The Manzi projection: an imaging method used in dentistry for differential diagnosis of atheroma

Guilherme Augusto Alves De Oliveira,Flávio Ricardo Manzi,Beethoven Estevão Costa

doi:10.1590/1981-863720170002000123361

Guilherme Augusto Alves De Oliveira, Flávio Ricardo Manzi + Show 1 more

Open Access

https://doi.org/10.1590/1981-863720170002000123361

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Abstract

ABSTRACT Atherosclerosis is a pathology of great importance worldwide, because of its direct relationship with cerebrovascular events, resulting in high morbidity and mortality rates. The possibility of atheromas being identified by means of panoramic radiography is consolidated in literature; however, limitations have been reported. Thus, the aim of the present clinical case was to demonstrate the possibility of using Manzi’s Projection, which is a technique that enables visualization of the carotid artery trajectory without superimpositions of other anatomic structures, capable of promoting differential diagnosis of calcified atheromas in the carotid artery during dental exams.

Highlights

Atherosclerosis is an important public health issue worldwide and is characterized by lipid and inflammatory cell deposition on the arterial walls, forming plaques denominated atheromas[1,2].The development of atheromas occurs predominantly at the level of the carotid artery bifurcation, as it presents a large turbulent flow that generates low intensity, but constant stress on the arterial wall[3].Clinically, Doppler Ultrasonography is the method of choice for detecting these atheromatous plaques, because it has an accuracy of approximately 90% in comparison with Intra-arterial Angiography - the gold standard
Atheromas may be diagnosed by means of routine dental radiographic exams as this calcified plaque is characterized as a radiopaque mass that may be circular, heterogeneous, unilateral or bilateral, in a lateral position to the intervertebral space C3-C45
For differential diagnosis between atheromas and other types of calcifications with some radiographic similarity, the option was taken to perform the Manzi Projection, an anterior-posterior projection performed in the cephalometric unit with the Kodak Ceph 9000 3D apparatus (Carestream Health, Inc.), in which the patient is positioned with the Frankfurt plane slightly inclined towards the vertical position

Summary

INTRODUCTION

Atherosclerosis is an important public health issue worldwide and is characterized by lipid and inflammatory cell deposition on the arterial walls, forming plaques denominated atheromas[1,2]. Atheromas may be diagnosed by means of routine dental radiographic exams (panoramic radiography) as this calcified plaque is characterized as a radiopaque mass that may be circular, heterogeneous, unilateral or bilateral, in a lateral position to the intervertebral space C3-C45. These atheromatous plaques may be identified in panoramic radiographs, further exams are required to establish a differential diagnosis, due to the presence of structures with similar characteristics, such as triticeous cartilage calcification, sialoliths, phlebolites, the hyoid bone, and calcified lymphatic ganglia, among others in the cervical region. The presence of a large calcified plaque was found in the left carotid artery, promoting 50-69% stenosis

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CONCLUSION