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  • 1.
    Ahlqvist, Jan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bryndahl, Frerik
    Umeå University, Faculty of Medicine, Department of Odontology.
    Eckerdal, Olof
    Isberg, Annika
    Sources of radiographic distortion in conventional and computed tomography of the temporal bone.1998In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 27, no 6, p. 351-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To identify those bony regions of the glenoid fossa where, due to the inclination, there is an increased risk of radiographic distortion in conventional and computed tomography (CT).

    METHODS: The inclination of the roof and posterior wall of the glenoid fossa was determined relative to established imaging planes. Measurements were performed on 50 corrected coronal MR and 50 axial CT images and 200 sagittal cryosections of 50 temporomandibular joints (TMJs). The location of regions with unfavourable bone wall inclination was identified using the condyle as a reference.

    RESULTS: The inclination of parts of the fossa roof exceeded the limit for reliable depiction in corrected sagittal and coronal planes in 40% and 8% of the joints respectively. The inclination of parts of the posterior wall of the fossa exceeded the limit for reliable depiction in corrected sagittal and in true sagittal planes in 100% and 84% of the joints respectively. In 84% of the joints the inclination exceeded the limit for reliable depiction in the axial plane. For both bone walls the regions with unfavourable inclination were in the medial part of the joint.

    CONCLUSIONS: The angulation of parts of the roof and posterior wall of the glenoid fossa in relation to established imaging planes makes them highly susceptible to distortion. The oblique coronal projection is well suited for depiction of the roof of the fossa and preferable to a sagittal projection. An oblique axial projection is required for the posterior wall.

  • 2.
    Ahlqvist, Jan
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Validity of computed tomography in imaging thin walls of the temporal bone1999In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 28, no 1, p. 13-19Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the validity of computed tomography (CT) for reproduction of the bone margins of the temporomandibular joint (TMJ).

    METHODS: Seven TMJ specimens were examined with a CT and then cryosectioned. The bone separating the TMJ from the middle cranial fossa, middle ear and external auditory canal was measured as the full width at half maximum (FWHM). Measurements were compared with the true thickness of the bone wall.

    RESULTS: There was good agreement when the bone walls were thicker than 1 mm: accuracy was influenced only by the angle of the bone wall to the scanning plane. Conversely, bone walls thinner than 1 mm were reproduced with a magnification that increased with decreasing bone thickness. The difference increased further as the inclination of the bone wall became greater.

    CONCLUSION: Measurements performed at FWHM are reliable within +/- 10% for bone walls more than approximately 1 mm thick which form an angle of less than 35 degrees to the perpendicular of the scanning plane. For bone walls thinner than 1 mm and for those thicker than 1 mm with an inclination exceeding approximately 35 degrees, partial volume effects result in a progressively increasing magnification of bone thickness.

  • 3.
    Bodin, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Intraoral sensation before and after radiotherapy and surgery for oral and pharyngeal cancer.2004In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 26, no 11, p. 923-929Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with unilateral oral or pharyngeal cancer often receive bilateral radiotherapy because of the potential for metastases. Because postoperative sequelae are evident on the tumor side, to date little attention has been paid to sensory alterations after radiotherapy on the healthy, nontumor side. The objective of this study was to investigate possible sensory alterations. METHODS: Intraoral sensation was tested bilaterally at standardized sites in 27 patients and 20 controls. Preoperative radiotherapy was bilateral in 19 patients and unilateral in eight patients. Patients were tested before treatment, after radiotherapy, and after surgery at 6 months and 1 year. Comparisons were performed interindividually and intraindividually and between groups. RESULTS: A delayed deterioration of sensation was revealed on the nontumor side 6 months after radiotherapy. There was no recovery 1 year after treatment. CONCLUSIONS: Intraoral sensation cannot be evaluated directly after radiotherapy. It is plausible that sensory deterioration after radiotherapy has an impact on functional rehabilitation after tumor treatment.

  • 4.
    Bodin, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Odontology.
    Lind, Magnus
    Henningsson, Gunilla
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Deterioration of intraoral hole size identification after treatment of oral and pharyngeal cancer.1999In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 119, no 5, p. 609-616Article in journal (Refereed)
    Abstract [en]

    Thirty-one patients with a diagnosed malignant tumour of the oral cavity or pharynx were tested in hole size identification on four test occasions: before all treatment, after radiotherapy and 6 months and 1 year after surgical treatment. They were compared within groups as well as with a group of healthy reference individuals of the same age who underwent the same test procedure at a 2 months' interval. The oral group did not decline in hole size identification after radiotherapy, but did after surgery. The deterioration was persistent 1 year after surgery. The pharyngeal group did not change performance in hole size identification after radiotherapy, nor after surgery. It is obvious that surgery of the oral structures causes the deterioration. No correlation with damage to the lingual nerve could be registered. The oral cavity reacts as one unit, despite sensory input from two sides. The non-operated side does not compensate for the operated side. It is plausible that decreased oral sensory acuity, in recognizing hole size of the bolus, contributes to postoperative swallowing problems.

  • 5.
    Bodin, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lind, Magnus
    Henningsson, Gunilla
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Deterioration of intraoral recognition of shapes after treatment of oral and pharyngeal cancer.2000In: Otolaryngology and head and neck surgery, ISSN 0194-5998, E-ISSN 1097-6817, Vol. 122, no 4, p. 584-589Article in journal (Refereed)
    Abstract [en]

    Thirty patients with diagnosed malignant tumors of the oral cavity or pharynx were tested in regards to intraoral shape recognition at 4 test occasions: before all treatment, after radiotherapy, 6 months after surgery, and 1 year after surgery. They were compared within groups as well as with a group of healthy reference individuals of the same age who underwent the same test procedure at a 2-month interval. The tumor itself did not influence the capability of shape recognition. The reference individuals demonstrated significantly better results on the second test occasion, which is known as a learning effect. Learning improvement was not seen in the patients whose second test occasions were after radiotherapy, implying an impediment amounting to the magnitude of the learning effect. At 6 months after surgery the patients' capabilities of shape recognition had deteriorated significantly with no difference between the oral cancer group and the pharyngeal cancer group. No spontaneous rehabilitation had taken place 1 year after surgery. The presence or absence of surgical lingual nerve damage did not influence the results. The nonoperated side does not compensate for the operated one. It is plausible that decreased oral sensory acuity in recognizing the shape of the bolus contributes to postoperative swallowing problems.

  • 6.
    Bryndahl, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Eriksson, Lars
    Malmö högskola.
    Legrell, Per Erik
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Bilateral TMJ disk displacement induces mandibular retrognathia2006In: Journal of dental research, ISSN 0022-0345, Vol. 85, no 12, p. 1118-1123Article in journal (Refereed)
  • 7.
    Bryndahl, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Legrell, Per Erik
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Eriksson, Lars
    Malmö Högskola.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology. Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Titanium screw implants in optimization of radiographic evaluation of facial growth in longitudinal Animal studies2004In: The angle orthodontist, ISSN 0003-3219, Vol. 74, no 5, p. 610-617Article in journal (Refereed)
  • 8.
    Bryndahl, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Warfvinge, G
    Eriksson, L
    Isberg, A
    Cartilage changes link retrognathic mandibular growth to TMJ disc displacement in a rabbit model2011In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 40, no 6, p. 621-627Article in journal (Refereed)
    Abstract [en]

    Recent experimental research demonstrated that non-reducing temporomandibular joint (TMJ) disc displacement in growing rabbits impaired mandibular growth. TMJ disc displacement is also shown to induce histological changes of the condylar cartilage. The authors hypothesized that the severity of these changes would correlate to the magnitude of mandibular growth. Bilateral non-reducing TMJ disc displacement was surgically created in 10 growing New Zealand White rabbits. Ten additional rabbits constituted a sham operated control group. Aided by tantalum implants, growth was cephalometrically determined for each mandibular side during a period equivalent to childhood and adolescence in man. At the end of the growth period, histologically classified cartilage features were correlated with the assessed ipsilateral mandibular growth. Non-reducing displacement of the TMJ disc during the growth period induced histological reactions of the condylar cartilage in the rabbit model. The severity of cartilage changes was inversely correlated to the magnitude and the direction of mandibular growth, which resulted in a retrognathic growth pattern.

  • 9.
    Bryndahl, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Warfvinge, Gunnar
    Malmö högskola.
    Eriksson, Lars
    Malmö högskola.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Cartilage changes link retrognathic growth to TMJ disk displacementManuscript (preprint) (Other academic)
  • 10.
    Bryndahl, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Warfvinge, Gunnar
    Rabie, A Bakr M
    Isberg, Annika
    Subchondral bone loss explains retrognathic mandibular growth at TMJ disk displacementManuscript (preprint) (Other (popular science, discussion, etc.))
  • 11.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    The life-threatening TMD2009In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903, Vol. 27, no 1, p. 1-2Article in journal (Refereed)
  • 12.
    Isberg, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Kreiner, Marcelo
    Craniofacial pain: authors' response2007In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 4, p. 440-441Article in journal (Refereed)
  • 13.
    Isberg, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Salé, Hanna
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Recalling pain: author's response2011In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 142, no 1, p. 24-24Article in journal (Refereed)
  • 14.
    Isberg, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Salé, Hanna
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    TMJ and whiplash: reply2007In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 11, p. 1422-1422Article in journal (Other academic)
  • 15.
    Jäghagen, Eva Levring
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Dahlqvist, Ake
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Isberg, Annika
    Prediction and risk of dysphagia after uvulopalatopharyngoplasty and uvulopalatoplasty.2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 10, p. 1197-1203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that preoperative asymptomatic pharyngeal swallowing dysfunction predisposes for the development of symptoms of dysphagia after uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP). MATERIAL AND METHODS: A total of 42 patients who snored were scheduled to undergo UPPP (n = 20) or UPP (n = 22). UPP was performed using either a CO2 laser or a conventional steel scalpel. Preoperatively and 1 year postoperatively all patients were examined videoradiographically to assess pharyngeal swallowing function. They also completed a questionnaire pre- and postoperatively concerning their snoring problems and swallowing function as well as the outcome of surgery. RESULTS: Preoperatively, 7 (17%) patients reported dysphagia. Pharyngeal swallowing dysfunction was demonstrated in 6/7 patients with preoperative dysphagia while pharyngeal swallowing dysfunction was evident preoperatively in 18/35 non-dysphagic patients. Of the 35 patients without preoperative dysphagia, 10 (29%/) developed dysphagia after surgery. There was no significant risk of development of postoperative dysphagia for patients with compared to patients without preoperative pharyngeal swallowing dysfunction. Only one of the seven patients with preoperative dysphagia experienced worsening of the problem. A total of 93% of the patients reported a decrease in snoring and 95% reported a decrease in daytime sleepiness. CONCLUSIONS: Preoperative pharyngeal swallowing dysfunction was not proven to predict the development of dysphagia after UPPP or UPP. The surgical method did not influence the frequency of postoperatively acquired dysphagia. The results do not indicate that patients with preoperative dysphagia should be excluded from treatment with UPPP or UPP.

  • 16.
    Kreiner, Marcelo
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Alvarez, R
    Michelis, V
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Muñiz, R
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Craniofacial pain of cardiac origin is associated with inferior wall ischemiaManuscript (preprint) (Other academic)
  • 17.
    Kreiner, Marcelo
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Alvarez, Ramón
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Michelis, Virginia
    Muñiz, Rosana
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Craniofacial pain of cardiac origin is associated with inferior wall ischemia2014In: Journal of oral & facial pain and headache, ISSN 2333-0384, Vol. 28, no 4, p. 317-321Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate possible associations between the presence of craniofacial pain of cardiac origin and the location of cardiac ischemia and conventional risk factors. Methods: A total of 326 consecutive patients with confirmed myocardial ischemia (192 males, 134 females, mean age 64 years) were studied. Demographic details, health history, risk factors, prodromal symptoms, electrocardiogram (ECG) findings, and pain characteristics during the ischemic episode were assessed. The location of the ischemia according to the ECG findings was categorized as anterior, inferior, or lateral. Univariate chi-square analyses and a multivariate logistic regression model were used for data analysis. Two age subgroups (< 65 and > 65) were established when controlling for covariates. Results: Craniofacial pain of cardiac origin was significantly associated with an inferior localization of cardiac ischemia (P < .001) and was more frequently reported in diabetic patients (P = .014). Thirty-eight patients (12%) did not experience chest pain during the myocardial ischemia. Nine patients (3%) experienced a prodromal angina episode without chest pain. Conclusion: The occurrence of craniofacial pain during myocardial ischemia, with or without an acute myocardial infarction, was associated with ischemia within the inferior wall. This result suggests the involvement of the vagal afferent system in the mechanisms of craniofacial pain of cardiac origin.

  • 18.
    Kreiner, Marcelo
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Falace, D
    Michelis, V
    Okeson, JP
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Quality difference in craniofacial pain of cardiac vs. dental origin2010In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 89, no 9, p. 965-969Article in journal (Refereed)
    Abstract [en]

    Craniofacial pain, whether odontogenic or caused by cardiac ischemia, is commonly referred to the same locations, posing a diagnostic challenge. We hypothesized that the validity of pain characteristics would be high in assessment of differential diagnosis. Pain quality, intensity, and gender characteristics were assessed for referred craniofacial pain from dental (n = 359) vs. cardiac (n = 115) origin. The pain descriptors "pressure" and "burning" were statistically associated with pain from cardiac origin, while "throbbing" and "aching" indicated an odontogenic cause. No gender differences were found. These data should now be added to those craniofacial pain characteristics already known to point to acute cardiac disease rather than dental pathology, i.e., pain provocation/aggravation by physical activity, pain relief at rest, and bilateralism. To initiate prompt and appropriate treatment, dental and medical clinicians as well as the public should be alert to those clinical characteristics of craniofacial pain of cardiac origin.

  • 19.
    Kreiner, Marcelo
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology. Department of General and Oral Physiology, Universidad de la República, School of Dentistry, Montevideo, Uruguay.
    lvarez, Ramon
    Michelis, Virginia
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Craniofacial pain can be the sole prodromal symptom of an acute myocardial infarction: an interdisciplinary study2016In: Acta odontológica latinoamericana : AOL, ISSN 0326-4815, Vol. 29, no 1, p. 23-28Article in journal (Refereed)
    Abstract [en]

    We recently found craniofacial pain to be the sole symptom of an acute myocardial infarction (AMI) in 4% of patients. We hypothesized that this scenario is also true for symptoms of prodromal (pre-infarction) angina. We studied 326 consecutive patients who experienced myocardial ischemia. Intra-individual variability analyses with respect to ECG findings and pain characteristics were performed for those 150 patients who experienced at least one recurrent ischemic episode. AMI patients (n=113) were categorized into two subgroups: "abrupt onset" (n=81) and "prodromal angina" (n=32). Age, gender and risk factor comparisons were performed between groups. Craniofacial pain constituted the sole prodromal symptom of an AMI in 5% of patients. In those who experienced two ischemic episodes, women were more likely than men to experience craniofacial pain in both episodes (p<0.01). There was no statistically significant difference between episodes regarding either ECG findings or the use of the two typical pain quality descriptors "pressure" and "burning". This study is to our knowledge the first to report that craniofacial pain can be the only symptom of a pre-infarction angina. Craniofacial pain constitutes the sole prodromal AMI symptom in one out of 20 AMI patients. Recognition of this atypical symptom presentation is low because research on prodromal AMI symptoms has to date studied only patients with chest pain. To avoid a potentially fatal misdiagnosis, awareness of this clinical presentation needs to be brought to the attention of clinicians, researchers and the general public.

  • 20.
    Kreiner, Marcelo
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Okeson, Jeffrey P
    Michelis, Virginia
    Lujambio, Mariela
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study2007In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 1, p. 74-79Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Craniofacial pain can be the only symptom of cardiac ischemia. Failure to recognize its cardiac source can put the patient's life at risk. The authors conducted a study to reveal the prevalence of, the distribution of and sex differences regarding craniofacial pain of cardiac origin.

    METHODS: The authors prospectively selected consecutive patients (N = 186) who had had a verified cardiac ischemic episode. They studied the location and distribution of craniofacial and intraoral pain in detail.

    RESULTS: Craniofacial pain was the only complaint during the ischemic episode in 11 patients (6 percent), three of them who had acute myocardial infarction (AMI). Another 60 patients (32 percent) reported craniofacial pain concomitant with pain in other regions. The most common craniofacial pain locations were the throat, left mandible, right mandible, left temporomandibular joint/ear region and teeth. Craniofacial pain was pre-ponderantly manifested in female subjects (P = .031) and was the dominating symptom in both sexes in the absence of chest pain.

    CONCLUSIONS: Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain.

    CLINICAL IMPLICATIONS: Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment.

  • 21. Kreiner, Marcelo
    et al.
    Okeson, Jeffrey
    Tanco, Veronica
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Orofacial Pain and Toothache as the Sole Symptom of an Acute Myocardial Infarction Entails a Major Risk of Misdiagnosis and Death2020In: Journal of Oral & Facial Pain and Headache, ISSN 2333-0384, Vol. 34, no 1, p. 53-60Article in journal (Refereed)
    Abstract [en]

    Aims: To provide an update of knowledge regarding the clinical presentation and neurophysiologic aspects of orofacial pain of cardiac origin in the form of a literature review. Methods: The peer-reviewed databases Scopus/Embase, NCBI (PubMed), and Science Direct were searched up to December 2018. Results: Patients with myocardial infarction presenting without chest pain run a higher risk of death due to missed diagnosis and subsequently a significantly greater delay between the onset of symptoms and arrival at the hospital. During myocardial ischemia, orofacial pain is reported by 4 in 10 patients and described as oppressive and/or burning. Up to 4% of myocardial infarction patients experience pain solely in the orofacial structures, women more often than men. Orofacial pain during myocardial ischemia is associated with ischemia within the inferior wall of the heart, suggesting the involvement of the vagal system. Conclusion: The clinician’s awareness of the full spectrum of clinical characteristics of a myocardial infarction constitutes a key factor in accurate diagnosis. Health care professionals and the general public should be aware of the possibility of myocardial infarction presenting with orofacial pain, toothache, or ear/temporomandibular joint pain as the only symptom.

  • 22.
    Legrell, P E
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Nyquist, H
    Umeå University, Faculty of Social Sciences, Department of Statistics.
    Isberg, A
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Validity of identification of gonion and antegonion in frontal cephalograms2000In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 70, no 2, p. 157-64Article in journal (Refereed)
    Abstract [en]

    This study was designed to develop a method of transferring gonion from lateral to frontal cephalograms, and to use this method as gold standard when evaluating observer performance in identifying gonion in frontal cephalograms. Observer ability to identify antegonion was also evaluated. There was a range of 28 mm in the observers' identification of gonion and a statistically significant deviation from gold standard. The factors "observer" and "cephalogram," regarded as random effects in an ANOVA analysis, and their interaction, each influenced the result, P < .001. The deviation from the mean of all observations for antegonion ranged 8 mm with "cephalogram" having a statistically significant influence. The results suggest that neither gonion nor antegonion can be routinely used as valid landmarks in frontal cephalograms. Gonion can, however, be used if first identified in a lateral cephalogram and transferred to a paired frontal cephalogram aided by radiographic indicators combined with a bilateral scrutiny of projection geometry in different planes through gonion and indicator.

  • 23.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology.
    Swallowing dysfunction related to snoring: a videoradiographic study2000In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 120, no 3, p. 438-443Article in journal (Refereed)
    Abstract [en]

    Biopsy studies of the soft palatal and oropharyngeal tissues in habitual snorers and patients suffering from obstructive sleep apnoea have shown signs of neurogenic lesions. These lesions might affect the pharyngeal swallowing function, which is dependent on adequate sensitivity. The objective of the present study was to test the hypothesis that snoring is associated with aberrant pharyngeal swallowing function. Forty-one consecutive patients without dysphagia, seeking medical attention because of heavy snoring and various degrees of daytime sleepiness, were prospectively selected. Fifteen non-snoring volunteers without dysphagia served as controls. Patients and volunteers were videoradiographically examined in lateral and posteroanterior views during the oral and pharyngeal phases of swallowing. The hypothesis was verified. Snoring patients demonstrated deviant pharyngeal swallowing function seven times more frequently than did the non-snoring volunteers. Deviant pharyngeal swallowing function was observed in 22 (54%) of the snorers compared with 1 (7%) of the non-snoring volunteers. Impaired bolus control with premature leakage of bolus into the pharynx and a delayed evocation of the swallowing reflex was the most common finding, followed by bolus residual in the pharynx and laryngeal penetration. The conclusion was that snoring is associated with subclinical pharyngeal swallowing dysfunction.

  • 24.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Bodin, Ingrid
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Pharyngeal swallowing dysfunction following treatment for oral and pharyngeal cancer: Association with diminished intraoral sensation and discrimination ability2008In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 30, no 10, p. 1344-1351Article in journal (Refereed)
    Abstract [en]

    Background.

    Swallowing disorders following treatment for oral and pharyngeal cancer are mainly considered a surgical sequel. The recent finding that radiotherapy-induced decline in intraoral sensory abilities established an incentive to elucidate any association between the degree of sensory decline and the degree of swallowing dysfunction.

    Methods.

    Oral and pharyngeal swallowing was cineradiographically examined in 15 patients with oral or pharyngeal cancer before and after treatment. The patients were also tested for intraoral sensation, shape recognition, and hole size identification.

    Results.

    Swallowing function deteriorated in 67% of the patients 6 months posttreatment, with no significant improvement after 12 months. The degree of swallowing dysfunction was statistically significantly associated with the degree of diminished intraoral sensation and shape recognition.

    Conclusion.

    In the quest for rehabilitation after treatment for oral and pharyngeal cancer, the impact of impaired intraoral sensation and discrimination ability on swallowing function should be taken into consideration

  • 25.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Franklin, KA
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Isberg, A
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Snoring, sleep apnoea and swallowing dysfunction: a videoradiographic study2003In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 32, no 5, p. 311-316Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Snoring is associated with subclinical pharyngeal swallowing dysfunction, probably owing to vibration trauma to the pharyngeal tissues caused by snoring. Negative intrathoracic pressure during apnoea causes stretching of the velum and pharynx. The aim of this study was to investigate whether patients with severe sleep apnoea have an increased frequency of videoradiographically diagnosed subclinical pharyngeal swallowing dysfunction compared with snoring patients with or without mild sleep apnoea as well as with non-snoring controls. METHODS: Eighty consecutive patients referred for sleep apnoea recordings because of snoring were examined. Fourteen of these patients were excluded because they suffered from dysphagia. Fifteen non-snoring, non-dysphagic volunteers served as controls. Videoradiography was performed to examine the oral and pharyngeal swallowing function in patients and controls. Overnight sleep apnoea recordings were used to evaluate the apnoea-hypopnoea index (AHI). RESULTS: Pharyngeal swallowing dysfunction was observed in 34/66 (52%) of the snoring patients and in 1/15 (7%) of the non-snoring controls. Pharyngeal swallowing dysfunction was observed in 50% of patients with an AHI of >or=30, in 61% of patients with an AHI of 5-29 and in 43% of patients with an AHI of <5. There was no significant difference in the frequency of pharyngeal swallowing dysfunction between snoring patients with different AHIs. CONCLUSION: Snoring patients run an increased risk of developing subclinical pharyngeal swallowing dysfunction independent of concomitant sleep apnoea.

  • 26.
    Nilsson, Tore
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Ahlqvist, Jan
    Johansson, Magnus
    Isberg, Annika
    Virtual reality for simulation of radiographic projections: validation of projection geometry2004In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 33, no 1, p. 44-50Article in journal (Refereed)
    Abstract [en]

    Objective: To develop a software for virtual reality (VR) simulation of X-ray images based on perspective projections through a patient model derived from data from a CT examination and to evaluate the accuracy in the projection geometry obtained by the software.

    Methods: A VR software was developed on a personal computer, with models of a patient, an X-ray machine and a detector. The model of the patient was derived from data from a CT examination of a dry skull. Simulated radiographic images of the patient model could be rendered as perspective projections based on the relative positions between the models. The projection geometry of the software was validated by developing an artificial CT data set containing high attenuation points as objects to be imaged. The accuracy in projection geometry was evaluated in a systematic way. The distances between two dots, representing the projected test points in the simulated radiographic images, were measured. They were compared with theoretical calculations of the corresponding distances using traditional mathematical tools.

    Results: The difference between the simulated and calculated projected distances never exceeded 0.5 mm. The error in simulated projected distances was in most cases within 1%. No systematic errors were revealed.

    Conclusion: The software, developed for personal computers, can produce simulated X-ray images with high geometric accuracy based on perspective projections through a CT data set. The software can be used for simulation of radiographic examinations.

  • 27.
    Salé, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Bryndahl, Fredrik
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    15-year natural course of temporomandibular joints in asymptomatic and symptomatic non-patient volunteers: a prospective clinical and MR imaging study2013In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 267, no 1, p. 183-194Article in journal (Refereed)
    Abstract [en]

    Purpose: To determine the incidence, prevalence, and progression of temporomandibular joint (TMJ) magnetic resonance (MR) imaging findings and symptoms during 15 years in adult asymptomatic and symptomatic volunteers (nonpatients).

    Materials and Methods: A regional committee for medical research ethics approved the study, and informed volunteer consent was obtained. Fifty-three volunteers were examined at study inception. For clinical assessment, a self-administered questionnaire was given, followed by an interview with each volunteer at study inception, at 1 year later, and at 15 years later. Bilateral TMJ MR imaging and clinical examination were performed at inception and at 15-year follow-up. The MR images were assessed for disk position, bone status, and joint fluid. All 53 volunteers participated at 1-year follow-up, and 50 of 53 volunteers participated at 15-year follow-up; of these 50 volunteers, 47 underwent MR imaging. The Fisher exact test was used to determine differences between groups, and the Wilcoxon signed-rank test was used to determine differences in prevalence of TMJ symptoms among the three examination times.

    Results: At study inception, TMJ disk displacement was observed in 31% of asymptomatic volunteers (nine of 29) compared with 89% of symptomatic volunteers (16 of 18, P < .001). Inceptive TMJ status was maintained after 15 years in 91% (43 of 47). Unilateral progression was observed in four volunteers (9%); one was symptomatic and three were asymptomatic. Progression involved development of new disk displacement (n = 1), development of new bone changes (n = 2), and aggravation from reducing to non-reducing disk displacement (n = 1). Prevalence of TMJ symptoms did not change significantly between examination times (P = .77). TMJ clicking was the most common clinical symptom.

    Conclusion: Volunteers with mild symptoms had a prevalence of disk displacement of the same magnitude as that reported in patients, although most volunteers, symptomatic as well as asymptomatic, maintained their TMJ status during 15 years.

  • 28.
    Salé, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology. Malmö Univ, Fac Odontol, Dept Oral & Maxillofacial Radiol, SE-20506 Malmö, Sweden.
    Bryndahl, Fredrik
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    A 15-year follow-up of temporomandibular joint symptoms and magnetic resonance imaging findings in whiplash patients: a prospective, controlled study2014In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, Vol. 117, no 4, p. 522-532Article in journal (Other academic)
  • 29.
    Salé, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Hedman, Leif
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Accuracy of patients' recall of temporomandibular joint pain and dysfunction after experiencing whiplash trauma: a prospective study2010In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 141, no 7, p. 879-886Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Researchers have conducted studies regarding whiplash-induced temporomandibular joint (TMJ) pain and dysfunction mainly under the presumption that patients' memory of symptoms remains accurate across time. In this prospective study, the authors aimed to determine the frequency of patients' inaccurate retrospective reports of TMJ pain and dysfunction after whiplash trauma.

    METHODS: The authors assessed TMJ pain and dysfunction in 60 patients consecutively seen in a hospital emergency department directly after the patients experienced whiplash trauma in rear-end automobile accidents. They followed up with 59 patients one year later. The participants completed a self-administered questionnaire followed by a comprehensive interview during both examinations. The study group consisted of the 40 patients who reported previous or current TMJ pain, dysfunction or both at either examination or at both examinations.

    RESULTS: The agreement between each patient's inceptive and retrospective reports of TMJ pain and dysfunction yielded a kappa value of 0.41 (95 percent confidence interval [CI] 0.18-0.64). Sixteen patients (40 percent, 95 percent CI 25-57 percent) had inaccurate recall. Recollection errors were addition, omission, and forward and backward telescoping. Seven patients incorrectly referred symptom onset to the accident.

    CONCLUSIONS: The high frequency of inaccurate recall of TMJ pain and dysfunction one year after whiplash trauma implies that clinicians and researchers should interpret with caution the results of previous studies that relied on retrospective data regarding whiplash-induced TMJ pain and dysfunction.

    CLINICAL IMPLICATIONS: To achieve valid long-term evaluations in clinical research, the patient's TMJ status should be established at the time of an accident.

  • 30.
    Salé, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Delayed temporomandibular joint pain and dysfunction induced by whiplash trauma: a controlled prospective study2007In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 8, p. 1084-1091Article in journal (Refereed)
    Abstract [en]

    Background. The Quebec Task Force on Whiplash-Associated Disorders urged for controlled, prognostic studies of symptoms after whiplash trauma. The authors conducted a study that met the design requirements to enhance knowledge about short-term and long-term temporomandibular joint (TMJ) pain, dysfunction or both induced by whiplash trauma.

    Methods. The authors studied 60 consecutive patients who had neck symptoms after whiplash trauma and were seen at a hospital emergency department. They followed up 59 subjects one full year later. At the inceptive examination and at follow-up, each subject completed a self-administered questionnaire, followed by a comprehensive interview. Fifty-three frequency-matched control subjects followed the same protocol concurrently.

    Results. The incidence of new symptoms of TMJ pain, dysfunction or both between the inceptive examination and follow-up was five times higher in subjects (34 percent) than in control subjects (7 percent). The frequency of TMJ pain increased significantly in female subjects, as did the frequency of TMJ symptoms that were reported to be the main complaint. At the follow-up, 20 percent of all subjects reported that TMJ symptoms were their main complaint.

    Conclusions. Our results suggest that one in three people who are exposed to whiplash trauma is at risk of developing delayed TMJ symptoms that may require clinical management.

    Clinical Implications. Awareness of a significant risk for delayed onset of TMJ symptoms after whiplash trauma is crucial for making adequate diagnoses, prognoses and medicolegal decisions.

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