Jaqueline S. Venturin

Applications of cone-beam computed tomography in fractures of the maxillofacial complex

Imaging plays an essential role in the evaluation of maxillofacial fractures both pre- and postoperatively. Several studies support the use of conventional two-dimensional imaging for traumas involving mainly the mandible, but for more complex situations advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging have higher indication. Nowadays, besides CT, cone-beam computed tomography (CBCT) has appeared as a reasonable and reliable alternative considering radiation dosage, image quality and comfort for the patient. The purpose of this study was to review the fracture patterns involving the maxillofacial complex, provide a technical and practical comparison between CT and CBCT, and finally present the potential applications of CBCT illustrated with clinical examples.

Imaging Modalities to Access Bony Tumors and Hyperplasic Reactions of the Temporomandibular Joint

Benign and malignant tumors in the temporomandibular joint (TMJ) are rare. However, when a patient presents with clinical findings such as altered occlusion or facial asymmetry, a morphologic alteration in the condyle should be ruled out. The differential diagnosis for benign hyperplastic bony lesions in the TMJ should include condylar hyperplasia, osteochondroma, osteoma, chondroma, and osteoblastoma. If malignant features are present, chondrosarcoma and osteosarcoma should be considered. For the differential diagnosis, imaging is the most noninvasive method to evaluate the integrity of the TMJ. Imaging can be classified as morphologic or functional according to the information provided. The current scientific data have shown that panoramic images have 97% sensitivity and 45% specificity for identifying hyperplastic conditions in the TMJ. The sensitivity and specificity of medical computed tomography (CT) and cone-beam CT is 70% and 100%, and 80% and 100%, respectively, for the detection of bony abnormalities. To differentiate benign and malignant bony tumors, magnetic resonance imaging has a sensitivity and specificity of 44% and 95%, respectively. The corresponding percentages for single positron emission CT are 91% and 94%, for single positron emission CT/CT are 100% and 100%, for positron emission tomography are 88% and 72%, and for positron emission tomography/CT are 100% and 97%. The combination of morphologic and functional (single positron emission CT and positron emission tomography) modalities appears to improve the sensitivity and specificity to assess a hyperplastic condyle, facilitating treatment planning and providing a better prognosis for the patient.

Temporomandibular Joint Condylar Abnormality: Evaluation, Treatment Planning, and Surgical Approach

The cartilage of the mandibular condyle is locatedbeneath the fibrous articular layer and undergoes atro-phic changes, assuming endochondral bone growthor adaptive growth, according to the absence or pres-ence of functional demand. Normal condylar growthfollows a sequence of transitory stages that are de-fined by molecules synthesized by undifferentiatedmesenchymal cells and differentiating chondrocytes.

Evaluation of interproximal caries using the IPad 2 and a liquid crystal display monitor.

OBJECTIVE The objective of this study was to compare the detection of interproximal caries in digital intraoral images presented in a 24-inch liquid crystal display (LCD) monitor and the IPad 2. STUDY DESIGN Twenty-seven digital bitewing radiographs of 102 adult teeth were generated by a charge-coupled device sensor and presented to 4 dentists in 2 sessions. The dentists were asked to rate the presence or absence of carious lesions using a 5-point scale. Differences in sensitivity, specificity, and accuracy were weighted using the Wilcoxon test, and the z test for the receiver operating characteristic curves. RESULTS For the IPad 2 and LCD monitor, A(z) values were 0.87 and 0.86, respectively. For the tablet, the mean values of sensitivity, specificity, and accuracy were 0.75, 0.86, and 0.83, respectively. For the LCD monitor, these values were 0.77, 0.82, and 0.80, respectively.

Application of advanced imaging modalities for the diagnosis of metastatic adenocarcinoma of the lungs in the temporomandibular joint

Several pathologies, including malignant diseases, may mimic temporomandibular disorders (TMD). Correct diagnosis is important to avoid treatment delay. Several new imaging diagnostic modalities are available and should be used accordingly. This is a case report of a 71-year-old woman with functional limitation and painful symptoms in the preauricular region. She was initially diagnosed and treated as TMD, however with no improvement of the symptoms. Advanced imaging studies were requested. Computerized tomography and magnetic resonance imaging findings were consistent with soft tissue tumor with nonhomogeneous content in the left temporomandibular joint region. Positron emission tomography showed significant radiotracer uptake in the site of the lesion as well as in the lungs, lumbar spine, and bladder, suggesting tumoral metastases. This report emphasizes the importance of imaging in the assessment and establishment of accurate differential diagnosis. Thorough knowledge of the available modalities and their indications is essential to avoid delay in treatment and improve outcomes.

Comparison between intraoral indirect and conventional film-based imaging for the detection of dental root fractures: an ex vivo study.

Digital intraoral radiographic systems have been rapidly replacing conventional dental X-ray films for diagnosis of dental diseases. Current scientific literature supports the use of these digital systems for the detection of dental caries, periodontal bone loss, and periapical pathologies. However, relatively few studies have been published addressing the detection of dental root fractures. The purpose of this study was to compare the intraoral F-speed film (Insight) with two photostimulable phosphor (PSP) indirect digital systems (ScanX and Digora Optime) for the detection of simulated dental root fractures. Ten raters evaluated images acquired from 10 dry human cadaver mandibles under optimal viewing conditions. These data were analyzed by a 5-point receiver operating characteristic curve analysis for statistical differences. Sensitivity and specificity of these systems were also assessed. Since statistically significant difference between the systems was not observed, the results of this study agreeably support indirect digital PSP plates as an alternative to the evaluated conventional film for the detection of dental root fractures.