Tarsal Coalition : Clinical and Radiographic Diagnosis and Management

Introduction: The aim of this study was to identify the reasons for failure in clinical, radiographic, and histopathologic diagnoses as well as their interactions with each other. Methods: Personal information and lesion characteristics of 51 patients with central or peripheral exophytic lesions were collected in Mashhad dental school. Specialists determined clinical and radiographic diagnoses and after taking biopsy, the clinical and radiographic diagnoses were compared with histopathologic diagnosis. Results: Fifty three patients with oral exophytic lesions were evaluated among which 66.6% were peripheral and 33.4% were central exophytic lesions. Males constituted 52.9% of the patients while 47.1% were female. The first clinical and radiographic diagnoses were not confirmed with the histopathologic diagnosis in some patients. 80.4% of the first clinical diagnoses were consistent with the pathologic reports and in other cases, the clinical diagnosis were not confirmed histopathologically. In addition, radiographic diagnoses in six patients were not consistent with pathologic diagnosis. Conclusion: Great concordance was observed between clinical and radiographic diagnosis with pathologic reports

Es importante conocer el somatotipo facial para establecer un plan de tratamiento. Se puede determinar de forma clínica y radiográfica, clasificándose así en tres patrones: dolicofacial, mesofacial y braquifacial. Cuando es identificado orrectamente, es importante saber si algunas anomalías pueden asentarse en un mismo biotipo, conocer qué maloclusiones están asociadas y brindar el tratamiento adecuado. Objetivo: Determinar si existen diferencias entre el diagnóstico clínico (plano frontal) y radiográfico (plano sagital) e identificar el somatotipo más frecuente utilizando los dos métodos. Métodos: Se seleccionaron 89 niños de ambos géneros, entre 6 y 10 años que acudieron a la Clínica de Odontopediatría de la División de Estudios de Postgrado e Investigación (DEPeI) de la Facultad de Odontología de la UNAM, durante el periodo 2004-2005. Se revisaron 5 niños por día, a cada uno de ellos se le realizó el diagnóstico clínico del somatotipo y se les tomó radiografía lateral de cráneo para realizar su diagnóstico radiográfico, hasta completar el tamaño de la muestra. Los datos fueron analizados y registrados en el programa estadístico SPSS 12.0 utilizando una prueba de Kappa para medir la confiabilidad de los diagnósticos. Resultados: En la comparación de la media por género no hubo diferencias significativas p = 0.82. La repetibilidad de los dos métodos es baja (Kappa = 0.192). La prueba Chi cuadrada indicó que hay asociación entre género y somatotipo (c2 = 8.4; p = 0.015) en la distribución de somatotipos por diagnóstico clínico por género. Sin embargo, en la distribución de somatotipos por diagnóstico radiográfico por género la prueba indicó que no hay asociación entre género y somatotipo (c2 = 0.2; p = 0.902). Conclusiones: No hay correlación entre ambos diagnósticos, ya que la repetibilidad entre ellos fue baja. Se considera que la determinación clínica del somatotipo facial es un elemento más a considerar para el diagnóstico.

Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: Tarsal coalition has been historically reported to be associated with a flatfoot deformity. There are however case reports demonstrating that it can be found in cavovarus and clubfoot deformities. The goal of this study was to retrospectively review all weightbearing CT (WBCT) scans that were taken in one medical center, to investigate the clinically diagnosed as well as missed cases of tarsal coalition, and to determine the hindfoot alignment and arch height features of each case. Methods: 800 WBCT scans were reviewed separately by two senior fellowship trained foot and ankle surgeons. The structure of the hindfoot and midfoot was carefully examined in all three views to screen for different types of tarsal coalition. For cases that were diagnosed with tarsal coalition on WBCT, the medical charts were then reviewed to determine the original clinical diagnoses. Hindfoot alignment and arch height features of the midfoot were subsequently evaluated on WBCT scans. Results: There were 41 feet that were diagnosed with tarsal coalition on WBCT (Figure 1). The clinical diagnosis of coalition was only made in 15 feet and 26 symptomatic feet were clinically missed. Among the 26 symptomatic feet diagnosed on WBCT but clinically missed, 16 had a clinical diagnosis of congenital or acquired flatfoot, 3 with subtalar arthritis, 1 with talonavicular arthritis, 1 with peroneal tendinopathy and a cavovarus foot deformity, 2 with cavovarus deformity and midfoot arthritis, 2 with posttraumatic ankle arthritis, and 1 with subtalar impingement. A valgus hindfoot was found in 19 feet, a neutral hindfoot in 18, and a varus hindfoot in 4 feet. In the midfoot, 38 feet had a positive (>=1) distal medial cuneiform/fifth metatarsal arch height index, and 3 feet had a negative index (<1); all 41 feet had a positive proximal cuneiform/cuboid height index (>=1). Conclusion: One should be aware that patients with tarsal coalition do not always present with a flatfoot and hindfoot valgus, since many can have a variety of hindfoot and midfoot alignment features. In cases presenting with history of trauma, degenerative arthritis, as well as a cavovarus or clubfoot deformity, tarsal coalition can easily be clinically overlooked.

Tarsal coalitions (TC) are congenital abnormal connections of the rearfoot bones. They occur in 1 to 13 % of all population. The article deals with the features of clinical and instrumental diagnosis of TC according to the literature. The main clinical manifestations are pain syndrome in the subtalar area, rigid flat foot; peroneal spastic flat foot is possible. Radiographic imaging of TC includes direct and indirect signs. To verify bone coalition, computed tomo-graphy is indicated, in cases of cartilaginous and fibrous — magnetic resonance imaging. Despite the long history of studying the problem, the diagnosis of TC remains a live issue today. Difficulties in diagnosing this pathology are due to the lack of physicians’ awareness of the clinical and radiographic picture of TC. Classical orthopedic exa-mination and suspicion of possible TC will allow detecting pathology in time and avoiding inappropriate treatment. The use of modern imaging techniques, such as computed tomography and magnetic resonance imaging, helps increase the accuracy of TC diagnosis.

Comparison of the clinical and radiographic diagnosis of paediatric pneumonia

Background. Accurate evaluation of the pulp condition is one of the greatest diagnostic challenges in pediatric dentistry. A comprehensive diagnosis of pulp status is achieved by integrating diagnostic data from multiple sources. Understanding the correlation and consistency among these various data points is important. This study aimed to determine the correlation between history-based, clinical, radiographic, and operative diagnoses.Methods. In this cross-sectional study, 4‒8-year-old children attending the Department of Pediatric Dentistry for routine dental treatment between August 1, 2021 and July 7, 2022 were included. A total of 180 primary molars were clinically and radiographically evaluated, and their dental histories were recorded. The pulpal diagnosis was determined based on the dental history, clinical findings, and radiography. The operative diagnosis was determined during pulp therapy. Finally, the correlation was assessed by Spearman’s correlation test.Results. The strongest correlation was observed between operative and radiographic diagnoses (r=0.831, P<0.001). Moreover, the correlations between clinical diagnosis and operative diagnosis and between clinical diagnosis and radiographic diagnosis were the weakest (r=0.556, P<0.001 and r=0.591, P<0.001, respectively). The correlation between the diagnosis based on history and operative diagnosis (r=0.676, P<0.001) was stronger than that with the clinical diagnosis (r=0.633, P<0.001) and radiographic diagnosis (r=0.656, P<0.001).Conclusion. The findings of this study underscore the importance of integrating multiple diagnostic approaches for an accurate assessment of pulp condition. Radiographic diagnosis demonstrated the strongest reliability in assessing the pulp status. Additionally, moderate correlations between clinical, history-based, and radiographic diagnoses indicate the need for a combined diagnostic strategy approach to achieve higher accuracy and effective treatment planning.

The objective of this study was to evaluate the sensitivity of unenhanced radiographic diagnosis of tarsal coalition. The study had two phases. The first was a retrospective case and control review. Radiographs of 37 feet (15 talocalcaneal coalitions and 15 calcaneonavicular coalitions) and of 17 patients with foot pain and no coalition used as controls were reviewed independently by three observers who had no prior knowledge of the cases. Each observer reviewed the cases for individual signs of coalition and then decided if coalition was present. The second phase of the study was a prospective evaluation by a single observer of 150 consecutive weightbearing foot radiographs obtained to evaluate nontraumatic foot pain. Patients diagnosed as positive for coalition underwent CT. On retrospective review of unenhanced radiographs, observers achieved 100% sensitivity and 88% specificity in the diagnosis of talocalcaneal coalitions. Sensitivity and specificity for calcaneonavicular coalitions ranged from 80% to 100% and 97% to 98%, respectively. Several previously unpublished radiographic signs increased sensitivity of diagnosis. For calcaneonavicular coalition, the new signs were altered navicular morphology and visualization of the bar on the anteroposterior radiograph. For talocalcaneal coalition, the new signs were a dysmorphic sustentaculum tali, nonvisualization of the middle subtalar facet, and shortening of the talar neck. In the prospective phase of the study, three talocalcaneal coalitions were detected with no false-positive results. Routine anteroposterior and lateral unenhanced radiographs are a valuable screening tool for tarsal coalition, even when used by inexperienced observers. The newly described signs increase sensitivity of radiographic diagnosis.

ABSTRACT. Introduction: dental caries is a public health problem affecting a large percentage of the population. The carious process is highly variable and has periods of progression that alternate with periods of stability of the damaged tissue. There are different techniques to diagnose dental caries, including clinical and radiographic evaluation. Objective: the objective of this study was to establish correlation between the clinical and radiographic caries diagnosis suggested by ICCMS TM , in deciduous and permanent molars of a school population. Methods : descriptive study evaluating a sample for convenience of 1174 proximal and occlusal tooth surfaces of permanent and deciduous molars, taken from the database of 35 outpatients treated at the school of dentistry, who were clinically and radiographically evaluated for caries as recommended by the ICCMS TM based on bitewing x-rays. Results: the clinical and radiographic diagnosis was correlated in 1174 proximal and occlusal surfaces, with 0.41 Spearman's rank correlation coefficient (p < 0,05). The findings suggest that 95.6% of teeth diagnosed as healthy coincided with the clinical and radiographic results; in early mild stages, there was coincidence in only 8.16% and 6.4% respectively. Conclusions: there is low correlation between the clinical diagnosis of caries and the radiographic examination, in relation to ICCMS TM standards

Congenital tarsal coalition involves failure of segmentation between two or more tarsal bones. Although coalition can be asymptomatic, foot or ankle pain occasionally occurs, especially in young patients, and is often overlooked at the first presentation. Radiography can be used to diagnose or indirectly identify tarsal coalition, and computed tomography (CT) or magnetic resonance imaging (MRI) can be used to confirm the diagnosis. Here, we present a case of a patient with a delayed diagnosis of tarsal coalition. In our patient, plain radiography of the left ankle showed the typical C-sign. Moreover, a noncontrast MRI of the left ankle revealed focal bone hypertrophy over the medial aspect of the talus and the sustentaculum tali of the calcaneus separated by a low signal gap. Familiarity with the radiographic features and signs of the tarsal coalition might aid in its diagnosis, and CT or MRI might provide additional information for its clinical management.

Context: Ultrasonography as an imaging modality in dentistry has been explored in recent years. It is particularly useful in the examination of superficial structures where the use of a high frequency linear transducer produces clearer sonographic images. Aim: To evaluate the efficacy of ultrasound when compared with other known diagnostic examinations. Materials and Methods: This was a prospective cross-sectional study involving patients with maxillofacial swellings in Aminu Kano Teaching Hospital. They were classified as malignant neoplasms, benign cysts, abscesses and infections and lymphoma, according to clinical, radiographic and ultrasound and diagnosis independently. The findings from these methods were then compared to the gold standard histologic findings. Chi-square test, Pearson contingency coefficient, and 2 x 2 contingency table were used in evaluating the diagnostic accuracy, sensitivity as well as the specificity of the examinations. Results: A total of 36 patients comprising 21 males and 15 females with mean age of 34.97 years were recruited. Diagnostic accuracy of ultrasound was 50% in the diagnosis of malignant tumors, 95.8% in benign cystic swellings, 50% in abscesses and infections, and 100% in lymphoma. Significant relationship exists between ultrasonography with histology, clinical and radiographic diagnosis with a contingency coefficient of 0.833, 0.759, and 0.798, respectively. Overall, the accuracy, sensitivity and specificity of ultrasound was 86.1%, 90.3%, and 60%, respectively. Conclusion: Ultrasonography provides accurate imaging of the maxillofacial region and provides information about the pathological characteristic of lesion, its extent, and relationship with the surrounding structures. Inclusion of ultrasonography to the clinical and histopathological examinations increases the accuracy of orofacial swelling diagnosis.

Background: Radiography is often used routinely by the general practitioner (GP) in knee osteoarthritis (KOA), even though the diagnosis can be made based on clinical findings. However, radiography may also be requested when serious pathology is suspected. The agreement between the radiographic and the GPs clinical diagnosis and the ability of radiography to rule out serious pathology in clinical KOA is unknown, despite that this is important to evaluate the clinical value of radiography.Objectives: The objectives were to evaluate agreement between the radiographic and clinical diagnosis in KOA; and to describe radiographic features in patients referred from their GP with clinical KOA.Methods: Referral forms from GPs and radiographs of 1 334 consecutive patients above 40 years not previously diagnosed with KOA were evaluated. The agreement between primary indication for radiographic referral (± clinical KOA; according to the recommendations from the European League Against Rheumatism) and the radiographic diagnosis (± radiographic KOA; Kellgren and Lawrence score ≥ 1) was estimated using Cohen's Κ statistics. Furthermore, an evaluation of radiographic features was carried out in patients with clinical KOA (n = 997).Results: The strength of the agreement was 0.106 to 0.298 with the lowest agreement in the youngest patients and the highest in the oldest patients. Five radiographs (0.5%) revealed conditions needing further investigation or specific treatment (osteonecrosis, osteochondral lesion, fracture and subluxation).Conclusion: In patients with clinical KOA, the radiography seems only indicated if the clinical assessment cannot rule out other diagnoses or serious pathology.

Tarsal coalitions – what you need to know

Background and aimsHistpathologic diagnosis of exophytic lesions is occasionally influenced by clinical and radiograph-ic diagnosis and even the surgeon’s observation during biopsy. The aim of this study was to evaluate the cases with failure in clinical diagnosis.Materials and methodsA total of 73 patients with peripheral exophytic lesions were evaluated in Zahedan Faculty of Den-tistry in 2006. Specialists gave their differential diagnoses based on the criteria of oral medicine texts. Then a biopsy was taken and the histopathologic diagnosis was determined. Finally, consistency rates of clinical and histopathologic diagnoses were de-termined. Statistical analysis was carried out with SPSS software using Chi-Square and Fisher’s exact tests.ResultsIn the present study 73 subjects with oral soft tissue (peripheral) exophytic lesions were orally examined and biopsies were taken. Forty-four subjects (60.35%) were females and 29 (39.7%) were males. A total of 81.7% (62 subjects) of clinical diagnoses were consistent with histopathologic reports. In 18.3% (11 subjects) of the cases clinical diagnoses were not con-firmed by histopathologic reports.Conclusion In order to reach a diagnostic agreement, conformity of clinical and histopathologic diagnoses is necessary.

The National Institute for Health and Care Excellence (NICE) suggest there is no role for routine radiography in the diagnosis of osteoarthritis (OA). It is not known how consistent this recommendation is across international guidelines, or the impact of UK guidance on domestic OA X-ray request rates. A systematic search identified guideline recommendations on the role of radiography in OA diagnosis. Full texts underwent dual screening and appraisal using the AGREE II tool. A narrative synthesis was performed. Consultation data were extracted from a UK primary care database: the Consultations in Primary Care Archives (CiPCA). The annual proportion of X-ray requests per 100 OA consulters from 2000 to 2012 were calculated. Joinpoint regression analysis examined if there were changes in the trend of X-ray request rates and compared these with the publication dates of UK guidelines. Eighteen evidence-based OA guidelines were included in the review. Eleven recommended a clinical diagnosis of OA without radiographic confirmation. Seven recommended routine radiography; these guidelines were predominantly for radiologists. A mean of 17.3 X-rays per 100 patients were requested in patients consulting for OA per year between 2000 and 2012. A statistically significant reduction in X-ray request rates was seen in 2003. Recommendations on the role of radiography in OA vary between medical specialty and countries. UK guidelines appear to have had a limited impact on X-ray request rates in OA.

To evaluate the efficacy of ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings