THU0527 FREQUENCY AND ANATOMIC DISTRIBUTION OF MAGNETIC RESONANCE IMAGING LESIONS IN THE SACRO-ILIAC JOINTS OF HEALTHY SUBJECTS AND PATIENTS WITH SPONDYLOARTHRITIS

Background:

Lesions detected by magnetic resonance imaging (MRI) of the sacroiliac joints are critical to the diagnosis of non-radiographic axial spondyloarthritis (1). However, some lesions, such as bone marrow edema (BME), usually observed in patients with spondyloarthritis may be encountered in other conditions. BME have been described in patients with nonspecific back pain, healthy subjects, women with postpartum and in athletes (2). Moreover, it has recently been shown that structural lesions of the sacroiliac joint, such as erosions and fat metaplasia, may be present in healthy subjects (3).

Objectives:

To evaluate and compare the frequency and location of lesions (BME, subchondral condensation, fat metaplasia, erosions and ankylosis) on MRIs of the sacroiliac joint of healthy individuals and patients with spondyloarthritis.

Methods:

This is a retrospective study conducted at the University Hospital of Besançon including 200 patients, each having received an MRI of the sacroiliac joints in coronal section and in T1 and Semicoronal short tau inversion recovery sequences. Two experienced readers evaluated the whole set of images to detect erosions, subchondral condensation, fat metaplasia, BME and ankylosis according to the definitions established by the Assessment of SpondyloArthritis MRI working group. We subdivided a sacroiliac joint into three segments, upper, medium and lower along the cranio-caudal axis. Within the middle segment, we retained 3 portions: anterior, intermediate, posterior along the ventro-dorsal axis. Overall, one sacroiliac joint contained five quadrants on the iliac side and five quadrants on the sacral side.

Results:

Collected MRI of 200 patients (62% female), 96 patients had spondyloarthritis (mean age 37.4±11.8 years, 48% HLA-B27+), 104 subjects were unaffected by the disease (mean age 39.9±11.6 years, 11% HLA-B27+). Of the 96 spondyloarthritis patients, 62 (65%) had inflammatory buttock pain compared to 26 (25%) in the group without spondyloarthritis. BME was seen in 62 (65%) patients with spondyloarthritis mainly in the iliac quadrant of the intermediate middle segment and in 21 (20%) patients without spondyloarthritis predominantly in the antero-middle quadrant. There were equal BME in women and men with spondyloarthritis. Subchondral condensation occurred in 45% of patients without spondyloarthritis, mostly in the antero-middle quadrant and in 36% of patients with spondyloarthritis. Fat metaplasia was present in 35% of spondyloarthritis patients and in 23% of control patients. Erosions were seen in 31% of healthy patients and in 61% of patients with spondyloarthritis.

Conclusion:

In this large retrospective cohort, we observed a significant frequency of inflammatory but also structural lesions on MRIs of sacroiliacs joints from healthy patients, which could lead to the misdiagnosis of spondyloarthritis. Fine identification of the location of these lesions is crucial to avoid erroneous diagnosis.

References:

[1]Maksymowych WP. The role of imaging in the diagnosis and management of axial spondyloarthritis. Nat Rev Rheumatol. nov 2019;15(11):657‑72.

[2]de Winter J, de Hooge M, van de Sande M, de Jong H, van Hoeven L, de Koning A, et al. Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain. Arthritis Rheumatol Hoboken Nj. juill 2018;70(7):1042‑8.

[3]Seven S, Østergaard M, Morsel-Carlsen L, Sørensen IJ, Bonde B, Thamsborg G, et al. Magnetic Resonance Imaging of Lesions in the Sacroiliac Joints for Differentiation of Patients With Axial Spondyloarthritis From Control Subjects With or Without Pelvic or Buttock Pain: A Prospective, Cross-Sectional Study of 204 Participants. Arthritis Rheumatol. 1 déc 2019;71(12):2034‑46.

Disclosure of Interests:

None declared

Benign Raeder's syndrome is probably a manifestation of carotid artery disease

Raeder first described Horner's syndrome with ipsilateral head pain due to paratrigeminal organic disease, but most subsequent reports of this syndrome were idiopathic. Our recent case prompted a review of past reports of idiopathic Raeder's syndrome. Because in recent years the features of Raeder's syndrome have been recognized as common manifestations of carotid artery dissection, we divided the cases into those with and those without carotid imaging studies. The classifications and differential diagnoses are discussed. Sixteen cases with carotid imaging studies were not very different from the 28 cases without such studies. Most studies were performed several weeks after onset of symptoms and carotid dissection could not be definitely excluded in any case. In most cases of idiopathic Raeder's syndrome, carotid artery dissection was not considered and in no case was that condition definitively excluded. People with Raeder's syndrome not associated with a paratrigeminal organic lesion probably have a disease of the carotid artery. Because of the different criteria and classifications of Raeder's syndrome it is best to relegate this eponym to history.

Pattern of bone resorption in vertically fractured, endodontically treated teeth

PURPOSE

To evaluate the clinical pattern of alveolar bone resorption associated with vertically fractured, endodontically treated teeth in correlation to clinical symptoms.

MATERIAL AND METHODS

The pattern of bone resorption was evaluated in 66 maxillary premolars, 13 mandibular premolars, and 31 mesial roots of mandibular molars extracted during an 18-month period because of vertical root fractures. Type and duration of symptoms were recorded and correlated to the pattern of bone resorption.

RESULTS

A V-shaped pattern osseous defect (dehiscence) was typical (91%) to the buccal plate rather than a U-shaped shallow, rounded, slow grade resorption in the palatal or lingual plate. Fenestration of the buccal plate was observed in 10 patients (9%). A positive correlation between type of symptoms and amount of buccal bone resorption was found (P <.0001). The resorptive defect was always facing the fracture line.

CONCLUSIONS

A typical pattern of bone resorption in vertical root fracture cases as shown in this study can be helpful to the clinician in diagnosing vertical root fracture when an exploratory full flap surgical procedure is performed.

Odontogenic cysts related to pulpotomized deciduous molars: clinical features and treatment outcome

OBJECTIVE

The purpose of this study was to assess the morbidity and outcomes associated with large cysts that developed in conjunction with pulpotomized deciduous molars.

STUDY DESIGN

This retrospective study was based on the files of 18 patients who were referred to 2 oral surgery departments during a 10-year period (1986-1996). The inclusion criteria were large cyst lesions (>1 cm in diameter) and complete documentation. Data regarding symptoms at presentation, histologic and radiologic features, treatment modalities, morbidity, and outcomes were analyzed.

RESULTS

An equal gender distribution of patients was found, as were a later development in males (12+/-2 years in boys, 9+/-2 years in girls) and a 5:1 ratio favoring the mandible over the maxilla. Treatment included enucleation (12 patients) and marsupialization (6 patients). The morbidity was high and included loss of permanent teeth (3 patients), extensive loss of alveolar bone (3 patients), use of flaps (2 patients), and adjuvant orthodontic treatment (9 patients).

CONCLUSION

Failure of early detection and treatment of cysts that develop in conjunction with pulpotomized deciduous molars can cause considerable morbidity. Therefore, periodic clinical and radiologic follow-up until the eruption of succedaneous teeth is recommended.

Immediate complications of local anesthetic administered to 1,007 consecutive patients

BACKGROUND

Probably the most common procedure in dentistry is the administration of local anesthetic, or LA. Immediate complications of LA administration include positive blood aspiration, blanching of the tissue and burning sensation on impingement of the nerve. Because studies about the immediate complications of LA administration were conducted before 1980, more recent data regarding this procedure are needed.

MATERIALS AND METHODS

In this prospective study, an experienced dentist administered, 2,528 LA injections to 1,007 consecutive patients with 1-inch 27-gauge needles, using a solution of 2 percent lidocaine and 1:100,000 nordefrine hydrochloride.

RESULTS

The authors observed positive blood aspiration in 73 injections (2.9 percent) without any further complications. The most severe immediate complication-syncope-occurred only in one case. In 63 injections (2.5 percent), the dentist touched the nerve, and the patient reported feeling an electric current sensation (40 times with inferior alveolar nerve blocks, 18 times with lingual nerve blocks, four times with mental nerve blocks and one time with a second injection to the same site) without any further complications.

CONCLUSIONS

The results confirm that LA injections that are properly carried out appear to be safer today than they were in the past.

CLINICAL IMPLICATIONS

LA is a safe procedure when the appropriate technique is used. It is even safer when an inferior alveolar nerve block is administered.

Lingual osteoma: a debatable entity

PURPOSE

This article analyzes osseous lesions in the tongue with regard to the clinical and histologic features and discusses the pathogenesis and terminology of these lesions.

MATERIALS AND METHODS

Thirty-eight cases of lingual osseous lesions were retrieved from the English language literature, and two new cases were added.

RESULTS

The lesions had a female predilection, with a female-to-male ratio of 2.3:1. Mean age of the patients at time of diagnosis was 31.4 years. The lesions were located in the posterior third of the dorsum of the tongue in 67.5% of the cases, in the lateral margins in 25%, and in the mid-third of the tongue in 7.5%. Size ranged from 0.5 to 5.0 cm. Duration of the lesions ranged from several months to 50 years. In eight cases, there was information that the lesions had increased in size. Histologically, the lesions appeared a well-circumscribed mass of vital bone under the surface epithelium. The two new cases, when examined by polarized light, showed a mixture of woven and mature bone.

CONCLUSION

The osseous lesions of the tongue represent a heterogeneous group of lesions in which some may represent a developmental malformation, and others may be a reactive lesion after trauma or irritation. Some lesions behave as true neoplasms and others as choristomas. It is suggested that the descriptive term "osseous tumorlike lesion of the tongue" may be more appropriate for this group.

Head and neck carcinoma in Fanconi's anaemia--report of a case and review of the literature

Fanconi's anaemia (FA) is a rare autosomal recessive syndrome characterised by progressive lethal pancytopenia, skeletal abnormalities, hyperpigmentation and increased chromosomal aberrations. A high incidence of leukaemia and hepatocellular and squamous cell carcinomas (SCC) have been reported in FA patients. A rare case of SCC of the dorsum of the tongue in a FA patient is presented. A review of the reported cases of head and neck carcinoma in FA patients shows a different male:female ratio than previously reported, and a high incidence of carcinoma of the tongue.

Cost evaluation of two methods of post tooth extraction hemostasis in patients on anticoagulant therapy

The classical management of patients on oral anticoagulant therapy included hospitalisation, cessation of the anticoagulant agent, and extraction of teeth when the prothrombine levels rise. This method was substituted in the High Risk Dental Clinic at Barzilai Medical Center in Ashkelon by use of a tissue sealant (Tisseel) which does not need hospitalisation nor cessation of the anticoagulant therapy. In comparing the last 23 sessions employing the former method to the first 23 sessions using the new method there were significant differences in the cost effectiveness for the health system, provider, insurer and patient. Despite the fact that from the health system point of view the new method is much more cost effective, there is no financial incentive for the provider (hospital) nor awareness on the part of the insurer (General Sick Fund) to embrace it and 'market' it.

Thrombolytic therapy for acute myocardial infarction after oral surgery

Two cases of mild-to-moderate bleeding after thrombolytic streptokinase therapy are presented, and the treatment modalities are discussed. To the best of our knowledge, these are the first two cases reported in the medical and dental literature.

Postextraction hemostasis in patients on anticoagulant therapy: the use of a fibrin sealant

A simple and safe method of achieving hemostasis after tooth extraction in patients on anticoagulant therapy is described. The use of a tissue sealant turns a complicated, difficult, and risky dental procedure into a simple one, suitable for any dental clinic. Sixty-one teeth were extracted in 23 sessions. Only four cases of very slight postsurgical bleeding were reported. Dental treatment of the majority of these medically compromised people can be performed by private practitioners, without referring the patients to specialty care centers.

Burns of the oral mucosa. Report of 6 cases

Burns of the oral cavity may be caused by prolonged use of certain drugs by the patient or by incorrect use of caustics by the dentist. Unwillingly-acquired self-inflicted injuries are also encountered, such as caustic ingestion (out of curiosity or by accident), excessive consumption of fresh fruit and fresh fruit juice, and wrong oral hygiene practice. Our experience with six infrequent and unfamiliar types of oral burns, caused by various components and material, is described and discussed.