A simple means of demonstrating skull fractures using radiographic altered image geometry

Multiple comminuted fractures distributed around a skull and resulting from repeated weapon impacts were poorly demonstrated on conventional lateral and upper frontal radiographs. This was due to superimposition of contralateral fractures, normal anatomy and tangential projection angles. Simple modification of a standard dental x-ray generator and manipulation of projection geometry allowed isolation of individual fractures with improved image quality. The above technique lends itself to cases in which soft tissue remains to obscure the detail of multiple fractures during clinical observation.

Nasal and bronchoalveolar lavage fluid cytokines in early cystic fibrosis

Cytokine levels in nasal and lower airways in young cystic fibrosis (CF) patients were compared with those in controls. Nasal (NLF) and bronchoalveolar (BALF) lavage fluids were obtained from children with or without CF who were undergoing bronchoscopy for clinical indications. In NLF, neither inflammatory cells nor cytokine concentrations differed between patients and controls. However, interleukin (IL)-8 levels in infected BALF from children with CF were markedly elevated compared with levels in infected and uninfected controls, even after standardization of IL-8 concentrations to bacterial counts. BALF IL-6 was modestly elevated in infected CF patients compared with uninfected but not infected controls; IL-10 did not differ among the groups. NLF and BALF IL-8 levels were not significantly correlated. Excessive airway inflammation in early CF thus appears to be confined to the lower respiratory tract, and IL-8 levels are markedly increased in children with CF compared with control children with a bacterial infection of the lower airways.

[Our experience with toracic outlet syndrome]

The Authors report their experience in 290 cases of thoracic outlet syndrome (TOS) and 71 cases of Paget-Schroetter syndrome, that is a condition due to thrombosis of the subclavian and/or axillary vein. They point out that diagnosis is mainly clinical-instrumental and the ulnar nerve conduction velocity (UNCV) test is of fundamental importance. The Authors emphasize how the good results obtained could be related to the complete removal of the first rib and to the axillary approach that they strongly support.

Pediatric bronchoscopy

Endoscopic techniques for evaluation and management of airway and pulmonary problems in pediatric patients have matured greatly in the past decade, especially with the introduction of flexible instruments suitable for use in the smallest infants. Careful selection of the most appropriate instrument and technique by well-trained medical or surgical endoscopists will result in safe and effective diagnosis and treatment of a wide variety of conditions affecting the upper and lower respiratory tract.

Pneumosinus dilatans of the ethmoid sinus--incidental finding on a cephalometric radiograph

A case of pneumosinus dilatans of the posterior ethmoidal region is presented. The condition known as pneumosinus dilatans is discussed, as are accessory ethmoidal air cells with respect to their most common localization and radiographic appearance. The diagnostic imaging features of this condition are described and a recommendation of views to adequately delineate this disorder are given. The importance of an adequate and thorough review of the cephalometric radiograph for pathologic conditions is stressed.

Innominate artery and tracheal compression due to aberrant position of the thymus

A 3-month-old infant with failure to thrive was found on bronchoscopy to have tracheal obstruction thought to be secondary to innominate artery compression. Subsequent diagnostic evaluation with magnetic resonance imaging revealed superior and posterior extension of the thymus with resultant compression of the innominate artery and trachea within the narrow confines of the thoracic inlet. Resection of the aberrantly positioned and enlarged thymus and aortopexy resulted in relief of tracheal compression.

Compression implants: case report of a surgical, prosthetic, and cosmetic failure

A case involving the use of non-submergible compression-type implants in an effort to rehabilitate a patient who had experienced tooth loss as a consequence of a motor vehicle accident is reported. The implants were placed in the maxillary arch without consideration of their contribution to subsequent prosthetic rehabilitation. The literature pertaining to compression-type implants is reviewed, and the difficulties related to their correct usage are delineated.

Image editing and computer assisted bitemark analysis: a case report

Bitemark evidence in a homicide usually involves a perpetrator biting the victim prior to or around the time of death. This paper presents a case in which a homicide victim bit his assailant. A suspect taken into custody was found to have what appeared to be a human bitemark on the proximal phalanx of his right thumb. Scale photographs of this injury were obtained and compared to the dentition of the decreased using digitized computer images for superimposition. Three different approaches for comparison with the bitemark photograph were utilized: comparison with radiographs of amalgam-filled impressions of dental casts, a transparent overlay technique and comparison with photographs of a simulated bitemark inked onto the hand of a volunteer. A review of these techniques as they apply to computerized bitemark analysis is presented.

The occlusal radiograph revisited

The purpose of this paper is to demonstrate occlusal radiography as an important projection for diagnostic purposes in general dental practice. There are many instances where bitewing and periapical radiographs are insufficient to demonstrate pathoses adequately. A descriptive and photographic review of the different occlusal projections and a series of illustrative cases demonstrating their diagnostic relevance is provided.

Biostereometric measurement of oral tumour growth. Description of the technique and case report

Following radiotherapy, it may be difficult to determine clinically whether tumour regression, stabilization or growth has occurred. Traditional diagnostic imaging may not be possible due to the small size of the tumour and the proximity of metallic restorations. A case of squamous cell carcinoma of the mandibular alveolar process in which these problems arose is presented. A computer-assisted biostereometric technique was used to identify volumetric change of the tumour. Polyvinylsiloxane impressions were obtained to record the anatomy of the tumour site. From these, stone models were made at four and eight weeks following radiotherapy. Using optical mapping techniques, tumour growth was demonstrated which was not evident on follow-up examinations. The methodolgy of biostereometry is presented and its advantages and potential applications are discussed.

Prophylactic extraction of third molars in cancer patients

Most studies on third molar extractions focus on the potential of tooth-associated pathoses when justifying or questioning the extraction. Scant attention is paid to potential medical problems of the patient "attached" to the third molar. This study presents 28 consecutive cancer cases seen by one dentist over a 2-year period in which third molars had a significant impact on the health of the patient and on their course of cancer therapy. In 15 patients on whom extractions were performed, 40% experienced postoperative complications. Prophylactic extraction of partially erupted or impacted third molars in cancer patients before their cancer therapy is recommended on the basis of the following observations: (1) the increased risks and difficulties associated with post-cancer-treatment extraction, (2) the potential for third molars to produce pathoses in immunocompromised patients before, during, or immediately after their anticancer treatment, and (3) the management of third molars may interfere with the patient's cancer treatment.

Advanced imaging in evaluation of a central mandibular haemangioma

We present a case of histologically-verified central cavernous haemangioma. The conventional radiological films as well as the computed tomographic (CT) and magnetic resonance imaging (MRI) features of this lesion are described. Plain films showed many of the typical radiological signs of haemangioma, whereas CT was primarily useful for illustrating the bony components of the tumour as well as delineating soft tissue extensions and bony defects not normally visible with plain film examination. MRI proved particularly useful, demonstrating the vascular nature and flow voids representative of feeder vessels and delineating the true extent of the lesion. The literature pertaining to the imaging features of central haemangioma is reviewed and the complementary use of plain films, CT and MRI described. To our knowledge, this is the first report detailing the MRI characteristics of a central mandibular haemangioma.

Update on pediatric flexible bronchoscopy

Technological advances in flexible bronchoscopy have expanded the clinician's ability to diagnose and treat pulmonary disease in children. During the neonatal period, flexible bronchoscopy has contributed to the understanding of the incidence and factors responsible for acquired airway lesions. The ability to selectively collect lower airway secretions has contributed to the care of immunocompromised patients with new pulmonary infiltrates. New therapies may use the flexible bronchoscope to specifically target lower airway tissues of interest. Because of the breadth of both current and future applications, most pediatricians will require a working familiarity with the benefits of flexible bronchoscopy in their patients.

Digitized slice interposition in forensic dental radiographic identification. An in vitro study

Traditional methods of comparison involving the presence of missing teeth, dental restorations, and other pathological features may be difficult due to the reduction in dental restorations in today's population. This study demonstrates an alternative method of identification using digitized images. It utilizes anatomical structures such as dental root morphology and spatial relations of teeth roots and their supporting structures on simulated antemortem and postmortem radiographs as the basis for identification. A total of 39 mandibular specimens were used and two radiographs representing the antemortem and postmortem radiographs of each hemimandible were exposed by two operators using different x-ray generators. The radiographs were scanned and digitized. The identities of the antemortem and postmortem radiographs were kept from the operator. Following this, horizontal sections were digitally cut from the antemortem radiographs through the roots approximately halfway between the neck of the tooth and the root apex. This section was manipulated onto the postmortem radiograph by using a computer graphics program and a quantitative comparison of the alignment of normal dental anatomical landmarks was undertaken. The technique enabled perfect matching of all 39 specimens by antemortem and postmortem dental radiographs. The mean number of identifying points was 17.5 and the mean number of nonmatching points was 0.1. The mean concordance was 99.2% between the antemortem and postmortem radiographs.

Progressive systemic sclerosis in a child: case report

A case of pediatric progressive systemic sclerosis is reported and a literature review concerning medical and dental aspects of this condition is provided. Systemic features include sclerodactyly, Raynaud's phenomenon, telangiectasia, calcinosis, myositis, arthritis, tenosynovitis, renal failure, esophageal hypomotility, pulmonary fibrosis and heart failure. Oral manifestations include reduced interincisal distance, xerostomia, telangiectasia, increased periodontal ligament width, osseous resorption of the mandible, periodontal disease, and increased decayed, missing, and filled teeth (DMFT). The prognosis is difficult to predict because spontaneous remission has been documented, but death may result from extensive visceral involvement (heart, kidney, and lung).

Dental radiographic identification utilising computerised digital slice interposition: a case report

A pair of ante- and post-mortem periapical dental radiographs of an individual were digitised on a personal computer with the aid of an X-ray scanner. The radiographs were appropriately prepared and compared using image editing software. In this case, dental restorations, root morphology, periodontal ligaments, pulp spaces, bony trabeculation and a retained root fragment were features used for comparison. The results showed that all the features were consistent in ante-mortem and post-mortem radiographs except for two points. Both discrepancies were related to dimensional differences found in dental restorations and the retained root fragment. Nevertheless, there were acceptable explanations to account for each discrepancy.

A clinical comparison of glass ionomer (polyalkenoate) and silver amalgam restorations in the treatment of Class 5 caries in xerostomic head and neck cancer patients

Fifty-four pairs of restorations (one glass ionomer and the other amalgam) were placed in the mouths of 36 xerostomic head and neck cancer patients. Patients were either fluoride users or fluoride nonusers. In patients who used a daily application of a mildly acidic (pH 5.8) sodium fluoride gel, glass-ionomer cements failed and amalgam restorations did not (P < 0.0001). In patients who neglected to use their topical fluoride as directed, glass-ionomer cement restorations did not fail, but amalgam restorations did (P < 0.001). The mean time to restoration loss for both restorative materials was 8.5 months. In severely xerostomic patients these findings were exaggerated.