The frequency and nature of incidental findings in large-field cone beam computed tomography scans of an orthodontic sample

Retrospective analysis of the upper airway anatomy and Sella turcica morphology across different skeletal malocclusions: a computerized technique

OBJECTIVE

This study aimed to investigate the normal volumetric space and variations in the measurements of different landmarks in adults with different skeletal relations of the maxilla and the mandible based on CBCT data. The study also analyses these landmarks to locate any correlations.

BACKGROUND

Numerous studies in orthodontics have found a relationship between orthodontic treatment and changes in the anatomy and function of the airway. Severe changes in airway morphology can cause breathing difficulties, lower quality of life, and even result in life-threatening conditions such as obstructive sleep apnoea. Consequently, orthodontic diagnosis and treatment planning require a thorough understanding of the airway space and its function.

METHODS

The present retrospective study was conducted using CBCT records of 120 adult patients, containing 40 samples of each skeletal class (20 males and 20 females). The boundaries were defined for the 3 major regions: the nasopharynx, the oropharynx, and the hypopharynx. Various measurements were recorded across these regions, as well as selective cephalometric landmarks. The obtained data was used to calculate average and standard deviation, while regression analysis was used to evaluate correlations and t-test was used to test statistical significance of gender differences.

RESULTS

The results demonstrate that skeletal Class III individuals exhibit a reduced airway volume in the nasopharynx compared to other groups, whereas skeletal Class II individuals displayed a diminished airway volume in the hypopharynx. A strong correlation was observed for Sella turcica parameters. There were no significant differences in skeletal parameters across genders. Nasopharynx cavity volume demonstrated significant differences between skeletal Class I-Class III as well as between skeletal Class II-Class III. Hypopharynx cavity volume also demonstrated significant differences between skeletal Class I-Class II and between skeletal Class II-Class III.

CONCLUSION

The major findings are the presence of a reduced nasopharyngeal volume in skeletal Class III malocclusions while skeletal Class II individuals displayed a diminished hypopharyngeal volume, making these critical areas to consider during the diagnostic and orthodontic treatment planning stages. This study also revealed a consistent correlation between Sella turcica parameters across various facial skeletal profiles, with skeletal Class II patients exhibiting a distinct pattern and skeletal Class I and Class III demonstrating an average relationship.

Frequency and Clinical Significance of Incidental Findings on CBCT Imaging: a Retrospective Analysis of Full-Volume Scans

Objectives

This retrospective study aims to identify incidental findings in cone-beam computed tomography scans of patients irradiated for preoperative evaluation for implant placement and obtained using the same imaging unit as well as the same field of view. The incidence of each incidental finding, as well as the overall incidence, were calculated and the findings were ranked according to their clinical significance.

Material and Methods

A total of 741 cone-beam computed tomography (CBCT) examinations with extended field of view (15 x 15 cm) were retrospectively evaluated for incidental findings (IFs). These were identified, recorded, classified as to their location, and ranked according to their clinical significance.

Results

The vast majority of CBCT examinations presented at least one IF, resulting in a surprisingly high prevalence in total. If extreme anatomical variants are considered (nasal septum deviation, sinus septations etc.), the cumulative prevalence exceeds 99%. IFs of major significance, that may require immediate attention, are beyond 10% in frequency.

Conclusions

We found high prevalence of incidental findings on cone-beam computed tomography examinations performed for preoperative evaluation for implant placement (99.5% if anatomical variants included). Most incidental findings were of minor significance. Although the number of incidental findings that require immediate attention is relatively low, there is a considerable number of cases that need periodic evaluation and/or referral.

Prevalence and Clinical Significance of Incidental Findings in the Maxillofacial Complex of Adolescent Orthodontic Patients: A Retrospective Cone Beam Computed Tomography Analysis

OBJECTIVES

The aim of this study was to determine the prevalence and severity of incidental findings in the maxillofacial complex of orthodontic patients imaged with cone beam computed tomography (CBCT) and assign those findings an appropriate clinical significance.

METHODOLOGY

Incidental findings (IF) were identified in 250 CBCT scans of adolescent orthodontic patients (aged 13-18 years) with a large field-of-view and categorized based on their anatomic location and placed into one of six subgroups based on anatomic region: i) sino-nasal, ii) dentoalveolar, iii) nasooropharyngeal airway, iv) temporomandibular joint, v) neck, vi) calcifications, and vi) miscellaneous findings. Additionally, findings were assigned a clinical significance score based on severity on a scale of mild, moderate and severe. Mild IF was defined as an IF that does not require any further investigation or referral. Moderate IF was defined as an IF that has the tendency to become clinically significant and should be observed periodically. IFs that warrant further investigation and/or intervention were designated as severe.

RESULTS

The percentage of IFs in sino-nasal and dento-alveolar regions were 44.7% and 19.1% respectively. The percentage of IFs with mild, moderate, and severe clinical significance were 27%, 72%, and 1%, respectively. Out of the IFs involving calcifications, 80.8% were stylohyoid calcifications and <1% were cranial cavity IFs such as petroclinoid calcifications and falx cerebri calcifications. Among the sino-nasal findings, 1.2% were identified as severe.

CONCLUSION

The sino-nasal region had the highest frequency of IFs. Understanding the prevalence of incidental findings and its clinical relevance is important for clinicians to allow for appropriate monitoring and timely treatment of patients.

Prevalence of Incidental Maxillary Sinus Anomalies on CBCT Scans: A Radiographic Study

CBCT significantly impacts dental procedures and has brought significant reforms to our approach to diagnosis and treatment planning despite its limitations in differentiating soft tissues. It is an excellent imaging modality and quickly identifies sinus opacification and provides valuable insight into paranasal sinus pathologies, with considerably lower radiation exposure. The present study aimed to investigate the occurrence of maxillary sinus abnormalities in CBCT scans, identify the frequency, type, and location of these findings, and find the correlation between the distance of periapical lesions and radiographic changes in the maxillary sinus. Two examiners independently evaluated 117 patients to diagnose and classify the cases into different abnormality subtypes. The periapical lesions most closely related to the sinus were recorded. The diameters of the left and right maxillary sinus ostium and the distance of the ostium's lower border to the sinus's osseous floor were recorded. The findings were correlated with the age and gender of these patients. The present study reveals that sixty-one patients were diagnosed with mucosal thickening (52.1%). The sinus wall most affected by mucosal thickening was the maxillary sinus floor, followed by the medial and lateral walls. Of 19 patients with periapical lesions, 15 had maxillary sinus mucosal thickening, which is statistically significant (p = 0.004). The high occurrence of abnormalities in the maxillary sinus emphasizes the importance for the radiologist to comprehensively interpret the whole volume acquired in CBCT images, including the entire sinus. Incidental findings may be considered in the individual clinical context of signs and symptoms, reducing the risk of overestimating the real impact of radiographic findings.

Prevalence of incidental findings in adult vs. adolescent patients in the course of orthodontic X-ray diagnostics

OBJECTIVE

Due to increasing numbers of adult patients presenting to orthodontic practices, an increase in incidental findings on diagnostic X‑rays, which are the cornerstone of orthodontic diagnostics, is expected. This raises the clinically relevant question of whether an age effect exists regarding prevalence, localisation and severity of incidental findings on orthodontic diagnostic X‑rays.

MATERIALS AND METHODS

The clinical, primarily retrospective study examined pathological incidental findings from 600 orthopantomograms (OPT) and lateral cephalogram (LC) images in two groups of orthodontic patients (group I: 150 children/adolescents, age 11.89 ± 2.47 years; group II: 150 adults, age 27.03 ± 10.42 years). Prevalence, localisation and severity of the findings were recorded based on a classification sheet. The assessment was done by three experienced examiners following a systematic approach along the nine locations: mandible, maxilla, dentition, paranasal sinuses, temporomandibular joint, cranial base, orbit, cervical spine, soft tissues.

RESULTS

In all, 1458 incidental findings were detected, with 66% of the findings having occurred away from the dentition. There was a significant age effect (p < 0.001) with respect to the prevalence of incidental findings (group II-adults 1026 findings-OPT: 566/LC 460 vs. group I-children/adolescents 432 findings-OPT: 221/LC 211). Regarding localisation, incidental findings in adults commonly occurred in the dentition, paranasal sinuses and mandibular regions. Furthermore, analysis of the LC images revealed significantly more incidental findings in the area of the cranial base and cervical spine in adults (p < 0.001, p = 0.003). Categorisation according to the severity of the incidental findings showed that 33% of the incidental findings needed further diagnostic investigation and possibly treatment by other specialities.

CONCLUSION

Diagnostic assessment using orthodontic diagnostic X‑rays results in a high prevalence of incidental findings away from the dentition. Particularly in adults, a large number of incidental findings outside the dental/alveolar region may be expected on orthodontic diagnostic X‑rays. Thus, a structured approach during diagnostic assessment is required to minimise the extent to which incidental findings of clinical relevance are overlooked.

Evaluation of clinical signs and magnetic resonance imaging findings in patients with temporomandibular disorders

This study assessed the relationship between clinical symptoms and magnetic resonance imaging (MRI) findings in temporomandibular disorders (TMD). A total of 324 temporomandibular joints (TMJs) from 162 patients were included. The TMJs were divided into three groups based on disc positions on MRI: normal disc position, anterior disc displacement with reduction (ADDwR), and anterior disc displacement without reduction (ADDwoR). Clinical findings included TMJ pain, TMJ noise, and maximum mouth opening (MMO). The disc configuration, disc positions, condylar morphology, and joint effusion were evaluated in proton density-weighted and T2-weighted open and closed-mouth sagittal sections. Patients comprised 135 females and 27 males, with a mean age of 37.63 ± 13.86 years. The VAS score was significantly higher in ADDwoR than in ADDwR (p = 0.007). Condylar sclerosis (β coefficient: 1.449, 95% confidence interval (CI): 0.505-2.393, p = 0.003) and condylar flattening (β coefficient: 1.024, 95% CI: 0.209-1.840, p = 0.014) had higher VAS scores than the other MRI findings in multiple regression analyses. Limited mouth opening (MO) was independently associated with ADDwoR. ADDwoR had a higher risk of having limited MO than normal disc position (odds ratio: 5.268), while there were no associations between limited MO and other MRI findings. None of the MRI findings showed significant performance in predicting TMJ noise. The convex and folded disc configuration percentages, the frequencies of osteophyte formation, and grade 3 effusion were significantly higher in the ADDwoR group. More severe clinical symptoms and a higher degree of disc deformity, osteophyte formation, and high-grade effusion were shown to be associated with ADDwoR.

Clinical and medico-legal considerations in endodontics

Endodontic treatment can be challenging for a number of reasons, including the microscopic nature of the clinical environment, reliance on tactile sensation and lack of direct visualization of the work being performed. Commonly, endodontic patients present with pain and distress, which can exacerbate an already difficult clinical situation. Complications may might arise prior to, or during treatment, despite practising with the utmost care and skill. Preventing and managing these complications can take considerable time and energy, and oftentimes assistance from or referral to more experienced colleagues is required. The aim of this review is to discuss medico-legal considerations in endodontics, with clinical correlations and a focus on the Australian legal landscape. [Correction added on 18 October 2023, after first online publication: The abstract was amended from a structured to an unstructured abstract.].

A Comparative Assessment of the Upper Pharyngeal Airway Dimensions among Different Anteroposterior Skeletal Patterns in 7–14-Year-Old Children: A Cephalometric Study

Background: The pharyngeal airway is a crucial part of the respiratory system’s function. Assessing the pharyngeal airway dimensions in different skeletal types is important in the orthodontic treatment of growing patients. The aim of this study was to compare the upper pharyngeal airway dimensions of 7–14-year-old children with different skeletal types. Methods: Three-hundred-sixty-one lateral cephalometric radiographs were grouped based on their skeletal patterns determined by the ANB angle as skeletal type I (n = 123), type II (n = 121), and type III (n = 117). The radiographs were divided into 4 groups: 7/8 YO (7–8 years old), 9/10 YO, 11/12 YO, and 13/14 YO. The cephalometric measurements comprised SNA, SNB, ANB, Ad1-PNS, Ad2-PNS, McUP, and McLP. An ANOVA was used to compare the group results. Results: Significant differences in Ad1-PNS, Ad2-PNS, McUP, and McLP in skeletal types II and III were found between age groups. Most upper pharyngeal airway dimensions in skeletal types II and III children were significantly wider in the 13/14 YO group than in the other age groups. Conclusion: The upper pharyngeal airway dimensions increased age-dependently in 7–14-year-old children, especially in skeletal types II and III. The upper pharyngeal airway dimensions could serve as a guide in differentiating the different skeletal classes in clinical settings.

Dental and Maxillofacial Cone Beam CT-High Number of Incidental Findings and Their Impact on Follow-Up and Therapy Management

Cone beam computed tomography (CBCT) is increasingly used for dental and maxillofacial imaging. The occurrence of incidental findings has been reported, but clinical implications of these findings remain unclear. The study’s aim was to identify the frequency and clinical impact of incidental findings in CBCT. A total of 374 consecutive CBCT examinations of a 3 year period were retrospectively evaluated for the presence, kind, and clinical relevance of incidental findings. In a subgroup of 54 patients, therapeutic consequences of CBCT incidental findings were queried from the referring physicians. A total of 974 incidental findings were detected, involving 78.6% of all CBCT, hence 2.6 incidental findings per CBCT. Of these, 38.6% were classified to require treatment, with an additional 25.2% requiring follow-up. Incidental findings included dental pathologies in 55.3%, pathologies of the paranasal sinuses and airways in 29.2%, osseous pathologies in 14.9% of all CBCT, and findings in the soft tissue or TMJ in few cases. Clinically relevant dental incidental findings were detected significantly more frequently in CBCT for implant planning compared to other indications (60.7% vs. 43.2%, p < 0.01), and in CBCT with an FOV ≥ 100 mm compared to an FOV < 100 mm (54.7% vs. 40.0%, p < 0.01). Similar results were obtained for paranasal incidental findings. In a subgroup analysis, 29 of 54 patients showed incidental findings which were previously unknown, and the findings changed therapeutical management in 19 patients (35%). The results of our study highlighted the importance of a meticulous analysis of the entire FOV of CBCT for incidental findings, which showed clinical relevance in more than one in three patients. Due to a high number of clinically relevant incidental findings especially in CBCT for implant planning, an FOV of 100 × 100 mm covering both the mandible and the maxilla was concluded to be recommendable for this indication.

Craniocervical Junction Visualization and Radiation Dose Consideration Utilizing Cone Beam Computed Tomography for Upper Cervical Chiropractic Clinical Application a Literature Review

Objectives

To highlight the detail obtained on a Cone Beam Computed Tomography (CBCT) scan of the craniocervical junction and its usefulness to Chiropractors who specialize in the upper cervical spine. A review of the dose considerations to patients vs radiography in a chiropractic clinical setting and to review the effective radiation dose to the patient.

Methods

A review of studies discussing cervical biomechanics, neurovascular structures, and abnormal radiographic findings, was discussed in relation to chiropractic clinical relevance. Further studies were evaluated demonstrating radiation dose to the patient from radiographs compared to CBCT.

Results

Incidental and abnormal findings of the craniocervical junction were shown to have superior visualization with CBCT compared to radiography. The radiation dose to the patient for similar imaging protocols to the craniocervical junction and cervical spine was equal or less utilizing CBCT when compared to radiographs.

Conclusions

The use of CBCT for visualization of the craniocervical junction and cervical spine in the chiropractic clinical setting allows for adjunctive visualization of the osseous structures which is germane to clinical protocol. Further with CBCT the effective dose to the patient is equal or less than similar imaging protocols utilizing radiographs to evaluate the craniocervical junction.

Incidental Finding in Pre-Orthodontic Treatment Radiographs of an Aural Foreign Body: A Case Report

The presence of foreign bodies in the external auditory canal of young patients may cause, if left untreated, severe permanent damage to the adjacent anatomical structures, and infections. A 10-year-old patient with an intellectual disability underwent orthodontic evaluation. An aural radiopaque finding was visible in the lateral cephalogram and in the orthopantomography. The patient’s mother reported that her son never showed any ear discomfort, except for a mild hearing impairment that was never investigated. The patient was referred to an ear, nose and throat (ENT) specialist that removed the foreign body located in the left external auditory meatus. The careful evaluation of dental radiographs, including pre-orthodontic and interim orthodontic radiographs, may help to identify silent incidental findings that may otherwise lead to severe complications if left untreated.

[Applications of cone beam computed tomography of the craneofacial structure in medical specialties. A review]

Cone-beam computed tomography (CBCT) of the craniofacial structure has demonstrated its usefulness in the dental area during the last decades, thus it has become a fundamental tool in the diagnosis, planning, and evaluation of treatment, and although it was not developed for the exclusive use in dentistry, as it is commonly considered, it is used in other areas such as medicine. It is specifically used in the head and neck area where different medical specialties interact, and at the same time these interact with dental specialties, so knowing the advantages of CBCT over different imaging technologies in the medical area is necessary. The purpose of this review was to describe the applications of observation, diagnosis, planning, and evolution of treatments using maxillofacial HSCT in different medical specialties. This work highlights the use of TCHC in different medical applications and highlights where it is most useful compared to other technologies.

Relationship between Clinical Symptoms and Magnetic Resonance Imaging in Temporomandibular Disorder (TMD) Patients Utilizing the Piper MRI Diagnostic System

Clinical problems of the temporomandibular joint (TMJ) and the masticatory musculature are both included in the term temporomandibular disorder (TMD). The purpose of the present study was to examine the pathology of the joints of patients diagnosed with TMD utilizing the dedicated Piper MRI-based classification, and to link these pathologies with various symptoms while considering their severity. In total, 64 patients with clinical TMD were examined. Symptoms were recorded using a questionnaire. The clinical examination included diagnosing the occlusion in centric relation, which was followed by a standardized MRI. It was confirmed that, although they occurred in a high percentage in all classes, muscle pain and occlusal interference are not indicators of TMJ damage. The results indicate that the progressive degradation of the TMJ, represented by qualification to the higher Piper classes, is associated with an increase in TMJ pain only up to a certain stage. For the highest Piper classes, the joint pain occurs in a smaller percentage of patients, but sounds are more frequent.

Foramen transversarium enlargement caused by vertebral artery tortuosity: Diagnosis with cone-beam computed tomography and magnetic resonance angiography

A markedly enlarged foramen transversarium was discovered incidentally on a cone-beam computed tomography scan of a 72-year-old male patient who was referred for dental implant placement. Further evaluation with magnetic resonance angiography revealed that the foramen enlargement was caused by a tortuosity in the course of the vertebral artery. This case report highlights the importance of recognizing significant incidental findings on diagnostic images and the potential need for additional imaging as part of the complete interpretative process.

Sinus Radiological Findings in General Asymptomatic Populations: A Systematic Review of Incidental Mucosal Changes

OBJECTIVE

To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology.

DATA SOURCES

Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles.

REVIEW METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis.

RESULTS

A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%).

CONCLUSION

The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.

Ossification of Pterygospinous Ligament: An Incidental Finding in Cone Beam Computed Tomography

Patient: Female, 35-year-old

Final Diagnosis: Ossification of the pterygospinous ligament

Symptoms: No symptoms

Medication:—

Clinical Procedure: —

Specialty: Anatomy • Dentistry • Neurology • Neurosurgery • Radiology

Incidental findings in maxillary sinus area on cone-beam-computed-tomographic-scans: A retrospective study with emphasis on gender and ethnicity

Aim

The aim was to assess the presence of incidental-findings (IFs) on cone-beam computed tomography (CBCT) scans of faciomaxillary region with emphasis on gender and ethnicity.

Materials and methods

A retrospective analysis of incidental findings (IFs) in the maxillary sinus was performed. All CBCT-scans were performed using a Cone Beam 3D imaging system and examined using a software program. These images were taken for treatment planning for dental implant therapy of partially edentulous individuals. Four-hundred CBCT scans were retrospectively evaluated. Data regarding age, gender and ethnicity (Saudi Arabian, Egyptian, Filipino and Pakistani) of the patients was recorded. When P-value were lesser than 0.05, the difference was deemed significant.

Results

Four hundred CBCT-based scans were investigated. The IFs were seen in 30.2%, 32.1%, 35.1% and 34.4% individuals belonging to the Egyptian, Saudi Arabian, Pakistani and Filipino ethnicities, respectively. Mucosal-thickening was more often identified in Saudi-Arabian (P < 0.05), Pakistani (P < 0.05) and Filipino males (P < 0.05) than females in the respective ethnic group. There was no difference in the identification of IFs (mucous retention cysts, opacifications, sinus septa and sinus floor discontinuation) related to the maxillary sinus region among males belonging to the Egyptian, Saudi-Arabian, Filipino and Pakistani ethnic groups.

Interpretations and conclusion

The CBCT-based technology is valuable resource for the identification of IFs.

Analysis of three-dimensional imaging findings and clinical symptoms in patients with temporomandibular joint disorders

Background

The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms.

Methods

A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test.

Results

TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85).

Conclusions

CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.

Incidental finding of metastatic malignancy involving the sphenoid sinus on a cone-beam computed tomographic scan: A case report

The increased use of cone-beam computed tomographic (CBCT) scans has made it increasingly necessary to evaluate incidental findings on CBCT scans. This report describes the case of a 66-year-old female patient who presented to the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at the College of Dentistry of the author's institution and underwent a CBCT scan for maxillary alveolar process implant planning. Upon evaluation of the CBCT scan, a radiopaque (soft tissue attenuation) mass in the left superior aspect of the nasal cavity and left locule of the sphenoid sinus with opacification of the left locule of the sphenoid sinus was incidentally noted. These radiographic findings were suggestive of a space-occupying mass with a high possibility of malignancy. A further medical evaluation confirmed renal cell cancer metastasis to the sphenoid sinus. This study shows the significance of reviewing the entire CBCT scan for incidental findings.

Incidental Findings in Cone Beam Computed Tomography for Dental Implants in 1002 Patients

PURPOSE

The purpose of this study is to analyze the frequency and elevate the awareness of the prevalence of nondental pathology in cone beam computed tomography (CBCT) scans taken for implant placement treatment planning and postplacement evaluation. The data from the CBCT should be read by an oral and maxillofacial radiologist for proper diagnosis of dental and nondental pathology and referred to the medical specialist for proper management when necessary.

MATERIALS AND METHODS

This retrospective study analyzed 1002 consecutive CBCT scans taken at a single private practice noting the prevalence of nondental pathology in CBCT images for all dental implant procedures. All scans were taken from November 2007 to March 2020. One board certified oral and maxillofacial radiologist systemically read all scans and reported all findings in the maxilla and mandible, condyles and TMJ, paranasal sinuses, nasal fossa, pharyngeal airway, skull base and temporal bone, neck soft tissues, and cervical spine. The incidental findings, variation of normal anatomy, or pathology reported in these structures were categorized based on anatomic location and significance and the incidence was investigated.

RESULTS

Pathologies ranged from innocuous sinusitis, to more serious atherosclerotic calcification of the carotid arteries, narrowed airways, and neoplastic lesions. Fifty-one different findings were noted, of which 36 were pathologies that required referral or follow-up.

CONCLUSIONS

Incidental findings can be detected in CBCT scans for dental implants. The clinician must be familiar with the radiographic diagnosis of head and neck pathology, and/or must refer these images to an appropriate specialist for the radiographic interpretation of the full volume.

Nature and clinical significance of incidental findings in maxillofacial cone-beam computed tomography: a systematic review

OBJECTIVE

This systematic review was conducted to assess the types, potential clinical significance, and treatment implications of incidental findings (IFs) in CBCT diagnostic imaging of the maxillofacial region.

MATERIAL AND METHODS

The authors searched several electronic databases and grey literature without time restriction for studies on the IFs in maxillofacial CBCT. Studies that classified the IFs based on their potential clinical significance were included. The methodological quality of the included studies was evaluated by the STROBE criteria.

RESULTS

The online searches of the electronic databases yielded 1323 records. Five articles were included in the final qualitative analysis. The methodological quality ranged from low to moderate risk of bias. Percentages of IFs with high (requiring intervention/referral), moderate (requiring monitoring), and low clinical significance ranged from 0.3 to 31.4%, 15.6 to 28.9%, and 43.46 to 71.1%, respectively. There was an inconsistency between the studies in the clinical significance of 58.8% of the IFs identified.

CONCLUSION

Most IFs in maxillofacial CBCT are either normal variants or findings that do not require referral or treatment. There was no clear consensus on the recommended management of most common IFs. The lack of consensus on clinical significance emphasizes the importance of collaboration between medical and dental specialties to establish professional guidelines for the management of commonly encountered IFs in CBCT.

Incidental Findings in Temporomandibular Joint Region Detected by Cone-beam Computed Tomography: A Retrospective Study

Purpose:

The purpose of this study was to investigate the prevalence of Incidental Findings (IFs) in the temporomandibular joint (TMJ) region detected in Cone-Beam Computed Tomography (CBCT) scans of maxilla and mandible.

Materials and Methods:

In this study, 384 CBCT scans were reviewed for IFs of the TMJ region. Demographic data including age and sex were recorded. The scans were evaluated in multiplanar views: corrected sagittal, corrected coronal and axial sections. IFs in TMJ region were categorized into eight groups: osteoarthritis, flattening and erosion of condyle and articular eminence, osteophytes, subchondral pseudocyst, condyle hyperplasia, condyle hypoplasia, bifid condyle, and soft tissue calcification. Statistical analyses were performed using the SPSS statistic v.22.

Results:

From the CBCT scans, a total of 81 (21.1%) IFs were identified. 184 of the subjects (47.9%) were male and 200 (52.1%) were females. Their age ranged from 10 to 75 years old with a mean of 36.8 and a standard deviation of 13.9 years. The most frequent IFs were flattening and erosion of condyle and articular eminence (40.74%), followed by soft tissue calcification (30.86%). Osteoarthritis was not observed in any of the subjects. There was no significant difference between females and males in IFs of TMJ joint and its related structures. Flattening and erosion of condyle and articular eminence, soft tissue calcification, osteophytes and, subchondral pseudo cyst showed significant differences between individuals of different age ranges.

Conclusion:

While examining CBCT images, it is critical to check for evidence of IFs in the TMJ region. The findings of this study emphasize the value of a thorough examination of all areas visualized on CBCT scans even those beyond the region of interest.

Incidental findings detected on cone beam computed tomography in an older population for pre-implant assessment

OBJECTIVES

The aim of this retrospective study was to record incidental findings in CBCT scans taken in an older population for pre-implant assessment, and to examine whether these findings would influence the intended dental implant placement.

METHODS

300 consecutive CBCT scans over the age of 40 years was carried out. The incidental findings were grouped into regions as follows: dentoalveolar structures, maxilla and mandible, paranasal sinuses, temporomandibular joint (TMJ), naso/oral-pharyngeal airway, cervical spine and neurovascular canals. The incidental findings are further categories into their significance towards the intended treatment plan.

RESULT

Incidental findings were noted on all of the scans. 555 incidental findings (1.85 findings/scan) were identified. The highest number of incidental findings was in the sinuses (34%), followed by dentoalveolar structures (31%), nasal/oral-pharyngeal airway (12%), maxilla and mandible (10%), TMJ (6%), cervical spine (4%) and neurovascular canals (3%). A total of 37% of findings required follow-up. In 12% of cases detection of the incidental findings lead to amendment or abortion of the intended implant treatment plan.

CONCLUSION

Incidental findings within and beyond the region of interest are common in CBCT scans. The numbers of incidental findings per scan in an older population is higher than in a younger population.

Cone-Beam Computed Tomography Incidental Findings in Individuals With Cleft Lip and Palate

OBJECTIVES

The use of cone-beam computed tomography (CBCT) is well-established in clinical practice. This study seeks to categorize and quantify the incidental finding (IF) rate on CBCT in patients with cleft lip and palate (CLP) prior to orthodontic or surgical treatment.

METHODS

This is systematic retrospective review of head and neck CBCTs in patients with nonsyndromic CLP taken between 2012 and 2019 at a single tertiary referral center. All assessments were performed independently by 4 observers (a head and neck radiologist and 3 orthodontists, including 2 fellowship-trained cleft-craniofacial orthodontists ). The images were divided into 9 anatomical areas and screened using serial axial slices and 3D reconstructions. The absolute number of IFs was reported for each area and statistical analysis was performed.

RESULTS

Incidental findings were found in 106 (95.5%) of the 111 patients. The most common sites were the maxilla (87.4%, principally dental anomalies), paranasal sinuses (46.8%, principally inflammatory opacification), and inner ear cavities (18.9%, principally inflammatory opacification). Eleven patients had skull malformations. Thirty-three patients had IFs in 1 anatomical area, 49 patients in 2 anatomical areas, 19 patients in 3 areas, and 5 patients presented with IFs in 4 of the 9 anatomical areas.

DISCUSSION

In patients with CLP, IFs on CBCT exam were present in the majority of cases. Most patients with IFs had them in multiple anatomical areas of the head and neck. The maxillary dental-alveolar complex was the most common area. Inflammatory changes in the inner ear cavities and paranasal sinuses were also common; however, cervical spine and skull abnormalities were also identified. Clinicians caring for patients with CLP should be aware of IFs, which may warrant further investigation and treatment.

Ameloblastoma incidentally detected in cone-beam computed tomography sialography: A case report and review of the literature

BACKGROUND AND OVERVIEW

Cone-beam computerized tomographic (CBCT) imaging is increasingly used in the maxillofacial region for various purposes. The volumetric dataset created by means of CBCT increases the possibility of detecting incidental findings.

CASE DESCRIPTION

In this case report, the authors describe an otherwise healthy 45-year-old man who was referred from the Sjogren's Syndrome Center in Jerusalem, Israel, for bilateral parotid CBCT sialographic imaging owing to xerostomia lasting for 4 months. CBCT sialographic imaging using iodine contrast material showed normal glandular structure and activity according to the postcannulation panoramic imaging. CBCT sialographic imaging routine volume interpretation revealed a lesion in the mandibular area causing destruction and perforation of the cortical plates, partial disappearance of adjacent lamina dura, and resorption of adjacent teeth, suggesting an aggressive benign tumor. Histopathologic examination confirmed mural cystic ameloblastoma, which was resected with preservation of the mental nerve and the lower mandibular border. The patient received bone graft and implants, with regular follow-ups and no recurrence after 4 years.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

This case strengthens the need for thorough examination of the whole CBCT imaging volume within and outside the region of interest to detect incidental findings with clinical importance.

A systematic review on incidental findings in cone beam computed tomography (CBCT) scans

OBJECTIVES

Cone beam CT's use (CBCT) in dentistry is increasing. Incidental findings (IFs: discoveries unrelated to the original purpose of the scan), are frequently found as a result of a large field of view. The aim of the systematic review is to analyze present literature on IFs using CBCT.

METHODS AND MATERIALS

The authors searched online databases of studies and assessed the prevalence of IFs among patients undergoing head and neck CBCT scans. STROBE criteria was used to evaluate the quality of the studies.

RESULTS

The original search retrieved 509 abstracts of which only 10 articles met the inclusion criteria. The sample size varied between 90 and 1000 participants. The frequency of IFs of the selected articles were 24.6-94.3%. The most common non-threatening IFs were found in the airway, such as mucous retention cyst (55.1%) and sinusitis (41.7%). Other non-threatening IFs were soft tissue calcifications such as calcified stylohyloid ligament (26.7%), calcified pineal gland (19.2%), and tonsillolith (14.3%). Threatening IFs were rare findings (1.4%). Three articles reported incidental carotid artery calcifications with a prevalence of 5.7-11.6%. Pathological findings were not common between the articles, but still relevant (2.6%). The studies had a risk of bias varying from moderate to low.

CONCLUSIONS

There is a high frequency of IFs, yet not all of them require immediate medical attention. The low prevalence of threatening IFs emphasizes that CBCT should not be considered a substitution for conventional radiographs, but when used, the scans should be evaluated by a maxillofacial radiologist.

Incidental Findings in TMJ Imaging

For years, the conventional imaging modalities are generally used in dental practice routine. They provide precious information about dentomaxillofacial region; they also have some limitations such as superimpositions, magnifications, distortions, and low-image quality. Because of these limitations, some pathologies, calcifications, and anatomical variations may be missed. Any findings on a radiographic image which are not related to the research areas of interest could be a description of “incidental findings.” Calcifications are one of these incidental findings. They are asymptomatic and also common in TMJ images. Although most of the calcifications require no treatment, correct identification will reduce further diagnostic assessments. Incidental findings on TMJ images were rare, while examining images for temporomandibular disorders and associated issues, it is important not only to examine the TMJ structures but also to look at the nearby anatomical features to check for evidence of incidental findings pathologies that may have mimicked signs and symptoms of TMJ disorders.

Prevalence and Reporting Rates of Incidental Dental Disease on Head CT Examinations

RATIONALE AND OBJECTIVES

Routine head computed tomography (CT) examinations often inadvertently include dental pathology which is often overlooked. The purpose of this study is to examine the prevalence of dental disease incidentally present and detected on head CT examinations, and to determine the effect of the institution of a dental disease field or macro in a standardized head CT dictation template on the rate of reporting dental disease.

MATERIALS AND METHODS

Head CT examinations were retrospectively and randomly selected from all examinations performed 6 months before, and 6 months after the institution of a dental disease field in a standardized head CT template. Dental findings were recorded from the initial finalized report. Examination images were subsequently reviewed for the presence of dental disease by two neuroradiologists who were blinded to the original reports and to each other's findings.

RESULTS

One hundred examinations were reviewed in the analysis. At our institution, 33% of the randomly selected head CT examinations included the level of the teeth (100/307). Dental disease was determined to be present in 40%-41% of these cases. Only 11% of the initial reports mentioned dental disease (P < .01). Addition of a dental disease field in the dictation template resulted in no significant difference in reporting dental disease (14% vs 8%, P = .371).

CONCLUSIONS

Incidental dental disease is common and frequently underreported. Inclusion of a dental disease field in a standardized template does not significantly improve the rate of reporting dental disease.

Frequency and type of incidentally detected radiodensities in the maxillary sinus: a retrospective analysis using cone beam computed tomography (CBCT)

OBJECTIVES

To evaluate the frequency, location, and characteristics of radiodensities in the maxillary sinus using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

All CBCT scans with a large field of view with both maxillary sinuses entirely visible were initially screened. Patients were included, if there was no suspicion of sinus pathology and no history of surgical intervention/trauma in the sinus region. The location and shape of the radiodensities were evaluated in axial, coronal, and sagittal CBCT views. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition.

RESULTS

A total of 169 patients (338 maxillary sinuses) were included. Radiodensities were found in 35 sinuses (10.4%) of 28 patients (16.6%) with a mean age of 32.0 years. Most of the 35 affected sinuses had one radiodensity (19/54.2%). The radiodensities were typically located at the sinus floor (22/62.9%). Of the sinuses presenting with radiodensities, 17 (48.6%) were exhibiting reactive changes of the Schneiderian membrane. The presence of periodontal pathology was found to be associated with the presence of radiodensities. Age and sinus pathology were influencing factors on the shape of radiodensities, and the status of the dentition was an influencing factor on the number of lesions.

CONCLUSIONS

One-sixth of the patients analyzed had incidentally diagnosed radiodensities in their maxillary sinuses. As almost 50% of the sinuses with radiodensities exhibited a form of chronic rhinosinusitis, the diagnosed ectopic calcifications may have formed as a result of mucosal changes of inflammatory origin. The presence of periodontal pathology was associated with a higher incidence of radiodensities. Nevertheless, this finding has to be interpreted with some caution due to the limited sample size available.

CLINICAL RELEVANCE

Incidentally detected radiodensities in the maxillary sinus are not an infrequent finding in CBCT scans of asymptomatic patients, and are located typically on the sinus floor. Future studies are needed to assess the clinical significance of these findings especially with regard to planned surgical interventions in the posterior maxilla.

Comparison of the Bony Changes of TMJ in Patients With and Without TMD Complaints Using CBCT

STATEMENT OF THE PROBLEM

Temporomandibular joint disorders (TMD) may show a poor correlation between their clinical findings and radiological characteristics.

PURPOSE

The aim of this study was to assess the osseous alterations of temporomandibular joint (TMJ) in symptomatic and asymptomatic subjects by employing cone beam computed tomography (CBCT) images.

MATERIALS AND METHOD

In this study, CBCT images of 120 temporomandibular joints in 30 patients with TMJ disorder and 30 age- and sex-matched individuals without TMJ complaints were evaluated. Osteoarticular derangements of the joint were assessed by two experienced examiners. Data was statistically analyzed with SPSS software using chi-square test (p <0.05).

RESULTS

Out of 120 CBCT images (60 in each group), at least one osseous change was observed in 90% and 86.7% joints in symptomatic and asymptomatic subjects, respectively. There were no significant differences between symptomatic and asymptomatic subjects regarding frequency of osteoarticular changes including flattening (73.3% vs. 75%), irregularity (36.7% vs. 48.3%), sclerosis (20% vs. 8.3%), cyst (3.3% vs. 3.3%), erosion (13.3% vs. 21.7%), hypoplasia (3.3% vs. 5%), ankylosis (1.7% vs. Zero), osteophyte (43.3% vs. 40%), decrease joint space (3.3% vs. 3.3%), and increase joint space (5% vs. 5%). (p> 0.05).

CONCLUSION

By employing CBCT as a modern diagnostic imaging tool, findings of this study revealed that the frequency of various temporomandibular joint alterations on CBCT images is comparable in patients with and without TMD complaints, suggesting that some people with TMJ structural damage may not display clinical manifestations. Moreover, CBCT imaging might not be necessary for TMD patients and more attention should be given to clinical examination.

Incidental findings in pre-orthodontic treatment radiographs

OBJECTIVES

To determine the frequency, radiodensity characteristics, topographic location and number per patient of incidental findings observed in radiographs taken before orthodontic treatment and to evaluate the relationship of the findings with age and sex.

METHODS

This was a cross-sectional study that investigated 1,887 panoramic and lateral cephalogram radiographs from 783 patients (23.31 ± 13.11 years of age; 453 women and 330 men) who were randomly selected from the orthodontics department of a private university. The images were systematically evaluated by an oral pathologist. A chi-square test was applied to evaluate the association between sex and the presence of pathology, radiodensity characteristics and topographic location. The Mann-Whitney U and Kruskal-Wallis tests were used to establish the association between age or number of findings per patient with other variables in the study.

RESULTS

The prevalence of incidental findings was 88.12%. The most frequent finding was maxillary sinus pneumatisation (25.80%). No significant association was detected between frequency or number of findings per patient and either sex or diagnostic hypothesis. A significant association was found between age and the presence of pathology and number of incidental findings per patient (P < 0.001), as well as between the type of radiographic image and incidental finding (P < 0.001).

CONCLUSION

The prevalence of incidental findings in the sample studied was high, and the structures most commonly involved were the maxillary sinuses. The results suggest that both the presence and the number of findings per patient increase with age but there is no association with sex.

Diagnosis of ethmoid sinolith by cone-beam computed tomography: case report and literature review

INTRODUCTION

The aim of this study was to report the first case of diagnosis of a rare ethmoid sinolith by cone-beam computed tomography (CBCT) and discuss the importance of carefully assessing the entire volume of the images regardless of the region of interest.

CASE PRESENTATION

A 22-year-old woman underwent CBCT examination to assess the upper permanent canine teeth. Analysis of the entire volume of CBCT revealed an oval-shaped hyperdense, homogeneous, expansive formation with defined boundaries located in the ethmoid bone. The differential diagnosis of a sinolith in the ethmoid sinus was confirmed after removal of the lesion by nasoendoscopy and histopathological examination.

CONCLUSION

The diagnosis of lesions in the ethmoid sinus is challenging because of the complex anatomy of this region. Considering the limitations of two-dimensional X-ray examination, CBCT examination has become an important imaging modality for the diagnosis of these calcifications. In addition, the ability of the dental surgeon to assess the entire volume of the CBCT images and the knowledge of imaging features of these calcifications allows for recognition of incidental findings, facilitating early diagnosis and appropriate treatment.

Correlation and reliability of cone-beam computed tomography nasopharyngeal volumetric and area measurements as determined by commercial software against nasopharyngoscopy-supported diagnosis of adenoid hypertrophy

INTRODUCTION

The aim of this study was to evaluate the diagnostic correlation and reliability of Dolphin Imaging fully automated segmentation (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for assessing adenoid hypertrophy. This was investigated through 3 modes: (1) intraobserver and interobserver agreement of repeated airway auto-segmentation procedures, (2) correlation between auto-segmentation measures of volume and minimal cross-sectional airway against nasopharyngoscopy, and (3) optimum diagnostic cutoff thresholds for volume and minimal cross-sectional airway identified and tested with sensitivity and specificity analyses.

METHODS

Cone-beam computed tomography scans of 38 patients with suspected upper airway obstruction were analyzed. Two calibrated evaluators applied a previously validated method to quantify nasopharyngeal minimal cross-sectional airway and volume using Dolphin Imaging. Assessments were compared against grades of obstruction provided by otolaryngologists' diagnoses.

RESULTS

The reliability between the 2 assessments by the same evaluator on the Dolphin automatic segmentation function for volume (ICC, 0.97; 95% CI, 0.95, 0.98) and minimal cross-sectional airway (ICC, 0.84; 95% CI, 0.69, 0.91) was excellent. The interoperator reliability for volume was also excellent (ICC, 0.97; 95% CI, 0.95, 0.98), but only good (ICC, 0.701; 95% CI, 0.44, 0.85) for minimal cross-sectional airway. In contrast, the Spearman rank correlation test demonstrated weak associations between the values of the automatic measurements for both volume (4.9%; ρ = -0.22) and minimal cross-sectional airway (3.7%; ρ = 0.19). Assessments of accuracy via Receiver Operating characteristic analysis, sensitivity, specificity, negative predictive values, positive predictive values, and likelihood ratios demonstrated the poor clinical applicability of volume and minimal cross-sectional airway numbers provided by Dolphin Imaging.

CONCLUSIONS

The evaluators were reliable at manipulating the selected software, achieving consistent volume and minimal cross-sectional airway measurements, However, Dolphin Imaging volumetric and minimal cross-sectional airway measurements did not correlate well with the nasopharyngoscopy-supported reference standard for adenoid hypertrophy assessment. Under these study conditions, volume and minimal cross-sectional airway used to assess localized adenoid hypertrophy with cone-beam computed tomography imaging based on automated measurements may not yield high-quality clinically relevant information about upper airway constriction related to adenoid hypertrophy.

Detection of Dental Pathologies in Routine Paranasal CT Scans: A Retrospective Study

INTRODUCTION

Multidetector Computed Tomography (MDCT) is a widespread method for evaluating paranasal sinuses and nasal cavity in daily practice. The maxillary teeth are in field of view in a paranasal sinus CT scan and it is possible to detect dental pathologies with CT.

AIM

To determine the incidence of maxillary teeth pathologies in routine paranasal sinus CT scans.

MATERIALS AND METHODS

A retrospective study was conducted. Consecutive 395 paranasal sinus CT scans were evaluated. All CT images were obtained with a 64 detector-CT. Patients with previous facial trauma, operation, invasive tumors and repeated exams were excluded. Detected findings were classified as "tooth loss, dental restorations or procedures and dental pathologies (carious lesions, dental developmental anomalies, periapical lesions and periodontal diseases). The proportion of findings was reported as simple percentiles.

RESULTS

Three hundred and eighty-four CT scans were included in the study. Dental restorations or procedures were determined in 129 (33.5%) patients. A total of 34 (8.8%) patients had normal teeth count and morphology. A total of 264 (64.3%) patients had at least one tooth loss. A total of 195 (51%) patients had at least one or more dental pathology. Number of dental carious lesions, dental developmental anomalies, periapical lesions and periodontal disease were 104 (27.0%), 78 (14.3%), 46 (11.9%), 44 (11.4%), respectively.

CONCLUSION

Dental pathologies were encountered in more than half of the patients. Detecting dental pathologies may prevent tooth loss and improve oral health. The radiologist should keep in mind dental pathologies while evaluating paranasal sinus CT in daily practice.

Cone beam computed tomography incidental findings of the cervical spine and clivus: retrospective analysis and review of the literature

OBJECTIVE

The aim of this study was to analyze and describe incidental findings in the cervical spine (C-spine) and the clivus encountered in cone beam computed tomography (CBCT) imaging. The wide range of possible anatomic variants and pathoses is discussed in the context of the medical and dental literature to clarify their radiographic appearance and clinical implications as a guide for the oral and maxillofacial radiologist.

STUDY DESIGN

A retrospective analysis of radiographic reports was conducted based on CBCT images from 2 oral and maxillofacial imaging centers. Reports documenting incidental findings in the C-spine or the clivus were selected. Data on patient age and sex were collected, and each incidental finding was categorized as degenerative, congenital, or developmental/pathologic. Each finding is discussed with clinical importance and is pictorially presented.

RESULTS

From a total of 7689 CBCT reports, there were 732 incidental findings (9.5%) in the C-spine or the clivus. Most findings were in the C-spine (92.3%), were degenerative in nature (78.7%), and occurred in females in their sixth decade. Logistic regression analysis showed that the odds of presenting with a degenerative incidental finding in the C-spine or the clivus did not differ based on sex but were 5.5 times (95% confidence interval, 3.77-8.04) higher if the patient was aged 50 years or older.

CONCLUSIONS

This review is the largest and the first to characterize incidental findings in the C-spine and the clivus. Such findings were reported in 9.5% of radiographic reports. Several presented as uncommon congenital variants that are not usually spotlighted during oral and maxillofacial radiology training.

Incidental cone beam computed tomographic findings among Taibah University patients, KSA: A retrospective study

Objectives

The aim of this study was to retrospectively evaluate the prevalence, type, and location of incidental findings by cone beam computed tomography (CBCT) scans. This study was performed to diagnose dental problems in the female population at Taibah University Dental Clinics (TUDC), KSA.

Methods

A series of 150 consecutive CBCT scans were identified between January 2014 and February 2016. The record was retrieved from the Carestream (CS) R4 Clinical and Practice Management Software database of TUDC. We retrospectively assessed them for incidental findings and then summarized and categorized them into five anatomical regions: nasopharyngeal airway, temporomandibular joint (TMJ), paranasal sinuses, dental findings, and alveolar bone region. We then analysed the frequency and percentage of findings in each category.

Results

A total of 248 incidental findings were reported in 83 of 90 scans (2.76 findings/scan). The prevalence of all incidental findings was 92.2%. The most common incidental findings were located in the paranasal sinuses and alveolar area, each representing about a quarter (27.4%) of all of the findings. Other common findings were in the TMJ (22.9%), followed by those in the nasopharyngeal airway (10.9%), dental area (10.5%), and others (0.8%).

Conclusion

This study confirms the high prevalence of incidental maxillofacial findings as shown by CBCT scans in a sample of female patients at TUDC. This emphasizes the need to thoroughly examine CBCT volumes for clinically significant findings inside and beyond the region of interest for the benefit of patients and the protection of practitioners.

Study of the frequency and location of incidental findings of the maxillofacial region in different fields of view in CBCT scans

OBJECTIVES

The aim of this study was to identify the type and frequency of incidental findings (IFs) in the maxillofacial region of CBCT scans with different sizes of field of view (FOV), and the clinical relevance of the findings was classified as requirement or not of monitoring, treatment or referral to a specialist.

METHODS

We analyzed 150 CBCT examinations, divided according to the size of the FOV into 3 groups: 6-cm maxilla, 6-cm mandible and 13-cm maxilla/mandible. The IFs were categorized into six areas: airway, temporomandibular joint (TMJ), bone, lesions of the jaws, teeth and soft-tissue calcifications.

RESULTS

The results showed 560 IFs that were found in 92% of the samples studied. A total of 225 IFs were found in examinations of the maxilla group, 99 findings in the mandible group and 236 findings in the maxilla/mandible group. The IFs were most frequent in the tooth zone (27.32%), followed by airways, soft-tissue calcifications, TMJ, bone, lesions of the jaw and other findings. We also found that 43.46% of the IFs did not need treatment or referral to another professional, 28.97% findings required the acquisition of new images for monitoring and 27.55% findings needed treatment or referral.

CONCLUSIONS

The present study confirmed the high frequency of IFs in CBCT scans. It was concluded that it is necessary to interpret and report the total volume obtained in CBCT examinations and not only the purpose of the examination region.

A retrospective cephalometric study on pharyngeal airway space changes after rapid palatal expansion and Herbst appliance with or without skeletal anchorage

Background

The aim of this study is to investigate the pharyngeal airway space changes in patients treated with rapid palatal expansion (RPE) and Herbst appliance with or without skeletal anchorage.

Methods

A 40-patient study group treated with the Herbst RME combination was included; moreover, a comparison between two subgroups based on whether miniscrews were used was evaluated. A subgroup 1 included 20 patients who were treated with RPE and an acrylic splint Herbst with miniscrews, and subgroup 2 included 20 patients who were treated with RPE and an acrylic splint Herbst. A cephalometric analysis was performed before (T1) and after (T2) treatment. The skeletal parameters of the sagittal occlusion analysis of Pancherz were utilized together with some extra measurements to evaluate the airways.

Results

An increased nasopharyngeal airway space was observed in group 1 (p < 0.05) from T1 to T2. Furthermore, the increase in nasopharyngeal airway space was significantly higher in subgroup 1 (p < 0.05) in comparison to the subgroup 2. Oropharyngeal (OA) and laryngopharyngeal (LA) dimensions were significantly increased in the subgroup 1 at the end of the treatment. In the subgroup 1, a significant decrease in SNA, a significant increase in SNB, and a significant decrease in ANB were observed from T1 to T2. In the subgroup 2, the treatment resulted in a significant decrease in ANB. In both groups, Pogonion increased significantly from T1 to T2.

Conclusions

The results suggest that the RPE and the Herbst appliance allow a slight improvement of the sagittal dimensions of the airways. The oropharyngeal dimension increased significantly more in the skeletal anchorage group.

Incidental Findings on Cone Beam Computed Tomography Studies outside of the Maxillofacial Skeleton

Objective. To define the presence and prevalence of incidental findings in and around the base of skull from large field-of-view CBCT of the maxillofacial region and to determine their clinical importance. Methods. Four hundred consecutive large fields of view CBCT scans viewed from January 1, 2007, to January 1, 2014, were retrospectively evaluated for incidental findings of the cervical vertebrae and surrounding structures. Findings were categorized into cervical vertebrae, intracranial, soft tissue, airway, carotid artery, lymph node, and skull base findings. Results. A total of 653 incidental findings were identified in 309 of the 400 CBCT scans. The most prevalent incidental findings were soft tissue calcifications (29.71%), followed by intracranial calcifications (27.11%), cervical vertebrae (20.06%), airway (11.49%), external carotid artery calcification (10.41%), lymph node calcification (0.77%), subcutaneous tissue calcification and calcified tendonitis of the longus colli muscle (0.3%), and skull base finding (0.15%). A significant portion of the incidental findings (31.24%) required referral, 17.76% required monitoring, and 51% did not require either. Conclusion. A comprehensive review of the CBCT images beyond the region of interest, especially incidental findings in the base of skull, cervical vertebrae, pharyngeal airway, and soft tissue, is necessary to avoid overlooking clinically significant lesions.

Agreement among orthodontists experienced with cone-beam computed tomography on the need for follow-up and the clinical impact of craniofacial findings from multiplanar and 3-dimensional reconstructed views

INTRODUCTION

In this study, we aimed to assess interrater and intrarater agreement among orthodontic clinicians in their assessments of reported incidental findings in regard to both the need for additional follow-up and the impact on future orthodontic treatment in large-field maxillofacial cone-beam computed tomography (CBCT) imaging.

METHODS

The study sample consisted of 18 nonrandomly selected large-field maxillofacial CBCT volumes containing a reported total of 88 radiographic findings. All scans were associated with formal radiologic reports. However, the suggestions of further follow-up were removed from the radiologic reports so as to not bias the 3 evaluating orthodontists in their subsequent decision making. The evaluators had on average 7.6 years of CBCT usage and self-interpretation experience. Reliability was determined by quantifying the level of agreement between the evaluators' assessments for both research questions for all 88 findings using a binary response (yes/no) as the outcome measure. The Cohen kappa statistic was calculated to quantify intrarater and interrater agreement globally for both statements.

RESULTS

Although interrater agreement was considerable, potential decisions with clinical impact were not consistent. This needs to be considered when interpreting maxillofacial incidental findings. Evaluators demonstrated higher levels of agreement for dentoalveolar findings compared with all other extragnathic regions when assessing clinical significance.

CONCLUSIONS

Among the evaluators who were considered experienced in CBCT, "fair-to-good" interrater agreement and "excellent" intrarater agreement were demonstrated in terms of the need for further follow-up and their potential impact on future orthodontic treatment.