Teeth in the maxillary sinus--imaging and management

PURPOSE

To evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus.

METHODS

Twelve patients with teeth in the maxillary sinus were studied by plain film radiography (PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored.

RESULTS

The radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation.

CONCLUSION

CT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.

The role of interventional radiology in the management of intra- and extra-peritoneal leakage in patients who have undergone continent urinary diversion

PURPOSE

To assess how radiologic intervention altered the hospital course of patients undergoing continent urinary diversion.

METHODS

Thirty-seven consecutive patients with bladder cancer invading the muscular layer were treated with total cystectomy and construction of a continent urinary reservoir. Eleven of 37 patients suffered early and late anastomotic leakage; six had prolonged extraperitoneal leakage at the urethroenteric anastomosis, three had prolonged intraperitoneal pouch leaks, and two had delayed ureteroenteric leaks. Seven of these patients required radiologic intervention.

RESULTS

Intervention in the form of drainage catheter manipulation (n = 4), percutaneous nephrostomy (n = 4), or ureteral stent placement (n = 2) resulted in cessation of leakage without surgical intervention in all seven patients. Intraperitoneal pouch leaks were more difficult to control than extraperitoneal leakage and required longer drainage intervals.

CONCLUSION

Interventional radiologic procedures played a key role in the management of continent urinary diversion complications, obviating the need for repeat surgical intervention in all instances.

Ehlers-Danlos syndrome, fibromyalgia and temporomandibular disorder: report of an unusual combination

An unusual case of temporomandibular disorder in the presence of both fibromyalgia and Ehlers-Danlos syndrome is presented. Some of the problems in treating these patients are discussed. It is suggested that early conservative treatment of the temporomandibular disorder with a stabilization splint and physical therapy is effective, and this approach should be attempted before any surgical intervention is chosen.

Growth potential of peripheral giant cell granuloma

PURPOSE

The purpose of this study was to investigate the association of selected demographic, systemic health, and oral health characteristics of patients with large (> 2 cm) peripheral giant cell granuloma and to assess its growth potential and the possible underlying causes.

METHODS

A series of 79 cases including 15 subjects with lesions 2 to 5 cm in the largest diameter is presented. Age, sex, site, size, systemic health, oral hygiene, and report of oral dryness of subjects with large lesions were compared with those of subjects with small lesions (< 2 cm).

RESULTS

No differences were found in mean age between the small lesion group (mean age = 31 +/- 6 years) and the large lesion group (mean age 53 +/- 24.2 years). Female predilection (male/female ratio 1:1.5, 1:2.75.) was more significant in patients with large lesions. No statistically significant differences were found in systemic health score (mean American Society of Anesthesiology score 1.39, 1.53). Oral hygiene score (percent calculus 78% +/- 3.1%, 95% +/- 2.7%, percent gingival bleeding 58% +/- 3.6%, 73% +/- 5.4%, percent deep pocket 30% +/- 2.8%, 42% +/- 3.1) was better among the patients with small lesions. The percentage of patients with a report of oral dryness was significantly higher (3.1%, 27%) among patients with large lesions.

CONCLUSIONS

Findings from this study suggest that patients with large (> 2 cm) peripheral giant cell granuloma lesions are more likely to be women with lower oral hygiene scores and xerostomia. Further studies are required to measure the relative risk of these factors.

Experimental tongue cancer in desalivated rats

A group of 39 rats underwent excision of the submandibular and sublingual glands and ligation of the parotid ducts through the midventral incision of the neck, while the control group (41 rats) underwent a sham operation. All rats were administered 4NQO in a final concentration of 0.001% in drinking water. At 7, 14, 22 and 28 weeks after administering 4NQO, both groups of rats were killed and their tongues dissected, inspected and then fixed in 10% buffered formalin for histopathological examination. Clinical examination during the first 14 weeks revealed that rats in both groups looked healthy and no differences in body weight were noticed. Afterwards, the average weight gain of the desalivated rats was lower than in the control group (P < 0.01). The number of macroscopic oral lesions increased with time in both groups. However, in the desalivated rats, the first identifiable lesions were seen as early as week 7, whereas in the control group macroscopic lesions were seen only after 22 weeks. Histological examination revealed more affected rats in the desalivated group in the first 14 weeks after administering the carcinogen; lesions showed more severe pathological changes including two cases with evidence of squamous cell carcinoma. The differences between the desalivated groups and control decreased after 22 weeks with almost no differences at the end of the experiment.

Condylar asymmetry measurements in patients with an Angle's Class III malocclusion

Condylar asymmetry/age relationships were investigated in a group of 23 dentate patients with an Angle's Class III malocclusion and no signs or symptoms of temporomandibular disorders and no prior orthodontic treatment. Condylar asymmetry was determined from panoramic radiographs. A graph of age versus asymmetry index was then plotted. There was no significant correlation between age and the asymmetry index in these patients (R2 = 0.019). This is similar to results obtained for a group of patients with a Class I occlusion who were included as controls, and similar to a group of patients with an Angle's Class II division 2 malocclusion investigated previously.

Temporomandibular joint dysfunction in children

Sixteen pediatric patients with temporomandibular joint (TMJ) dysfunction were successfully diagnosed following appropriately selected imaging methods. The role of radiography in diagnosis of TMJ dysfunction is essential in distinguishing between the osteogenic and non-osteogenic etiologies. Computed tomography (CT) was found to be a valuable imaging method, with advantages over plain film radiography. The treatment modalities considered were: non-invasive therapy, occlusal therapy and surgical treatment. The treatment of choice was dependent on the osteogenic or non-osteogenic etiology. Surgery was considered only when the non-invasive or occlusal therapies were ineffective.

Clinical characteristics and treatment of patients with oral lichen planus in Israel

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.

Effect of decalcified freeze-dried bone allograft on the healing of jaw defects after cyst enucleation

PURPOSE

This study radiographically evaluated the changes that occur in jaw defects after enucleation of cysts and either grafting with demineralized freeze-dried bone allograft (DFDBA) or packing with absorbable gelatine sponge (Gelfoam).

PATIENTS AND METHODS

Thirty-two patients (14 males, 18 females) with cystic lesions of the jaws were divided into two groups. Group A underwent enucleation and bone grafting with DFDBA. Group B underwent enucleation and packing with Gelfoam. Both groups were evaluated radiographically before surgery, immediately postoperatively, and 6, 12, 24, and 36 months postoperatively. The density of the area was measured with a digital densitometer.

RESULTS

The density in group A was significantly (P < .05 to .01) greater than in group B at 6 and 12 months postoperatively. The difference at 24 months was not significant. Group A reached density levels at 6 months that were reached by group B at 12 months.

CONCLUSION

The findings demonstrate that decalcified freeze-dried bone allograft enhances bone healing in jaw defects after cyst removal.

Lectin histochemistry of the submandibular and sublingual salivary glands in rats

Tissue sections from rat submandibular and sublingual glands were studied with lectin probes to identify terminal sugars of the glycoconjugates in various cell types of the salivary glands. The lectins used in the study were Canavalia ensiformis (Con A), Triticum vulgaris (WGA), Succinyl WGA (S-WGA) Ricinus communis I (RCA-I), Arachis hypogaea (PNA), and Ulex europeaus (UEA-I). The cytoplasm and cell membrane of both the serous and mucous acinar cells present high similarity in the distribution of some sugar residues, but differ considerably in the expression of specific sugars which appear either in the serous or in the mucous cells. The cytoplasm and cell membrane of the serous and mucous acinar cells express Mannose (Man) and Glucose (Glc), but lack Galactose (Gal), and N-acetylgalactosamine (GalNAc). Fucose (Fuc) is present only in the mucous acinar cytoplasm. The moderate to intense binding of WGA to the acinar and ductal cells and the lack of binding of S-WGA, indicate the presence of sialic acid rather than N-acetylglucosamine (GlcNAc). These sialic acid residues are not associated with PNA-binding sugar sequences as pretreatment with neuraminidase is not associated with exposure of additional PNA receptors.

Computed tomography in pediatric oral and maxillofacial surgery

The use of computed tomography (C.T.) in the diagnosis and management of developmental and pathological conditions of the jaws in children was evaluated. CT was found to be superior to plain film radiography in estimation of the three-dimensional morphology of the abnormality in the jaws, in determining spatial relationship and proximity to vital structures. It is valuable by allowing accurate planning of the surgical procedure, estimation of the extent of the surgery and prediction of outcome as well as complications and prognosis. CT in the appropriate circumstances, is a very useful diagnostic tool in pediatric maxillofacial surgery. Tissue preservation and precision are of utmost importance, especially in children where many structures have not reached their final dimensions. Careful consideration should be given to risk benefit ratios due to higher exposure to radiation.

Radiographic features of central giant cell granuloma of the jaws in children

The radiographic features of ten pediatric cases of central giant cell granuloma of the jaws were studied, using plain film radiography (PFR), computed tomography (CT), and a dental CT software program (DS). The radiologic features varied from ill-defined destructive lesions to a well-defined, multilocular appearance. Teeth or root displacement was found as the most consistent feature. Root resorption was rare. The features seen on CT were clearer than those seen on PFR. DS, by its visualization of the jaw in three plans - axial, panoramic, and buccolingual - provided useful information for determining the topography of the lesion in its structure (uni- or multilocular) and proximity to adjacent anatomic structures, such as teeth, nerves, or maxillary sinus. CT and, ideally, CT with DS should be used for diagnosis and surgical management of central giant cell granuloma of the jaws in children.

Technical note: oroantral fistula: improved imaging with a dental computed tomography software program

Oroantral fistula (OAF) is an uncommon complication in oral surgery. About 5% of all extractions of maxillary premolars or molars may result in communication to the antrum. Small fistulae, 1-5 mm in diameter may close spontaneously, but larger fistulae usually require surgical closure. Pre-operative determination of the size of the fistula is often unreliable leading to difficulties in planning subsequent clinical management. We report a method for the precise determination of the size of the OAF using a dental computed tomography (CT) software program.

Epithelium and connective tissue regeneration during palatal wound healing in desalivated rats--a comparative study

Reduction of salivary secretion leads to alteration in the physiologic functions of saliva, including the effect on wound healing. The present study evaluates epithelial regeneration as compared with new connective tissue formation during the healing of a palatal wound in a desalivated rat model. Experimental rats underwent sialadenectomy of the submandibular and sublingual glands and ligation of the parotid ducts. Small or large mucoperiosteal circular wounds, 3 mm or 5 mm in diameter respectively, were produced in the palate. The distance between epithelial margins and the amount of myofibroblasts were determined at 0, 3, 7, 14, 21 and 28 days post-surgery. The distance between epithelial margins of the small wound (3 mm) was similar in experimental and control groups; however, the distance in the large wound (5 mm) was greater (P < 0.001-0.05) in experimental rats. New connective tissue formation, as indicated by the amount of myofibroblasts, was less (P < 0.01-0.05) in desalivated rats with either the small or the large wound between days 3 and 14. The present results indicate that there is a tissue-specific effect of desalivation, and connective tissue is much more sensitive to desalivation than epithelium.

Parotid and submandibular calculi in children

Twelve pediatric patients with parotid or submandibular salivary gland calculi were successfully diagnosed following appropriately aimed imaging methods. The treatment modalities were: secretory stimulation of the gland to induce spontaneous passage, sialolithotomy or sialadenectomy. The treatment of choice was dependent on the size and location of the calculi, as well as on the affected gland and its functional secretory state.

Ameloblastic fibrodentinoma: report on two new cases

Brain heterotopia of the tongue is a rare, congenital malformation, probably not embryologically related to encephaloceles or to the so called "nasal gliomas." The progressive growth frequently noted confers to the lesion a tumor-like appearance and can raise a clinical suspicion of some rare neonatal neoplasia. The non-neoplastic nature of the lesion is well established, and the growth may well be due to the fact that heterotopic brain grows as rapidly as normal brain in the infant. Although local recurrence after incomplete resection has been reported, the clinical behavior of brain heterotopia of the tongue is benign.

CT of cystic jaw lesions

OBJECTIVE

Our goal was to compare the efficacy of CT with that of plain film radiography (PFR) in analyzing the three-dimensional shape and structure of cystic jaw lesions.

MATERIALS AND METHODS

Twenty patients with cystic lesion of the jaw were studied by PFR and CT. The three-dimensional outline of the cyst and the distances between the cyst wall and adjacent vital teeth, cortical jaw bone, maxillary sinus, and mandibular canal were estimated on PFR and on CT scans.

RESULTS

Computed tomography was superior to PFR in the demonstration of the three-dimensional bony margins of the cyst and in determination of its proximity to adjacent vital structures (p < 0.01, sign test).

CONCLUSION

Application of CT is useful for diagnosis and treatment planning of cystic lesions of the jaws.

Histochemical characterization of collagen fibers in fibrous overgrowth (irritation fibroma) of the oral mucosa: effect of age and duration of lesion

In a study of 43 specimens of oral mucosa irritation fibroma, polarization colours of collagen thin (0.8 microm) and thick (1.6-2.4 microm) fibers were recorded in formalin-fixed and paraffin-embedded sections stained with Picrosirius red. Examination of polarization colours of both the 'thin' and 'thick' collagen fibers revealed an increase of yellowish-orange and orange fibers as a function of age in patients over 30 years old (P < 0.05 only in thick fibers). When the polarization colours of thin and thick collagen fibers were recorded as a function of duration of the lesion, there was an increase in the number of yellowish-orange and orange fibers and a decrease in blue-green and green fibers in both thin (P < 0.1) and thick (P < 0.05) populations as the lesion matured. These findings show that increments in both the patient's age and the duration of the lesions increase the amount of collagen fibers which exhibit yellowish-orange and orange polarization colours indicating tighter packing and better alignment of the microfibrils, similar to normal mature collagen. These differences may have an effect on the timing of the surgical excision.

Long-term effect of desalivation on extraction wound healing: a densitometric study in rats

The study evaluates radiographically the long-term changes that occur during the healing of tooth sockets in a desalivated rat model. Experimental rats underwent sialadenectomy of the submandibular and sublingual glands and ligation of the parotid ducts. Mandibular left first molars were extracted and the rats killed at 0, 14, 21, 28, 45 and 60 days post-extraction. The mandibles were removed, cleaned of soft tissue, placed on a size 2 dental X-ray film and exposed together with an aluminium stepwedge 0.5-3.0 mm. Socket density was measured using a digital densitometer and related to the equivalent density of aluminium. The density of the image of the apical area of the socket was similar in control and desalivated groups (P > 0.05) throughout the study. However, the density of the image of the crestal area of the socket was lower (P < 0.01-0.001) between days 21 and 60 in desalivated rats. This suggests that desalivation causes a long-term delay in socket healing.

Central odontogenic fibroma. A case report

A case of a central odontogenic fibroma in a 16-year-old boy is presented. The clinical appearance and surgical treatment are described; and the pathogenesis and histopathologic diagnosis are discussed.

Extraction site healing in rats. A radiologic densitometric study

The present study uses a simple, objective method to radiographically evaluate the changes that occur during socket healing in rats. Mandibular left first molars were extracted in 35 Wistar rats, which were then sacrificed at 0, 7, 14, 21, 28, 45, and 60 days after surgery. Mandibles were removed, placed on an ANSI size 2 film, and exposed with an aluminum step-wedge, 0.5 to 3.0 mm. Socket density was measured with a digital densitometer and related to the equivalent density of aluminum. Increased density of the image of the apical and crestal areas of the socket was observed on day 7. Maximum density was reached by day 28 in the apical area; in the crestal area, density increased at a slower rate. The density changes found in the present study agree with the known histologic reports of socket healing in rats. Densitometric evaluation of extraction socket healing, using a step-wedge with 0.5 mm increments, is a useful and reliable tool to objectively assess bone formation and mineralization.

Characteristics of palatal wound healing in desalivated rats

The healing of excisional wounds in the palate of desalivated rats was evaluated. Experimental rats became desalivated after extirpation of the submandibular and sublingual glands and ligation of the parotid ducts. Small or large circular wounds, 3 or 5 mm in diameter, were produced in the palate. The wound area, area of inflammation, area of connective tissue formation and the number of myofibroblasts were determined at 0, 3, 7, 14, 21 and 28 days after surgery. The area of the small wound (3 mm) was similar in experimental and control groups; however, the area of the large wound (5 mm) was greater in the experimental group (p < 0.05-0.01). The area of inflammation was greater in the experimental group with small or large wounds (p < 0.05-0.01). Connective tissue formation was less (p < 0.01) in desalivated rats with a small wound at day 14 and with a large wound at days 21 and 28. There were fewer myofibroblasts in the large wound of desalivated rats (p < 0.01) than in controls between days 3 and 14. The results indicate that palatal wound healing is delayed in desalivated rats and that larger wounds are more sensitive to desalivation than smaller wounds.

Healing of experimental wounds in sialadenectomized rat

The present study evaluates the healing of an experimental standardized full thickness excisional wound in the palate of a sialadenectomized rat model. Experimental rats underwent sialadenectomy of the submandibular and sublingual glands and ligation of the parotid ducts. A full thickness circular wound, 3 mm in diameter, was produced in the palate. Wound diameter was measured clinically and the area of inflammation and area of new connective tissue formation were determined histologically at 3, 7, 14, 21 and 28 days post-surgery. Wound diameter was similar in both the experimental and the control groups. The area of inflammation, however, was larger (p less than 0.05) in experimental rats at days 3, 7 and 14. New connective tissue formation was less (p less than 0.05) in sialadenectomized rats at days 14 and 21. The present results indicate that palatal wound healing is altered and delayed in sialadenectomized rats.