To determine the value of MRI in temporomandibular joint (TMJ) disorders, the data of MRI-proven anterior disc dislocation without reduction (ADWOR) were correlated with clinical history and clinical data. MRI demonstrated degenerative bony changes and a reduced sagittal diameter of the condyle, a variable degree of disc deformation, and a thinned bilaminar zone in each of the joints with ADWOR, which clearly differed from patients with anterior disc dislocation with reduction (ADWR) (P = .01) and normal disc position (NDP) (P < .001). Of 59 patients and 83 TMJs that had been investigated in a 2-year period, as shown by MRI, 22 patients (27 TMJs) had ADWOR (32%), 16 joints had NDP (19%), and 40 patients had ADWR (49%). In patients with ADWOR, the clinical history revealed pain in either of the joints and/or cervical or masticatory muscles in 25 (93%) joints. Clinical investigation revealed various abnormalities in 22 joints; five of those presented without any pathologic clinical finding. Mouth opening was unlimited in nine patients (47%), palpation of the muscles of mastication was painless in 13 patients (52%), and joint noises during mouth opening or closing were noted in 14 patients (56%). According to clinical histories, four patients were suspected to have become symptomatic only after dental treatment. ADWOR is difficult to diagnose with clinical methods alone. The indication for MRI evaluation of the TMJ should be extended for asymptomatic patients with a history of limitation in mouth opening and pathologic x-ray morphology of the condyle. Because symptoms may arise after dental treatment in these patients, aggravation of internal derangement may be avoided by careful handling.

Adult↗

PubMedDate not supplied

The transformation of laryngeal keratosis into invasive carcinoma.

Although 93.0% to 97.0% of all laryngeal carcinomas are diagnosed on the first biopsy, 3.0% to 6.7% of them occur in patients who have what is initially diagnosed as "laryngeal keratosis." To study this phenomenon, we examined data from 1,019 patients with laryngeal keratosis seen between 1962 and 1981. Eleven patients with keratosis and initially undetected cancer at different laryngeal sites were excluded, as were 87 outside referrals for whom no records were available beyond the histologic report. The remaining 921 patients were classified on the basis of the initial histologic findings into groups comprising 604 patients with keratosis without atypia (group 1), 204 patients with mild atypia (group 2), 23 patients with moderate atypia (group 3), and 90 patients with severe atypia (group 4). All 921 were followed for from 5 to 25 years. Invasive carcinoma of the larynx developed in 18 patients from group 1 (3.0%), 15 from group 2 (7.4%), four from group 3 (17.4%), and 25 from group 4 (27.8%). Fifty-seven patients (91.9%) developed invasive carcinoma after less than 10 years but only five (8.1%) did so after 10 years or more.

Adolescent↗

PubMedDate not supplied

Droperidol--a preferred neuroleptic in narcoanalysis.

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Adolescent↗