal Chondrocytes Transplantation in Patients with Rheumatoid Arthritis

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    Natalya Krivoruchko

    2014-12-01

    .03. Furthermore, patients in the second group had 2.7 times higher risk of ankylosis compared to the first group. We did not observe any complications of fetal chondrocytes transplantation.Conclusions. Application of fetal chondrocytes therapy had the desired clinical effect, which was confirmed by reduction of the RA activity and decrease of cartilage and bone destruction. 

  15. Kaks luustikku Tartu toomkirikust: arheoloogia ja osteoloogia andmed / Two skeletons from the Tartu Cathedral Cemetery: archaeological and osteological data

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    Martin Malve

    2011-01-01

    from slight forms of various spinal diseases, which include Schmorl’s nodes, spondyloarthrosis, and spondylosis. The fourth and fifth cervical vertebrae had ankylosis, the cause of which is unknown. Signs of osteoartrosis, a joint disease, were also noticed. Traumas recorded in the skeleton include a healed fracture of a rib and vertebral compression. The man’s head was decapitated with a sharp blade between the sixth and seventh cervical vertebrae (fig. 7.

  16. Tissue preserving total hip arthroplasty using superior capsulotomy.

    Science.gov (United States)

    Capuano, N; Del Buono, A; Maffulli, N

    2015-08-01

    The goals of a tissue-preserving minimally invasive approach to the hip are to allow early short-term recovery, achieve hip joint stability, minimize muscle strength loss from surgery, spare the peri-articular soft tissues, and allow unrestricted motion in the long term. Hip arthroplasty in patients with no pre-existing hardware, with a sufficient space between the acetabular rim and greater trochanter; management of subcapital femoral fractures in older patients. Protrusio acetabuli. Joint stiffness. This is the main concern when undertaking the superior capsulotomy. Stiffness may result from bone causes, including ankylosis, large osteophytes, bone bridges etc., extra-articular retraction of surrounding soft tissues with capsular contracture of both ligaments and muscles, or a combination of bony and soft tissues causes, resulting in limited adduction. Indeed, maximal adduction is necessary to increase the distance between the apex of the greater trochanter and the superior acetabular edge. In the approach described in the present article, the real limitation is the impossibility to introduce a straight stem through the trochanteric fossa without weakening the trochantericarea. If adduction is restricted, excessive lateralization of the femoral stem would result in postoperative pain and discomfort, especially as we advocate immediate full weight bearing. Even though patients fare better when the trochanteric area is intact, many types of stem such as the GTS (Biomet), or stem Microplasty (Biomet) or even stem Parva (Adler Ortho) may pressurize the internal bone of the trochanteric structures. Therefore, these stems may be implanted in maximal hip adduction. This is the case in coxa profunda or coxa vara, which require more invasive and destabilizing surgical approaches. Lateral position, 5-8 cm incision from the tip of the greater trochanter, identification and transaction of piriformis tendon. Anterior mobilization of the gluteus minimus and exposure of the

  17. Reconstrucción de la articulación temporomandibular postraumática con prótesis a medida: Planificación quirúrgica virtual Post-traumatic reconstruction with custom prosthesis of the temporomandibular joint: Computerized surgical planning

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    Aitor García Sánchez

    2011-06-01

    surgical execution of three cases of bilateral articular ankylosis (6 joints is presented with simulation of osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint. Conclusions: A comprehensive approach to articular biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction.

  18. Tratamento ortodôntico em pacientes com dentes reimplantados após avulsão traumática: relato de caso Orthodontic treatment in patients with reimplanted teeth after traumatic avulsion: a case report

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    Simone Requião Thá Rocha

    2010-08-01

    Full Text Available INTRODUÇÃO: a alta prevalência de indivíduos com traumatismo dentário prévio ao tratamento ortodôntico justifica os cuidados a serem observados antes e durante o tratamento, considerando todas as implicações do movimento ortodôntico sobre os dentes traumatizados. Entre as lesões traumáticas dentárias, a avulsão com posterior reimplantação do dente é a que apresenta maior risco de complicações - como necrose pulpar, reabsorção radicular e anquilose -, sendo também a que inspira maiores cuidados pelo ortodontista. OBJETIVO: este trabalho busca, através do relato de um caso clínico, analisar as implicações do reimplante dentário após avulsão traumática, em pacientes que requerem tratamento ortodôntico. CONCLUSÕES: a movimentação ortodôntica de um dente reimplantado, após sua avulsão traumática, é possível desde que não ocorra qualquer sinal de anormalidade. Porém, dentes que sofrem anquilose não são passíveis de movimentação ortodôntica, mas devem ser preservados como mantenedores de espaço, até a reabsorção total da raiz, desde que não apresentem infraposição severa. Ocorrendo infraposição severa do dente anquilosado, é indicada a amputação da coroa e o sepultamento da raiz, como meio de favorecer a manutenção do osso alveolar na região, pois ocorrerá reabsorção por substituição da raiz sepultada, como ocorreu no caso clínico apresentado.INTRODUCTION: The high prevalence of individuals with dental trauma prior to orthodontic treatment justifies the precautions that should be followed before and during treatment, considering all possible effects of orthodontic movement on traumatized teeth. Among the major traumatic dental injuries, avulsion with subsequent tooth reimplantation entails a higher than average risk of complications, such as pulp necrosis, root resorption and ankylosis. Therefore, it gives orthodontists several reasons for concern. OBJECTIVE: This case report sought

  19. Utilización del colgajo de músculo temporal en cirugía reconstructiva maxilofacial: Revisión de 104 casos Use of the temporalis muscle flap in maxillofacial reconstruction surgery: A review of 104 cases

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    I. Zubillaga Rodríguez

    2004-08-01

    . Aims: To show our indications and results using the temporalis flap in craniofacial reconstruction. Material and methods: A retrospective analysis of our experience with temporalis flap along the last decade. Results: A total of 108 flaps have been used in the following situations: postmaxillectomy defect reconstruction (44; cranial base (25 including anterior, middle and posterior cranial fossas; oral cavity and oropharynx (23; orbital exenteration (6; Temporomandibular joint ankylosis (6; others (2 with an overall success rate (no partial or total flap failure over 94 %. Conclussions: Temporalis muscle flap is one of the «first choice» elections in reconstructive craniofacial surgery, for midfacial and cranial base indications. Non-careful surgical dissection and flap suture under tension predispose to complications such as flap necrosis (commonly partial and wound dehiscence.

  20. Clinical application of PET/CT imaging in search of the primary carcinoma

    International Nuclear Information System (INIS)

    Dang Yaping; Liu Gang; Li Miao

    2004-01-01

    Full text: To explore the clinical value of PET/CT scanning in search of the primary carcinoma, we selected 4 patients who were subjected to PET/CT examination during Oct. 2002 to Dec. 2002. The primary lesion in all these patients was not detected. One of them had metastasis to liver, one had metastases in both lungs and the other two were having metastases to the bones. 18F-FDG in doses of 5.55MBq / kg body weight was injected to a fasting patient (at least 6 hours). PET/CT whole body examination was done using Discovery LS-PET/CT (GE Medical System, U.S.A.) 40-60 minutes later. In the first patient with metastasis to liver, primary lesion was localized in the transverse colon near the liver. The PET/CT showed multiple high radioactive uptake lesions of different sizes in the liver. No obvious change in position of the colon uptake was seen on the delayed images. After PET/CT, barium examination showed thinned cavity of the colon near the liver with coarse ankylosis of colon wall just like saw tooth. The mucous membrane was destroyed. Of the two patients with metastases in the bone, first - a 31 years old, was diagnosed to have primary lung cancer with multiple metastases to the liver and the bones. PET/CT showed high radioactive uptake in the inferior left lobe near the hilum with irregular shaped uneven distribution. A round high radioactive uptake area of 1.82 x 1.84 x 1.46cm size was also seen in the right lobe of the liver having clear edge and uneven distribution. The destroyed bones (L-10, L-11, L-12, T-1 and ala ossis i lii) showed high radioactive uptake. Second patient, 57-year male was diagnosed to have malignant lymphoma. PET/CT fusion showed high radioactive uptake in the marrow of whole body. Few destroyed parts of bones were also seen on CT images. Several cervical and the thoracic vertebrae as well as the ninth rib showed irregular radioactive accumulation with clear edges and well-distributed tracer raising the possibility of multiple myeloma or

  1. HIPEROSTOSIS ESQUELÉTICA DIFUSA IDIOPÁTICA EN UNA COLECCIÓN OSTEOLÓGICA CONTEMPORÁNEA (LA PLATA, BUENOS AIRES, ARGENTINA / Difusse Idiopathic Skeletal Hyperostosis in a contemporary osteological collection (La Plata, Buenos Aires, Argentina

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    Marcos Plischuk

    2015-06-01

    Full Text Available La Hiperostosis Esquelética Difusa Idiopática (DISH es una enfermedad caracterizada por provocar anquilosis entre cuerpos vertebrales, sumada a la osificación masiva de ligamentos y tendones en el resto del sistema esqueletal. El objetivo del presente trabajo es establecer la prevalencia de DISH en una colección osteológica documentada contemporánea y discutir rasgos patognomónicos y factores de riesgo asociados. A fin de establecer un diagnóstico se relevó, en 100 individuos adultos, la formación de bloques óseos de al menos tres vertebras fusionadas por la osificación de ligamento vertebral anterior. Se consideró además que no estuvieran comprometidos los espacios intervertebrales y la articulación sacroilíaca. En la zona extra espinal se registraron como evidencia complementaria la presencia de entesopatías. Como resultado del análisis se observaron seis individuos con DISH, sin diferencias significativas entre ambos sexos. El segmento vertebral principalmente afectado fue el torácico, los espacios intervertebrales no se vieron comprometidos en ningún caso y la articulación sacroilíaca tampoco presentó señales de osificación patológica; a la vez que se relevaron numerosas entesopatías. Las prevalencias observadas se deberían a la avanzada edad de los individuos analizados y las características nutricionales de la población de referencia.  Abstract  The diffuse idiopathic skeletal hyperostosis (DISH is a disease characterized by vertebral ankylosis, with massive ligaments and tendons ossification in the rest of the skeletal system. The aim of this study is to establish the prevalence of DISH in a well-documented and contemporary osteological collection, and to discuss pathognomonic features and associated risk factors. In order to establish the diagnosis, we registered, in 100 adults, the formation of bone blocks, with at least three fused vertebrae by ossification of the anterior vertebral ligament. It was

  2. Image Guidance Technologies for Interventional Pain Procedures: Ultrasound, Fluoroscopy, and CT.

    Science.gov (United States)

    Wang, Dajie

    2018-01-26

    to fluoroscopy. However, further studies are required to prove the efficacy of ultrasound-guided transforaminal epidural injections. SI joint is unique due to its multiplanar orientation, irregular joint gap, partial ankylosis, and thick dorsal and interosseous ligament. Therefore, it can be difficult to access the joint space with fluoroscopic guidance and ultrasound guidance. CT scan, with its cross-sectional images, can identify posterior joint gap, is most likely the best guidance technology for this intervention. Intercostal nerves lie in the subcostal grove close to the plural space. Significant risk of pneumothorax is associated with intercostal blocks. Ultrasound can provide visualization of ribs and pleura. Therefore, it may improve the accuracy of the injection and reduce the risk of pneumothorax. At present time, most pain specialists are familiar with fluoroscopic guidance techniques, and fluoroscopic machines are readily available in the pain clinics. In the contrast, CT guidance can only be performed in specially equipped facilities. Ultrasound machine is generally portable and inexpensive in comparison to CT scanner and fluoroscopic machine. As pain specialists continue to improve their patient care, ultrasound and CT guidance will undoubtedly be incorporated more into the pain management practice. This review is based on a paucity of clinical evidence to compare these guidance technologies; clearly, more clinical studies is needed to further elucidate the pro and cons of each guidance method for various pain management interventions.

  3. Magnetic resonance imaging for ankylosing spondylitis; Magnetresonanztomographie bei ankylosierender Spondylitis (Morbus Struempell-Marie-Bechterew)

    Energy Technology Data Exchange (ETDEWEB)

    Bollow, M. [Augusta-Kranken-Anstalt, Inst. fuer Radiologie, Bochum (Germany)

    2002-12-01

    Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2% is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99% of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5-9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchrondritis of the public symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called 'biologicals' are employed. (orig.) [German

  4. A retrospective study of isolated fractures of the alveolar process in the permanent dentition.

    Science.gov (United States)

    Marotti, Maja; Ebeleseder, Kurt Alois; Schwantzer, Gerold; Jauk, Stefanie

    2017-06-01

    There is a lack of studies of fractures of the alveolar process (FAP). Only five were published in the last 50 years. The aim of this study was to analyze the risk of pulp necrosis and infection (PN), pulp canal obliteration (PCO), infection-related root resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) as well as to identify the possible risk factors for teeth involved in an isolated alveolar process fracture. In the second part, any late complications of the involved teeth were reported in patients who responded to a follow-up examination. This study was a retrospective analysis of 126 patients with 329 traumatized permanent teeth treated in a regional dental trauma clinic. Follow-up examination was performed on 31 (24.6%) patients with 75 (22.8%) teeth. The risks of PN, PCO, RR, MBL, and TL were analyzed using the Kaplan-Meier method. Possible risk factors for PN (stage of root development, fracture position in relation to the root apex, concomitant injury, treatment delay, and antibiotics) were analyzed using univariate and multivariate Cox regression and generalized estimating equation. The level of significance was 5%. Pulp necrosis was observed in 43% of the teeth, and it was significantly associated with the presence of a concomitant injury and complete root formation. PCO was recorded in 2.8%, root resorption (RR, IRR, and ARR) in 4%, MBL in 8%, and TL in 0.6% of the teeth. Thirty-four percent of the teeth were assumed to have normal pulps, but they did not respond to pulp sensibility testing. At the follow-up examination, PN was found in 49%, PCO in 28%, RR (IRR and ARR) in 4%, MBL in 17%, and TL in 5%. Estimated risk after a 5-years follow up was as follows: PN: 48.2% (95% confidence interval (CI): 42.0-54.5), IRR: 7.2 (95% CI: 3.5-10.9), ARR: 33.0% (95% CI: 22.4-43.6), BL: 16.7% (95% CI: 9.6-23.8), TL: 4.0% (95% CI: 0.0-8.5). The following factors significantly increased the risk of PN: mature root

  5. Abnormal Mechanical Loading Induces Cartilage Degeneration by Accelerating Meniscus Hypertrophy and Mineralization After ACL Injuries In Vivo.

    Science.gov (United States)

    Du, Guoqing; Zhan, Hongsheng; Ding, Daofang; Wang, Shaowei; Wei, Xiaochun; Wei, Fangyuan; Zhang, Jianzhong; Bilgen, Bahar; Reginato, Anthony M; Fleming, Braden C; Deng, Jin; Wei, Lei

    2016-03-01

    Although patients with an anterior cruciate ligament (ACL) injury have a high risk of developing posttraumatic osteoarthritis (PTOA), the role of meniscus hypertrophy and mineralization in PTOA after an ACL injury remains unknown. The purpose of this study was to determine if menisci respond to abnormal loading and if an ACL injury results in meniscus hypertrophy and calcification. The hypotheses were that (1) abnormal mechanical loading after an ACL injury induces meniscus hypertrophy and mineralization, which correlates to articular cartilage damage in vivo, and (2) abnormal mechanical loading on bovine meniscus explants induces the overexpression of hypertrophic and mineralization markers in vitro. Controlled laboratory study. In vivo guinea pig study (hypothesis 1): Three-month-old male Hartley guinea pigs (n = 9) underwent ACL transection (ACLT) on the right knee; the left knee served as the control. Calcification in the menisci was evaluated by calcein labeling 1 and 5 days before knee harvesting at 5.5 months. Cartilage and meniscus damage and mineralization were quantified by the Osteoarthritis Research Society International score and meniscus grade, respectively. Indian hedgehog (Ihh), matrix metalloproteinase-13 (MMP-13), collagen type X (Col X), progressive ankylosis homolog (ANKH), ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1), alkaline phosphatase (ALP), inorganic pyrophosphate (PPi), and inorganic phosphate (Pi) concentrations were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay. In vitro bovine meniscus explant study (hypothesis 2): Bovine meniscus explants were subjected to 25% strain at 0.3 Hz for 1, 2, and 3 hours. Cell viability was determined using live/dead staining. The levels of mRNA expression and protein levels were measured using real-time quantitative reverse transcription polymerase chain reaction and Western blot after 24, 48, and 72 hours in culture. The conditioned medium was collected for sulfated

  6. Oclusão Completa do Arco Aórtico em Paciente Portadora de Arterite de Takayasu e Espondilite Anquilosante / Total Aortic arch Occlusion in a Patient with Takayasu's Arteritis and Spondylitis Ankylosans

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    Rodolfo Souza Cardoso

    2015-03-01

    stiffness of the spine, headache, dizziness, absence of pulses in the upper limbs and systemic hypertension. The CT angiography revealed occlusion of the aorta of the supra-aortic trunks (SAT and signals of spondylopathy, characterized by syndesmophytes between vertebral bodies and signs of ankylosis of the sacroiliac joint. The digital subtraction angiography confirmed a complete occlusion of the TSA in its origins and extensive collateral circulation. Treatment was started with immunosuppressants and corticosteroids, and treatment of hypertension, with a reduction in blood pressure and improvement of headache, although a maintenance of low back pain and joint stiffness was observed. Conclusion: The simultaneous occurrence of two seemingly distinct diseases such as TA and AS should be interpreted as the manifestation of a systemic inflammatory condition of unknown etiology not yet fully defined.

  7. Comparative evaluation of the efficacy of radiosynovectomy with conventional intra-articular therapy in rheumatoid arthritis and haemophilic arthropathy (CERAHA)

    International Nuclear Information System (INIS)

    Barrenechea, E.A.; Navarra, S.; Chua, M.

    2005-01-01

    Full text: The objective of this study is to determine the therapeutic efficacy of radiosynovectomy on rheumatoid and hemophilic arthropathy as compared to the usual intra-articular steroids on painful joints. Rheumatoid arthritis is a chronic, systemic and inflammatory disease that involves the joints and is quite disabling. It has a worldwide prevalence of 1%. Hemophilia is a congenital blood disease that produces abnormal bleeding at the musculoskeletal level. It is a sex-linked trait that cause coagulation defects brought about by lack of Factor Vlll for Hemophilia A and Factor lX for Hemophilia B. In this study, under the auspices of IAEA, we used Yttrium 90 colloids and Rhenium 188 intra-articularly in the knee in the experimental group and steroids on the control group. Radioactive colloids (beta radiation) create fibrosis of the hypertrophic and highly vascularized synovium. It leads to coagulation necrosis and sloughing of the cells, destroying diseased pannus and inflamed synovium with the hope that the regenerating synovium, after destruction, will be free of the disease. Included in this study were established cases of RA set by the American Rheumatoid Assn which are stage 1, 2, and 3 by Larsen classification, no ankylosis, non-responders for NSAIDS and DMARDS for at least 6 months and with their informed consent. For the hemophilic group, they should have at least 3 bleeding episodes for the last six months and at least with 30% coagulopathy at the time of the procedure. Exclusion criteria included being pregnant or lactating, with infection on site of injection, beyond stage 3 and presence Baker's cyst. Baseline radiography and two-phase bone scans were taken as well as repeating these procedures at 6 an 12 months post-treatment. There were 39 evaluable patients under the experimental group consisting of 18 RA patients (mostly females) and 21 HA patients (all males). Thirty-eight patients were given Yttrium-90 colloid with doses ranging from 60 Mbq to