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PubMed1992

A comparative study of three therapeutic modalities in a temporomandibular disorder (TMD) population.

A comparative study of three treatment modalities, pharmacologic, occlusal appliance, and their combined use, was conducted to test their therapeutic efficacy on 61 temporomandibular disorder (TMD) patients. Alprazolam (Xanax) was used for the pharmacologic treatment; the occlusal appliance therapy consisted of a flat maxillary stabilization splint. Of the 61 patients, 19 received Alprazolam, 30 received occlusal appliance therapy, and 12 received combined therapy. Subjects were examined at two-week intervals for two months. Only 42 patients attended all follow-up visits. Eight parameters were studied: severity of pain, periodicity of pain, self-evaluated stress, muscle sensitivity to palpation, joint sensitivity to palpation, joint noises, limitation of opening, and limitation of lateral movement. No significant difference was found between the treatment modalities for most of the parameters. All three proved to be effective. Alprazolam increased the restricted mandibular movement, was least effective on joint sensitivity to palpation, and had no effect on joint noises. The combined treatment approach not only failed to prove superior to the other treatments, but showed less improvement in some parameters, possibly due to the small sample.

Alprazolam↗
PubMed1993

A clinical observation: a relationship of occlusal contacts to distal musculature.

Dentists treating craniomandibular dysfunction frequently encounter pain and dysfunction in seemingly unrelated distal areas of the body. This is a study using manual palpation to demonstrate a change in distal muscle pain response caused by altering an apparent noxious tooth contact. Forty-four (n = 44) patients with a defined muscle involvement were selected for this study. After isolating one tooth and the single contact that influenced the muscles under observation, one or two slight alterations were made to the contact to redirect the occlusal force in all but the four control subjects. Thirty-eight (n = 38) patients showed marked relief in tenderness to palpation following minute tooth alteration in the muscles being observed. Two (n = 2) showed slight improvement. No significant change in pain to palpation was noted in the control group (n = 4). The results suggest that altering an apparent noxious occlusal contact has a direct influence on muscles in other parts of the body.

Adolescent↗
PubMed1998

Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration.

The application of fine-needle aspiration (FNA) to the evaluation of the thyroid nodule has greatly enhanced the ability of the clinician to appropriately select patients for thyroidectomy. However, despite extensive experience with thyroid FNA, the cytological distinction of benign from malignant follicular neoplasia remains problematic. As a result, most patients with FNA findings of a follicular neoplasm are referred for thyroidectomy. The goal of the present study was to develop clinical criteria capable of predicting malignancy in patients with an FNA diagnosis of follicular neoplasm. Among 1121 patients undergoing thyroid FNA at two large teaching centers during the period 1990 to 1995, 149 patients had cytological findings consistent with a follicular neoplasm. Among 103 patients referred for thyroidectomy, 22 (21%) were found to have a malignancy in the biopsied nodule. Among patients subjected to thyroidectomy, the risk of malignancy was significantly higher when follicular neoplasia was present in a male (43% vs. 16% for females, p = 0.007), when the nodule was greater than 4 cm to palpation (40% vs. 13% for nodules less than 4 cm, p = 0.03), or when the nodule was judged to be solitary by palpation (25% vs. 6% for a dominant nodule in a multinodular goiter, p = 0.02). Bayesian analysis of the data reveals that after an FNA showing a follicular neoplasm, the risk of malignancy in males with large nodules was nearly 80%, compared with a rate of only 3% in females with small nodules. These results suggest that clinical features including gender, nodule size, and character of the gland by palpation can be systematically integrated into the decision analysis, thereby improving the selection of patients for surgical referral.

Bayes Theorem↗
PubMed2003

Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy.

BACKGROUND: Clinical and histopathologic characteristics that may predict risks of recurrence in women with ductal carcinoma in situ (DCIS) have not been consistently identified. We identified factors associated with recurrence as DCIS versus invasive breast cancer and determined the 5-year absolute risks of recurrence as a function of these factors. METHODS: We conducted a population-based cohort study among 1036 women in the San Francisco Bay Area who were aged 40 years or older when diagnosed with DCIS and treated by lumpectomy alone from January 1983 through December 1994. Standardized pathology reviews were conducted to determine disease recurrence, defined as DCIS or invasive breast cancer diagnosed in the ipsilateral breast containing the initial DCIS lesion or at a distant site more than 6 months after the initial diagnosis and treatment of DCIS. Conditional logistic regression models were used to determine factors associated with recurrence. All statistical significance tests were two-sided. RESULTS: During a median follow-up of 77.9 months, 209 women (20.2%) experienced a recurrence. Overall, the 5-year risks of recurrence as invasive cancer and as DCIS were 8.2% (95% confidence interval [CI] = 6.6% to 9.8%) and 11.7% (95% CI = 9.9% to 13.3%), respectively. The 5-year risks of recurrence as invasive cancer and as DCIS were 4.8% (95% CI = 3.7% to 6.8%) and 4.8% (95% CI = 3.8% to 5.8%), respectively, for women with low-nuclear-grade DCIS; 11.8% (95% CI = 9.9% to 14.1%) and 17.1% (95% CI = 15.5% to 18.7%), respectively, for women with high-nuclear-grade DCIS; 11.6% (95% CI = 11.3% to 12.0%) and 8.6% (95% CI = 7.1% to 10.2%), respectively, for women whose initial DCIS lesion was detected by palpation; and 6.6% (95% CI = 6.2% to 7.1%) and 14.1% (95% CI = 11.4% to 17.8%), respectively, for women with DCIS detected by mammography alone. High- (versus low-) nuclear-grade DCIS lesions and detection of the initial DCIS lesion by palpation (versus mammography) were associated with recurrence as invasive cancer. High- (versus low-) nuclear-grade lesions; resection margins that were positive, uncertain, or less than 10 mm disease-free (versus > or = 10 mm disease-free); and age 40-49 years at diagnosis (versus > or =50 years) were associated with recurrence as DCIS. CONCLUSIONS: Nuclear grade is strongly associated with recurrence but not with the type of recurrence. Women with high-nuclear-grade DCIS or DCIS detected by palpation who are treated by lumpectomy alone are at relatively high risk of having an invasive breast cancer recurrence, compared with women with low-nuclear-grade or mammographically detected DCIS, and may be appropriate candidates for additional treatment.

Adult↗
PubMed1985

The prevalence of appendiceal fecaliths in patients with and without appendicitis. A comparative study from Canada and South Africa.

Appendicitis is more common in developed than in developing societies and appendiceal fecaliths are thought to have an etiologic role in the disease. The geographic distribution of appendiceal fecaliths was investigated by systematic, intraoperative palpation of the appendix in patients in Toronto, Canada and Johannesburg, South Africa. The incidences of fecaliths found on pathologic sectioning of the appendix in appendicitis patients in both societies were compared. In the Canadian population, the prevalence of fecaliths in patients whose appendices were palpated incidentally was 32% versus 52% for those with appendicitis (p less than 0.01). In the African population, the prevalence of fecaliths in patients whose appendices were palpated incidentally was four per cent versus 23% for those with appendicitis (p = 0.04). The difference in prevalence of incidental appendiceal fecaliths in the two populations was statistically significant (p less than 0.005). The prevalence of fecaliths is higher in developed countries, such as Canada, than in developing countries, such as Africa, and is also higher in patients with than in those without appendicitis. These data support the theory that the low-fiber diets consumed in developed countries lead to fecalith formation, which then predisposes to appendicitis.

Adolescent↗
PubMed1994

Assessment of basic physical examination skills of internal medicine residents.

BACKGROUND: Internal medicine faculty at the Mayo Clinic designed a clinical evaluation exercise that separates assessment of physical examination skills from that of medical interviewing and reasoning skills. This report summarizes the first year's experience with assessment of basic physical examination skills. METHOD: A core faculty of five general internists and three internist subspecialists designed a 45-item general examination checklist (e.g., measure blood pressure, examine mouth, palpate liver, drape to ensure privacy). In addition, the core faculty generated a menu of 27 focused examination skills (e.g., examine for carpal tunnel syndrome) from which the faculty examiner would select five items for the resident to perform. Each checklist item was scored 0, 1, or 2 for a maximum possible score of 100. The core faculty selected a criterion-based scoring reference and established a passing score of 90 based on practice examinations with residents and faculty. The core faculty made an instructional videotape of a model examination that was available to all residents. In 1991-92, prior to examination, the checklist was distributed to all first-year categorical (43), preliminary (25), and newly appointed second-year residents (eight). RESULTS: Of the 76 residents examined, 11 (14%) failed and 65 (86%) passed. All failing scores were 86 or lower. The absence of scores 87, 88, and 89 suggested that faculty upgraded borderline performances. All 11 residents who initially failed retook the examination and passed. The five most commonly missed items were (1) inspect the skin, (2) complete examination in logical sequence, (3) palpate aorta, (4) auscultate anterior breath sounds, and (5) palpate axillary and inguinal nodes. Other important observed errors were failure to measure vital signs, confusion of liver and spleen, failure to use bell on stethoscope, and inadequate breast examination. Twenty-eight residents completed an optional feedback form. Reviews were mixed but generally favorable. CONCLUSION: Assessment of the basic physical examination skills of the internal medicine residents was useful, and such skills were able to be assessed separately from physical diagnosis skills and interviewing skills. Direct observation of basic physical examination skills revealed important deficiencies, which provided opportunity for remediation.

Adult↗
PubMed1999

Does spinal instrumentation influence the healing process of posterolateral spinal fusion? An in vivo animal model.

STUDY DESIGN: An in vivo sheep model was used to investigate the effect of spinal instrumentation on the healing process of posterolateral spinal fusion. OBJECTIVES: To examine the role of spinal instrumentation during the healing process of posterolateral fusion. SUMMARY OF BACKGROUND DATA: In long bone fractures, internal fixation improves the union rate but does not accelerate the healing process. Spinal instrumentation also improves the fusion rate in spinal arthrodesis. However, it remains unclear whether the use of spinal instrumentation expedites the healing process of spinal fusion. METHODS: Sixteen sheep underwent posterolateral spinal arthrodeses at L2-L3 and L4-L5 using equal amounts of autologous bone. One of those segments was selected randomly to be augmented with transpedicular screw fixation (Texas Scottish Rite Hospital spinal system). The animals were killed at 8 weeks or 16 weeks after surgery. Fusion status was evaluated by biomechanical testing, manual palpation, plain radiography, computed tomography, and histology. RESULTS: Instrumented fusion segments demonstrated significantly higher stiffness than did uninstrumented fusions at 8 weeks after surgery. Radiographic assessment and manual palpation showed that the use of spinal instrumentation improved the fusion rate at 8 weeks (47% versus 38% in radiographs, 86% versus 57% in manual palpation). Histologically, the instrumented fusions consisted of more woven bone than the uninstrumented fusions at 8 weeks after surgery. The 16-week-old fusion mass was diagnosed biomechanically, radiographically, and histologically as solid, regardless of pedicle screw augmentation. CONCLUSION: The current study's results demonstrated that spinal instrumentation creates a stable mechanical environment to enhance the early bone healing of spinal fusion.

Animals↗
PubMed2001

2000 Young Investigator Research Award winner. Evaluation of OP-1 as a graft substitute for intertransverse process lumbar fusion.

STUDY DESIGN: An established rabbit intertransverse process lumbar fusion model was used to evaluate osteogenic protein (OP)-1 as a potential graft substitute. OBJECTIVES: To determine whether OP-1 is effective in producing intertransverse process lumbar fusion in a rabbit model. SUMMARY OF BACKGROUND DATA: Autogenous iliac crest bone is the gold standard in grafting material for inducing intertransverse process fusion. However, bone graft substitutes are being considered as supplementary or alternative means to achieve such fusion with less morbidity. Relatively little research has been undertaken to investigate the efficacy of OP-1 in this role. METHODS: Single-level intertransverse process lumbar fusions were performed at L5-L6 of 31 New Zealand White rabbits. These were divided into three study groups: autograft, carrier alone, and carrier with OP-1. The animals were killed 5 weeks after surgery. Resultant fusion masses were evaluated by manual palpation, radiography, biomechanical multidirectional flexibility testing, and histology. RESULTS: Seven rabbits (23%) were excluded because of complications. Of the remaining 24 rabbits, 5 (63%) of the 8 in the autograft group had fusion detected by manual palpation, none (0%) of the 8 in the carrier-alone group had fusion, and all 8 (100%) in the OP-1 group had fusion. Radiographs were 55% sensitive and 92% specific for determining fusion. Biomechanical testing results correlated well with those of manual palpation. Histologically, autograft specimens were predominantly fibrocartilage, OP-1 specimens were predominantly maturing bone, and carrier-alone specimens did not show significant bone formation. CONCLUSIONS: OP-1 was found to reliably induce solid intertransverse process fusion in a rabbit model at 5 weeks.

Animals↗
PubMed2004

Comparison of posterolateral lumbar fusion rates of Grafton Putty and OP-1 Putty in an athymic rat model.

STUDY DESIGN: Posterolateral lumbar spine fusions in athymic rats. OBJECTIVES: To compare spine fusion rates of two different osteoinductive products. SUMMARY OF BACKGROUND DATA: Many osteoinductive bone graft alternatives are available. Grafton (a demineralized bone matrix [DBM]) and Osteogenic Protein-1 (OP-1, an individual recombinant bone morphogenetic protein) are two such alternatives. The relative efficacy of products from these two classes has not been previously studied. The athymic rat spine fusion model has been validated and demonstrated useful to minimize inflammatory responses to xenogeneic or differentially expressed proteins such as those presented by DBMs of human etiology. METHODS: Single-level intertransverse process fusions were performed in 60 athymic nude rats with 2 cc/kg of Grafton or OP-1 Putty. Half of each study group was killed at 3 weeks and half at 6 weeks. Fusion masses were assessed by radiography, manual palpation, and histology. RESULTS: At 3 weeks, manual palpation revealed a 13% fusion rate with Grafton and a 100% fusion rate with OP-1 (P = 0.0001). At 6 weeks, manual palpation revealed a 39% fusion rate of with Grafton and a 100% fusion rate with OP-1 (P = 0.0007). Similar fusion rates were found by histology at 3 and 6 weeks. Of note, one or two adjacent levels were fused in all of the OP-1 animals and none of the Grafton animals. CONCLUSIONS: Significant differences between the ability of Grafton and OP-1 to induce bone formation in an athymic rat posterolateral lumbar spine fusion model were found.

Activin Receptors, Type I↗
PubMed2005

Alendronate inhibits spine fusion in a rat model.

STUDY DESIGN: A posterolateral lumbar fusion model in rats. OBJECTIVE: To study the effects of alendronate on posterolateral lumbar fusion in rats. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no studies that show a significant inhibition of manual palpation-assessed spine fusion by alendronate. METHODS: A total of 75 Sprague-Dawley rats underwent intertransverse fusion with 7-tailbone autograft at L4-L5. Animals received saline (control), alendronate equivalent to human dose (dose1, 5 microg/kg/day), or 10 times the human dose (dose10, 50 microg/kg/day) via subcutaneous osmotic pumps starting the day of surgery. Eight weeks after surgery, animals were euthanized, and fusion was assessed by manual palpation. Radiographic area and optical density of fusion masses were calculated. Histomorphometry was used to assess the percentage area of fusion masses occupied by bone or marrow tissues. RESULTS: Manual palpation fusion rates were lower in alendronate groups (50% and 40%, respectively) than in the control group (95%, P = 0.002). Interobserver and intraobserver kappa values were high (0.97-1.00). There were dose-dependent and statistically significant (P < 0.001) increases in fusion mass area and optical density with increasing alendronate dose. Fusion masses in dose10 animals had significantly higher percent area of bone tissue (P = 0.01) and lower percent area of marrow elements (P < 0.001) when compared to control animals. CONCLUSIONS: Alendronate inhibits spine fusion in rats. Fusion masses in alendronate-treated animals appeared radiographically larger and denser than those in control animals despite lower fusion rates. Quantitative histomorphometry confirmed that alendronate inhibited bone graft resorption and incorporation. We recommend that patients undergoing spine arthrodesis should not take alendronate until fusion is achieved.

Alendronate↗
PubMed2005

The efficacy of different commercially available demineralized bone matrix substances in an athymic rat model.

OBJECTIVE: Bone graft substitutes have been developed because there is a limited supply of autogenous graft and the harvesting of iliac crest bone graft is associated with significant morbidity. Currently, there are a number of different commercially available demineralized bone matrix (DBM) products available that have been prepared by different methods and have different carriers. The objective of this study was to compare eight different commercially available DBM products. METHODS: Eight different DBMs were used to attempt a spinal fusion between the L4-L5 transverse processes in athymic rats. There were 10 rats in each group, and 5 rats were killed at both 4 and 8 weeks. Radiographic and histologic analyses were performed. Manual palpation testing was also performed. RESULTS: At 4 weeks, Osteofil Paste had the highest radiographic scores, whereas Grafton Putty had the best radiographic scores at 8 weeks. Conversely, the spines implanted with Allomatrix had the lowest radiographic scores at both 4 and 8 weeks. In regard to forming a spinal fusion confirmed by manual palpation, Osteofil Paste was the most effective at 4 weeks, whereas Grafton Flex and Grafton Putty had the highest rate of fusion at 8 weeks. Conversely, the lowest rates of fusion were seen in the Allomatrix and Grafton Crunch groups. Statistical analysis showed that there were significant differences among the groups seen on radiographs and by manual palpation. Qualitative differences could be appreciated between the groups histologically. CONCLUSION: Significant differences exist among commercially available DBMs in forming a spinal fusion in an athymic rat.

Animals↗
PubMed2003

Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: a case-control study.

PURPOSE: Men with chronic pelvic pain syndrome (CPPS) type III experience pelvic pain of uncertain etiology. Pain has been attributed to prostatic, bladder and muscular origins. Few studies have documented pelvic and abdominal muscle function in men with CPPS or compared their muscular examination to that of men without pain. We hypothesized that the musculoskeletal examinations of men with CPPS types IIIA and IIIB would show more spasm, tenderness and dysfunction than in men without CPPS. MATERIALS AND METHODS: A total of 62 men with CPPS and 89 healthy men without pelvic pain underwent a standardized musculoskeletal examination by a licensed physical therapist. RESULTS: Controls and patients with pain showed a significant difference in muscle spasm, increased muscle tone, pain with internal transrectal palpation of the pelvic muscles, and increased tension and pain with palpation of the levator ani and coccygeus muscles (p <0.001). Patients with pain also had significantly greater pain and tension with palpation of the psoas muscles and groin. Patients and controls did not differ significantly in strength testing of the lower abdominal and oblique muscles. CONCLUSIONS: Men with CPPS have more abnormal pelvic floor muscular findings compared with a group of men without pain. Abnormalities of the pelvic muscles may contribute to this pain syndrome.

Abdominal Muscles↗
PubMed1984

Prevalence of mandibular dysfunction in 10-18 year old Israeli schoolchildren.

The prevalence of mandibular dysfunction in a sample of 369 Israeli schoolchildren was found to be 56.4%, indicating that one or more of the cardinal symptoms were present. It increased with age from about 51% in the 10-13 year old group to 67.8% in the 16-18 year olds. The most common cardinal sign of dysfunction was joint sounds (35.8%), which increased with age from 28% in the youngest group to 44.3% in the oldest group. The second most common sign was joint sensitivity to palpation (30.4%), which showed a slight increase in the oldest group. Sensitivity of the superficial muscles was recorded third, with 20%. Joint pain and restriction of mandibular movement appeared infrequently. Two of the more common cardinal symptoms, namely joint sounds and muscle sensitivity, were statistically related to several possible aetiological factors and to age and sex. Analysis of association showed that the probability of muscle sensitivity increased in the presence of malocclusion and/or joint sensitivity to palpation. It also showed that age, occlusal wear, locking of the jaw and joint sensitivity to palpation increased the probability of joint sounds.

Adolescent↗
PubMed1994

Ultrasonography of the bovine postpartum uterus with retained fetal membranes.

The aim of this study was to describe the potential application of ultrasound in combination with the rectal palpation method and to compare the results to determine the involution period in 11 Swedish dairy cows with retained fetal membranes (RFM). The animals were examined three times a week during the first 8-week postpartum (PP) period. Significant quantity of abnormal vaginal discharges with concomitant accumulation of snowy fluid and thickening of the endometrial and uterine walls were interpreted as evidence of endometritis. The discharges decreased most markedly during the third week PP concomitantly with a marked decrease in the cervical and uterine size. Resumption of cyclical ovarian activity occurred within a month in 7 animals. Five of these cows had 2 ovulations and two animals had 1 and 3 ovulations, respectively. A slight increase of the cervix and uterine size was observed in all ovulating animals in relation to the oestrous periods. Several different calculation methods of the ultrasonographic results were evaluated to describe the completion of uterine involution and compared with findings at rectal palpation. The best congruency with rectal palpation was found to use a 0.5 cm difference for comparison of the previous pregnant and non-pregnant uterine horns in singleton cows and an 80% reduction of the uterine size in all studied animals.

Animals↗
PubMed1993

Intra-operative ultrasound for the detection of hepatic metastases from colorectal cancer.

The aim of this study was to compare the accuracy of intra-operative ultrasound (IOUS) with other imaging modalities and with surgical palpation in detecting liver metastases from colorectal cancer (CRC). Intra-operative ultrasound was performed in 100 patients undergoing surgery for CRC. All patients had pre-operative liver function tests, transcutaneous ultrasound and computerized tomography (CT) scan of the liver. The liver was palpated intra-operatively by a surgeon who was unaware of the pre-operative findings. The liver was then assessed by IOUS. Intra-operative ultrasound detected more patients with metastases than either CT scan, transcutaneous ultrasound or surgical palpation. It also detected a greater number of smaller metastases in these patients and allowed better anatomical definition compared with pre-operative investigations.

Adult↗
PubMed2006

Localization of small pulmonary nodules for videothoracoscopic surgery.

The aim of this study is to discuss and summarize the localization of small pulmonary nodules for video-thoracoscopic surgery. Thirty-eight patients were selected, 22 men and 16 women, and they underwent video-assisted thoracoscopic surgery resection for small pulmonary nodules: 28 patients for small solitary pulmonary nodules and 10 patients for multiple small pulmonary nodules. In all cases, resection of the nodules was successful. Localization methods included: (i) computed tomography (CT)-guided methylene blue labelling for preoperative localization; (ii) a high-quality chest CT scan for preoperative localization; (iii) visual exploration, digital palpation and 'instrumental' palpation to locate the nodule; and (iv) endosonographic inspections of intraoperative localization. Using a combination of CT scan, digital palpation, methylene blue labelling and endosonographic inspections, all nodules were successfully localized and resected without significant complications. Video-assisted thoracoscopic surgery is an effective approach but the small lung nodules (especially those less than 1.0 cm in diameter) localized at thoracoscopic resection must be treated carefully. Combined imaging and thoracoscopic techniques may help identify small nodules.

Adult↗
PubMed1997

Levator ani function before and after childbirth.

OBJECTIVE: To evaluate pelvic floor muscle strength before and after vaginal birth. DESIGN: Prospective repeated measures study. SETTING: Main district hospital. POPULATION: Fifty-five women: 25 primiparae and 20 multiparae following vaginal birth, and 10 women following elective caesarean delivery as a control group. METHODS: Pelvic muscle strength was evaluated by palpation, perineometry and perineal ultrasound before childbirth in the 36th to 42nd week of pregnancy, three to eight days postpartum and six to ten weeks postpartum. MAIN OUTCOME MEASURES: Pelvic floor muscle strength on palpation, intravaginal squeeze pressure and vesical neck elevation during squeeze. RESULTS: Pelvic floor muscle strength is significantly reduced three to eight days postpartum in women following vaginal birth but not in women after caesarean delivery. Six to ten weeks later palpation and vesical neck elevation on perineal ultrasound do not show any significant differences to antepartum values, while intravaginal pressure on perineometry remains significantly lower in primiparae, but not in multiparae. CONCLUSIONS: Pelvic floor muscle strength is impaired shortly after vaginal birth, but for most women returns within two months.

Adult↗
PubMed1983

Clinical, microscopical and biochemical investigation of synovial fluid from temporomandibular joints.

The aim of this study was to investigate the relationship between pain and tenderness to palpation of the temporomandibular joint (TMJ), radiographic changes of the joint and signs of inflammation in the synovial fluid. Saline was injected into and aspirated from the TMJ of 29 patients with painful and tender TM joints and from five individuals with healthy joints. In another two patients synovial fluid could be aspirated without saline. The aspirated fluid was analyzed for inflammatory cells and for plasma proteins. A clinical examination of the stomatognathic system and a radiographic examination of the TMJ were performed before the aspiration. Besides tenderness to palpation of the TMJ, pain on mandibular movement and tenderness to palpation of the masticatory muscles were common. Erosion of the cortical outline of the joint surfaces was the most common radiographic finding. Inflammatory cells were present in the fluid of three patients but in none of the healthy individuals. Plasma proteins of inflammatory type could be detected in the fluid from seven of the patients. The results show that radiographic, cellular or biochemical signs of inflammation can frequently be found in the TMJ of patients with longstanding pain and tenderness of this joint.

Adolescent↗