Anitha Potluri

Position and course of the mandibular canal in skulls

OBJECTIVE The aim of this study was to examine and describe the topography of the mandibular canal (MC) in both vertical and occlusal dimensions. STUDY DESIGN Fifty-two adult skulls deposited in the University of Pittsburgh School of Dental Medicine skull collection were evaluated in this study. Cone-beam computerized tomographic scans of each skull were obtained. RESULTS The vertical course of MC was classified into 3 types: straight projection (12.2%), catenary-like configuration (51.1%), and progressive descent from posterior to anterior (36.7%). The evaluation of the buccolingual dimension showed that the mandibular canal was located either in contact with or close to the lingual cortical plate (≤ 2 mm) in the molar region of the majority of the cases. As it proceeds anteriorly it moves toward the buccal aspect of the mandible, where it finally emerges through the mental foramen. Three emerging patterns of mandibular canal were observed: sharp turn (53.2%), soft curved exit (28.8%), and straight path (17.4%). The examination of the vertical dimension showed that the canal was located almost 1 cm above the inferior border of the mandible and then ascended to reach the mental foramen, which is located ~16 mm (range 13.4-20.3 mm) above the inferior border of the mandible. We found a strong correlation between height of the mandible and location of the mental foramen (r = 0.64; P < .0001). CONCLUSIONS The course of mandibular canal described in vertical and axial dimensions and variation in its path have been classified. In addition to variation in location of MC, it has different anatomic configurations which clinicians should be familiar with in any surgical procedures involving the posterior mandible.

Psammomatoid and trabecular juvenile ossifying fibroma: two distinct radiologic entities

OBJECTIVE Evaluate and compare the radiologic features of psammomatoid versus trabecular variants of juvenile ossifying fibromas. STUDY DESIGN Twelve of fifteen cases of juvenile ossifying fibroma of the craniofacial bones, retrieved from our pathology archives for the period between 2002 and 2013, had available preoperative computed tomography (CT) scans. The radiologic features of each case were analyzed and compared by two neuroradiologists and one oral and maxillofacial radiologist, each blinded to the histopathologic diagnosis. RESULTS Juvenile psammomatoid ossifying fibroma (JPOF) exhibited a ground-glass pattern, as an outer mantle with central radiolucency, a single mural nodule, or a solid homogeneous mass. The trabecular variant presented as a radiolucent lesion with irregular, scattered calcifications. Both variants displayed a well-defined border. CONCLUSION This study demonstrates that psammomatoid and trabecular juvenile ossifying fibromas exhibit unique radiologic features that allow for distinction between the two variants on CT studies.

Case Report: a Pediatric Case of Cementoblastoma with Histologic and Radiographic Features of an Osteoblastoma and Osteosarcoma

One case of an expansile mass involving the roots of a mandibular left first molar in a nine year old male is presented. The lesion has features of a cementoblastoma (CB), osteoblastoma (OB), and osteosarcoma (OS) both radiographically and histologically. Radiographically, a “sunburst” appearance is present. Histologically, the lesional tissue is intimately involved with the root, not the periosteum. The clinical, radiographic, and histopathologic characteristics of CB, OB, and OS are discussed as well as the difficulties associated with distinguishing between these lesions in the gnathic region.

The reliability of tablet computers in depicting maxillofacial radiographic landmarks.

Purpose This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5). Materials and Methods A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images. Results Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs. Conclusion Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma: Report of a case in the oral cavity

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (DLBCL/BL) is a new category of B-cell lymphoma according to the 4 th edition of the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues (2008). The following report presents a case of this rare, newly described entity on the palate of a 59 year-old male.

Is Computed Tomography an Adequate Imaging Modality for the Evaluation of Juvenile Ossifying Fibroma? A Comparison of 2 Imaging Modalities (Computed Tomography and Magnetic Resonance Imaging)

PURPOSE Given the problems of overuse of medical technology and the current burden of health care cost in the United States, it is important to establish clear imaging guidelines to diagnose conditions such as juvenile ossifying fibroma (JOF). This study compared the efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of JOF and thus could aid establishing such guidelines. MATERIALS AND METHODS Radiologic criteria were established by 2 radiologists to compare the efficacy of CT and MRI in the evaluation of JOF. The following parameters were compared: presence of a well-defined corticated border, presence of a well-delineated internal calcified component, fluid-to-fluid levels, and anatomic extent of the lesion. Six patients diagnosed with JOF of the craniofacial bones from 2002 to 2013 had preoperative CT and MRI studies available for review. RESULTS After review of CT and MRI images, fluid-to-fluid levels and anatomic extent of the lesions were comparable on CT and MRI. However, the corticated borders and the internal calcified component were better defined on CT images, which also enabled for distinction between the 2 subtypes of JOF. No MRI characteristics were identified that allowed for this distinction. CONCLUSION Based on these findings, CT is an adequate and preferable imaging modality in the evaluation of JOF.

Multilocular radiolucency of the anterior mandible

A 10-year-old boy sought care at the Department of Oral and Maxillofacial Surgery at the University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, with a large swelling in the anterior mandible and multiple loose teeth. The patient’s medical history was clinically significant for exercise-induced asthma. A panoramic radiograph (Figure 1) demonstrated a large well-defined, multilocular radiolucency with thin corticated borders in the anterior mandible extending between the premolars bilaterally. Fine, wispy septations were noted within the lesion, giving it a multilocular appearance. The lesion expanded the inferior border of the mandible. To determine the extent of the lesion, we prescribed a computed tomographic (CT) examination. A sagittal view (Figure 2) of the area demonstrated a multilocular lesion causing buccolingual expansion of the anterior mandible with thinning of the buccal and lingual plates, and root resorption. Axial bone window sections (Figure 3) showed the extent of the lesion in a buccolingual direction, as well as the extent of the lesion from the left mandible to the right, crossing the midline and extending into the bilateral molar areas, which was not clearly visible on a standard panoramic radiograph. The lesion was more extensive on the right side and extended to the right buccal vestibule and posteriorly to the molar area. The lesion was 4.6 2.7 2.3 centimeters. A soft-tissue window with contrast showed the lesion had areas of density compared with the nearby soft tissues within the septations and also scattered calcifications. It also showed the extent of the expansion, thinning of the cortices, and preservation of the cortices.

Mandibular condylar dimensions: Correlation between 3D tomography and dried skull measurements

Abstract Objective Compare the anatomical dimensions of mandibular condyles with the same CBCT measurements. Methods Four landmarks were identified on the condyles of dried skulls and are measured with their corresponding areas in CBCT images: Right Width of Condyle (RW), Left Width of Condyle (LW), Right Length of Condyle (RL), and Left Length of Condyle (LL). Results With respect to direct measurements on the dry skulls, statistically significant differences were found between sexes (p < 0.001). When the real values were compared with the CBCT, it was observed that the bias depends on the magnitude of the measurement. It means that there is an underestimation for smaller values and an overestimation for larger values. Conclusion CBCT is reliable imaging modality, but when compared real measures of condyle length are more reliable then width.

Intraoral Pseudo-Onion Bulb Intraneural Proliferations in a Patient with Hemimandibular Hyperplasia: A Case Report and Review of the Literature

This report and review of the literature describes a case of benign intraoral lesions of perineurial origin in a patient with symptomatic hemimandibular hyperplasia causing partial denture soreness. Perineuriomas are a benign peripheral nerve sheath tumor composed of perineurial cells. Intraoral perineuriomas are an extremely rare entity. Two main types of perineuriomas have been described: intraneural and extraneural perineuriomas. A third, similar entity, called an intraneural pseudoperineuriomatous proliferation, has recently been proposed in the literature as a separate and distinctive diagnosis. This report describes the histologic and clinical presentation of intraneural pseudoperineuriomatous proliferations in a patient with hemimandibular hyperplasia.