Mel Mupparapu

Radiologic Assessment of the Periodontal Patient

Periodontal examination involves evaluation of soft and hard tissue parameters to gauge gingival inflammatory changes and quantify attachment loss. Conventional radiographs are vital components of this process and can be used to assess the presence of calculus and other local factors to establish a diagnosis, prognosis, and periodontal treatment plan. The 2-dimensional nature of these images limits their utility. The advent of high-resolution cone beam computed tomography (CBCT) offers 3-dimensional images that might overcome these limitations. We discuss the use of conventional radiographic techniques as well as CBCT for evaluating, diagnosing, and treatment planning patients presenting for periodontal and/or implant therapy.

Fossa navicularis magna detection on cone-beam computed tomography

Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed.

Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature

The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patients history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.

Developmental salivary gland depression in the ascending mandibular ramus: A cone-beam computed tomography study

A static, unilateral, and focal bone depression located lingually within the ascending ramus, identical to the Stafnes bone cavity of the angle of the mandible, is being reported. During development of the mandible, submandibular gland inclusion may lead to the formation of a lingual concavity, which could contain fatty tissue, blood vessels, or soft tissue. However, similar occurrences in the ascending ramus at the level of the parotid gland are extremely rare. Similar cases were previously reported in dry, excavated mandibles, and 3 cases were reported in living patients. A 52-year-old African American male patient was seen for pain in the mandibular teeth. Panoramic radiography showed an unusual concavity within the left ascending ramus. Cone-beam computed tomography confirmed this incidental finding. The patient was cleared for the extraction of non-restorable teeth and scheduled for annual follow-up.

Investigation of dental cone-beam CT pixel data and a modified method for conversion to Hounsfield unit (HU)

OBJECTIVES To investigate the relationship in dental cone-beam CT (CBCT) between the manufacturer-reported image pixel data and a modified conversion to CT number densities in Hounsfield unit (HU). METHODS A standardized CT phantom was imaged using typical clinical parameters on CBCT from three manufacturers (Carestream 9300®, Carestream Health, Rochester, NY; J Morita 3D Accutomo®, J. Morita Mfg. Corp., Kyoto, Japan; and Planmeca Promax 3D®, Planmeca Helsinki, OY, Finland). Reconstructed axial slices were evaluated using regions of interest to ascertain the mean pixel value in five materials in the phantom. The Digital Imaging and Communications in Medicine data were also evaluated to determine if raw pixel data had been adjusted during the image reconstruction. A modified version of the existing manual HU conversion technique was applied, and the resultant slope and y-intercept were used to scale the pixel values ultimately to HU for all images. RESULTS The DICOM header data show that a modified rescale y-intercept was applied to both the Carestream and Planmeca image data yielding manufacturer-produced results in HU. The Morita pixel data were unmodified and report in shades of grey or grey values (GV). The Carestream manufacturer-derived HU measurements showed good correlation in air (-1000 HU), but all other materials ranged from 2.6 to 13.5 σ from the specified phantom value. Results in the modified conversion technique images fell within 1.0-2.4 σ from the specified phantom values. CONCLUSIONS While more studies are needed to test for regularity, this study suggests that our modified technique could be a means of getting more accurate quantitative data from dental CBCTs.

Evaluation of canalis basilaris medianus using cone-beam computed tomography

The aim of this report is to present two cases of canalis basilaris medianus as identified on cone-beam computed tomography (CBCT) in the base of the skull. The CBCT data sets were sent for radiographic consultation. In both cases, multi-planar views revealed an osseous defect in the base of the skull in the clivus region, the sagittal view showed a unilateral, well-defined, non-corticated, track-like low-attenuation osseous defect in the clivus. The appearance of the defect was highly reminiscent of a fracture of the clivus. The borders of osseous defect were smooth, and no other radiographic signs suggestive of osteolytic destructive processes were noted. Based on the overall radiographic examination, a radiographic impression of canalis basilaris medianus was made. Canalis basilaris medianus is a rare anatomical variant and is generally observed on the clivus. Due to its potential association with meningitis, it should be recognized and reported to avoid potential complications.

Incidental Finding of an Extensive Oropharyngeal Mass in Magnetic Resonance Imaging of a Patient With Temporomandibular Disorder: A Case Report

In this report, we describe the incidental finding of an oropharyngeal mass in a patient who presented with a chief complaint of temporomandibular pain. The patient was initially evaluated by an otorhinolaryngologist for complaints of headaches, earache, and sinus congestion. Due to worsening headaches and trismus, he was further referred for the management of temporomandibular disorder. The clinical evaluation was uneventful except for limited mouth opening (trismus). An advanced radiological evaluation using magnetic resonance imaging revealed a mass in the nasopharyngeal/oropharyngeal region. The mass occupied the masticatory space and extended superioinferiorly from the skull base to the mandible. A diagnostic biopsy of the lesion revealed a long-standing human papilloma virus (HPV-16)-positive squamous cell carcinoma of the oropharynx. This case illustrates the need for the timely radiological evaluation of seemingly innocuous orofacial pain.

Systemic Diseases and Conditions Affecting Jaws

This article discusses the radiographic manifestation of jaw lesions whose etiology may be traced to underlying systemic disease. Some changes may be related to hematologic or metabolic disorders. A group of bone changes may be associated with disorders of the endocrine system. It is imperative for the clinician to compare the constantly changing and dynamic maxillofacial skeleton to the observed radiographic pathology as revealed on intraoral and extraoral imagery.

Advanced maxillofacial imaging for temporomandibular disorder in special needs patients: ADVANCED MAXILLOFACIAL IMAGING

Temporomandibular disorder (TMD) is prevalent in special needs patients. Clinical examination of the temporomandibular joint (TMJ) complex and imaging in this patient population can be challenging due to patient disposition and cooperation. We report a case of a 29-year-old male with neurologic and behavioral special needs who required advanced maxillofacial imaging for a suspected TMD under general anesthesia, which has not been reported previously. This article intends to serve as a resource for health care providers who may encounter similar clinical situations.

Oral and Maxillofacial Anatomy

This article deals with identification and descriptions of intraoral and extraoral anatomy of the dental and maxillofacial structures. The anatomic landmarks are highlighted and described based on their radiographic appearance and their clinical significance is provided. Cone beam CT-based images are described in detail using the multiplanar reconstructions. The skull views are depicted via line diagrams in addition to their normal radiographic appearance to make identification of anatomic structures easier for clinicians. The authors cover most of the anatomic structures commonly noted via radiographs and their descriptions. This article serves as a clinicians guide to oral and maxillofacial radiographic anatomy.