Metastatic cancer presenting as TMD--again. A case report.
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Biomedical subjects
Publications and source records attributed to H V Cohen.
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The dentist's responsibility in managing patients should include the awareness that not every pain in the face is due to a toothache or a temporomandibular disorder (TMD). This paper reviews the case of a 66-year-old patient who presented to the dental office with a chief complaint of unilateral jaw pain. The symptoms seemed consistent with TMD. Two years prior, the patient had undergone successful removal of a cancerous prostate and had remained under urologist care with a favorable prognosis. Subsequent imaging studies confirmed that the facial pain was due to multiple metastatic lesions to areas including the zygoma, infratemporal fossa, maxilla and brain. However, these metastatic lesions were not of prostate origin, but rather were from a squamous cell carcinoma originating in a primary site other than the prostate.
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The dentist who manages temporomandibular disorders must choose among multiple imaging techniques when temporomandibular joint imaging is to be part of the diagnostic workup. By using a selective imaging approach, the practitioner can intelligently acquire the temporomandibular joint image that will complement his or her clinical findings. The purpose of this article is to present the advantages and technology of the more commonly available imaging techniques. Other factors that influence modality selection also will be discussed.
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This article illustrates the need for specific diagnosis of temporomandibular joint disorder patients. The latest concepts of different phases of treatment are reviewed and explained. A process of weaning and the necessity of proper appliance design to maintain tooth position and dental arch integrity are discussed.
Evaluation of the nonresorbable particulate form of hydroxylapatite for localized ridge augmentation has been described. The surgical technique using this material is simple and effective, and produces an improved ridge base for pontic function. Six-month postoperative examination showed the area to be clinically stable with significant improvement of cosmetic appearance. The augmented area of the ridge was convex and had improved contour in width and height.
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The urgent or after hours phone call to the dentist's office usually indicates a dental, traumatic, infectious, or pain emergency relating to the teeth or adjacent supporting structures. One subject not discussed at length in the professional literature is the emergency patient with acute pain or dysfunction of the orofacial musculoskeletal system, primarily the muscles of mastication and the temporomandibular joint (TMJ). The practitioner should be able to rapidly and efficiently diagnose and manage these emergency patients, or make adequate referral as necessary. Essential features in the diagnosis involve distinguishing muscle problems from intracapsular disorders. Knowledge of general medical-dental differential diagnosis is essential to rule out those problems masquerading as muscle or TMJ disorders. Proper emergency management is directed at controlling the pain or hypomobility disorder and stabilizing the patient. Contrary to most other aspects of dental practice, rapid and complete elimination of symptomatology may not be possible at this visit. Subsequent management should further define the pathologic process and direct the patient to additional phases of care. This report suggests a series of diagnostic and therapeutic guidelines.
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