Maxillofacial Radiology Clinic Research Articles

Assessment of Frequency and Anatomical Characteristics of Haller Cells in Cone-Beam Computed Tomography Scans of Patients Referring to a Private Oral and Maxillofacial Radiology Clinic During 2015-2017

Assessment of Frequency and Anatomical Characteristics of Haller Cells in Cone-Beam Computed Tomography Scans of Patients Referring to a Private Oral and Maxillofacial Radiology Clinic During 2015-2017

Demographics and referral patterns of a university-based oral maxillofacial radiology clinic over a 20 year period

The aim of this study was to review the referral patterns, distribution of interpretations, and type of diagnostic imaging used in a university based oral maxillofacial radiology clinic for patients referred for consultation from both dental and nondental clinicians. The database of the Special Procedures clinic in the oral radiology department of the University of Toronto, Faculty of Dentistry, containing over 5000 entries, from 1993 to 2013, was queried. Using descriptive categorical analysis, the results were analyzed to describe patient demographic characteristics, the specialty of the referring clinicians, the imaging modalities used, and the interpretation provided. Most referrals were from oral and maxillofacial surgeons and general dentists. Approximately 25% of referrals were interpreted as variations of normal anatomic structures. The most common reasons for referral were intraosseous lesions (42%), temporomandibular joints (39%), and sialography. Ten percent of all referrals were for recall examinations. The distribution of image modalities has changed through the years covered by this study. This study reflects a lower proportion of referrals reported as normal structures and their variations, than reported in a previous comparable study.

Radiographic assessment of maxillary sinus lateral wall thickness in edentulous posterior maxilla.

Background and aimGiven the importance of evaluating the maxillary sinus lateral wall thickness (LWT) to avoid complications during surgery, the aim of this study was to examine LWT as well as the effect of residual ridge height (RH), edentulous region, type of edentulism, age and gender on it.MethodsIn this cross-sectional study conducted in 2016, 150 samples of the CBCT imaging archives of the Oral and Maxillofacial Radiology Clinic in Babol, Iran, were evaluated retrospectively. In the coronal section, RH and LWT (at 3, 7, 10 and 15 mm from the lowest point of the sinus floor) were measured in NNT software in millimeters. Data were analyzed using the SPSS v22 software through independent-samples t-test, paired-samples t-test and ANOVA.ResultsIn 150 assessed images, by increasing the wall distance from the floor, the mean sinus lateral wall thickness was increased (p=0.01). There was no relationship between gender and age with the sinus lateral wall thickness (p>0.05). RH showed a significant relationship with LWT so that the higher the RH, the greater the LWT (p<0.05). It was also observed that the mean LWT was 1.31±0.3 mm in the partial edentulism and 0.95±0.26 mm in the complete edentulism (p<0.05). The maximum thickness was found in the first molar and the minimum values were in the second premolar and the second molar.ConclusionDue to the impact of residual ridge height and type of edentulism on LWT and anatomical variations observed in the maxillary sinus, CBCT assessment is recommended before surgery such as sinus lifting in this area.

Elongated Stylohyoid Process: A Pathological or Physiological Phenomenon?

Background: Calcification and morphological variation are fairly common in patients presenting to oral and maxillofacial radiology clinics with stylohyoid complex. Objectives: The present study used digital radiography to investigate in detail whether or not elongated stylohyoid complex is linked to clinical symptoms, gender, and increased age. Finding such relationship can affect the diagnosis of the condition and the selection of treatments. Methods: The present cross-sectional study was conducted on 186 patients aged 30 to 70 presenting to a private oral and maxillofacial radiology clinic in Rafsanjan, Iran, for digital dental panoramic radiography. All the patients completed a demographic questionnaire and clinical symptoms associated with stylohyoid complex. The chi-square test and Fisher’s exact test were used to compare categorical variables, while independent two-sample t-test and one-way ANOVA were used to compare quantitative variables, in both men and women and across age groups. The significance level was set at 0.05. Results: A total of 186 participants entered the study, consisting of 90 men (48.4%) and 96 women (51.6%). The mean stylohyoid process size was calculated as 27.08 ± 7.80. The most common radiographic morphology (on both the right and the left sides) was continuous, followed by pseudo calcified and segmental. The most common calcification pattern observed on both sides was completely calcified pattern, followed by partially calcified pattern, calcified outline, and nodular pattern. Conclusions: According to the results obtained, the calcification and elongation of the stylohyoid process as shown by radiography are more of a physiological than pathological phenomenon that exacerbates with age.

Prevalence of idiopathic osteosclerosis on cone beam computed tomography images

Objectives This study was performed to investigate the prevalence of idiopathic osteosclerosis on cone beam computed tomography (CBCT) images of patients.Methods In this descriptive, cross-sectional study, 240 CBCT scans of patients (125 women, 115 men) referred to a private oral and maxillofacial radiology clinic in Tehran in 2013 were selected and evaluated. Presence of idiopathic osteosclerosis and its features including its location in the jaw, its association with teeth, presence or absence of root resorption, number, shape and size of lesions and age and gender of patients were assessed. Descriptive statistics were reported. Chi-square test and independent t-test were used for statistical analysis.Results Idiopathic osteosclerosis was seen on CBCT images of 20 patients (8.33%). The lesion was more frequent in women than men, but the difference was not significant (P = 0.50). Also, the lesion was more common in the mandible than the maxilla (95.6% vs. 4.4%). Most lesions were observed in the molar (56.5%) and premolar (34.7%) areas of the lower jaw. Most lesions did not have any association with teeth (73.9%). More than half of the lesions (56.5%) were round in shape and the rest (43.4%) were irregular. The mean size of the lesions was 5.4 ± 1.8 and 5.7 ± 1.4 mm in the mesiodistal and superior-inferior aspects, respectively.Conclusion The prevalence of idiopathic osteosclerosis of the jaws on CBCT images of an Iranian population was within the range reported by other studies. The lesions were more common in the mandibular molar region with no relation to teeth.

Panoramic Radiomorphometric Indices of the Mandible in an Iranian Population

Objectives: Radiomorphometric indices measured on simple radiographic images can be used for qualitative and quantitative assessment of bone. Panoramic radiographic imaging can therefore assist dentists in early detection of osteoporosis in patients. Considering the effect of ethnic and environmental factors on development of osteoporosis and absence of normal values of radiomorphometric indices for the Iranian population, which results in use of normal values of other ethnicities for determining the presence or absence of osteoporosis in patients, the present study was conducted to evaluate radiomorphometric indices in patients presenting to a private oral and maxillofacial radiology clinic in Rafsanjan, Iran.Methods: The present cross-sectional study examined 385 eligible patients who met the inclusion criteria. Their demographic characteristics including age, gender and level of education were recorded. Their panoramic radiographic data, including radiomorphometric indices such as mandibular cortical index (MCI), antegonial index (AI), and gonial index (GI), were evaluated on each image. Multiple logistic regression was used to evaluate the effect of variables on mandibular bone radiomorphometric indices. P-value less than 0.05 was considered statistically significant.Results: The mean AI and GI were 2.19±0.56 and 0.87±0.31mm, respectively. In assessment of MCI, since none of the patients fell under the C3 category, all patients were categorized as C1 or C2. Assessment of demographic variables and radiomorphometric indices showed that age had a significant relationship with MCI and AI while gender had a significant relationship with GI.Conclusion: Radiomorphometric indices can be used to assess the risk of osteoporosis in patients.

The Prevalence of Tonsilloliths and Other Soft Tissue Calcifications in Patients Attending Oral and Maxillofacial Radiology Clinic of the University of Iowa

Objective. The purpose of this study was to determine the prevalence of tonsiliths in patients attending the oral and maxillofacial radiology clinic of The University of Iowa and to determine if there is any correlation between the presence of tonsiliths and the presence of stones in other body tissues, ducts, or organs. Study Design. This was a two-part study. The first part was a prevalence study whereas the second was a matched pair case-control study. The matched pair case-control study commenced after the prevalence study was concluded. No new or unusual radiographs were made in this study. The study only reviewed radiographs that were made for clinical purposes. Results. A total of 1524 pantomographs were reviewed and 124 subjects (53 males and 71 females) aged 9 years and 2 months to 87 years (mean age 52.6 years) were included for data analysis. Thirty-eight subjects had single tonsiliths whereas 86 subjects had multiple tonsiliths. The prevalence of tonsiliths in the study population was 8.14%. A total of 20 subjects were included in the second part of the study, comprising 10 each for matched pair case-control groups. The observations did not indicate any correlation between the presence of tonsiliths and the presence of stones in other body tissues, ducts, or organs. Conclusion. The prevalence of tonsiliths in our study population was 8.14%. The observations in our study do not support any correlations between tonsiliths and calcifications in other body tissues, organs, or ducts.

Assessment of Cone-Beam Computed Tomography (CBCT) Findings in Facial Asymmetric Patients

Introduction: Due to the complexity of facial asymmetry, the diagnosis of different aspects of asymmetry via conventional radiographs is not precise. In this study, we investigated findings of facial asymmetry by using cone- beam computed tomography (CBCT) images. Materials and Methods: In this descriptive study, we evaluated CBCT fi ndings of 18 pa ents i.e. a group of 14 females and 4 males having a mean age of 22.7 years who referred to a maxillofacial radiology clinic due to facial asymmetry from 2010 to 2011. Findings of asymmetry were investigated using axial, coronal and sagittal views. Results: As detected in axial view, 9 of 18 p aents had yaw in the maxilla. Approximately 14 and 11 pa ents had yaw in the mandible and zygoma respectively. Differences were observed between the medio-lateral dimensions of the condylar heads in 7 pa ents. We also detected the cervical spine devia on in 9 cases. Moreover, a difference in the antero-posterior position of the glenoid fossa in 10 pa ents was observed. In coronal view, “roll” i.e “cant” in the maxilla, mandible and orbital cavi es was found in 14, 12 and 1 patient respectively. Differences in the condylar neck height in 9 pa ents and in the level of the glenoid fossa in 11 pa ents were observed. Conclusion: CBCT is effective in evaluating the details of asymmetry and its effects on facial structures. In addition, three-dimensional approaches for the analysis of asymmetry transform it from a simple and predictable phenomenon into an incredibly complicated process. Pursuing orthodontic treatment plan without considering these complexities and details is not successful.

Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study

To evaluate the type and prevalence of incidental findings from cone beam computed tomography (CBCT) of the maxillofacial region. Findings are divided into those that require (i) intervention/referral, (ii) monitoring, and (iii) no further evaluation. Three hundred consecutive CBCT scans conducted in the University of North Carolina School of Dentistry Oral and Maxillofacial Radiology Clinic from January 1 to August 31, 2008 were retrospectively reviewed. Findings were categorized into airway, soft tissue calcifications, bone, temporomandibular joint (TMJ), endodontic, dental developmental, and pathological findings. A total of 272 scans revealed 881 incidental findings (3.2 findings/scan). The most prevalent was airway findings (35%) followed by soft tissue calcifications (20%), bone (17.5%), TMJ (15.4%), endodontic (11.3%), dental developmental (0.7%), and pathological (0.1%). 16.1% required intervention/referral, 15.6% required monitoring, and the remainder (68.3%) required neither. This study underscores the need to thoroughly examine all CBCT volumes for clinically significant findings within and beyond the region of interest.

Why should we insist patients remove all jewellery?

Body piercing is now a popular trend among adolescents and adults. According to Armstrong et al,1 body piercing is defined as the insertion of a needle to create an opening into either cartilage or skin for the introduction of decorative jewellery. A study at one US college found the prevalence of body piercing was 51% among 454 undergraduate students who completed a survey in 2001.2 Another study at an urban hospital-based adolescent clinic found that, among 225 participants aged between 12 and 21 years in 2000, 48% had a body piercing. Among this sample of pierced participants the most common sites for body piercings were the ears (74%), nose (34%), tongue (30%), navel (27%) and eyebrow (15%), with fewer than 7% reported piercings in other places.3 Of concern for oral and maxillofacial imaging are piercings in the ears, nose and tongue owing to the potential for metallic artefacts in the radiographic images. A 30-year-old female attended the emergency dental clinic in the Oral and Maxillofacial Radiology Clinic at Texas A & M Health Science Center, Baylor College of Dentistry and a panoramic projection (Figure 1) was taken. The patient stated that she could not remove the earrings before the X-ray exposure. As a result, the image had large ghost images across the maxillary sinuses from the retained earrings. During a surgical procedure the same day, the oral and maxillofacial surgeon extracted a non-restorable right maxillary second molar and tooth fragments/odontomas distal to this second molar. Owing to the serous fluid expressed from a sinus fistula in that area, the oral and maxillofacial surgeon ordered a follow-up appointment with a new panoramic projection. The patient was informed that she must remove all of her earrings before the second radiograph to clearly visualize the entire right maxillary sinus and rule out the possibility of a cystic lesion. The panoramic projection (Figure 2) was taken at the Oral and Maxillofacial Radiology Clinic 1 week later. A displaced impacted tooth was noted at the superior border of the right maxillary sinus. A cone beam CT (CBCT) study was acquired 2 days later. A cystic lesion associated with the impacted tooth in the right maxillary sinus/orbit area was noted (Figure 3). Biopsy and surgical treatment are pending. Figure 1 Panoramic radiograph for the extraction of right maxillary second molar and ghost images of earrings noted (arrow heads) Figure 2 Panoramic radiograph 1 week later and a displaced impacted tooth noted in the right maxillary sinus region (arrow) Figure 3 Cone beam CT images. (a) Coronal view; (b) frontal three-dimensional image Earrings are the most popular type of body piercing. It is common today to find both male and female patients with unilateral or bilateral ear lobe jewellery, in single or multiple pierced sites. Some patients are unable to remove the piercings because of permanent soldering of the metals. To remove or not to remove… that is the question. In a well-positioned panoramic projection the metal-based earrings will be visible, along with the ghosting caused by these objects. The non-midline ghost images appear more superior on the contralateral side and reversed with less definition than the image of the actual objects. Along with earrings, an increasing number of patients present to dental clinics wearing jewellery inserted into the perioral (lips and cheeks) and intraoral tissues (tongue and uvula), or any combination of these sites.4 While some practitioners routinely recommend that all jewellery be removed, others feel that a selective approach to removal of jewellery is appropriate. If the object is thought to interfere with the diagnostic quality of the film then it should be removed.5 When metal jewellery is present during radiographic examination, it may prevent visualization of normal anatomy and/or pathoses, as in this case. Non-diagnostic images may lead to retakes, with an increase in ionizing radiation exposure to the patient. By avoiding production of these artefacts when possible, we can reduce radiation exposure to patients while obtaining the most diagnostically acceptable images possible.5 In summary, patients should be strongly advised to remove any piercings of the head and oral cavity that will be visualized in the radiographs before X-ray exposure and counselled as to the consequences of failure to do so.

Revisiting the Intraoral Radiographic Re-Exposure Data Between Dental Students and Trained Dental Assistants in a University Based Oral and Maxillofacial Radiology Clinic

Revisiting the Intraoral Radiographic Re-Exposure Data Between Dental Students and Trained Dental Assistants in a University Based Oral and Maxillofacial Radiology Clinic

Comparison of re-exposure rates of intraoral radiographs between dental students and trained dental assistants in an oral and maxillofacial radiology clinic

To compare the re-exposure rates of dental radiographs taken over a period of 1 year between dental students and trained dental assistants at a university-based oral and maxillofacial radiology clinic. Detailed records of the number and type of intraoral radiographs taken by the students and staff members and the number of re-exposures that were required from July 2003 to July 2004 were used. Statistical analyses were performed on the data. A chi2 test showed that re-exposure rates of radiographic series between students and staff were statistically different. When comparing the students' re-exposure rates during each of the four quarters of their radiology rotation, one-way analysis of variance test showed that the results were not statistically significant for reduction in the number of re-exposures over the entire year. There were significant differences in the re-exposure rates between staff dental assistants and students. Film re-exposure rates for the students during the four quarters were expected to decrease with time. Instead, the consistency of the re-exposure rates of the students during the four quarters demonstrates the need to recognize why the students did not perform better as the year progressed. The percentage of films that needed to be re-exposed by either group (students or the staff dental assistants) was not extremely high.

3D reconstruction and treatment planning of a facial trauma case

3D RECONSTRUCTION AND TREATMENT PLANNING OF A FACIAL TRAUMA CASE. S. Mardini, M. Noujeim, and A. Hamidaddin, Department of Dental Diagnostic Science, University of Texas Health Science Center at San Antonio. Background. Facial fractures are a common injury in the US. The most common cause is motor vehicle accident. Reconstruction of these multiple facial fractures can pose a difficult task for the surgeon. Visualization of the fractured fragments and adjacent structures is very important for a successful outcome. Computerized tomography (CT), along with new reconstruction software, has allowed for the radiologist to unveil the complexity of the case. Objective. To illustrate the role of the radiologist and the use of multiplanar reconstruction in the diagnosis and the treatment of complex fracture cases. Study design. A case was referred to the Graduate Oral and Maxillofacial Radiology Clinic at the University of Texas Health Science Center at San Antonio. A conventional CT study was reconstructed using 2 multiplanar 3-dimensional reconstruction software (Mimics 8.0 [Materialise Inc, Leuven, Belgium] and Vitrea 2 [Vital Image Inc, Plymouth, Minn]) prior to the reconstruction surgery. Results. These reconstructions revealed lesions of the body of the mandible, TMJs, the zygomaticofrontal, zygomaticotemporal, and zygomaticomaxillary sutures, the floor of the orbits, and the posterior walls of the maxillary sinuses. Conclusions. The reconstructions showed the complexity of the fractures of the mandible and the midface, including bilateral TMJ condylar fractures. Based on these reconstructions, a surgical treatment plan was formed and applied during the reconstructive surgery.

A benign fibro-osseous lesion of the mandible masquerading as a multilocular radiolucency

The fibro-osseous lesions represent a large group of lesions classified together by a similar histology and progression. Most are of unknown etiology, some are believed to be neoplastic, whereas others are related to metabolic imbalances. It is not unusual to see a lesion with a range of presenting radiographic appearances, causing considerable diagnostic confusion, resolved only by a confirmatory biopsy. A 41-year-old African-American woman presented to the Oral and Maxillofacial Radiology clinic for a full mouth radiographic examination. Her medical history was significant only for controlled hypertension. A large radiolucent lesion was observed on the edentulous right mandibular premolar-molar region in the periapical views, extending mesiodistally from the distal of the second premolar to the mesial of the third molar region and superioinferiorly from the crest of the edentulous alveolar ridge to the lower border of the mandible. The radiolucent lesion was distinct and multilocular in appearance and measured approximately 5 × 8 cm. The locules seem to have coalesced. The borders were corticated in several areas, suggesting cystic behavior of the lesion. The radiographic differential diagnosis included OKC, ameloblastoma, odontogenic myxoma, ossifying fibroma, and an early stage fibro-osseous lesion.1Mayer D.P. Siskind B.N. Rosen D.C. Imaging and interpretation of fibro-osseous disease.Oral Maxillofac Clin North Am. 1997; 9: 607-623Google Scholar The remaining radiographic examination was unremarkable. Clinically the edentulous ridge on the side of the lesion was nonexpansile and had a normal appearance. The patient was referred to Oral and Maxillofacial Surgery for further diagnosis and treatment. After a positive FNA yielded a straw-colored aspirant, an incisional biopsy of the area was obtained. The histopathologic diagnosis was a benign fibro-osseous lesion. Fibro-osseous lesions of the jaws are of particular interest to the maxillofacial radiologist because they emphasize the central role of the radiologist in the diagnostic process. Fibro-osseous lesions tend to have a wide range of presenting radiographic appearances. Usually beginning with a radiolucent stage, these lesions tend to become infiltrated by osteoid and cementoid tissues and their appearances change over time. The radiolucent stage is replaced by a mixed opaque-lucent stage, which may yield to a completely opaque appearance.2MacDonald-Jankowski D.S. Fibro-osseous lesions of the face and jaws.Clin Radiol. 2004; 59: 11-15Google Scholar