Liu Dg

The ability of cone-beam computerized tomography to detect vertical root fractures in endodontically treated and nonendodontically treated teeth: a report of 3 cases

A definitive diagnosis of vertical root fracture (VRFs) is often a challenging task for clinicians. Two-dimensional periapical radiographs (PRs) may be not helpful in such a diagnosis when the x-ray beam is not parallel to the plane of the fracture line. This report presents a set of 3 cases in which 1 endodontically treated and 2 nonendodontically treated mandibular molars were diagnosed with VRFs based on findings from clinical, radiographic, and cone-beam computerized tomographic (CBCT) examinations. After extraction, VRFs were confirmed in all of the teeth. Deep and narrow periodontal pockets were detected in 2 molars. A widening of the root canal space was observed in the PR of 1 molar only, and crown cracks were detected in none of these cases. However, in all 3 molars, fracture lines were visible on the CBCT images. Thus, CBCT provided useful information in diagnosing VRFs in both endodontically treated and nonendodontically treated teeth, especially when VRFs could not be confirmed by clinical findings and PRs.

Diagnostic accuracy of parotid CT for identifying Sjögren's syndrome

PURPOSE To evaluate the diagnostic accuracy of computed tomography (CT) of the parotid gland for Sjögrens syndrome in comparison with conventional X-ray sialography. METHODS CT scans and X-ray sialography were performed in 34 patients with confirmed Sjögrens syndrome and 22 symptomatic controls without the disease. CT data from 57 asymptomatic controls were included for quantitative analysis. The CT findings of heterogeneity, abnormal diffuse fat tissue deposition, diffuse punctate calcification, swelling or atrophy, nodularity or cystic changes of the parotid gland were analyzed by two independent blinded readers. The correlation between CT and X-ray sialography findings was evaluated. Diagnostic performance and receiver operating characteristics curves were calculated. RESULTS On CT, heterogeneity of the parotid gland was seen in 30/31 (reader 1/reader 2) Sjögrens syndrome patients by the two readers (sensitivity 88.2%/91.2%; specificity 100%/90.9%). Abnormal diffuse fat tissue deposition was seen in 28/28 SS patients by the readers (sensitivity 82.3%/82.3%; specificity 100%/90.9%). Diffuse punctate calcification was seen in 10/12 Sjögrens syndrome patients (sensitivity 29.4%/35.2%; specificity 100%/100%). Stagings of CT findings correlate positively with sialography. The areas under the receiver operating characteristics curves were 0.887 (P=0.000) and 0.908 (P=0.000) for the maximum and standard deviation (SD) of the CT value. CONCLUSIONS Parotid CT is accurate and reliable in the diagnosis of Sjögrens syndrome. Heterogeneity, abnormal diffuse fat tissue deposition, and diffuse punctate calcification are specific for Sjögrens syndrome. CT attenuation analysis is helpful in diagnosis.

Diagnosis and management of sialolithiasis with a semirigid endoscope.

OBJECTIVE The aim was to evaluate a semirigid endoscopic technique for diagnosis and management of sialolithiasis. STUDY DESIGN Diagnostic and interventional sialendoscopic procedures were performed in 90 patients with sialoliths (78 submandibular glands and 12 parotid glands). RESULTS Owing to its extreme flexibility and rigidity, the endoscope can be introduced easily into the ductal system. Sialoliths with a round or irregular shape were detected by endoscopy in all cases, including 84 radiopaque and 6 radiolucent stone cases. Of the 78 cases with sialoliths in the submandibular (Whartons) duct, 14 were present in the hilum of the main duct, 34 in the premolar region of the duct, 24 in the molar region of the duct, and 6 in both the premolar and the molar regions of the duct. Among these cases, we could remove the stones intraductally in 44 cases by endoscopy alone. Additionally, 6 cases were treated with basket retrieval and endoscopic-assisted surgery, and the remaining 27 were treated with endoscopic-assisted surgery. Of the 12 cases of sialoliths in the parotid (Stensens) duct, 9 were treated with basket retrieval and 1 with basket-capturing and open surgery via a buccal incision. In total, 87 of 90 cases were successfully treated, with (n = 34) or without (n = 53) endoscopic-assisted surgery. These patients were stone free at their last follow-up (3 to 30 months). CONCLUSIONS The semirigid endoscope permits a better visualization of sialoliths and coexisting obstructive pathologies. With minimally invasive procedures, most stones in the main duct of the salivary gland can be removed using either an intraductal or an extraductal approach.

Tooth lengths of the permanent upper incisors in patients with cleft lip and palate determined with cone beam computed tomography.

Objective To measure the tooth lengths of fully developed permanent upper incisors and to qualitatively evaluate the root shapes of the incisors in patients with cleft lip and palate (CLP). Design Cross-sectional, noninterventional, case-control imaging study. Setting Hospital and Stomatology Unit of Peking University, Beijing, China (institutional tertiary care). Participants Sixty consecutive nonsyndromic CLP patients (including 40 unilateral [UCLP] and 20 bilateral [BCLP]), and 53 age- and sex-matched controls were selected for this study. Main Outcome Measure Crown heights and root lengths of permanent upper incisors were measured from cone beam computed tomography scans, and the root shapes of upper incisors were evaluated. Results Compared with controls, the crown heights of upper incisors in CLP patients were reduced by 9.7% to 22.5% (p < .05), and the root lengths were reduced by 15.8% to 31.7% (p < .05). BCLP patients had greater reductions than the UCLP cases (p < .05). There were no significant differences between incisors and their antimeres in controls and BCLP patients. However, measurements on the cleft side in UCLP patients were lower than those of the noncleft side (p < .05). The prevalence of atypical root shape was higher in CLP than in the control group (p = .002); of these, 83.3% (30/36) occurred in central incisors near the cleft. Conclusion The permanent upper incisors in nonsyndromic CLP patients are underdeveloped. Incisor developmental deficiency was greater in teeth adjacent to the cleft.

Intraosseous Embolotherapy of Central Arteriovenous Malformations in the Jaw: Long-Term Experience With 8 Cases

PURPOSE To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw. MATERIALS AND METHODS Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraosseous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression. RESULTS Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications. CONCLUSIONS Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.

Obstructive sialadenitis of a transplanted submandibular gland: chronic inflammation secondary to ductal obstruction

Aims To determine the pathological basis and clinical features of obstructive sialadenitis in transplanted submandibular glands (SMGs). Methods A total of 161 patients (174 eyes) with keratoconjunctivitis sicca underwent microvascular SMG transplantation. Patients were followed up at approximately 1 and 4 months and annually thereafter. Clinical data, including dry eye discomfort, symptoms of ductal obstruction, and Schirmer test, were recorded. Sialography was performed in six patients. In addition, SMG autotransplantation was performed in 22 rabbits. Salivary flow was recorded and the morphology of glands was examined at 6 months postoperatively by light microscopy. Results Among the patients, 16 out of 172 glands during the latent period (0–3 months) and 2 out of 154 glands with long-term follow-up (>1 year) showed obstructive sialadenitis. Typical manifestations were continuous small volumes of viscous secretions, recurrent gland swelling, decreased Schirmer test values, and irregular dilation of the main duct on sialography. The transplanted SMGs eventually showed no secretion in five cases. Of the 22 rabbit SMGs, 4 had obstructive sialadenitis. Morphological examination showed chronic inflammatory infiltration with salivary deposits. Conclusions Obstructive sialadenitis of transplanted SMGs is a chronic inflammation secondary to ductal obstruction, which leads to insufficient ocular lubrication and potential treatment failure.

Sialoendoscopy-Assisted Sialolithectomy for Submandibular Hilar Calculi

PURPOSE To assess the clinical effects of endoscopy-assisted sialolithectomy for submandibular hilar calculi. MATERIALS AND METHODS The present study was undertaken in 70 patients with symptomatic stones in the hilum of submandibular glands who underwent endoscopy-assisted sialolithectomy from December 2005 through March 2011 in the Peking University School and Hospital of Stomatology. The operative data were analyzed retrospectively. All patients were followed periodically postoperatively. Submandibular gland function was investigated by postoperative symptoms, clinical examinations, sialography, and scintigraphy. RESULTS Submandibular stones were successfully removed in 65 patients, with a success rate of 92.9%. Temporary lingual nerve injury occurred in 1 patient. Two patients developed ranulae and underwent an uneventful sublingual gland excision. During a mean follow-up of 23 months (range, 6 to 55 mo), 52 of 65 patients were symptom free, whereas 11 patients complained of occasional swelling of the affected gland at mealtimes and 2 patients developed a recurrent stone. Thirty patients underwent postoperative sialography. The sialographic appearances included 4 types: 1) approximately normal; 2) the main duct was significantly dilated at the hilum, but no persistent contrast was seen on the functional film; 3) the main duct was significantly dilated in the hilar region, and persistent contrast was seen at the dilated hilum of the functional film; 4) the main duct was dilated or strictured, and persistent contrast was seen on the functional film. Three of the 4 patients who underwent scintigraphy exhibited good function. CONCLUSIONS Sialoendoscopy-assisted sialolithectomy is a safe and effective gland-preservation technique for patients with hilar stones of the Whartons duct.