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Biomedical subjects

R P Juniper

Publications and source records attributed to R P Juniper.

At least 19 recordsLinked to original sources
PubMed1999

Association between paroxysmal trigeminal neuralgia and atypical facial pain.

Paroxysmal trigeminal neuralgia and atypical facial pain are both fairly common conditions that produce pain in the face of different character. Trigeminal neuralgia is sharp and shooting, brought on by facial movement, change of temperature and by touching the face at a specific point (the trigger point). Atypical facial pain is dull and unrelenting and its site is ill-defined. Trigeminal neuralgia is generally more common in older people, and affects women slightly more than men, and atypical facial pain generally affects younger people, with women predominating. The pains should never be confused. We have noticed that many patients with trigeminal neuralgia have additional symptoms of atypical facial pain and so we reviewed the records of the Pain Relief Unit retrospectively. Of the 83 patients identified with trigeminal neuralgia where records were adequate, 35 (42%) also had atypical facial pain. Five of these had developed it before the onset of trigeminal neuralgia and could be examples of pretrigeminal neuralgia. There were eight patients in the series with multiple sclerosis, of whom two also had atypical facial pain. There seemed to be no relationship between the development of atypical facial pain and the interventions used to treat trigeminal neuralgia. It is important that both conditions are identified and treated individually.

Acute Disease↗
PubMed1998

Re-accreditation, re-certification and the postgraduate database.

A consultation paper from the GDC has suggested that there will be a re-accreditation and re-certification procedure for dental practitioners which will require evidence of continuing postgraduate education. There is debate as to how that information should be held and who should hold it.

Accreditation↗
PubMed1997

Morphometric analysis of the insertion of the upper head of the lateral pterygoid muscle.

OBJECTIVE: This article reports on the morphometric characteristics of the upper head of the lateral pterygoid muscle. STUDY DESIGN: Several morphologic characteristics were initially examined in 40 postmortem specimens. The length of the upper head of the lateral pterygoid muscle was determined in 34 specimens. Of the 26 specimens in which the upper head of the lateral pterygoid muscle was found to be inserted into the meniscus and condyle, 22 specimens were examined microscopically to morphometrically quantify the proportion of muscle fibers to their respective insertions. RESULTS: The upper head of the lateral pterygoid muscle was approximately 33.3 mm in length and was significantly longer in males. There were no age-related differences. Approximately 29.5% of the fibers of this muscle were inserted into the meniscus of the temporomandibular joint. CONCLUSION: This study demonstrated that the insertion of the upper head of the lateral pterygoid muscle to the meniscus ranged from a fleshy mass to a few fibers. The number of fibers entering both the meniscus and the condyle decreased correspondingly as they approached the joint and could be interpreted as this muscle having a tendon of insertion into the meniscus.

Adult↗
PubMed1996

Ibuprofen compared with ibuprofen plus caffeine after third molar surgery.

OBJECTIVES: To compare the relative merits of single doses of ibuprofen and ibuprofen plus caffeine in the treatment of pain after third molar removal. DESIGN: Randomised, double-blind, placebo-controlled, single-dose parallel-group comparison of placebo, ibuprofen 200 and 400 mg with ibuprofen 200 mg plus 50, 100 or 200 mg of caffeine. SUBJECTS: 161 patients undergoing lower third molar removal. RESULTS: All active treatments produced significant analgesia and mood elevation compared with placebo. There was no significant difference in the effects of 200 and 400 mg of ibuprofen. Adding caffeine to 200 mg ibuprofen produced significantly more analgesic effect at 45 and 60 min than ibuprofen 200 mg alone. Ten patients reported 11 adverse effects, none in the highest caffeine dose group. CONCLUSIONS: Caffeine increased the analgesic effect of ibuprofen 200 mg, through an earlier onset of analgesic effect. This was achieved in this single dose context without problematic adverse effects.

Adult↗
PubMed1994

The development of the human lateral pterygoid muscle and the temporomandibular joint and related structures: a three-dimensional approach.

The development of the human fetal temporomandibular joint and surrounding structures was investigated in 11 specimens on the basis of histologic examination and three-dimensional reconstructions. Until the 10th week, there were no signs of the disc, joint spaces and capsule formation of the temporomandibular joint (TMJ). Apart from Meckel's cartilage, all the temporomandibular joint and related structures attained their adult shape at 14 weeks. Throughout the embryologic and fetal development, the relative positions of the branches of the mandibular nerve remained unchanged. From 11-12 weeks onwards, the lateral pterygoid muscle became a complex structure which was segmented by aponeuroses dividing the muscle into three main parts: superior, infero-medial and infero-anterior parts. The superior segment was attached to the TMJ disc superiorly and medially. The infero-medial segment was inserted onto the antero-medial aspect of the TMJ condyle and disc. The infero-anterior portion was attached to the anterior aspect of the condyle.

Embryonic and Fetal Development↗
PubMed1994

The shape of the condyle and position of the meniscus in temporomandibular joint dysfunction.

The position of the meniscus seems to be significant in the natural history of temporomandibular joint dysfunction. It can be identified on MRI and arthrography but generally its displacement is referred to only in the sagittal plane. Little consideration is given to the shape and size of the condyle which could have great influence upon the position which the meniscus takes up. This paper reports the findings in 105 TM joints which have had arthrotomy for meniscoplasty (meniscopexy) and menisectomy over an 8-year period. Only 30% of the condyles had a normal size and shape; 24% were excavated on the medial side, 15% had lost the anterior surface of the condyle and were oblique in shape, 15% were small and round, while 12.5% were flattened, two having no discernable condyle at all. The meniscus was found to be displaced anteromedially most commonly, with the anterior position, to which reference is so frequently made, being rare; the medial position was more common. The significance of these findings is discussed with particular reference to imaging.

Cartilage, Articular↗
PubMed1993

A multiple dose comparison of ibuprofen and dihydrocodeine after third molar surgery.

The objectives were to compare the relative merits of ibuprofen 400 mg and dihydrocodeine 30 mg or 60 mg taken up to four times daily for up to 6 days in the treatment of pain after third molar removal. A randomised, double-blind, multiple dose, crossover study was undertaken in 68 patients undergoing two-stage bilateral lower third molar removal. The results showed that ibuprofen produced significantly greater analgesia than either of the dihydrocodeine treatments on the day of surgery. Ibuprofen and dihydrocodeine 60 mg produced significantly greater analgesia than dihydrocodeine 30 mg on the day after surgery, and on days 4 and 5 ibuprofen was again significantly superior to dihydrocodeine 60 mg. Roughly half the patients taking dihydrocodeine stopped the study on the day after surgery, because of adverse effects and/or inadequate relief, compared with 6 out of 44 taking ibuprofen. Dihydrocodeine 60 mg produced four times the number of patients affected by adverse effects compared with ibuprofen, and dihydrocodeine 30 mg three times as many. The principal adverse effects were nausea, vomiting and drowsiness. In conclusion, ibuprofen produced better analgesia than dihydrocodeine with significantly fewer adverse effects and is therefore a better choice for pain relief after oral surgery.

Administration, Oral↗
PubMed1993

The embryologic development of the human lateral pterygoid muscle and its relationships with the temporomandibular joint disc and Meckel's cartilage.

The morphology of the developing lateral pterygoid muscle and its relationships with the temporomandibular joint disc and Meckel's cartilage were studied in 16 human embryos and fetuses ranging in age from 5 weeks to 14 weeks. All the temporomandibular joint structures and the lateral pterygoid muscle assumed their adult shapes by the 14th week of fetal life. At this stage, the lateral pterygoid muscle is a complex structure with several aponeuroses dividing the muscle into three main parts: superior, inferomedial, and inferoanterior. The superior part is attached to the disc superiorly and medially. The inferomedial part inserts into the anteromedial aspect of the condyle and disc. The inferoanterior portion is attached to the anterior aspect of the condyle. Anteriorly, the buccal nerve and associating blood vessels traverse the muscle in a mediolateral direction, dividing it into superior (small) and inferior (large) compartments. Posteriorly, the muscle remains intact with no separation. The lateral pterygoid muscle fibers show no direct attachment to Meckel's cartilage at any stage of development.

Cartilage↗
PubMed1993

Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction.

In this study, audiological assessments of the 57 patients with temporomandibular joint dysfunction and 57 controls were made. The analyses of audiograms, tympanograms and Eustachian tube functions showed no significant differences statistically. A slight increase in compliance peak in 48 female patients suggests that the sound conducting structures of the middle ear could be influenced by the reflex spasm of the tensor tympani muscle to a minor degree. This change does not seem to cause a major dysfunction either in the middle ear or in the Eustachian tube.

Acoustic Impedance Tests↗
PubMed1992

Workload in oral and maxillofacial surgery: analysis of time trends from linked statistics in a defined population.

Data from the Oxford Region were used to study trends in hospital admission rates and demographic profiles of hospital care in the National Health Service in oral and maxillofacial surgery. In a defined population of 1.9 million people, admission rates for inpatient care, day case care, and outpatient attendance rates all almost doubled between 1975-1985. Population-based age-specific admission rates were much higher in teenagers and young adults than in other age-groups. In these age-groups admission rates for females were about double those for males. Whilst perhaps not surprising to the oral and maxillofacial surgeon, these demographic profiles of workload are strikingly different from those found in most other hospital specialties.

Adolescent↗
PubMed1992

A multiple dose comparison of combinations of ibuprofen and codeine and paracetamol, codeine and caffeine after third molar surgery.

In a randomised, double-blind, double-dummy, multiple dose, crossover study in 30 patients we compared an ibuprofen/codeine combination (400 mg ibuprofen/25.6 mg codeine phosphate) with a paracetamol/codeine/caffeine combination (1 g paracetamol/16 mg codeine phosphate/60 mg caffeine) for pain relief over 6 days after two-stage bilateral lower third molar removal. The ibuprofen combination produced significantly greater analgesia than the paracetamol combination, both on single-dose analysis of the first and second days and on multiple-dose measures for days 1, 2, 3 and 4. The mean incidence of adverse effects over the 6 days was 20% for both combinations. This trial design (crossover with multiple dosing in outpatients) is a sensitive way of testing for analgesia, and is potentially more predictive of adverse effect problems than single-dose studies. It confirms that multiple dosing may show increased efficacy.

Acetaminophen↗
PubMed1991

Trigeminal neuralgia--treatment of the third division by radiologically controlled cryoblockade of the inferior dental nerve at the mandibular lingula: a study of 31 cases.

Cryoblockade of the peripheral nerve affected by trigeminal neuralgia is an established technique for treatment. Freezing the inferior dental nerve using C-arm image-intensification control, and a nerve stimulator to guide the slim Spembly Lloyd probe, offers an additional technique for treatment of a small number of patients with trigeminal neuralgia. This paper reports the results of 31 cryoblockades of the inferior dental nerve in 11 patients.

Adult↗
PubMed1990

Peripheral streptomycin/lidocaine injections versus lidocaine alone in the treatment of idiopathic trigeminal neuralgia. A double blind controlled trial.

Seventeen patients with long-lasting idiopathic trigeminal neuralgia (ITN) were treated with either five, weekly peripheral streptomycin/lidocaine (S/L) or lidocaine alone injections, in a double blind controlled study. Eight patients responded initially to the treatment in the S/L group and three patients in the lidocaine group. Pain recurred in four patients from the S/L group within two weeks and six months following the last injection. One patient from the lidocaine group remained pain-free for eight months. At the final assessment, three patients from the S/L group and two patients from the lidocaine group remained pain-free up to 30 months. Neither treatment affected sensory functions of the injected nerves. It is concluded that S/L injections are initially effective in the treatment of ITN. In the long term, however, their effects are similar to the effects of lidocaine alone.

Aged↗