Zhipeng Sun

Long-term efficacy of botulinum toxin type A for the treatment of habitual dislocation of the temporomandibular joint.

Injection of botulinum toxin type A (BTX-A) into the lateral pterygoid muscles is a recently reported treatment for habitual dislocation of the temporomandibular joint (TMJ). We report five cases of dislocation in elderly patients with neurological or other severe systemic disease, and their successful treatment with one injection of BTX-A into the lateral pterygoid muscles. This is a relatively conservative option. Injection into the muscle is straightforward and can be done in outpatients with few complications. We recommend it as the first choice for patients with habitual dislocation and systemic or neurological diseases, particularly in the elderly.

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.

Intraosseous trigeminal schwannoma of mandible with intracranial extension

OBJECTIVE There have been few previous reports of intraosseous schwannomas within the mandible with extension into the cranium. We report two such cases and discuss the relevant clinical features, radiological manifestations and treatment protocols. METHOD Two case reports of trigeminal schwannoma of the mandible with intracranial extension, including analysis of clinical, radiological and pathological aspects. RESULTS Panoramic radiographs showed both tumours as multilocular radiolucencies. Solid and cystic components were seen on computed tomography and magnetic resonance imaging. The two tumours extended into the cranium through the pterygomandibular space and an obviously expanded foramen ovale. CONCLUSION Trigeminal schwannoma of the mandible can develop to involve intracranial extension. Radiological identification of an expanded foramen ovale may facilitate pre-operative identification.

Multidetector computerized tomographic fistulography in the evaluation of congenital branchial cleft fistulae and sinuses.

OBJECTIVE The aim of this study was to primarily investigate the usefulness of computerized tomographic (CT) fistulography in the diagnosis and management of branchial cleft fistulae and sinuses. STUDY DESIGN Fifteen patients with confirmed branchial fistulae or sinuses who had undergone CT fistulography were included. The diagnoses were confirmed by clinical, radiologic, or histopathologic examinations. The internal openings, distribution, and neighboring relationship of the lesions presented by CT fistulography were analyzed to evaluate the usefulness in comparison with x-ray fistulography. RESULTS Nine patients were diagnosed with first branchial fistulae or sinuses, 2 with second branchial fistulae, and 4 with third or fourth branchial fistulae. The presence and location of the lesions could be seen on x-ray fistulography. The distribution of the lesions, internal openings, and neighboring relationship with parotid gland, carotid sheath, and submandibular gland could be clearly demonstrated on CT cross-sectional or volume-rendering images. CONCLUSIONS CT fistulography could provide valuable information and benefit surgical planning by demonstrating the courses of branchial anomalies in detail.

Tooth abnormalities in congenital infiltrating lipomatosis of the face.

OBJECTIVE The aim of this study was to present a literature review and case series report of tooth abnormalities in congenital infiltrating lipomatosis of the face (CIL-F). METHODS Four typical cases of CIL-F are presented. Tooth abnormalities in CIL-F documented in the English literature are also reviewed. The clinical and radiological features of tooth abnormalities are summarized. RESULTS In total, 21 cases with tooth abnormalities in CIL-F were retrieved for analysis. Accelerated tooth formation and eruption (17 cases), macrodontia (9 cases), and root hypoplasia (8 cases) were observed in CIL-F. CONCLUSION Tooth abnormalities including accelerated tooth formation or eruption, macrodontia, and root hypoplasia are common in CIL-F.

Multiple complex odontoma of the maxilla and the mandible

OBJECTIVE The aim of this study was to present a literature review and case report of multiple odontoma. METHODS A case of multiple odontoma is presented with a review of the English-language literature. The clinical and radiologic features are summarized. RESULTS In total, 12 cases of multiple odontoma were retrieved from the literature for analysis. The multiple odontomas were localized or extensive and involved two to four quadrants of the jaws. The histologic types were compound or complex. CONCLUSION Odontomas can be multiple and involve multiple quadrants of the jaws.

Partial duplication of the mandible, parotid aplasia and facial cleft: a rare developmental disorder

Duplication deformity of the mandible is exceedingly rare. Its occurrence with congenital facial cleft and parotid gland aplasia has been rarely reported as 1 entity. We report such a case with detailed computed tomography (CT) description and provide a review of the literature on mandible duplication.

Congenital salivary fistula of an accessory parotid gland in Goldenhar syndrome.

OBJECTIVES We report two cases of congenital salivary fistula of an accessory parotid gland, and we discuss its occurrence in Goldenhar syndrome. METHODS Two teenagers complained of a congenital cheek fistula with constant salivary discharge. Computed tomography fistulography and sialography were performed. The diagnosis of Goldenhar syndrome was established based on clinical and imaging findings. Previously reported cases are reviewed and the clinical and radiological features summarised. RESULTS In these two patients, a salivary fistula of an accessory parotid gland was demonstrated on computed tomography fistulography, and did not communicate with Stensens duct. Deformity of Stensens duct and hypoplasia of the ipsilateral mandibular ramus were present. Tragal appendices have frequently been reported in such cases. CONCLUSION A congenital cheek salivary fistula of an accessory parotid gland should be considered indicative of Goldenhar syndrome.

Lingual dermoid cyst with congenital discharging sinus: a rare entity

OBJECTIVE There have been few reports of lingual dermoid cysts with a congenital discharging fistula. We report such a case, which mimicked lipoma on computed tomography, and we discuss relevant clinical and radiological features. METHOD We present a case report and a review of the English language literature concerning lingual dermoid cysts either mimicking lipoma or with a congenital discharging sinus. RESULTS A 35-year-old man presented with a lingual mass associated with a congenital fistula in the midline of the tongue dorsum, which discharged abnormal secretions. Computed tomography images showed that the lesion was well defined and contained homogeneous fatty tissue giving computed tomography attenuation values of -120 Hounsfield units. CONCLUSION Lingual dermoid cysts may develop with a midline discharging fistula, and may exhibit radiological similarity to lipomas on computed tomography.

Classification and characteristics of pterygoid process fracture associated with maxillary transverse fracture

OBJECTIVE This study aimed to classify pterygoid process fractures associated with maxillary transverse fractures. STUDY DESIGN Pterygoid process fractures in 100 patients with maxillary transverse fractures were observed 2- and 3-dimensionally using image processing software. Fracture line course and height and sphenoid sinus involvement were recorded. RESULTS Pterygoid process fractures were classified as follows: class I, vertical (simple separation between medial and lateral plates); or class II, transverse (3 subcategories according to location of fracture line: II-1, within pterygoid fossa; II-2, above pterygoid fossa, not extending to sphenoid sinus floor; II-3, above pterygoid fossa, involving sphenoid sinus floor). Class I fracture was observed on 5 sides (2.7%); II-1, on 125 (66.5%); II-2, on 36 (19.1%); and II-3, on 22 (1.7%). CONCLUSIONS Pterygoid process fractures were predominantly near the upper edge of the pterygoid fossa. Pneumatization of the pterygoid process is a risk in fractures involving the sphenoid sinus floor.