A comparison of imaging techniques with surgical experience in orbital injuries: A prospective study

The aim of the study is to compare the effectiveness of computerised tomography (CT) and magnetic resonance (MR) imaging in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. 15 consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with CT and MR. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. CT and MR were equally accurate in demonstrating or excluding orbital wall fractures but both modalities slightly underestimated their incidence. CT and MR underestimated the actual incidence of soft tissue herniation and entrapment when compared with the surgical findings but the extent of soft tissue herniation and entrapment were demonstrated more clearly by MR than by CT scanning. MR imaging when available should therefore be used as the initial imaging modality and CT held in reserve for confirmation as positioning in the MR unit is easier and more comfortable for recently injured patients who may well have other injuries.     

Simple bone cyst in the mandible--a rare occurrence in an elderly patient

Simple bone cyst (SBC) is an intra-osseous pseudocystic lesion lined by a thin fibrovascular membrane but lacks an epithelial lining. SBC is uncommon and comprises of approximately 1% of all jaw cysts. The lesion is usually discovered incidentally during the first two decades of life. Males are affected slightly more frequently than females. The most common sites of occurrence are the molar and premolar regions of the mandible; maxillary lesions are uncommon. The lesion is usually solitary, radiolucent, well demarcated, and non-expansile. Margins may be scalloped, between vital teeth, and root resorption is rare. A surgical approach to the lesion reveals an empty cavity with serosanguinous fluid. Histologically, the cavity lining consists of a loose connective tissue layer and hemosiderin-laden macrophages. Pathogenesis and etiology of SBC are still not clearly understood. It is assumed that the cyst forms following traumatic intra-osseous hemorrhage with subsequent lysis and resorption of the cellular content. Trauma, as the main cause of SBC, is not always conclusive and the origin of the lesion may be multifactorial. Treatment of SBC is by curettage. Intralesional hemorrhage due to either intentional curettage or during exploratory procedure may induce a reparative process. A rare occurrence of SBC in a 71 year old healthy male, referred to the Oral and Maxillofacial Outpatient Clinic, Sheba Medical Center by his dentist, because of a large radiolucent lesion in the left mandibular body is reported. The patient received a complete lower denture 3 months earlier. He returned to his dentist with a complaint of local pain and an ulcer under the denture. A panoramic radiograph revealed a large unilocular radiolucent lesion with demarcated borders in the left mandibular body and bone erosion in the upper alveolar border of the lesion Clinical examination showed a deep ulcer in the denture-bearing area of the left posterior alveolar ridge. There was no cortical expansion of the mandible. Incisinal biopsy revealed an empty cavity lined by fibrous connective tissue with no epithelial lining. According to the clinico-radiologic and histologic findings, a diagnosis of a simple bone cyst was made. The incidence of SBC is higher in younger age groups (second decade). Occurrence of the lesion in the elderly is rare with only a few reports in the literature. In the present case, the fact that SBC is asymptomatic, may be responsible for the late discovery of the lesion.     

基于micro-CT的下颌牙龈癌颌骨侵犯的影像学评估及分析

目的： 对下颌牙龈癌颌骨侵犯进行影像学评估及分析,为进一步优化手术方案及术后治疗提供影像学依据。方法： 选择60例下颌牙龈癌手术患者,分析术前曲面体层片、平扫和增强CT,并对其中符合条件的30例手术标本进行micro-CT三维重建,分析骨密度、骨小梁厚度、骨小梁分离度等相关参数。采用SPSS 22.0软件包对数据进行统计学分析。结果： 常规影像学检查,曲面体层片、平扫及增强CT均有不足,micro-CT三维重建可以准确区分骨松质及骨皮质,评估下颌骨侵犯的范围及程度,相应的数据参数分析癌边缘及癌中心与正常下颌骨组织的皮质骨骨密度显著降低（P<0.05）,骨小梁厚度显著变薄（P<0.05）,松质骨骨密度显著降低（P<0.05）。癌中心与正常下颌骨组织骨小梁分离度增加（P<0.05）。结论： 目前对于下颌牙龈癌的手术方案还存在争议,进一步提高CT检查精度,可能会为制定下颌牙龈癌手术方案提供更精确的指导。     

Modern imaging of the masseter muscle: normal anatomy and pathosis on CT and MRI

Tremendous advances in diagnostic imaging technology have produced computed tomography (CT) and magnetic resonance (MR) imaging--new ways to depict the normal anatomy and pathosis of the masseter muscle. This article reviews the masseter muscle's normal appearance on CT and MR images and demonstrates the clarity with which CT, in particular, is able to depict soft tissue lesions and neighboring bony involvement. Analysis of the strengths, weaknesses, and availability of these new techniques leads to the conclusion that CT is currently the test of choice for imaging masseteric lesions but that MR shows greater promise for the future.     

Simple bone cyst: A discrepancy between magnetic resonance imaging and surgical observations

OBJECTIVE: The purpose of this study was to compare magnetic resonance (MR) imaging and surgical observations of fluid in simple bone cysts. STUDY DESIGN: Findings during MR imaging of 7 simple bone cysts were compared with surgical observations 1 day or 1.8 months (mean) after MR imaging. RESULTS: All MR images showed cavities filled with fluid. In 2 patients operated on the day after the imaging, surgical observations were in accordance with the MR findings. At surgery 1.8 months after the MR examination, 4 cavities were found to be empty and 1 cavity contained only a minor amount of fluid. CONCLUSION: A discrepancy between MR imaging and surgical observations of fluid in simple bone cyst cavities was observed that might be dependent on the time between the observations, indicating that a fairly rapid absorption of fluid might occur or that the amount of fluid in a simple bone cyst can vary for unknown reasons.     

Giant salivary gland calculi: diagnostic imaging and surgical management

OBJECTIVE: Giant salivary gland calculi (GSGC; >15 mm) are considered rare. Only 14 well-documented cases have been reported in the literature since 1942. The purpose of this study was to evaluate the imaging modality and treatment outcome of patients with GSGC. STUDY DESIGN: Six personally observed subjects with GSGC were evaluated and treated. Occlusal film, panoramic radiograph, axial computed tomographic (CT) scan, and scintigraphy were used for imaging. Stone location, shape, and size were estimated on occlusal film, panoramic radiograph, and CT scans. Stones were removed with transoral sialolithotomy, and size was measured directly on the surgical specimen. Treatment outcome was evaluated with scintigraphy 2 months after surgery. RESULTS: The mean age of the patients (all male) was 48 years (range, 25 to 61 years). Five subjects had stone in the submandibular gland, and 1 in the parotid gland. The mean stone size was 30 x 15.8 mm, as measured directly on the surgical specimen. The preoperative estimation of the stone size with occlusal film was limited to those located in the anterior portion of the duct. Panoramic radiograph was precise and comparable with the estimation with CT scan for all stones. In 5 of the 6 subjects, a nearly normal function of the glands was seen 2 months after surgery. CONCLUSION: GSGC of the submandibular or parotid glands is a disease that affects the middle-aged male patient. An occlusal film is a suitable imaging modality for stones, but estimation of size is limited to stones in the anterior duct portion. Panoramic radiograph and CT scan were comparable in precise preoperative estimation of stone size, regardless of stone location. Removal of the GSGC with the minimally invasive method, via the transoral sialolithotomy, is the treatment of choice, with reasonable results.     

Validation of new soft tissue software in orthognathic surgery planning

This study tests computer imaging software (SurgiCase-CMF^®, Materialise) that enables surgeons to perform virtual orthognathic surgical planning using a three dimensional (3D) utility that previews the final shape of hard and soft tissues. It includes a soft tissue simulation module that has created images of soft tissues altered through bimaxillary orthognathic surgery to correct facial deformities. Cephalometric radiographs and CT scans were taken of each patient before and after surgery. The surgical planning system consists of four stages: CT data reconstruction; 3D model generation of facial hard and soft tissue; different virtual surgical planning and simulation modes; and various preoperative previews of the soft tissues. Surgical planning and simulation is based on a 3D CT reconstructed bone model and soft tissue image generation is based on physical algorithms. The software rapidly follows clinical options to generate a series of simulations and soft tissue models; to avoid TMJ functional problems, pre-surgical plans were evaluated by an orthodontist. Comparing simulation results with postoperative CT data, the reliability of the soft tissues preview was >91%. SurgiCase^® software can provide a realistic, accurate forecast of the patient's facial appearance after surgery.     

Magnetic resonance in lesions of the parotid gland

In a prospective study the relevance of magnetic resonance (MR) for the diagnoses of tumors of the parotid gland has been evaluated. Due to the excellent soft tissue contrast and also the possibility of imaging in various planes and sections and to the high resolution achieved by surface coils, it was possible to visualize the lesions and the surrounding anatomy in great detail. MR combines the advantages of ultrasound and computed tomography and is indicated if a tumor cannot be defined sharply by using ultrasound or CT.     

Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review

The three important tissue groups in orthognathic surgery (facial soft tissues, facial skeleton and dentition) can be referred to as a triad. This triad plays a decisive role in planning orthognathic surgery. Technological developments have led to the development of different three-dimensional (3D) technologies such as multiplanar CT and MRI scanning, 3D photography modalities and surface scanning. An objective method to predict surgical and orthodontic outcome should be established based on the integration of structural (soft tissue envelope, facial skeleton and dentition) and photographic 3D images. None of the craniofacial imaging techniques can capture the complete triad with optimal quality. This can only be achieved by ‘image fusion’ of different imaging techniques to create a 3D virtual head that can display all triad elements. A systematic search of current literature on image fusion in the craniofacial area was performed. 15 articles were found describing 3D digital image fusion models of two or more different imaging techniques for orthodontics and orthognathic surgery. From these articles it is concluded, that image fusion and especially the 3D virtual head are accurate and realistic tools for documentation, analysis, treatment planning and long term follow up. This may provide an accurate and realistic prediction model.     

Ameloblastic carcinoma of the mandible resembling odontogenic cyst in a panoramic radiograph

Ameloblastic carcinoma is a rare odontogenic tumor exhibiting histologic evidence of malignancy in the primary or recurrent tumor, regardless of whether it has metastasized or not. Most ameloblastic carcinomas are presumed to have arisen de novo, with few cases of malignant transformation of ameloblastoma being apparent. A case is reported of a 21-year-old caucasian female with ameloblastic carcinoma in the left angulus area of the mandible resembling an odontogenic cyst in the panoramic radiograph. In addition to the panoramic radiograph, computerized tomography (CT) and magnetic resonance (MR) images were taken preoperatively. This report demonstrates that CT or MR examinations may be crucial in differentiating odontogenic tumors from cysts.     

Anterior Stafne's Bone Cavity Mimicking a Periapical Lesion of Endodontic Origin: Report of Two Cases

IntroductionThis report of 2 cases describes the diagnostic procedures used to identify 2 Stafne's bone cavities (SBC) found in unusually anterior locations in the mandible, both mimicking periapical lesions of endodontic origin.MethodsIn the first patient, a 47-year-old man, an SBC was diagnosed in the area of teeth #27, 28, and 29. In the second patient, a 62-year-old man, the SBC was a fortuitous finding, because this patient was referred for dental implant therapy.ResultsIn both cases, the final diagnosis was achieved by using limited cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI). In both patients, the lingual bone cavity was found to be occupied by accessory salivary gland tissue.ConclusionsThe combination of CBCT and MRI as noninvasive diagnostic techniques seems ideal to avoid surgical explorations, incisional biopsies, or enucleations of the lesion for diagnostic purposes.     

Comprehensive treatment of arteriovenous malformations in the oral and maxillofacial region.

PURPOSE: Arteriovenous malformations (AVMs) in the oral and maxillofacial region are rare but potentially life-threatening vascular lesions. We report our experience in treating these lesions in the oral and maxillofacial region. PATIENTS AND METHODS: Superselective intra-arterial embolization (SIAE), sclerotherapy, bone wax packing of bone cavity and curettage, radiotherapy, and surgical resection were used alone or in combination in 28 patients with AVMs in the oral and maxillofacial region. Among them there are 13 cases involving the soft tissue, 11 cases involving bone, and 4 cases involving both the soft tissue and bone. RESULTS: Follow-up ranged from 3 to 60 months (median, 22 months) after comprehensive treatment. The rates of improvement and cure were 89.3% and 60.7%, respectively. Sclerotherapy in 6 cases of AVMs was ineffective. The rates of improvement and cure in AVMs involving soft tissue treated by surgical resection were 23.1% and 84.6%, respectively. The rates of cure for AVMs involving the jaws treated by SIAE, bone wax packing, curettage, and partial bone resection alone or in combination was 100%. CONCLUSION: Three cases of AVMs involving both soft tissue and bone treated with SIAE and radiotherapy as well as surgical resection were cured. SIAE was an adjunctive treatment for the AVMs of soft tissue and jaws and for controlling bleeding. Surgical resection was an important treatment modality for AVMs. Bone wax packing of bone cavity and curettage was a simple, safe, and effective method for the treatment of AVMs of the jaws. Radiotherapy and sclerotherapy may not be effective methods for AVMs involving the soft tissue.     

Imaging characteristics of a Stafne bone cavity—panoramic radiography,computed tomography and magnetic resonance imaging

Introduction

A rare case of Stafne bone cavity (SBC) with salivary gland herniation confirmed by magnetic resonance imaging (MRI) is described.

Results

It was diagnosed in a 72-year-old male patient. Surgical intervention was avoided. The report highlights imaging findings of panoramic radiography, computed tomography, and especially magnetic resonance tomography.

Conclusion

It is demonstrated that employment of MRI for further evaluation of suspicion of SBC on panoramic radiographs can be a helpful diagnostic tool.     

Synovial chondromatosis of the temporomandibular joint

Synovial chondromatosis is an uncommon monoarticular proliferative disease of the synovium characterized by loose bodies developed in the synovial membrane. The literature is reviewed and two cases of synovial chondromatosis of the temporomandibular joint characterized by swelling, pain and limitation of mandibular movement are reported. Radiographic evidence of loose bodies may or may not be present. Computed tomography (CT) or magnetic resonance (MR) might be helpful in the diagnosis of synovial chondromatosis. The treatment of choice of synovial chondromatosis is surgical and the loose bodies should be removed by arthrotomy with examination of the joint cavity. In our patients, no recurrence had occurred according to other authors' experience.     

成人骨性Ⅲ类错牙合患者软组织侧貌形态Holdaway分析

［摘要］ 目的 研究成人骨性Ⅲ类错牙合畸形患者的软组织侧貌形态。方法 选取53例（女32例,男21例）成人骨性Ⅲ类患者及53例成人骨性Ⅰ类患者治疗前的CBCT数据,利用Dolphin imaging 11.0软件重建头颅侧位片,采用Holdaway软组织测量方法进行头影测量分析,测量结果按不同性别及不同矢状向骨面型进行比较,用SPSS 20.0软件进行单因素方差分析。结果 成人骨性Ⅲ类患者与骨性Ⅰ类患者相比,骨性Ⅲ类患者的面中1/3凹陷明显（A点突度、Sn-H线）、上唇前突（上唇沟深度、上唇紧张度）、下唇前突（LL-H线）、颏部前突、颏唇沟变浅（软组织面角、H角、颏唇沟深度、颏部厚度）。成人骨性Ⅲ类患者不同性别间的软组织侧貌形态差异主要集中在软组织面角、上唇沟深度及上唇紧张度,其余指标无明显差异,显示出女性患者具有较好的软组织代偿。结论 由于成人骨性Ⅲ类患者上下颌骨间存在明显的矢状向不协调,因此与骨性I类患者相比,其软组织侧貌有着显著不同的特点。     

Radiology of the hand

This is an overview of radiological imaging of the hand highlighting the various imaging modalities used in the work-up and diagnosis of a range of orthopaedic and rheumatological disorders. The biomechanics and anatomy of the human hand is extremely complex, and a good understanding is required to diagnose pathology. In this article we explain the anatomy and highlight pathology of the hand from a radiological perspective with respect to plain film, CT, ultrasound and MR imaging. Trauma of the hand is extremely common and radiology plays an important role in the diagnosis of treatable injuries including fractures, dislocations and ligament tears. Plain radiography and CT are excellent at evaluating bony injury (e.g. Rolondo or Bennett's fracture) whereas ultrasound and MR are better at evaluating soft tissue injury (e.g. Stener lesion). The hands are a common location for degenerate and inflammatory arthropathies which all have hallmark radiological features. Radiology also plays an important role in the diagnosis and work-up of bone lesions in the hand including enchondromas, osteoid osteomas and chondrosarcomas.     

A comparative study of magnetic resonance imaging versus computed tomography for the evaluation of maxillary and mandibular tumors

The relative value of magnetic resonance imaging (MRI) versus computed tomography (CT) for imaging benign and malignant lesions of the maxilla and mandible was studied in a group of 16 patients. The imaging methods were evaluated for their ability to detect the lesion and define lesion margins, soft tissue extension, and bone involvement. The abnormality was identifiable with both imaging methods. For benign cystic lesions of either the maxilla or mandible (50%), MRI was overall equal to or better than CT. Magnetic resonance imaging was superior to CT in the evaluation of lesion margins and soft tissue extent of disease, whereas it was equal or slightly inferior to CT in lesion detection and in the evaluation of bone involvement. In the imaging of malignant neoplasms (50%), MRI was overall superior to CT in all four categories reviewed. Magnetic resonance imaging also had the highest rate of correlation with clinical findings, either from physical examination or at the time of surgery.     

口腔颌面部肌间血管瘤不同病理分型的影像学表现

目的 ：探讨口腔颌面部高血循肌间血管瘤（IMH）的CT、MRI（包括磁共振动态增强）的表现特征与病理分型的关系。方法 ：回顾分析2001—2013年间18例经病理检查证实的口腔颌面部IMH患者的术前影像学资料。其中男3例,女15例,年龄5~57岁,平均年龄33.4岁。结果 ：CT、MR图像显示,6例患者累及多块肌肉,12例累及单块肌肉。好发于咬肌（6例）及舌体（6例）。3例患者影像学表现为高血循病变,磁共振动态增强的SI-time曲线为Ⅱ型：早期快速强化后出现平台期,病理分型为毛细血管型2例、混合型1例。15例患者影像学表现为低血循病变,SI-time曲线为Ⅰ型,病理分型为海绵血管型。4例发现静脉石。结论 ：IMH的 CT、MR影像学表现及其SI-time曲线分型,能进一步帮助诊断其病理分型。     

骨性Ⅱ类错(牙合)畸形患者侧貌相关分析及正畸正颌联合治疗后组织变化

目的 通过研究颌面部软硬组织变化情况来了解正畸-正颌联合治疗对骨性Ⅱ类错(牙合)畸形患者的疗效,并分析患者软硬组织之间的相关性,为联合治疗技术提供参考和指导.方法 选择23例骨性Ⅱ类错(牙合)畸形患者,分别在正畸-正颌联合治疗前后影像学资料中选取21项能够反映颌面部软硬组织、侧貌形态的参数进行对照分析,并对治疗前患者软硬组织进行相关性分析.结果 骨性Ⅱ类错(牙合)畸形患者治疗后相比治疗前所有参数中除ANS-Me/N-Me(%)、Pg-Pg′(mm)外,余下19项参数差异均有统计学意义(P<0.05);通过将患者治疗前的硬组织指标及其软组织侧貌美学指标进行相关性分析,可发现侧貌美学受很多硬组织参数影响.结论 正畸-正颌联合技术对于骨性Ⅱ类错(牙合)畸形的改善成效明显,骨性Ⅱ类错(牙合)畸形患者硬组织面型构成软组织面型的基础和支架,同时软组织也具有一定的独立性.     

The use of cone beam computed tomography as an aid in evaluating and treatment planning for mandibular cancer.

PURPOSE: The workup for oral malignancy involving the mandible typically involves a head and neck exam, laboratory studies, a panoramic radiograph, and computed tomography (CT) or magnetic resonance imaging of the head and neck to evaluate the primary lesion and cervical lymph nodes. Panoramic plain film radiography of the mandible is often unreliable for detecting bony invasion; therefore, other imaging studies are necessary before staging is complete. Bony invasion is typically imaged with the use of conventional CT scanners. In this article we relate the use of cone beam computed tomography (CBCT) to image the mandible with less cost and morbidity to the patient and its use in the evaluation and treatment planning of mandibular cancer. MATERIALS AND METHODS: A retrospective review of 3 patients with mandibular malignancies was performed. All patients had a panoramic radiograph, magnetic resonance imaging, and chest radiograph, in addition to laboratory studies. CBCT scans were ordered, after bony involvement was suspected, and compared with the other imaging studies. RESULTS: Two patients with squamous cell carcinoma of anterior mandible and 1 patient with osteogenic sarcoma were reviewed. In all cases CBCT aided the evaluation of the mandible. The cone beam panoramic view, as part of the CBCT, was used to determine extent of resection. CONCLUSION: CBCT can accurately aid in evaluating and treatment planning for malignant tumors of the mandible with less cost and decreased radiation to the patient relative to conventional CT.