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Biomedical subjects

A Isberg

Publications and source records attributed to A Isberg.

At least 37 records · Page 2Linked to original sources
PubMed1998

Persistent dysphagia after laser uvulopalatoplasty: a videoradiographic study of pharyngeal function.

In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

Adult↗
PubMed1998

Incidence of temporomandibular joint changes after whiplash trauma: a prospective study using MR imaging.

OBJECTIVE: The purpose of this study was to describe the incidence of temporomandibular joint (TMJ) changes after a well-defined whiplash trauma. SUBJECTS AND METHODS: Sixty consecutively admitted patients with symptoms in the neck after rear-end traffic collisions underwent MR imaging of the TMJs within 3-14 days after the collisions. Fifty-three healthy volunteers constituted a control group. RESULTS: No statistically significant differences were found between the 60 patients and the 53 volunteers regarding frequency, stage, grade, or direction of TMJ disk displacement or joint effusion. MR imaging revealed that 45% of the control group and 53% of the patient group had a displaced disk in one or both TMJs (p = .393). Disk displacement was seen in 35% of TMJs in the control group and 40% of TMJs in the patient group. Effusion was seen in 8% of TMJs in the control group and 6% of TMJs in the patient group. No signs of bleeding or edema in the soft tissues were observed. In 15% of the patients, mild clinical symptoms in the TMJ or masticatory muscles developed in association with the trauma; in one third of these patients the symptoms were transient. CONCLUSION: This prospective study does not show any significantly increased incidence of disk displacement, joint effusion, or any other injury to the TMJ after whiplash trauma that could be revealed by MR imaging.

Adolescent↗
PubMed1996

Magnetic resonance imaging of the temporomandibular joint: value of pseudodynamic images.

Magnetic resonance fast scanning technique (gradient recalled acquisition at steady state) has been reported to be useful when evaluating the dynamics of the temporomandibular joint and also to be accurate for determining the disk position. Yet in our clinical experience gradient recalled acquisition at steady state images have frequently been inferior to proton density images for diagnosis of temporomandibular joint internal derangement. The first aim of this study was to compare gradient recalled acquisition at steady state images with proton density images for diagnosis of disk position. The second aim was to identify what additional information could be gathered from gradient recalled acquisition at steady state images when compared with static proton density images. We obtained unilateral images from 20 patients with signs and symptoms of temporomandibular joint internal derangement and from 20 asymptomatic volunteers. Multiple gradient recalled acquisition at steady state images were obtained during mouth opening and closing and proton density images were obtained at the closed and open mouth positions. The results showed that the gradient recalled acquisition at steady state images were in accordance with the proton density images in 32 joints (80%) and were false negative in 8 joints (20%). Six of the joints with false-negative gradient recalled acquisition at steady state images showed sideways disk displacement, and two showed partial anterior disk displacement. Gradient recalled acquisition at steady state images, on the other hand, provided information about movement pattern and also demonstrated impingement of the joint structures on the muscles anterior to the joint at maximal mouth opening. It was concluded that gradient recalled acquisition at steady state images cannot replace proton density images for diagnosis of disk position but they can provide supplementary information for evaluation of joint function.

Adolescent↗
PubMed1995

Steepness of the articular eminence in the temporomandibular joint. Tomographic comparison between asymptomatic volunteers with normal disk position and patients with disk displacement.

OBJECTIVE: A steep articular eminence has been proposed as one etiologic factor for the development of TMJ disk displacement. The purpose of this study was to determine the steepness of the articular eminence in asymptomatic volunteers with superior disk position and to compare it with the articular eminence in patients with internal derangement. STUDY DESIGN: We investigated 34 asymptomatic volunteers and 71 patients. The steepness of the articular eminence was determined on sagittally corrected tomograms, and disk position was diagnosed by dual space arthrotomography. RESULTS: The results showed that the articular eminence was on the average steeper in the asymptomatic volunteers in the lateral (64.9 degrees), central (64.4 degrees), and medial (65.4 degrees) sections of the joint than in the patients (56.1 degrees, 60.2 degrees, 58.9 degrees, respectively). When the comparison of the steepness of the eminence was based on the presence or absence of osseous changes in the form of remodeling or osteoarthrosis, no difference was found between the asymptomatic volunteers and the patients with disk displacement but without such changes. The largest difference in the steepness of the eminence was found between the persons with osseous changes and those without. CONCLUSION: These findings contradict earlier studies that have indicated a steep articular eminence to be one etiologic factor for the development of disk displacement. The results of this study showed that the steepness of the articular eminence is decreased in the patients as a result of remodeling or degenerative changes of the bone that are a result of the internal derangement.

Adolescent↗
PubMed1995

Condyle position in the temporomandibular joint. Comparison between asymptomatic volunteers with normal disk position and patients with disk displacement.

Though the significance of condyle-fossa relationship in the temporomandibular joint has not yet been clarified and normal condyle position not yet defined, efforts have been made to guide the mandibular condyle into a centric position in the glenoid fossa with the aim of relieving the symptoms in patients with orofacial pain and temporomandibular joint internal derangement. The present study investigated the mandibular condyle position in 34 joints in asymptomatic volunteers with normal disk position as verified by arthrography and compared it with the mandibular condyle position in 85 joints in patients with different stages of internal derangement. The results showed that in the volunteers with normal joints including normal superior disk position, the condyles were almost randomly distributed in anterior, centric, and posterior positions in the glenoid fossa. Of the joints with anterior disk displacement approximately half of the number of joints with reducing disks and two thirds of the joints with nonreducing disks appeared to have posterior condyle position. Posterior condyle position cannot, however, be used to diagnose internal derangement because the condyle was found to be either in anterior or centric position in many joints with a displaced disk. The variety in condyle position in the healthy joints ought to be taken into consideration if treatment is chosen to normalize the mandibular condyle position by bringing it into a centric position in the glenoid fossa.

Adolescent↗
PubMed1995

Tinnitus in patients with temporomandibular joint internal derangement.

Tinnitus has commonly been reported in patients with temporomandibular joint (TMJ) disorders. The aim of this study was to determine if there was any correlation between arthographically verified disk displacement of the TMJ and ear symptoms related to tinnitus. Fifty-three patients with unilateral tinnitus and disk displacement and 82 individuals with disk displacement, but no tinnitus, were analyzed. Disk displacement was found to be present in the ipsilateral joint in all 53 patients with unilateral tinnitus, while the contralateral joint was asymptomatic in 50 (94.3%) of them. Patients with tinnitus suffered more extensive and intense pain in the oro-facial area compared to patients without tinnitus. The results of this study revealed a significant correlation between internal derangement of the TMJ and tinnitus.

Adolescent↗
PubMed1995

Velopharyngeal incompetence and persistent hypernasality after adenoidectomy in children without palatal defect.

Persistent hypernasal speech after adenoidectomy has been reported in children with palatal deficiency. Hypernasality after adenoidectomy can also occur in children with normal palatal function. The aim of the present study was to identify the cause of velopharyngeal incompetence and hypernasality after adenoidectomy in children who did not have palatal defect as a predisposing factor. Sixteen children who developed hypernasality after adenoidectomy were included in the present study. Standard lateral cephalometry, videofluoroscopy, and nasopharyngoscopy were performed to visualize the velopharynx and its function during speech. The results showed that enlarged tonsils and prominent remaining adenoid tissue on the posterior pharyngeal wall were the causes of hypernasality in these children. Incomplete removal of the adenoid tissue should be avoided and enlarged tonsils should be removed at the time of adenoidectomy to prevent the risk for postoperative hypernasality.

Adenoidectomy↗
PubMed1994

Comparison of tongue position during speech before and after pharyngeal flap surgery in hypernasal speakers.

Tongue position was cineradiographically analyzed during speech, before and after pharyngeal flap surgery, in 19 hypernasal cleft palate speakers with acceptable articulation and in 10 noncleft reference individuals. The results showed that the position of the tongue was significantly retracted during production of the consonants (/ti/, /ki/, and /ka/) in the cleft palate speakers with VPI compared to the reference individuals. Following pharyngeal flap surgery, the position of the tongue remained different in cleft palate speakers compared to reference individuals, although the articulation quality and resonance were evaluated to have normalized in almost all the speech samples produced by cleft palate speakers. It was suggested that the cleft palate speakers with VPI may exploit the plasticity of the speech system in order to achieve perceptually good speech, even though their tongue movements might be different from tongue movement in noncleft speakers.

Adult↗
PubMed1994

The influence of pharyngeal flap on facial growth. Long-term results in the patients with isolated cleft palate.

The facial growth of 22 children from 6 to 17 years of age with repaired isolated cleft palate was studied. Eleven patients had had posterior pharyngeal flap surgery at about 7 years of age and were examined one year before, and three and 10 years after, flap surgery. The other eleven patients served as matched references. The convexity of the facial profile decreased significantly in both groups. There were differences in growth between the two groups in the variables that concerned mandibular position and anterior facial height. The results indicated that the reference individuals had achieved more anterior growth rotation during the development of the face. There was no improvement in mandibular retrognathism in the flap group until the patients were 10 years of age, but the mandible then resumed the normal anterior rotation and had caught up with the reference group after puberty, to result in a facial form with no significant difference from that in adolescents with cleft palate and without pharyngeal flaps. We suggest that the influence of a pharyngeal flap on facial growth has no long term clinical importance in patients with an isolated cleft palate, but the impact of the temporary change in facial growth after pharyngoplasty should be taken into consideration when orthodontic treatment is planned.

Adolescent↗
PubMed1993

Interactive influence of a pharyngeal flap and an adenoid on maxillofacial growth in cleft lip and palate patients.

The aim was to evaluate whether a large adenoid, which aids velopharyngeal function, influences facial growth and if a pharyngeal flap reinforces the effect. Forty cleft palate patients were divided into two groups: adenoid and nonadenoid. Twenty of the patients had a pharyngeal flap operation. All the patients had three cephalograms taken at the same ages over a period of 5 years. At an average age of 4.7 years, i.e., one year before any pharyngoplasty, the mandibular inclination was larger in the adenoid group. This inferioposterior mandibular position was aggravated when a flap was added and with age. The present study suggests that the nasopharyngeal space, which is indicative of nasal airway patency, is influenced by a pharyngeal flap as well as an adenoid which, in turn, influences facial growth direction in the cleft palate population. Airway variables ought to be taken into consideration when the growth effect of cleft palate treatment is evaluated.

Adenoids↗
PubMed1993

Facial growth after pharyngeal flap surgery in cleft palate patients: a five-year longitudinal study.

To assess the influence of a pharyngeal flap on facial morphology in patients with cleft lip and palate, we studied prospectively 20 consecutive patients with cleft lip and palate aged 4 to 9 years who needed a pharyngeal flap. We also studied a control group of 20 subjects matched with regard to age, sex, diagnosis, and method of primary treatment. Facial growth was followed for five years, beginning one year before operation. Before operation there was no significant difference between the operated group and the reference group as far as skeletal facial dimensions and angular measurements were concerned. The longitudinal comparison within each group showed that there was a change in mandibular growth direction backwards and downwards in the operated group. The changes in facial growth after pharyngeal flap operation were similar to those reported in patients with enlarged adenoids. Four years after operation, the change in the direction of mandibular growth did not result in any specific facial form that could be identified clinically.

Child↗
PubMed1992

Tongue posture in cleft palate patients with a pharyngeal flap.

Position of the tongue was studied in lateral cineradiographic pictures of 15 patients with cleft palate and velopharyngeal incompetence, and from ten unaffected reference subjects. The patients were examined before and after pharyngoplasty. Before operation there was no difference in the degree of tongue/velum contact between the patients and the reference subjects, but after the operation, contact was lost in 13 of the 15 patients because the tongue was lowered and the velum raised by the pharyngeal flap. This contradicts the previous theory that the position of the tongue should be expected to be higher to maintain the posterior oral seal. The tongue was in a more posterior position in the patients than in the reference subjects both before and after operation. After operation the tip of the tongue retracted into the anterior oral cavity. The posterior and downward change in position of the tongue may account for part of the posterior and downward growth pattern of the lower third of the face which occurs in children after pharyngoplasty. A loss of tongue-lip balance around the premaxilla may be one of the factors that causes the maxillary retrusion that has been reported after pharyngoplasty in patients with cleft palates.

Adult↗
PubMed1991

The anterosuperior insertion of the temporomandibular joint capsule and condylar mobility in joints with and without internal derangement: a double-contrast arthrotomographic investigation.

The insertion of the anterior temporomandibular joint capsule at the temporal bone constitutes an anatomic boundary of the joint. When condylar translation exceeds this site, the joint is classified as hypermobile. In this study, the distance from the apex of the articular eminence to the antero-superior capsule insertion was assessed in double-contrast arthrotomograms from 192 joints with and without disc displacement. Maximum condylar translation was also measured. The insertion point of the antero-superior capsule was, on the average, located 4.4 mm (SD, 1.7 mm) anterior to the apex of the eminence, regardless of disc position. Hypermobility was present in 56 joints. Sixty-eight percent of the hypermobile joints had a reducing disc and 62% of all the joints with a reducing disc were hypermobile. In joints with permanent disc displacement, the condyle generally was halted posterior to the apex of the eminence, but could pass extensively anterior to it. Condylar hypermobility thus does not exclude the presence of a permanently displaced disc. In 71% of patients with hypermobility, the condition was bilateral. Because of the close topographic relationship between the joint and nerve branches in the anterior vicinity of the joint, a hypermobile condyle may mechanically irritate the masseteric and deep posterior temporal nerve branches.

Adolescent↗
PubMed1991

Frequency of bilateral temporomandibular joint disc displacement in patients with unilateral symptoms: a 5-year follow-up of the asymptomatic joint. A clinical and arthrotomographic study.

Bilateral arthrotomography was performed in 50 consecutive patients with unilateral symptoms of disc displacement to evaluate the frequency of temporomandibular joint disc displacement in asymptomatic joints. Using well-defined clinical criteria, there were no false-positive findings of either reducing or non-reducing discs. On the other hand, a risk of false-negative diagnosis of non-reducing disc was apparent. Sixty per cent of the patients had a non-reducing displaced disc in the asymptomatic joint. Most of these patients could recall a previous spell of discomfort from this joint. Severe or moderate deformation had taken place in non-reducing discs, while reducing discs were normal in shape or had, at most, a thickening of the posterior band. The duration of symptoms was significantly correlated with the degree of deformation in the symptomatic joints (P less than 0.01). Perforation was statistically, significantly correlated with disc deformation and, in symptomatic joints, hard tissue changes. Fifty-seven per cent of the asymptomatic joints with displaced discs developed pain following the onset of symptoms from the contralateral side, most within 2 years. Less than half of them were free of pain at the end of the 5 year follow-up period. In view of this tendency for an asymptomatic joint with a displaced disc to subsequently develop pain refractory to treatment, such a joint must be considered a weakened link in the craniomandibular system, vulnerable to changes in mandibular function such as, for instance, displacement of the disc on the contralateral side.

Adolescent↗
PubMed1991

A cineradiographic study of velopharyngeal movements for deviant versus nondeviant articulation.

Five patients who displayed both glottal stop compensations and normal articulatory placement and production during connected speech and also had weak pressure articulatory consonants and hypernasal resonance had cineradiographic study of their velopharyngeal movements. The results showed that velopharyngeal movements were impaired during weak pressure consonants whereas velopharyngeal valving was maximal when articulation was not impaired. Velopharyngeal movements were the worst when glottal stop substitutions were produced. Poor quality or absence of velopharyngeal movements in connection with deviant articulation could be erroneously interpreted as weakness or incapability of motor activity if nondeviant articulation is not observed in individual patients.

Adult↗
PubMed1991

Comparison between multiview videofluoroscopy and nasendoscopy of velopharyngeal movements.

The videofluoroscopic and nasopharyngoscopic observations of velopharyngeal movements during speech were compared in 80 subjects with hypernasal speech. An endviewing flexible fiberoptic endoscope was used for nasopharyngoscopic examination. This failed to demonstrate movements of the lateral pharyngeal walls that were videofluoroscopically documented in one third of the patients. In the cases of disagreement, the angle of view was impaired because of the presence of adenoid tissue. The misinterpretation at nasopharyngoscopy was explained by an unfavorable observation position of the flexible scope and failure to pass it further into the pharynx. Conclusions are satisfactory that videofluoroscopy is an indispensable procedure for assessing velopharyngeal function.

Adolescent↗
PubMed1990

A radiographic and histologic study of the topographic relations in the temporomandibular joint region: implications for a nerve entrapment mechanism.

A radiographic and histologic investigation was performed in 18 temporomandibular joint (TMJ) autopsy specimens. Disc position was determined arthrotomographically. The pathway of the nerve branches in the vicinity of the joint was reconstructed from serial sagittal or frontal histologic sections. The relationship between the joint components and the different nerves running in the vicinity of the joint was studied. The results revealed the existence of topographical prerequisites for mechanical influence upon the nerve branches passing in the TMJ region. In two joints, both with a displaced disc, the auriculotemporal nerve trunk was almost in contact with the medial aspect of the condyle instead of having its normal sheltered course at the level of the condylar neck, thus exposing the nerve to the risk of mechanical irritation during condylar movements in an anteromedial direction. Two joints with normal disc position had an extension of the medial fossa wall in a caudal direction. In these joints the auriculotemporal nerve had its course between the condyle and the elongated fossa wall, exposing it to the risk of mechanical irritation during medial disc displacement. Compression of the masseteric nerve anterior to the TMJ was found in one joint with excessive condylar translation. The deep posterior temporal nerves may pass close to the anterior insertion of the joint capsule on the temporal bone, exposing them to the risk of mechanical irritation when there is condylar hypermobility. It was also found that the inferior alveolar and the lingual nerves may pass close to the medial part of the condyle. In joints with this nerve topography, a medially displaced disc could interfere mechanically with these nerves. These findings could offer an explanation for the sharp, shooting pain felt locally in the joint with jaw movements and the pain and other sensations projecting to the terminal area of distribution of the nerve branches in the vicinity of the TMJ such as the ear, temple, cheek, tongue, and teeth.

Aged↗