Sayde Sokhn

Maxillary nerve block via the greater palatine canal: An old technique revisited.

Background: Maxillary nerve block through the greater palatine canal is rarely adopted by dental practitioners due to lack of experience in the technique at hand which may lead into several complications. Nevertheless, it is an excellent method to achieve profound anesthesia in the maxilla. This review focuses on the anatomy as well as the indications, contraindications, and complications associated with this technique. Materials and Methods: A literature search was performed using the scientific databases (PubMed and Google Scholar) for articles published up to December 2014 in English, using the key words maxillary nerve block via the greater palatine canal. A total of 34 references met the inclusion criteria for this review and were selected.Conclusion Block of the maxillary nerve through the greater palatine canal is a useful technique providing profound anesthesia in the hemi-maxilla, if practiced properly.

Radiolucency in the mandible: a seventeen-year follow-up

CLINICAL PRESENTATION In 2009, a 43-year-old white woman was referred to the Department of Oral and Maxillofacial Imaging at the Lebanese University with an approximately 1 year history of a slowly expanding, painless mass along the left inferior part of the mandible in the premolar region. The patient initially consulted her dentist in 2007, and a panoramic radiograph was acquired at that time (Figure 1). The practitioner told her that there is nothing to worry about, and he scheduled a follow-up appointment. Sixteen months later, the patient went to the dental school for a second opinion. She was referred to our department, where a panoramic radiograph was taken (Figure 2). It showed a well-circumscribed, round, radiolucent area extending from the inferior border of the mandible in the premolar region and overlapping the mandibular canal. Cone beam computed tomography imaging (using i-CAT (Imaging Sciences International, USA) with voxel size 0.3 mm (field of volume 6 cm), tube voltage of 120 kV, current of 23.87 mA, and exposure time of 20 s) demonstrated a 13 11 mm lytic lesion in the left mandibular premolar region. The lesion was situated on the buccal aspect in the inferior third of the mandible. The lesion was irregular in shape, noncorticated, but fairly well demarcated. The alveolar process was interrupted, with the presence of what seemed to be a communication between the buccal and lingual aspect and a bone structure connecting the mesial and distal sides. The mandibular canal was displaced to the lingual side; the lingual cortex was intact (Figure 3). During the clinical examination, the patient complained of mild pain over the swollen area; however, she reported that chewing, swallowing, and speech were normal. On clinical examination, there was a slightly firm swelling in the region, slightly painful on pressure. Skin and the oral mucosa over the swelling were normal; however, the swelling could not be

Analysis of the greater palatine foramen in a Lebanese population using cone-beam computed tomography technology

Objective: The aim of this study was to describe the diameter and the position of the greater palatine foramen (GPF) in relation to adjacent anatomical landmarks in the maxilla in a Lebanese population using cone-beam computed tomography (CBCT) technology. Materials and Methods: CBCT images of 58 Lebanese adult patients were included in this study and a total of 116 GPF were evaluated bilaterally. The diameter of the GPF and its position relative to the maxillary molars, and distances to the midline maxillary suture and to the anterior nasal spine were analyzed. Results: Of all foramina assessed, 41.38% were located opposite to the third molar, 29.31% were distal to it, 27.59% were between the second and the third, and only 1.72% were opposite to the second. The average diameter was 5.633 mm on the right and 5.723 mm on the left, and the average distances to midline maxillary suture and anterior nasal spine were 16.228 mm and 48.294 mm on the right and 14.907 mm and 48.122 mm on the left, respectively. Conclusion: Within the limits of this study, we conclude that in Lebanese patients, the GPF location is variable, very rarely opposite to the second molar, and more closely related to the third, but may present mesial or distal to it in one-fourth of patients.

Assessment of the Nasopalatine Canal: an Anatomical Study

Objective: The aim of this study was to evaluate the anatomy of the nasopalatine canal in a Lebanese population using cone-beam computed tomography (CBCT) technology. Materials and Methods: CBCT images of 63 Lebanese adult patients were included in this study. The length, shape, diameter of the oral opening corresponding to the incisive foramen and inclination in relation to the hard palate of the nasopalatine canal were analyzed. Results: Of all canals assessed, 13 were hourglass-shaped, 23 were cylindrical-shaped, 23 were funnel-shaped and 4 were spindle-shaped. The mean canal length and the incisive foramen anteroposterior diameter were respectively 11.52 mm and 4.91 mm. The average canal inclination related to the hard palate was 17.09 degrees. Conclusion: Within the limits of this study, we conclude that in Lebanese patients, the shape of the nasopalatine canal is variable. No statistical significance was noticed between genders except for the canal length which was found shorter in our female sample.

Radio-anatomical Study of the Greater Palatine Canal and the Pterygopalatine Fossa in a Lebanese Population: A Consideration for Maxillary Nerve Block

Aim: The aim of this study was to describe the morphology of the component, greater palatine canal-pterygopalatine fossa (GPC-PPF), in a Lebanese population using cone-beam computed tomography (CBCT) technology. Materials and Methods: CBCT images of 79 Lebanese adult patients (38 females and 41 males) were included in this study, and a total of 158 cases were evaluated bilaterally. The length and path of the GPCs-PPFs were determined, and the data obtained analyzed statistically. Results: In the sagittal plane, of all the GPCs-PPFs assessed, the average length was 35.02 mm on the right and 35.01 mm on the left. The most common anatomic path consisted in the presence of a curvature resulting in an internal narrowing whose average diameter was 2.4 mm on the right and 2.45 mm on the left. The mean diameter of the upper opening was 5.85 mm on the right and 5.82 mm on the left. As for the lower opening corresponding to the greater palatine foramen, the right and left average diameters were 6.39 mm and 6.42 mm, respectively. Conclusion: Within the limits of this study, we concluded that throughout the Lebanese population, the GPC-PPF path is variable with a predominance of curved one (77.21% [122/158] in both the right and left sides); however, the GPC-PPF length does not significantly vary according to gender and side.

Lingual Foramina and Canals of the Mandible: Anatomic Variations in a Lebanese Population

Objective: The aim of this study was to evaluate the mandibular lingual foramina (LF) and canals and their anatomic variations using cone-beam computed tomography (CBCT) technology in a Lebanese population. Materials and Methods: In this study, we analyzed CBCT images of 90 adult Lebanese patients (41 males and 49 females). We assessed the number and location of the LF. In additional, we measured: (a) The distance from both the alveolar crest and the inferior border of the mandible to the LF and (b) the length of the lingual canals (LCs). The data obtained was analyzed statistically using Shapiro–Wilk normality test, t-test, Chi-square, and Fishers exact tests. Statistical significance was set at 0.05. Results: In our sample, the LF and canals were present in 93.33% of the CBCT analyzed, and the majority (76.64%) was located above the genial tubercles. The distance from the foramen of the superior and the inferior LCs to the alveolar crest was 16.24 ± 2.82 mm and 25.49 ± 2.43 mm, respectively. The distance from the foramen of the superior canal to the inferior border of the mandible was 14 ± 2.32 mm. The mean length of the superior canal was 5.81 ± 1.6 mm and 4.25 ± 1.2 mm for the inferior one. There were no gender-related differences in the anatomic characteristics of the LF and canals except for the distance measured from the superior canal foramina to the alveolar crest where the measurement was significantly greater in males compared to females. Neither the number of canals nor the positions of the foramina were different between males and females. Conclusion: Within the limits of this study, we concluded that in our sample of Lebanese adults, there was substantial variability in the LF and canals anatomy and location.

Use of CBCT in the Detection of Second Mesiobuccal (MB2) Canal in Maxillary First Molar

Multiple procedures are used to detect the presence of second mesiobuccal canal in the mesial root of the upper first molar. In this article, a case will be presented in order to show the use of cone-beam computed tomography (CBCT) in the detection of asecond mesiobuccal (MB2) canal in maxillary first molar, unidentified neither clinically nor with conventional radiographic methods.

Comparison between photostimulable phosphor plates using one or two angulations and cone beam computed tomography scans in detecting root fracture in endodontically treated teeth

Objectives: Artifacts due to the Gutta-percha may result in an incorrect diagnosis when using cone-beam computed tomography (CBCT) only. Compare CBCT scans with photostimulable phosphor (PSP) plates using one angulation and PSP plates using two different angulations in detecting root fractures (RFs) in endodontically treated teeth. Materials and Methods: Sixty-six roots were collected and treated endodontically using gutta-percha. One-half of the roots were randomly selected and fractured. 8 cm × 8 cm fields of view (FOV) were acquired with a CBCT machine. Periapical radiographs (using intra-oral PSP plates) were also acquired using one and two angulations. Results: The area under the receiver operating characteristic curve and sensitivity were significantly greater using CBCT than using one or two PSP plate angulations. There were no significant differences between one or two PSP plate angulations. Conclusion: The accuracy of RF depiction in endodontically treated teeth using 8 cm × 8 cm FOV CBCT was greater than that obtained using one or two PSP plate angulations.