The prevalence, radiographic appearance, and characteristics of zygomatic air cell defects (ZACDs) in symptomatic temporomandibular joint disorder patients in North Indian population

Prevalence of Zygomatic Air Cell defects in a sample of 6-18-year-old patients in Saudi Arabia and Yemen: a retrospective study

OBJECTIVES

This study aimed to comprehensively analyze the prevalence and influencing factors of Zygomatic Air Cell Defects (ZACD) among pediatric and adolescent populations in Saudi Arabia and Yemen.

MATERIALS AND METHODS

A cross-sectional retrospective study was conducted, utilizing digital panoramic radiographs of dental outpatients aged 6 to 18 years. The data were collected from registered digital databases of dental clinics in Al-Qassim, Saudi Arabia, and an oral and maxillofacial radiology center in Sana'a, Yemen, covering the period from July 2018 to September 2022. The radiographs were evaluated based on inclusion and exclusion criteria, and ZACD was assessed using standardized descriptions. Statistical analysis, including logistic regression, was employed to examine the impact of the associated factors.

RESULTS

The study encompassed a total of 3,169 participants, revealing an overall ZACD prevalence of 28.5%. Age emerged as a significant predictor (p ≤ 0.0001), with the likelihood of ZACD increasing as the age of the individual advances. Gender and geographic region did not exhibit statistically significant differences in ZACD prevalence.

CONCLUSION

This study provides crucial insights into the prevalence of Zygomatic Air Cell Defects among pediatric and adolescent populations in Saudi Arabia and Yemen. It underscores the prevalence of ZACD and the notable influence of age on its occurrence. Additionally, the research challenges prior notions of gender and regional variations in ZACD prevalence, emphasizing the complexity of the factors involved. Early detection is essential to avoid unwanted complications during any surgical intervention in this area.

Articular eminence pneumatization in patients with different sagittal skeletal patterns: Cone-beam computed tomography study

Objectives:

This study objectives to evaluate the type and degree of articular eminence pneumatization in individuals with different sagittal skeletal patterns.

Material and Methods:

Cone-beam computed tomography images of 139 patients were included in the study. The population was divided into groups according to their sagittal skeletal anomalies by A point-nasion-B point angle measurement. The laterality, grade, and type of pneumatization were recorded. Pearson Chi-square test and Fisher’s exact test were performed to evaluate gender, sagittal skeletal anomalies, pneumatization type, and grade.

Results:

A pneumatized articular eminence (PAT) was found in 74.8% of the population. Grade 1 pneumatization and the multilocular type where the most common pneumatization. There were no correlations between sagittal skeletal anomalies and pneumatization grades.

Conclusion:

The prevalence of PAT was high concerning the previous studies. However, there were no correlations between the sagittal skeletal anomalies, pneumatization type, and grade. Clinicians must always be aware of the potential for pneumatizations as they may cause untoward complications.

Patterns of pneumatization of the tympanic plate

OBJECTIVE

This study aimed to investigate the prevalence of tympanic plate (TP) pneumatisation as well as the various potential patterns.

METHODS

A retrospective study involving the archived Cone-Beam Computed Tomography (CBCT) files of 70 patients was performed to investigate anatomical variations of TP pneumatisation.

RESULTS

Forty-eight TPs were found to be non-pneumatised, while 92 were found to contain at least peritubal air cells. Twenty patients (28.5%) did not present any variety of TP pneumatisation, while 36 patients (51.4%) exhibited a symmetrical pattern of pneumatisation.

CONCLUSION

Aside from those patients who lacked TP pneumatisation, the peritubal pneumatisation pattern was found to be the most common. Further, bilateral symmetry was found to occur in more than half of all cases. CBCT is a powerful diagnostic tool, although appropriate knowledge of the anatomical possibilities remains mandatory for adequate surgical planning.

The prevalence of pneumatized articular eminence in the temporal bone. Do we need a high resolution computed tomography-based novel risk classification for eminectomy?

INTRODUCTION

Besides mastoid air filled cells, pneumatizations (PN) occasionally occur in the articular eminence (AE) of the temporomandibular joint (TMJ). These findings represent no pathological character but may increase the risk of perforating the AE during eminectomy with potential harming the skull base. Various classifications catagorize the degree of temporal PN without focussing solely on the AE. Panoramic radiograph (PR) and computed tomographie (CT) are both described as suitable for diagnosing PNs. Are the common ways of imaging capable for precise diagnosis and do we need a risk pattern for eminectomy?

METHODS

A 4-year retrospective study evaluated high resolution computed tomographie (HRCTs) of 300 patients. We screened digitalized skull images for PN of the AE. The frankfort horizontal was determined as the reference mark for measurements. Images were assessed by a craniomaxillofacial surgeon and a radiologist.

RESULTS

300 patients (600 AEs) were investigated. We detected 60 PNs (10% of all AEs) in 44 patients (14.7%). We subdevided the findings according to the extent of PN. 10 AEs showed PNs of less than 20% (type 1); n=18: 21-40% (type 2); n=18: 41-70% (type 3). n=14: 71 to 100% (type 4). In 32 cases (72.7%) with 42 PNs a PR existed. Of the 42 AEs, corresponding PN could be detected in 21 cases (50%).

DISCUSSION

PNs are a potential threat when performing TMJ surgery. Sufficient preoperative imaging is required to avoid severe endangerment for the patient. CT imaging is most suitable detecting PNs. PR seem to fail in diagnosing PNs of different degree. Our novel HRCT-based classification shows the distribution of PNs and provides a risk pattern.

CONCLUSION

HRCT exceeds the diagnostic accuracy of PR in detecting pneumatized AEs. PR is not capable for detecting PNs of different degree. A novel classification may increase the prediction of perforation risk. Restricting eminectomy to reduce height only to a certain amount reduces the risk of complications.

Pneumatization of the zygomatic process of temporal bone on computed tomograms

PURPOSE

Zygomatic air cells (ZAC) are a variant of temporal bone pneumatization that needs no treatment. However, ZAC can have an impact on surgical procedures in the temporo-mandibular joint region. Recent reports suggest that computed tomography will disclose more ZAC than can be diagnosed on panoramic radiography. The aim of this study was to analyze ZAC prevalence on CT in a population that was not pre-selected by admission to a dental clinic. Furthermore, an extensive literature review was performed to assess the prevalence of ZAC and to address the impact of imaging technique on the definition of the item.

MATERIAL AND METHODS

Digitalized cranial CTs of 2007 patients were retrospectively analyzed. The Frankfort horizontal was used to define a ZAC on sagittal CTs.

RESULTS

In this study group, 806 were female (40.16%) and 1,201 were male (59.84%). Mean age was 49.96 years in the whole group (female: 55.83 years, male: 46.01 years). A ZAC was diagnosed in 152 patients (female: 66, male: 86). Unilateral ZAC surpasses bilateral findings (115 vs. 37 patients). ZAC were diagnosed in children 5 years of age and older. Sectional imaging techniques show a better visualization of the region of interest. However, presently an increase of ZAC prevalence attributable to imaging technique cannot conclusively be derived from the current literature. The normal finding of a ZAC on radiograms is a sharply defined homogenous transparent lesion restricted to the zygomatic process of the temporal bone that has no volume effect on the shape of the process.

CONCLUSION

ZAC is an anatomical variant of the temporal bone that has come into focus of maxillofacial radiology due to its noticeable aspect on panoramic radiograms. The harmless variant can be expected in about one in thirteen individuals undergoing facial radiology. Panoramic radiograms appear to be sufficient to present ZAC of relevant size. However, in preparation for surgical procedures affecting the articular eminence the application of sectional images is recommended.