Werner H. Shintaku

Correlation between retroglossal airway size and body mass index in OSA and non-OSA patients using cone beam CT imaging

Most obstructive sleep apnea (OSA) patients are overweight, and OSA is substantially more common in obese individuals. In morbidly obese patients, at least 70% suffer from OSA. However, the exact mechanism by which obesity causes OSA is unclear. The aim of this study is to evaluate the retroglossal airway configuration quantitatively and to make clear the relationship between Body mass index (BMI) and airway configuration. This retrospective study included 15 OSA patients (maleu2009=u200911; femaleu2009=u20094) and 14 normal controls (maleu2009=u20098; femaleu2009=u20096). We studied the airway configuration on an axial slice at the level of the anterior–inferior corner of the second cervical vertebra. Maximum anterior–posterior diameter (AP) and lateral width (LW) of the airway were measured, and the square area (SA) was calculated. The airway cross-section area (AWA) was also measured, and then the AWA/SA ratio was calculated. AP, LW, and AWA were not statistically significantly different between controls and OSA patients. On the other hand, the AWA/SA ratio in OSA patients was 8.8% statistically significantly smaller than in controls after adjusting for sex, age, and BMI. In this sample, there was a negative correlation between age and the AWA/SA ratio but only in the OSA group. The AWA/SA ratio was significantly negatively correlated with OSA status (Ru2009=u2009−0.5; pu2009=u20090.008) after adjusting for BMI and age. In this present study, we could evaluate the retroglossal airway configuration quantitatively. The AWA/SA ratio was correlated with OSA status after adjusting for BMI and age.

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.

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.

Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates

BACKGROUNDnThe purpose of this study was to evaluate whether intravenous (IV) bisphosphonate (BP) therapy can change the radiographic patterns of multiple myeloma (MM) in the jawbones.nnnMETHODSnThe authors evaluated panoramic radiographs obtained from 188 patients with MM for the presence of solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, lamina dura abnormalities, nonhealing alveolar sockets, and bone sequestration. The authors compared results obtained from patients treated with IV BPs with those obtained from patients who had never been exposed to BPs.nnnRESULTSnMultiple osteolytic lesions (Pxa0= .001), diffuse osteoporosis (Pxa0= .001), and diffuse sclerosis (Pxa0= .0036) occurred more often in the mandible in both groups. Solitary osteolytic lesions occurred less frequently in the BP group (Pxa0= .0078). Lamina dura abnormalities (Pxa0= .0006) and nonhealing alveolar sockets (Pxa0= .0021) were associated with BP treatment.nnnCONCLUSIONSnIV BP therapy changes the radiographic patterns of MM in the jawbones.nnnPRACTICAL IMPLICATIONSnThe effect of BPs in the maxillofacial area is a matter of concern for health practitioners because this type of medication causes several alterations of the jawbones in patients with cancer.

Panoramic and skull imaging may aid in the identification of multiple myeloma lesions

Background The purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients. Material and Methods One hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques. Results MM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately. Conclusions All investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions. Key words:Multiple myeloma, osteolytic lesions, panoramic radiography.