Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献_第2页

Kikuchi-Fujimoto disease: the great masquerader: a rare case report

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.015

Dr. Pallak Arora , Dr. Joshua Fountain , Dr. Jake Gibbons , Dr. Tyler Murray , Dr. Hui Liang

Clinical Presentation

Kikuchi disease (KD), also known as Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis, is a self-limiting cause of cervical lymphadenopathy. The prime cause may be infection, mostly being viral or autoimmune but the exact mechanism remains unclear. This case is challenging because of the misconception in view of the nonspecific clinical features leading to potential delay in diagnosis and irrelevant treatment costs.

A 49-year-old Asian woman reported fever, pain, and multiple swellings in the right side of her neck. Clinical findings of the case suggested further investigation through computed tomography evaluation. Multidetector computed tomography study with contrast revealed multiple pathologically enlarged lymph nodes in the right neck, with central low attenuation/necrosis, rim enhancement, and perinodal infiltration. Mild fat stranding and edema around the lymph nodes and in the fascial spaces of the right neck are present. Largest lymph nodes measured up to 14 mm in the right level 1B and level 2 regions.

Differential Diagnosis

Differential diagnosis included non-Hodgkin lymphoma, tuberculosis adenitis, systemic lupus erythematous, cat scratch disease, or toxoplasmosis.

Diagnosis and Management

Acid-fast bacilli and Grocott methenamine silver stains were negative for mycobacterial and fungal organisms respectively. Ultrasonography-guided right cervical lymph node biopsy revealed cylindrical cores of tissue predominantly consisting of necrosis with few viable lymphocytes. Focal histiocytes were present at the junction of necrosis. The features were consistent with necrotizing lymphadenitis/Kikuchi disease. The patient was managed supportively with nonsteroidal anti-inflammatory drugs and is currently being followed up.

Conclusion

This intriguing case of an uncommon cause of right tender lymphadenitis prompts investigation and recognition by physicians, radiologists, and pathologists for commonly misdiagnosing as lymphoma. Awareness of greater prevalence among East Asian populations and highlighting the self-limiting nature of Kikuchi disease may help for more accurate diagnosis and management of the disease.

{"title":"Kikuchi-Fujimoto disease: the great masquerader: a rare case report","authors":"Dr. Pallak Arora , Dr. Joshua Fountain , Dr. Jake Gibbons , Dr. Tyler Murray , Dr. Hui Liang","doi":"10.1016/j.oooo.2024.11.015","DOIUrl":"10.1016/j.oooo.2024.11.015","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>Kikuchi disease (KD), also known as Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis, is a self-limiting cause of cervical lymphadenopathy. The prime cause may be infection, mostly being viral or autoimmune but the exact mechanism remains unclear. This case is challenging because of the misconception in view of the nonspecific clinical features leading to potential delay in diagnosis and irrelevant treatment costs.</div><div>A 49-year-old Asian woman reported fever, pain, and multiple swellings in the right side of her neck. Clinical findings of the case suggested further investigation through computed tomography evaluation. Multidetector computed tomography study with contrast revealed multiple pathologically enlarged lymph nodes in the right neck, with central low attenuation/necrosis, rim enhancement, and perinodal infiltration. Mild fat stranding and edema around the lymph nodes and in the fascial spaces of the right neck are present. Largest lymph nodes measured up to 14 mm in the right level 1B and level 2 regions.</div></div><div><h3>Differential Diagnosis</h3><div>Differential diagnosis included non-Hodgkin lymphoma, tuberculosis adenitis, systemic lupus erythematous, cat scratch disease, or toxoplasmosis.</div></div><div><h3>Diagnosis and Management</h3><div>Acid-fast bacilli and Grocott methenamine silver stains were negative for mycobacterial and fungal organisms respectively. Ultrasonography-guided right cervical lymph node biopsy revealed cylindrical cores of tissue predominantly consisting of necrosis with few viable lymphocytes. Focal histiocytes were present at the junction of necrosis. The features were consistent with necrotizing lymphadenitis/Kikuchi disease. The patient was managed supportively with nonsteroidal anti-inflammatory drugs and is currently being followed up.</div></div><div><h3>Conclusion</h3><div>This intriguing case of an uncommon cause of right tender lymphadenitis prompts investigation and recognition by physicians, radiologists, and pathologists for commonly misdiagnosing as lymphoma. Awareness of greater prevalence among East Asian populations and highlighting the self-limiting nature of Kikuchi disease may help for more accurate diagnosis and management of the disease.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e72-e73"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A unique case of calcifications of torus tubarius in cone beam computed tomography (CBCT)

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.054

Dr. Suvendra Vijayan , Mr. Aarav Suarpaneni , Dr. Shobena Jeevan , Dr. Elizabeth Bilodeau , Dr. Anitha Potluri

Clinical Presentation

A 97-year-old female patient was presented to a private dental clinic for evaluation and treatment due to pain in her lower jaw. The patient had ill-fitting complete and partial dentures and severe bone loss and mobility of the remaining teeth. The patient was on multiple medications. A cone beam computed tomography (CT) was recommended as part of the treatment plan. Along with common clinical findings, the cone beam CT exposed significant degenerative changes with the C-spine and atherosclerotic calcifications in the internal carotids. A rare finding consisting of bilateral calcifications was noted with cartilaginous parts of Eustachian tubes. The calcifications appear as tear drop structures.

Differential Diagnosis

The various lesions considered for reasonable diagnostic possibilities include calcifications of the torus tubarius, tubal tonsils, and other dystrophic calcifications of soft tissues in the region.

Diagnosis and Management

The bilateral, teardrop structures were diagnosed as rare calcifications of the torus tubarius, which are mucosal elevations of the cartilaginous portions of the Eustachian tubes. As no clinical significance has yet been established, no further treatment is warranted.

Conclusion

Torus tubarius calcifications are rare; however, they increase in occurrence with aging. One study noted 0.6% prevalence in a 1571-patient dataset. The first report of these calcifications on a CT was presented by Mafee et al. in 2011. A case report of a 67-year-old woman with a medical history of hyperthyroidism, presented by Syed et al, reported similar ossifications of the Eustachian tube. Even though no clinical significance is established, loss of elasticity of the cartilages due to calcification leading to Eustachian tube dysfunction for elderly people, including otitis media, is proposed by Mafee et al. Torus tubarius calcifications can easily be confused with calcifications of tubal tonsils, as they are very close to each other.

{"title":"A unique case of calcifications of torus tubarius in cone beam computed tomography (CBCT)","authors":"Dr. Suvendra Vijayan , Mr. Aarav Suarpaneni , Dr. Shobena Jeevan , Dr. Elizabeth Bilodeau , Dr. Anitha Potluri","doi":"10.1016/j.oooo.2024.11.054","DOIUrl":"10.1016/j.oooo.2024.11.054","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>A 97-year-old female patient was presented to a private dental clinic for evaluation and treatment due to pain in her lower jaw. The patient had ill-fitting complete and partial dentures and severe bone loss and mobility of the remaining teeth. The patient was on multiple medications. A cone beam computed tomography (CT) was recommended as part of the treatment plan. Along with common clinical findings, the cone beam CT exposed significant degenerative changes with the C-spine and atherosclerotic calcifications in the internal carotids. A rare finding consisting of bilateral calcifications was noted with cartilaginous parts of Eustachian tubes. The calcifications appear as tear drop structures.</div></div><div><h3>Differential Diagnosis</h3><div>The various lesions considered for reasonable diagnostic possibilities include calcifications of the torus tubarius, tubal tonsils, and other dystrophic calcifications of soft tissues in the region.</div></div><div><h3>Diagnosis and Management</h3><div>The bilateral, teardrop structures were diagnosed as rare calcifications of the torus tubarius, which are mucosal elevations of the cartilaginous portions of the Eustachian tubes. As no clinical significance has yet been established, no further treatment is warranted.</div></div><div><h3>Conclusion</h3><div>Torus tubarius calcifications are rare; however, they increase in occurrence with aging. One study noted 0.6% prevalence in a 1571-patient dataset. The first report of these calcifications on a CT was presented by Mafee et al. in 2011. A case report of a 67-year-old woman with a medical history of hyperthyroidism, presented by Syed et al, reported similar ossifications of the Eustachian tube. Even though no clinical significance is established, loss of elasticity of the cartilages due to calcification leading to Eustachian tube dysfunction for elderly people, including otitis media, is proposed by Mafee et al. Torus tubarius calcifications can easily be confused with calcifications of tubal tonsils, as they are very close to each other.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e88"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness of a metal artifact reduction algorithm on the imaging of titanium and zirconium implants: preliminary results

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.053

Dr. Youngjae Kim , Dr. Massieh Moayedi , Dr. Jim Lai , Dr. Anil Kishen , Dr. Ernest Lam

Objective

To quantify, in 3 dimensions, the degree of metal artifacts arising from titanium and zirconium dental implants on cone beam computed tomography images, and to evaluate the effectiveness of one metal artifact reduction (MAR) algorithm on reducing the metal artifacts produced by such dental implants.

Study Design

Four titanium- and 4 zirconium-based bone-level dental implants were placed centrally into bovine rib blocks of equal size. The rib blocks were submerged in water and subjected to cone beam computed tomography imaging, before and after implant placement. A postacquisition metal artifact reduction (MAR) algorithm was subsequently applied to the image volumes. The imaged rib blocks before and after implant placement were aligned, and a voxel-wise analysis was conducted to independently quantify the volumes of “light” and “dark” components of the metal artifacts before and after MAR application using FMRIB's Software Library (FSL, Oxford, UK).

Results

The preliminary results do not show a statistically significant reduction in either the “light” or “dark” components of the metal artifacts when the MAR algorithm is invoked for both implant types.

Conclusion

On the basis of the preliminary findings, the application of the MAR algorithm does not effectively reduce metal artifacts originating from titanium and zirconium dental implants. We intend to increase the sample size to align with our earlier work, and re-run the analysis to confirm this result.

{"title":"Effectiveness of a metal artifact reduction algorithm on the imaging of titanium and zirconium implants: preliminary results","authors":"Dr. Youngjae Kim , Dr. Massieh Moayedi , Dr. Jim Lai , Dr. Anil Kishen , Dr. Ernest Lam","doi":"10.1016/j.oooo.2024.11.053","DOIUrl":"10.1016/j.oooo.2024.11.053","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify, in 3 dimensions, the degree of metal artifacts arising from titanium and zirconium dental implants on cone beam computed tomography images, and to evaluate the effectiveness of one metal artifact reduction (MAR) algorithm on reducing the metal artifacts produced by such dental implants.</div></div><div><h3>Study Design</h3><div>Four titanium- and 4 zirconium-based bone-level dental implants were placed centrally into bovine rib blocks of equal size. The rib blocks were submerged in water and subjected to cone beam computed tomography imaging, before and after implant placement. A postacquisition metal artifact reduction (MAR) algorithm was subsequently applied to the image volumes. The imaged rib blocks before and after implant placement were aligned, and a voxel-wise analysis was conducted to independently quantify the volumes of “light” and “dark” components of the metal artifacts before and after MAR application using FMRIB's Software Library (FSL, Oxford, UK).</div></div><div><h3>Results</h3><div>The preliminary results do not show a statistically significant reduction in either the “light” or “dark” components of the metal artifacts when the MAR algorithm is invoked for both implant types.</div></div><div><h3>Conclusion</h3><div>On the basis of the preliminary findings, the application of the MAR algorithm does not effectively reduce metal artifacts originating from titanium and zirconium dental implants. We intend to increase the sample size to align with our earlier work, and re-run the analysis to confirm this result.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e87-e88"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An unusual lesion in the mandible: a puzzling case

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.062

Dr. Noor Algafly , Dr. Abrar Alamoudi , Dr. Ali Syed

Clinical Presentation

A 39-year-old African American male patient referred to oral maxillofacial surgery after multiple consultations with outside clinic for incidental finding of right posterior mandibular lesion. Patient had a history of multiple superficial biopsies with inconclusive results. Extraoral examination showed right facial swelling at the level of the mandibular angle. The patient was asymptomatic and without lymphadenopathy. The intraoral examination revealed stable and reproducible occlusion, significant mandibular expansion, and normal mucosal covering.

A panoramic radiograph revealed a well-defined, corticated multilocular radiolucent space-occupying mass with thick straight septa and scalloped borders involving the right mandible. Displacement and thinning of the cortical border of the ramus were noted. IAC is displaced. Multidetector computed tomography scan showed that the lesion occupied the whole buccolingual width of the ramus and body of the mandible. Internal density of the lesion revealed soft-tissue density on the basis of Hounsfield unit.

Differential Diagnosis

The differential diagnoses for the lesion were benign odontogenic or nonodontogenic tumor/cyst or tumor like lesion ameloblastoma, odontogenic keratocyst or brown tumor.

Diagnosis and Management

The biopsy revealed a dense fibrous connective tissue with focal myxoid degeneration and mild chronic inflammation. Due to the history of multiple nonconclusive previous biopsies, a diagnosis of idiopathic bone cavity (IBC) with irregular behavior was provided radiographic monitoring recommended and follow-up showed significant healing.

Discussion/Conclusion

IBC is a benign bone lesion that occurs in the mandible. This condition is characterized by the formation of a cyst-like structure within the bone tissue, which is often asymptomatic and discovered incidentally during radiographic examination.

This case highlights the diagnostic and therapeutic challenges associated with IBC. The clinical presentation of IBC is variable, and the lesion can be easily mistaken for other conditions, such as a tumor or a cystic lesion.

Radiographic imaging is crucial both in diagnosis and follow ups.

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引用次数: 0

Coronoid process: cone beam computed tomography (CBCT) evaluation and proposal of radiographic classification

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.006

Dr. Archna Sharma , Dr. Aditya Tadinada

Objective

The objective of the study was to investigate the cone beam computed tomography (CBCT) features of coronoid processes in patients without mouth opening limitations and to develop a functional classification of coronoid process considering its relationship with the zygomatic bone.

Study Design

This cross-sectional retrospective study analyzed CBCTs of 204 patients (408 coronoid processes). CBCTs were acquired in a closed-mouth position, capturing the coronoid process and the temporomandibular joint. The scans with temporomandibular joint abnormalities, orofacial trauma or syndromes, and artifacts were excluded. Volume renderings and axial images were evaluated for the shape, surface configuration, coronoid length, condylar length, coronoid/condyle ratio, distance of the coronoid process from the posteromedial surface of the zygoma and its vertical level. The coronoid process was considered hyperplastic when coronoid/condyle ratio was greater than 1.

Results

Most coronoid processes (221) had a triangular shape. The mean length of the coronoids and condyles was 13.85 mm and 16.77 mm, respectively. The mean coronoid/condyle ratio was 0.84. A total of 87 coronoid processes were hyperplastic. The mean distance from the coronoid process to posteromedial surface of zygoma was 15.99 mm, ranging from 5.8 to 27.9 mm. The mean vertical level of coronoid processes in the study sample was 9.6 mm. A novel working classification was developed using the results of this study. The coronoid process was classified as either type I, II, III (a,b,c) and type IV (a,b,c). Type IIIa was the most common (45.83%); followed by type II (29.6%); type I (16.17%); type IIIc (4.41%); type IIIb (3.18%); type IVa (0.49%); and type IV b (0.24%).

Conclusions

The coronoid process can present a wide variety of shapes, sizes, and positions. On the basis of the results, we also propose a working radiographic classification of coronoid process that can help oral and maxillofacial radiologists to identify any abnormalities associated with the coronoid process.

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引用次数: 0

The state of generative artificial intelligence (GAI) in radiology and dentistry

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.003

Dr. Suvendra Vijayan , Dr. Anitha Potluri

Objective

This oral presentation proposes to explain the current state of generative artificial intelligence (GAI) in health care and education. We will also showcase a research project that used GAI to create radiographic images and another ongoing project exploring the potential of GAI in dental education and research.

Study Design

Research 1—A pilot study was conducted to enhance ultra-low dose cone beam computed tomographic images of dry skulls to diagnostically acceptable standards. The images were trained using a pix2pix deep generative model.

Research 2—A pilot study is being conducted exploring the accuracy of case reports generated by ChatGPT. We queried ChatGPT to create hypothetical case reports and modified the queries to get the best possible output.

Results

Research 1—Preliminary results indicated that the synthesized images are comparable with images made with normal exposure.

Research 2—Preliminary results indicate that ChatGPT can create a convincing and accurate case report. Limitations in use of citations were observed.

Conclusion

GAI like Open AI's ChatGPT, Google's Bard, and Microsoft's CoPilot have caused a massive shift in public knowledge of AI. GAI will have major impact in health care and education.

GAI tools like ChatGPT have huge potential for use and misuse in educational and research spheres. Creating questions and explanation on complex topics can be done on these tools. Websites like MidJourney can create interesting and novel images. Radiographic images can be created using specific algorithms.

We intend to demonstrate how to effectively use GAI like ChatGPT, describe ethical concerns and how to address and regulate them in academia, and identify innovative uses for AI and ChatGPT in dental care and education. GAI is a freight train with no breaks and as educators and healthcare practitioners we need to discuss and propose policies and safeguards for responsible use of AI.

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引用次数: 0

Fibromyxoma of nasal fossa: features on magnetic resonance imaging

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.041

Dr. Farnaz Namazi , Dr. Suresh Mukherji , Dr. Mehrnaz Tahmasbi , Dr. Funda Yilmaz , Dr. Madhu Nair

Clinical Presentation

A 50-year-old female patient presented with a bi-lobed, bell-shaped, smooth, mucosalized mass involving the nose. Thin-section pre- and postcontrast magnetic resonance imaging (MRI) performed through the sinonasal cavity showed a midline, bi-lobed mass involving the floor of the nasal cavity. The superior aspect involves the nasal septum and extends to the inferior portion of the bilateral middle turbinate and anterior hard palate. Regressive remodeling of the medial wall of both maxillary sinuses and erosion of the anterior portion of the right hard palate, the right lateral nasopalatine canal, and maxillary alveolus were noted. Superficial muscles of facial expression were evident. The mass was intermediate signal on T1, and homogeneously enhanced with contrast. It had a heterogeneous T2 signal.

Differential Diagnosis

Differential diagnoses included minor salivary gland neoplasms, sarcomas, osteosarcoma/chondrosarcoma, hematopoietic lesion (lymphoma), or neoplasm of histiocytic origin. Although squamous cell carcinoma is the most common neoplasm to involve the sinonasal region, the imaging features and submucosal appearance make it less likely.

Diagnosis and Management

Histopathologic examination revealed a fibromyxoma. The lesion was resected out. Due to the high recurrence rate of >25%, a minimum 5-year follow-up is required.

Conclusion

Fibromyxomas of the jaws are rare with an incidence of approximately 0.07 new cases per million people per year. Anterior maxilla is rarely affected. The location, aggressive behavior involving the nasal fossae and maxillary sinuses, and high recurrence rate underscores the complexity of diagnosis. Radiographic examination, including MRI, plays a crucial role in the differential diagnosis and treatment planning. With scant reports in the literature on MRI findings of fibromyxoma of the nasal fossa, this report, including a review of the literature, expounds on the variations in clinical and radiographic features of this lesion.

{"title":"Fibromyxoma of nasal fossa: features on magnetic resonance imaging","authors":"Dr. Farnaz Namazi , Dr. Suresh Mukherji , Dr. Mehrnaz Tahmasbi , Dr. Funda Yilmaz , Dr. Madhu Nair","doi":"10.1016/j.oooo.2024.11.041","DOIUrl":"10.1016/j.oooo.2024.11.041","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>A 50-year-old female patient presented with a bi-lobed, bell-shaped, smooth, mucosalized mass involving the nose. Thin-section pre- and postcontrast magnetic resonance imaging (MRI) performed through the sinonasal cavity showed a midline, bi-lobed mass involving the floor of the nasal cavity. The superior aspect involves the nasal septum and extends to the inferior portion of the bilateral middle turbinate and anterior hard palate. Regressive remodeling of the medial wall of both maxillary sinuses and erosion of the anterior portion of the right hard palate, the right lateral nasopalatine canal, and maxillary alveolus were noted. Superficial muscles of facial expression were evident. The mass was intermediate signal on T1, and homogeneously enhanced with contrast. It had a heterogeneous T2 signal.</div></div><div><h3>Differential Diagnosis</h3><div>Differential diagnoses included minor salivary gland neoplasms, sarcomas, osteosarcoma/chondrosarcoma, hematopoietic lesion (lymphoma), or neoplasm of histiocytic origin. Although squamous cell carcinoma is the most common neoplasm to involve the sinonasal region, the imaging features and submucosal appearance make it less likely.</div></div><div><h3>Diagnosis and Management</h3><div>Histopathologic examination revealed a fibromyxoma. The lesion was resected out. Due to the high recurrence rate of >25%, a minimum 5-year follow-up is required.</div></div><div><h3>Conclusion</h3><div>Fibromyxomas of the jaws are rare with an incidence of approximately 0.07 new cases per million people per year. Anterior maxilla is rarely affected. The location, aggressive behavior involving the nasal fossae and maxillary sinuses, and high recurrence rate underscores the complexity of diagnosis. Radiographic examination, including MRI, plays a crucial role in the differential diagnosis and treatment planning. With scant reports in the literature on MRI findings of fibromyxoma of the nasal fossa, this report, including a review of the literature, expounds on the variations in clinical and radiographic features of this lesion.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Page e83"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges in distinguishing amongst large maxillary sinus lesions with calcified matrix: a differential diagnostic exhibit

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.033

Dr. Samantha Gallia , Dr. Pattana Wangaryattawanich , Dr. Peggy Lee

Clinical Presentation

Case 1: A 64-year-old man with history of metastatic pancreatic cancer underwent a computed tomography (CT) scan for suspected recurrence, which revealed an incidental large, destructive mass with internal calcified matrix in the left maxillary sinus with associated bone destruction. The tumor extended into the left sinonasal cavity, oral cavity, and retroantral soft tissue, with resultant obstructive sinusitis.

Case 2: A 19-year-old man presented with intermittent epistaxis of the right nostril. Examination revealed a polyp-like mass in the right nasal cavity. The CT scan demonstrated a large, expansile mass with extensive internal calcifications centered in the right nasal vault, completely involving the right maxillary sinus, right ethmoid air cells, and the posterior bony orbit.

Case 3: A 15-year-old female patient with history of swelling and a slow-growing lesion underwent CT imaging, which revealed a well-defined, expansile lesion with calcified matrix in the left maxilla protruding into the left maxillary antrum. There was destruction of the posterior wall of the left maxillary sinus, and the lesion displaced #15 laterally and #16 superiorly into the maxillary sinus.

Differential Diagnosis

Case 1 and 2: The extensive and destructive findings are concerning for malignancy, particularly chondrosarcoma and osteosarcoma. An alternative diagnosis for case 1 includes metastasis, given the history of cancer.

Case 3: Differential diagnoses include chondrosarcoma, ossifying fibroma, and venous malformation of bone.

Diagnosis and Management

Histologic examination revealed glomangiopericytoma for case 1, mesenchymal chondrosarcoma for case 2, and unusual ossifying fibroma for case 3. All tumors were surgically removed. Case 3 displayed recurrence upon follow-up imaging 11 months later.

Conclusions

A wide range of expansile sinus masses with calcified matrix exists, comprising both benign and malignant entities. Radiographic features help distinguish between benign and malignant categories; however, differentiating between malignancies is challenging due to overlapping radiologic characteristics. Thus, histopathologic examination is crucial for definitive diagnosis.

{"title":"Challenges in distinguishing amongst large maxillary sinus lesions with calcified matrix: a differential diagnostic exhibit","authors":"Dr. Samantha Gallia , Dr. Pattana Wangaryattawanich , Dr. Peggy Lee","doi":"10.1016/j.oooo.2024.11.033","DOIUrl":"10.1016/j.oooo.2024.11.033","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>Case 1: A 64-year-old man with history of metastatic pancreatic cancer underwent a computed tomography (CT) scan for suspected recurrence, which revealed an incidental large, destructive mass with internal calcified matrix in the left maxillary sinus with associated bone destruction. The tumor extended into the left sinonasal cavity, oral cavity, and retroantral soft tissue, with resultant obstructive sinusitis.</div><div>Case 2: A 19-year-old man presented with intermittent epistaxis of the right nostril. Examination revealed a polyp-like mass in the right nasal cavity. The CT scan demonstrated a large, expansile mass with extensive internal calcifications centered in the right nasal vault, completely involving the right maxillary sinus, right ethmoid air cells, and the posterior bony orbit.</div><div>Case 3: A 15-year-old female patient with history of swelling and a slow-growing lesion underwent CT imaging, which revealed a well-defined, expansile lesion with calcified matrix in the left maxilla protruding into the left maxillary antrum. There was destruction of the posterior wall of the left maxillary sinus, and the lesion displaced #15 laterally and #16 superiorly into the maxillary sinus.</div></div><div><h3>Differential Diagnosis</h3><div>Case 1 and 2: The extensive and destructive findings are concerning for malignancy, particularly chondrosarcoma and osteosarcoma. An alternative diagnosis for case 1 includes metastasis, given the history of cancer.</div><div>Case 3: Differential diagnoses include chondrosarcoma, ossifying fibroma, and venous malformation of bone.</div></div><div><h3>Diagnosis and Management</h3><div>Histologic examination revealed glomangiopericytoma for case 1, mesenchymal chondrosarcoma for case 2, and unusual ossifying fibroma for case 3. All tumors were surgically removed. Case 3 displayed recurrence upon follow-up imaging 11 months later.</div></div><div><h3>Conclusions</h3><div>A wide range of expansile sinus masses with calcified matrix exists, comprising both benign and malignant entities. Radiographic features help distinguish between benign and malignant categories; however, differentiating between malignancies is challenging due to overlapping radiologic characteristics. Thus, histopathologic examination is crucial for definitive diagnosis.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e79-e80"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Freehand 3-dimensional ultrasound imaging of midpalatal suture in maxillary transverse deficiency treatment: an ex vivo study

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.063

Ms. Trang H. Hoang , Dr. Kim-Cuong T. Nguyen , Dr. Neelambar R. Kaipatur , Prof. Manuel O. Lagravere Vich , Prof. Paul Major , Prof. Lawrence H. Le

Objective

Rapid maxillary expansion is widely regarded as the treatment of choice for correcting maxillary transverse deficiency (MTD), a significant concern in the facial growth of children and adolescents. A critical component of the rapid maxillary expansion treatment process involves the precise evaluation of the patency of the midpalatal suture (MPS). Ionizing radiation-based modalities are commonly employed to assess the status of the MPS. This study proposes a nonionizing radiation method to measure the MPS opening using freehand 3-dimensional intraoral ultrasound (US) reconstructed images.

Study Design

The US imaging system includes a portable customized high-frequency scanner, accompanied by 4 infrared cameras that record the corresponding image coordinates and orientation. A 3-month-old pig palate with a manmade defect mimicking the MPS expansion was freehand scanned and real-time reconstructed to generate 3-dimensional images. The palatal bone underlying the ruggae was then segmented to unveil the MPS expansion. A micro-computed tomography (μCT) scan was performed on the pig jaw to establish the ground truth. The widths of the MPS opening were measured 3 times at 10 different locations spaced 1.5-mm apart along the MPS on the US-reconstructed images. The results were validated by μCT data.

Results

The MPS width comparison between US and μCT measurements shows a strong correlation of R^b = 0.99 (P < .05) and absolute errors of less than 0.19 mm (6 %). In general, 95% of the difference between the measurements fell between -0.27 mm and 0.07 mm, which is clinically acceptable. The results revealed good accuracy in measuring MPS opening using US in comparison with μCT.

Conclusion

This study has demonstrated the feasibility of examining the MPS patency by 3D intraoral US-reconstructed images. The technique holds great promise in providing a low-cost, safe, and highly accurate modality for MTD treatment.

{"title":"Freehand 3-dimensional ultrasound imaging of midpalatal suture in maxillary transverse deficiency treatment: an ex vivo study","authors":"Ms. Trang H. Hoang , Dr. Kim-Cuong T. Nguyen , Dr. Neelambar R. Kaipatur , Prof. Manuel O. Lagravere Vich , Prof. Paul Major , Prof. Lawrence H. Le","doi":"10.1016/j.oooo.2024.11.063","DOIUrl":"10.1016/j.oooo.2024.11.063","url":null,"abstract":"<div><h3>Objective</h3><div>Rapid maxillary expansion is widely regarded as the treatment of choice for correcting maxillary transverse deficiency (MTD), a significant concern in the facial growth of children and adolescents. A critical component of the rapid maxillary expansion treatment process involves the precise evaluation of the patency of the midpalatal suture (MPS). Ionizing radiation-based modalities are commonly employed to assess the status of the MPS. This study proposes a nonionizing radiation method to measure the MPS opening using freehand 3-dimensional intraoral ultrasound (US) reconstructed images.</div></div><div><h3>Study Design</h3><div>The US imaging system includes a portable customized high-frequency scanner, accompanied by 4 infrared cameras that record the corresponding image coordinates and orientation. A 3-month-old pig palate with a manmade defect mimicking the MPS expansion was freehand scanned and real-time reconstructed to generate 3-dimensional images. The palatal bone underlying the ruggae was then segmented to unveil the MPS expansion. A micro-computed tomography (<em>μ</em>CT) scan was performed on the pig jaw to establish the ground truth. The widths of the MPS opening were measured 3 times at 10 different locations spaced 1.5-mm apart along the MPS on the US-reconstructed images. The results were validated by <em>μ</em>CT data.</div></div><div><h3>Results</h3><div>The MPS width comparison between US and <em>μ</em>CT measurements shows a strong correlation of <em>R</em><sup>b</sup> = 0.99 (<em>P</em> < .05) and absolute errors of less than 0.19 mm (6 %). In general, 95% of the difference between the measurements fell between -0.27 mm and 0.07 mm, which is clinically acceptable. The results revealed good accuracy in measuring MPS opening using US in comparison with <em>μ</em>CT.</div></div><div><h3>Conclusion</h3><div>This study has demonstrated the feasibility of examining the MPS patency by 3D intraoral US-reconstructed images. The technique holds great promise in providing a low-cost, safe, and highly accurate modality for MTD treatment.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e91-e92"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Symptomatic and asymptomatic endodontic material extrusion involving the inferior alveolar canal: a case series

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Oral Surgery Oral Medicine Oral Pathology Oral Radiology

Pub Date : 2025-02-04 DOI: 10.1016/j.oooo.2024.11.035

Dr. Victor Vinh , Dr. Peggy Lee

Clinical Presentation

Three cases of left jaw pain and numbness post-root canal treatment with follow-up up to 8 years with cone beam computed tomography and intraoral imaging.

Case 1: Endodontic material extrusion within surrounding trabecular bone approximating, but not within, the inferior alveolar canal (IAC) and mental foramen with neurosensory changes along V3 mental and long buccal nerve distribution.

Case 2: Endodontic material within the IAC with normal sensation distal of #19 and numbness/tingling extending from #19 to midline.

Case 3: Endodontic material along, but not within, the IAC in #30-#32 area with paresthesia for 10 years.

Two companion cases show endodontic material IAC approximation without symptoms.

Differential Diagnosis

Trigeminal neuropathic pain secondary to endodontic material extrusion vs IAN block with articaine, periapical inflammation-related pressure on the nerve, and trigeminal neuralgia.

Diagnosis and Management

Case 1: Initial retreat root canal treatment did not improve symptoms. Continued numbness and decreasing pain managed with pregabalin on periodic 6-month follow-up; 6 years later, reported isolated periods without pain and left lower lip numbness gone. Continued improvement to present.

Case 2: Managed with prednisone and antibiotics; same pain radiating anteriorly at 2-week follow-up with numbness of #24, left lower lip, and gingiva. Decreased numbness at 2-month follow-up.

Case 3: No treatment was rendered.

Both cases show minimal radiographic changes over time as symptoms diminish with management.

Conclusion

When patients are symptomatic, cone beam computed tomography may confirm the presence of endodontic material within the IAC, indicating that extrusion is the likely cause of symptoms. Symptomatic cases, both with and without direct IAC involvement, have been successfully treated in this series and reported in the literature. Endodontic material located at the IAC border, but not within it, may present with or without symptoms. Thus, it is important to localize endodontic material in relation to the IAC.

{"title":"Symptomatic and asymptomatic endodontic material extrusion involving the inferior alveolar canal: a case series","authors":"Dr. Victor Vinh , Dr. Peggy Lee","doi":"10.1016/j.oooo.2024.11.035","DOIUrl":"10.1016/j.oooo.2024.11.035","url":null,"abstract":"<div><h3>Clinical Presentation</h3><div>Three cases of left jaw pain and numbness post-root canal treatment with follow-up up to 8 years with cone beam computed tomography and intraoral imaging.</div><div>Case 1: Endodontic material extrusion within surrounding trabecular bone approximating, but not within, the inferior alveolar canal (IAC) and mental foramen with neurosensory changes along V3 mental and long buccal nerve distribution.</div><div>Case 2: Endodontic material within the IAC with normal sensation distal of #19 and numbness/tingling extending from #19 to midline.</div><div>Case 3: Endodontic material along, but not within, the IAC in #30-#32 area with paresthesia for 10 years.</div><div>Two companion cases show endodontic material IAC approximation without symptoms.</div></div><div><h3>Differential Diagnosis</h3><div>Trigeminal neuropathic pain secondary to endodontic material extrusion vs IAN block with articaine, periapical inflammation-related pressure on the nerve, and trigeminal neuralgia.</div></div><div><h3>Diagnosis and Management</h3><div>Case 1: Initial retreat root canal treatment did not improve symptoms. Continued numbness and decreasing pain managed with pregabalin on periodic 6-month follow-up; 6 years later, reported isolated periods without pain and left lower lip numbness gone. Continued improvement to present.</div><div>Case 2: Managed with prednisone and antibiotics; same pain radiating anteriorly at 2-week follow-up with numbness of #24, left lower lip, and gingiva. Decreased numbness at 2-month follow-up.</div><div>Case 3: No treatment was rendered.</div><div>Both cases show minimal radiographic changes over time as symptoms diminish with management.</div></div><div><h3>Conclusion</h3><div>When patients are symptomatic, cone beam computed tomography may confirm the presence of endodontic material within the IAC, indicating that extrusion is the likely cause of symptoms. Symptomatic cases, both with and without direct IAC involvement, have been successfully treated in this series and reported in the literature. Endodontic material located at the IAC border, but not within it, may present with or without symptoms. Thus, it is important to localize endodontic material in relation to the IAC.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"139 3","pages":"Pages e80-e81"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0