Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

{"title":"Coronoid process: cone beam computed tomography (CBCT) evaluation and proposal of radiographic classification","authors":"Dr. Archna Sharma ,&nbsp;Dr. Aditya Tadinada","doi":"10.1016/j.oooo.2024.11.006","DOIUrl":"10.1016/j.oooo.2024.11.006","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of the study was to investigate the cone beam computed tomography (CBCT) features of coronoid processes in patients without mouth opening limitations and to develop a functional classification of coronoid process considering its relationship with the zygomatic bone.</div></div><div><h3>Study Design</h3><div>This cross-sectional retrospective study analyzed CBCTs of 204 patients (408 coronoid processes). CBCTs were acquired in a closed-mouth position, capturing the coronoid process and the temporomandibular joint. The scans with temporomandibular joint abnormalities, orofacial trauma or syndromes, and artifacts were excluded. Volume renderings and axial images were evaluated for the shape, surface configuration, coronoid length, condylar length, coronoid/condyle ratio, distance of the coronoid process from the posteromedial surface of the zygoma and its vertical level. The coronoid process was considered hyperplastic when coronoid/condyle ratio was greater than 1.</div></div><div><h3>Results</h3><div>Most coronoid processes (221) had a triangular shape. The mean length of the coronoids and condyles was 13.85 mm and 16.77 mm, respectively. The mean coronoid/condyle ratio was 0.84. A total of 87 coronoid processes were hyperplastic. The mean distance from the coronoid process to posteromedial surface of zygoma was 15.99 mm, ranging from 5.8 to 27.9 mm. The mean vertical level of coronoid processes in the study sample was 9.6 mm. A novel working classification was developed using the results of this study. The coronoid process was classified as either type I, II, III (a,b,c) and type IV (a,b,c). Type IIIa was the most common (45.83%); followed by type II (29.6%); type I (16.17%); type IIIc (4.41%); type IIIb (3.18%); type IVa (0.49%); and type IV b (0.24%).</div></div><div><h3>Conclusions</h3><div>The coronoid process can present a wide variety of shapes, sizes, and positions. On the basis of the results, we also propose a working radiographic classification of coronoid process that can help oral and maxillofacial radiologists to identify any abnormalities associated with the coronoid process.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e69"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The state of generative artificial intelligence (GAI) in radiology and dentistry","authors":"Dr. Suvendra Vijayan ,&nbsp;Dr. Anitha Potluri","doi":"10.1016/j.oooo.2024.11.003","DOIUrl":"10.1016/j.oooo.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>This oral presentation proposes to explain the current state of generative artificial intelligence (GAI) in health care and education. We will also showcase a research project that used GAI to create radiographic images and another ongoing project exploring the potential of GAI in dental education and research.</div></div><div><h3>Study Design</h3><div>Research 1—A pilot study was conducted to enhance ultra-low dose cone beam computed tomographic images of dry skulls to diagnostically acceptable standards. The images were trained using a pix2pix deep generative model.</div><div>Research 2—A pilot study is being conducted exploring the accuracy of case reports generated by ChatGPT. We queried ChatGPT to create hypothetical case reports and modified the queries to get the best possible output.</div></div><div><h3>Results</h3><div>Research 1—Preliminary results indicated that the synthesized images are comparable with images made with normal exposure.</div><div>Research 2—Preliminary results indicate that ChatGPT can create a convincing and accurate case report. Limitations in use of citations were observed.</div></div><div><h3>Conclusion</h3><div>GAI like Open AI's ChatGPT, Google's Bard, and Microsoft's CoPilot have caused a massive shift in public knowledge of AI. GAI will have major impact in health care and education.</div><div>GAI tools like ChatGPT have huge potential for use and misuse in educational and research spheres. Creating questions and explanation on complex topics can be done on these tools. Websites like MidJourney can create interesting and novel images. Radiographic images can be created using specific algorithms.</div><div>We intend to demonstrate how to effectively use GAI like ChatGPT, describe ethical concerns and how to address and regulate them in academia, and identify innovative uses for AI and ChatGPT in dental care and education. GAI is a freight train with no breaks and as educators and healthcare practitioners we need to discuss and propose policies and safeguards for responsible use of AI.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e68"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibromyxoma of nasal fossa: features on magnetic resonance imaging","authors":"Dr. Farnaz Namazi ,&nbsp;Dr. Suresh Mukherji ,&nbsp;Dr. Mehrnaz Tahmasbi ,&nbsp;Dr. Funda Yilmaz ,&nbsp;Dr. Madhu Nair","doi":"10.1016/j.oooo.2024.11.041","DOIUrl":"10.1016/j.oooo.2024.11.041","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>A 50-year-old female patient presented with a bi-lobed, bell-shaped, smooth, mucosalized mass involving the nose. Thin-section pre- and postcontrast magnetic resonance imaging (MRI) performed through the sinonasal cavity showed a midline, bi-lobed mass involving the floor of the nasal cavity. The superior aspect involves the nasal septum and extends to the inferior portion of the bilateral middle turbinate and anterior hard palate. Regressive remodeling of the medial wall of both maxillary sinuses and erosion of the anterior portion of the right hard palate, the right lateral nasopalatine canal, and maxillary alveolus were noted. Superficial muscles of facial expression were evident. The mass was intermediate signal on T1, and homogeneously enhanced with contrast. It had a heterogeneous T2 signal.</div></div><div><h3>Differential Diagnosis</h3><div>Differential diagnoses included minor salivary gland neoplasms, sarcomas, osteosarcoma/chondrosarcoma, hematopoietic lesion (lymphoma), or neoplasm of histiocytic origin. Although squamous cell carcinoma is the most common neoplasm to involve the sinonasal region, the imaging features and submucosal appearance make it less likely.</div></div><div><h3>Diagnosis and Management</h3><div>Histopathologic examination revealed a fibromyxoma. The lesion was resected out. Due to the high recurrence rate of &gt;25%, a minimum 5-year follow-up is required.</div></div><div><h3>Conclusion</h3><div>Fibromyxomas of the jaws are rare with an incidence of approximately 0.07 new cases per million people per year. Anterior maxilla is rarely affected. The location, aggressive behavior involving the nasal fossae and maxillary sinuses, and high recurrence rate underscores the complexity of diagnosis. Radiographic examination, including MRI, plays a crucial role in the differential diagnosis and treatment planning. With scant reports in the literature on MRI findings of fibromyxoma of the nasal fossa, this report, including a review of the literature, expounds on the variations in clinical and radiographic features of this lesion.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e83"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in distinguishing amongst large maxillary sinus lesions with calcified matrix: a differential diagnostic exhibit","authors":"Dr. Samantha Gallia ,&nbsp;Dr. Pattana Wangaryattawanich ,&nbsp;Dr. Peggy Lee","doi":"10.1016/j.oooo.2024.11.033","DOIUrl":"10.1016/j.oooo.2024.11.033","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>Case 1: A 64-year-old man with history of metastatic pancreatic cancer underwent a computed tomography (CT) scan for suspected recurrence, which revealed an incidental large, destructive mass with internal calcified matrix in the left maxillary sinus with associated bone destruction. The tumor extended into the left sinonasal cavity, oral cavity, and retroantral soft tissue, with resultant obstructive sinusitis.</div><div>Case 2: A 19-year-old man presented with intermittent epistaxis of the right nostril. Examination revealed a polyp-like mass in the right nasal cavity. The CT scan demonstrated a large, expansile mass with extensive internal calcifications centered in the right nasal vault, completely involving the right maxillary sinus, right ethmoid air cells, and the posterior bony orbit.</div><div>Case 3: A 15-year-old female patient with history of swelling and a slow-growing lesion underwent CT imaging, which revealed a well-defined, expansile lesion with calcified matrix in the left maxilla protruding into the left maxillary antrum. There was destruction of the posterior wall of the left maxillary sinus, and the lesion displaced #15 laterally and #16 superiorly into the maxillary sinus.</div></div><div><h3>Differential Diagnosis</h3><div>Case 1 and 2: The extensive and destructive findings are concerning for malignancy, particularly chondrosarcoma and osteosarcoma. An alternative diagnosis for case 1 includes metastasis, given the history of cancer.</div><div>Case 3: Differential diagnoses include chondrosarcoma, ossifying fibroma, and venous malformation of bone.</div></div><div><h3>Diagnosis and Management</h3><div>Histologic examination revealed glomangiopericytoma for case 1, mesenchymal chondrosarcoma for case 2, and unusual ossifying fibroma for case 3. All tumors were surgically removed. Case 3 displayed recurrence upon follow-up imaging 11 months later.</div></div><div><h3>Conclusions</h3><div>A wide range of expansile sinus masses with calcified matrix exists, comprising both benign and malignant entities. Radiographic features help distinguish between benign and malignant categories; however, differentiating between malignancies is challenging due to overlapping radiologic characteristics. Thus, histopathologic examination is crucial for definitive diagnosis.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e79-e80"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Freehand 3-dimensional ultrasound imaging of midpalatal suture in maxillary transverse deficiency treatment: an ex vivo study","authors":"Ms. Trang H. Hoang ,&nbsp;Dr. Kim-Cuong T. Nguyen ,&nbsp;Dr. Neelambar R. Kaipatur ,&nbsp;Prof. Manuel O. Lagravere Vich ,&nbsp;Prof. Paul Major ,&nbsp;Prof. Lawrence H. Le","doi":"10.1016/j.oooo.2024.11.063","DOIUrl":"10.1016/j.oooo.2024.11.063","url":null,"abstract":"<div><h3>Objective</h3><div>Rapid maxillary expansion is widely regarded as the treatment of choice for correcting maxillary transverse deficiency (MTD), a significant concern in the facial growth of children and adolescents. A critical component of the rapid maxillary expansion treatment process involves the precise evaluation of the patency of the midpalatal suture (MPS). Ionizing radiation-based modalities are commonly employed to assess the status of the MPS. This study proposes a nonionizing radiation method to measure the MPS opening using freehand 3-dimensional intraoral ultrasound (US) reconstructed images.</div></div><div><h3>Study Design</h3><div>The US imaging system includes a portable customized high-frequency scanner, accompanied by 4 infrared cameras that record the corresponding image coordinates and orientation. A 3-month-old pig palate with a manmade defect mimicking the MPS expansion was freehand scanned and real-time reconstructed to generate 3-dimensional images. The palatal bone underlying the ruggae was then segmented to unveil the MPS expansion. A micro-computed tomography (<em>μ</em>CT) scan was performed on the pig jaw to establish the ground truth. The widths of the MPS opening were measured 3 times at 10 different locations spaced 1.5-mm apart along the MPS on the US-reconstructed images. The results were validated by <em>μ</em>CT data.</div></div><div><h3>Results</h3><div>The MPS width comparison between US and <em>μ</em>CT measurements shows a strong correlation of <em>R</em>^b = 0.99 (<em>P</em> &lt; .05) and absolute errors of less than 0.19 mm (6 %). In general, 95% of the difference between the measurements fell between -0.27 mm and 0.07 mm, which is clinically acceptable. The results revealed good accuracy in measuring MPS opening using US in comparison with <em>μ</em>CT.</div></div><div><h3>Conclusion</h3><div>This study has demonstrated the feasibility of examining the MPS patency by 3D intraoral US-reconstructed images. The technique holds great promise in providing a low-cost, safe, and highly accurate modality for MTD treatment.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e91-e92"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic and asymptomatic endodontic material extrusion involving the inferior alveolar canal: a case series","authors":"Dr. Victor Vinh ,&nbsp;Dr. Peggy Lee","doi":"10.1016/j.oooo.2024.11.035","DOIUrl":"10.1016/j.oooo.2024.11.035","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>Three cases of left jaw pain and numbness post-root canal treatment with follow-up up to 8 years with cone beam computed tomography and intraoral imaging.</div><div>Case 1: Endodontic material extrusion within surrounding trabecular bone approximating, but not within, the inferior alveolar canal (IAC) and mental foramen with neurosensory changes along V3 mental and long buccal nerve distribution.</div><div>Case 2: Endodontic material within the IAC with normal sensation distal of #19 and numbness/tingling extending from #19 to midline.</div><div>Case 3: Endodontic material along, but not within, the IAC in #30-#32 area with paresthesia for 10 years.</div><div>Two companion cases show endodontic material IAC approximation without symptoms.</div></div><div><h3>Differential Diagnosis</h3><div>Trigeminal neuropathic pain secondary to endodontic material extrusion vs IAN block with articaine, periapical inflammation-related pressure on the nerve, and trigeminal neuralgia.</div></div><div><h3>Diagnosis and Management</h3><div>Case 1: Initial retreat root canal treatment did not improve symptoms. Continued numbness and decreasing pain managed with pregabalin on periodic 6-month follow-up; 6 years later, reported isolated periods without pain and left lower lip numbness gone. Continued improvement to present.</div><div>Case 2: Managed with prednisone and antibiotics; same pain radiating anteriorly at 2-week follow-up with numbness of #24, left lower lip, and gingiva. Decreased numbness at 2-month follow-up.</div><div>Case 3: No treatment was rendered.</div><div>Both cases show minimal radiographic changes over time as symptoms diminish with management.</div></div><div><h3>Conclusion</h3><div>When patients are symptomatic, cone beam computed tomography may confirm the presence of endodontic material within the IAC, indicating that extrusion is the likely cause of symptoms. Symptomatic cases, both with and without direct IAC involvement, have been successfully treated in this series and reported in the literature. Endodontic material located at the IAC border, but not within it, may present with or without symptoms. Thus, it is important to localize endodontic material in relation to the IAC.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e80-e81"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiogenic osteosarcoma following therapy: delayed presentation","authors":"Dr. Yashaswini Jagadeesh ,&nbsp;Dr. Suresh Mukherji ,&nbsp;Dr. Mehrnaz Tahmasbi ,&nbsp;Dr. Madhu Nair","doi":"10.1016/j.oooo.2024.11.040","DOIUrl":"10.1016/j.oooo.2024.11.040","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>Radiation therapy is commonly used to treat head and neck cancers and can present with adverse complications such as osteoradionecrosis, radiation-induced osteitis, and radiogenic osteosarcoma. Radiation-induced sarcomas can develop in irradiated tissues without a specific site preference. The average time between radiotherapy and onset of such sarcomas is typically reported to be 10 to 12 years. Here we have the radiologic features of a 71-year-old-female patient with facial asymmetry on the right side. She presented with history of squamous cell carcinoma of the right hemimandible, for which she underwent surgery and radiation therapy 20 years ago. Contrast-enhanced, soft-tissue window computed tomography revealed an ill-defined, expansile, low-attenuation, mixed-density, lytic lesion in the right mandible, with effacement of the fat planes.</div></div><div><h3>Differential Diagnosis</h3><div>Differential diagnosis included recurrent squamous cell carcinoma, lymphoma, salivary gland tumors and soft-tissue sarcomas.</div></div><div><h3>Diagnosis and Management</h3><div>After the work-up of this patient, a diagnosis of radiogenic osteosarcoma was made on the basis of histopathology and associated history. Surgical resection of the tumor was performed with clear margins. Adjuvant chemotherapy was provided since the tumor was larger than 5 cm in diameter. The prognosis of the tumor is poor, and the patient continues to be followed up.</div></div><div><h3>Conclusions</h3><div>Although radiation-induced sarcomas are rare, their incidence has risen because of the increased use of radiation therapy. Radiation therapy is commonly used to treat squamous cell carcinoma, the most common primary malignancy in the head and neck region. It is critical to consider the potential occurrence of radiation-associated sarcoma in a patient presenting with a painful swelling in a previously irradiated area. Even though these lesions appear within the second decade post-radiation, they can appear well over 30 years as well. Continued monitoring is advised for early intervention should this complication develop. A review of the extant literature is included.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e82-e83"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple radiolucencies with focal radiopacities in both jaws: a rare case report","authors":"Dr. Farnaz Namazi ,&nbsp;Dr. Victoria Scarpa ,&nbsp;Dr. Robert Peak ,&nbsp;Dr. Lisa Yi- Shing Cheng ,&nbsp;Dr. Hui Liang","doi":"10.1016/j.oooo.2024.11.021","DOIUrl":"10.1016/j.oooo.2024.11.021","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>A 30-year-old Black female patient presented with the chief complaint of “my face is swollen.” The patient had no history of systemic diseases and was otherwise asymptomatic. Panoramic radiograph and cone beam computed tomography study revealed multifocal, multiple multilocular, low attenuation, expansile lesions in the maxilla and mandible in all 4 quadrants. These radiolucencies showed well-defined borders, areas of thinning and disruption of the cortices and scalloping between roots of teeth with areas of loss of periodontal ligament space but no radiographic evidence of resorption or displacement. Foci of irregular shape with high attenuation at apical regions of multiple teeth were noted as well.</div></div><div><h3>Differential Diagnosis</h3><div>Differential diagnoses included simple bone cysts (SBC) with cemento-osseous dysplasia and brown tumors of hyperparathyroidism.</div></div><div><h3>Diagnosis and Management</h3><div>Biopsy specimens from right maxilla #4-5 area and left mandible #18-19 area, in March 2020, revealed vital bone and surgically there were empty cavities upon entering both biopsy sites, rendering a diagnosis compatible with SBC for both biopsies. In September 2022, biopsies on right maxilla #5 area and anterior mandible revealed sclerotic vital bone and a benign fibro-osseous lesion. Surgical exploration found empty cavities for both biopsy sites. The patient's blood test showed normal parathyroid hormone and calcium levels, which rule out brown tumors of hyperparathyroidism. A diagnosis of multiple SBCs with benign fibro-osseous lesion favoring cemento-osseous dysplasia was made. Follow-up panoramic and cone beam computed tomography images in April 2023 showed remarkable new bone formation in the cystic cavities that had been surgically entered before, validating the diagnosis and management of this case.</div></div><div><h3>Conclusion</h3><div>Multiple SBCs has been reported mostly in mandible with slight female predominance. However, multilocular appearance and maxillary location is quite uncommon. The unique and scarce occurrence of multifocal simple bone cysts in both maxilla and mandible presenting with bone expansion merits reporting.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e75"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone beam computed tomography (CBCT) radiographic findings in a patient with Prader-Willi syndrome","authors":"Dr. Ben Bartlett ,&nbsp;Dr. Rujuta Katkar","doi":"10.1016/j.oooo.2024.11.032","DOIUrl":"10.1016/j.oooo.2024.11.032","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>A 17-year-old Hispanic male with Prader-Willi syndrome (PWS) and autism was referred to the radiology clinic for a cone beam computed tomography scan to evaluate the bone density of the maxilla, mandible, and the temporomandibular joints. The patient had difficulty eating, speaking, and limited mouth opening. Clinical findings included a long narrow head, convex facial profile with class II occlusion, malalignment of maxillary teeth, crowding of mandibular teeth, excessive curve of Spee, increased overjet, and generalized gingival hyperplasia.</div><div>Radiographic findings showed mild mandibular asymmetry, unique molar root morphology, periodontal ligament space widening, mild-to-moderate localized periodontal bone loss, crowding of mandibular teeth, increased overjet, and bilateral Brodie bite. The arch profile of the mandible was narrow with inward inclination of the alveolar bone, especially of the right side. The trabecular bone pattern of the posterior mandible was sparse, and the mandibular angles showed increased convexity.</div><div>The mandibular condyles were wider than normal with a broad condylar neck and narrow sigmoid notch. Although the condyles were centered in the glenoid fossae, the lateral aspects of the condyles were more anteriorly positioned thus narrowing the articular space.</div></div><div><h3>Differential Diagnosis</h3><div>The patient was already diagnosed with PWS. The craniofacial and dentoalveolar features in this syndrome vary wildly and are not pathognomonic.</div></div><div><h3>Diagnosis and Management</h3><div>Because of the multisystemic nature of this syndrome, unique treatment needs of these patients should be identified and managed with a multidisciplinary approach involving orthodontics, periodontics, prosthodontics, oral surgery working with patients’ primary care physicians, and social workers.</div></div><div><h3>Conclusion</h3><div>PWS is a rare and complex genetic multisystem disease that currently affects 50,000 Americans. It is important to recognize the variation in dental and skeletal findings this syndrome presents and to seek early intervention. In our review of literature, we could not find any publication on radiographic findings using cone beam computed tomography in patients with PWS.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e79"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does open-mouth temporomandibular joint computed tomographic imaging provide added value in the diagnosis of temporomandibular disorders?","authors":"Dr. Jamila Taylor ,&nbsp;Dr. Ellen Gould ,&nbsp;Dr. Sherwin Arman ,&nbsp;Dr. Sanjay Mallya","doi":"10.1016/j.oooo.2024.11.031","DOIUrl":"10.1016/j.oooo.2024.11.031","url":null,"abstract":"<div><h3>Objective</h3><div>Temporomandibular disorders (TMDs) include a group of conditions that involve the temporomandibular joints (TMJs), masticatory muscles, and all associated tissues. Computed tomography (CT) is the modality of choice to evaluate the TMJ for osseous degenerative changes. Considering that limitation of mouth opening is a frequent manifestation of many TMDs, protocols for TMJ imaging traditionally have included views in the open and closed positions to assess condylar movement relative to the crest of the articular eminence. In this study, we examined the added value of the open scan to clinical decision making.</div></div><div><h3>Study Design</h3><div>This retrospective study evaluated records of patients who presented with TMD and were evaluated with cone beam computed tomography (CBCT) imaging. The pilot phase includes 22 subjects. The range of motion from the clinical examination was recorded and extent of condylar translation was assessed on the CBCT scans. Condylar movement was scored as “limited” when translation stopped before the crest of the articular eminence and “positive” when the condyle reached or went beyond the crest of the articular eminence.</div></div><div><h3>Results</h3><div>There was concordance in assessment between clinical mouth opening and radiographic condylar translation in 7 of 22 subjects (32%). When radiographic translation was scored as positive (n = 5), bilaterally, clinical opening was more than 40 mm. Likewise, when limitation of condyle translation was unilateral (n = 4), mouth opening was more than 40 mm. In contrast, in 13 subjects with radiographic limitation of condyle translation, mouth opening was more than 40 mm.</div></div><div><h3>Conclusion</h3><div>Our results suggest that radiographic translation is not a good surrogate for mouth opening noted clinically. Therefore, we do not support the use of open-mouth CBCT scans to assess condylar translation. The elimination of the open scan will decrease the radiation dose to the patient and free up personnel time. Next, we are examining whether the open-mouth scan provides any value to patient management.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e79"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}