The Combination of Panoramic Imaging and Waters' Projection Contributes to the Diagnosis of Odontogenic Maxillary Sinusitis.

The purpose of this study was to evaluate the usefulness of adding Waters' projection to panoramic imaging compared with panoramic imaging or Waters' projection alone. Maxillary sinusitis in 106 patients (206 sinuses) was retrospectively assessed with panoramic imaging, Waters' projection, and computed tomography imaging by two oral radiologists. The diagnostic performance was assessed with computed tomography imaging as the gold standard. Receiver operating characteristic curves and area under the curve values were obtained. Inter- and intra-observer agreement was quantified using weighted kappa coefficients. Observer A performed the same procedure twice (A1 and A2 for the first and second observations, respectively). The accuracies of observers A1, B, and A2 with combination imaging were 0.699, 0.636, and 0.718, respectively. Their area under the curve values with combination imaging were 0.746, 0.640, and 0.771, respectively. Inter-observer agreement was good for Waters' projection (κ, 0.650), and poor for panoramic imaging (κ, 0281). Intra-observer agreement was good for Waters' projection (κ, 0.752), and moderate for panoramic imaging (κ, 0.597). Panoramic imaging was equivalent to Waters' projection for diagnosing maxillary sinusitis. Combination imaging comprising panoramic imaging and Waters' projection can contribute to the diagnosis of odontogenic maxillary sinusitis because of its high sensitivity.

SAPHO syndrome of the temporomandibular joint associated with trismus: a case report and review of the literature.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a disorder characterized by pustular skin lesions and osteoarticular lesions. Mandibular involvement occurs in approximately 10% of the cases, and is often seen as recurrent mandibular osteitis with bone sclerosis, mainly involving the body of the mandible in the head and neck region. Middle cranial base with temporomandibular joint (TMJ) involvement in SAPHO syndrome can be diagnostically challenging because of its rarity. Herein, we present a case of a 37-year-old man who suffered from trismus and dull pain in the left TMJ region. The initial panoramic image revealed spotty osteolysis around the left condylar head. Computed tomography (CT) images showed an osteosclerotic change in the middle cranial base including the TMJ. Magnetic resonance images showed a cortical bone change in the left TMJ without anterior disk displacement, with spotty low signal intensity in the left condyle bone marrow on T2- weighted images. Our initial diagnosis was osteomyelitis of the middle cranial base including the TMJ region. However, antimicrobial therapy, training for TMJ opening, and a surgical procedure were not effective. A detailed medical interview, careful check for skin lesions, and further imaging examinations including bone scintigraphy and chest CT led to the diagnosis of SAPHO syndrome. The possibility of SAPHO syndrome should be considered in patients suspected of osteomyelitis of the middle cranial base including the TMJ with unknown etiology.

Diagnostic usefulness of panoramic imaging of the pterygopalatine fossa: case of a schwannoma causing pterygopalatine fossa expansion.

The pterygopalatine fossa is a small area between the posterior wall of the maxillary sinus and the anterior surface of the pterygoid process of the sphenoid bone. The pterygopalatine fossa can be seen clearly on panoramic imaging. We present the case of a 57-year-old man who exhibited right pterygopalatine fossa expansion on panoramic imaging. Computed tomography (CT), magnetic resonance imaging (MRI), and panoramic imaging all showed a tumor at the right pterygopalatine fossa in this patient. CT indicated that the tumor replaced right retromaxillary fat and displaced the posterior wall of the maxillary sinus. On MRI, the tumor showed intermediate signal intensity at the paranasal area on T1-weighted images, and variable intermediate and high signal intensities on fat-suppressed T2-weighted images. It was eventually diagnosed as a schwannoma. Thus, panoramic imaging can be used for disease screening at the posterior border of the maxilla. Our conclusion is based on this report of a patient with a schwannoma at the posterior wall of the maxillary sinus, which panoramic imaging revealed to have pterygopalatine fossa expansion.

Compliance with infection control practices when taking dental x-rays: Survey of a Japanese dental school.

The aim of this study was to assess knowledge, attitude, behavior, and compliance concerning infection control among dental practitioners in a dental university hospital in Japan. A 12-item questionnaire about infection control during radiographic procedures was distributed to 686 dental personnel working at Osaka Dental University. The questionnaire collected information on occupation and the use of gloves, holders, door handles, control panels, dental chairs, protectors, tube head, tube arms, tube cones, and keyboards for personal computers. To identify misunderstandings about, and thus noncompliance with, current infection control practices, the percentage of correct answers (PCA) was calculated. Understanding and compliance with the current practices was considered low when <75% and high when ≥75%. In addition, contaminated objects in the clinical setting were examined using black light. PCA was low for one question on using gloves in film positioning and high for three questions on using protective film barriers, regardless of the respondents' occupation. PCA was generally high for three questions on practicing hand hygiene before putting on gloves, methods to protect film holders, and methods to protect radiographic equipment, but was low among some subjects. PCA was generally low for four questions on using film protective barriers, developing images from unprotected films, practicing hand hygiene after removing gloves, and awareness of a procedures manual for taking intraoral x-rays, but was high among some subjects. Saliva contamination of radiographic equipment was confirmed by direct visualization using black light. Awareness was low of infection control measures to be used during intraoral projection. This study indicates the need for additional education and training to improve infection control practices, through, for example, using a standard procedures manual for all dental practitioners and visual evidence (visualization) of contamination.

Gas gangrene in the deep spaces of the head and neck visualized on computed tomography images.

Cellulitis accompanied by gas gangrene is a rapidly-spreading and potentially fatal infection. Here, we present a case of gas gangrene in the deep spaces of the head and neck in an elderly woman, diagnosed by computed tomography (CT). An 86-year-old woman with Alzheimer's disease, hypertension, hyperlipidemia, and osteoporosis was referred to our institute by her local dentist. The patient exhibited trismus caused by severe swelling in the left submandibular area. CT images of the head and neck area showed swelling of the cervical tissue with air in the parapharyngeal and masticator spaces. She was treated with antibiotics, followed by drainage. Although the therapy was continued, the patient died from a cardiac complication on hospital day 42. Our case highlights the usefulness of CT for diagnosing gas gangrene in the deep spaces of the head and neck in a woman with Alzheimer's disease.

Non-contrast computed tomography and magnetic resonance imaging features of mucoepidermoid carcinoma in the salivary glands.

BACKGROUND: Use of contrast-enhanced cross-sectional imaging is considered standard practice for investigating mucoepidermoid carcinoma (MEC) in the salivary glands. The purpose of this study was to present the common features of MEC on computed tomography (CT) and magnetic resonance imaging (MRI) without contrast enhancements, and to investigate the possibility of discriminating between MEC and pleomorphic adenoma based on the features observed on both modalities. METHODS: Twenty cases of biopsy-confirmed MEC originating in the salivary glands were reviewed and characterized by two oral and maxillofacial radiologists with regard to the following aspects: detectability, margin, border, encapsulation, content, contrast between lesion and masticator muscle, and bone changes. RESULTS: Ninety percent of bone changes caused by MEC were detected by CT and sixty-nine percent of tumor existences were detected by MRI. The lesion border could provide a clue to distinguish MEC from pleomorphic adenoma. CONCLUSIONS: Observation of MEC features was possible by both CT and MRI. Among the features, the lesion border could be a clue to distinguish MEC from pleomorphic adenoma.

Intracranial meningeal melanocytoma diagnosed using an interdisciplinary approach: a case report and review of the literature.

BACKGROUND: Meningeal melanocytoma is a rare pigmented tumor arising from leptomeningeal melanocytes. Patients with this tumor might initially consult a dentist because a mass lesion in Meckel's cave could manifest as dental pain and malocclusion, thereby mimicking temporomandibular disorder. The diagnostic approach, especially using imaging modalities, would be challenging in such cases unless an interdisciplinary approach is used. CASE PRESENTATION: Here, we report a case of a 39-year-old Japanese man who had a history of pain and numbness on the left side of his face and malocclusion for 3 months before the initial visit. The diagnosis was primary intracranial meningeal melanocytoma arising from Meckel's cave. CONCLUSIONS: The process by which the final diagnosis of meningeal melanocytoma was reached highlights the importance of collaboration between the medical and dental disciplines. This case also demonstrates that meningeal melanocytoma has a specific signal pattern on magnetic resonance imaging, including high signal intensity on T1-weighted images and low signal intensity on T2-weighted images.

Calcifying cystic odontogenic tumor accompanied by a dentigerous cyst: A case report.

A calcifying cystic odontogenic tumor (CCOT) is a proliferation of odontogenic epithelium and scattered nests of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass. It was previously described by Gorlin et al in 1962 as a calcifying odontogenic cyst. Dentigerous cysts are developmental odontogenic jaw cysts, commonly manifesting in the second and third decades of life. The present study reports an asymptomatic case in a 13-year-old boy who was referred to the outpatient clinic of the Osaka Dental University Hospital (Osaka, Japan) for additional investigation of an area of radiolucency in the lower right jaw. X-ray demonstrated a unilocular, well-circumscribed, radiolucent lesion in the mandible, which measured 30×20 mm, with radiopaque structures within it. Enucleation of the lesion with tooth extraction was performed, which histopathologically revealed features of a CCOT and a cyst. To the best of our knowledge, the occurrence of such a lesion has not been previously identified. The present study examined the significance of the case with a brief review of the literature.

Anesthetic Management of a Patient With Multiple Sclerosis.

A 54-year-old woman diagnosed with multiple sclerosis (MS) at the age of 19 years was scheduled to undergo temporomandibular joint mobilization. She was currently in a remission phase from her MS but with persistent sequelae, including impaired eyesight and muscle weakness of the limbs. In addition, the blood vessels in her upper limbs were compromised by the formation of internal shunts secondary to vascular prosthesis replacements for plasma exchange therapy in MS. After a previous joint mobilization surgery, her temporomandibular joint developed adhesions with resultant trismus. One of the adverse effects of general anesthesia can be exacerbations of MS symptoms. Minimizing mental and physical stress caused by surgical and anesthetic procedures and maintenance of stable body temperature are important considerations. Awake intubation was performed under sedation with midazolam and fentanyl. After intubation, anesthesia was induced with propofol, remifentanil, and rocuronium. Maintenance of anesthesia was achieved with oxygen-N2O-sevoflurane, remifentanil, fentanyl, and rocuronium. In this case, no adverse events occurred intraoperatively. However, the patient experienced lingering weakness of the limbs in the postoperative period, and activities of daily living of the patient were affected.

Management of infusion reactions associated with cetuximab treatment: A case report.

Cetuximab is a drug targeting the epidermal growth factor receptor, which is indicated for the treatment of unresectable advanced or recurrent head and neck or colorectal cancer. Cetuximab also enhances the cytotoxic effects of radiation in squamous cell carcinoma. The severity of infusion reactions (IR) is categorized from grade 1 to 5; grades 3 and 4 are associated with life-threatening reactions (anaphylaxis), whereas grade 5 indicates death. The incidence of grade 3-4 IR with premedication is reported to be 1.1%. We herein describe a case of a 77-year-old man who developed IR during intravenous administration of cetuximab. The patient developed grade 3-4 anaphylaxis with pruritus, rash and urticaria, followed by hypotension and bradycardia. The timely diagnosis and treatment with intravenous infusion of a vasopressor drug and Ringer's acetate solution proved to be effective. The case presented herein demonstrated an unfeatured aspect of cetuximab-related IR as dermatological reactions over the entire body followed by circulatory collapse.

The role of computed tomography and magnetic resonance imaging in diagnosing clear cell ameloblastoma: A case report.

Ameloblastoma is the most common and clinically relevant type of odontogenic tumor. Clear cell odontogenic carcinoma is histologically characterized by solid sheets and nests of clear cells, whereas clear cell ameloblastoma (CCAM) is histologically characterized by an ameloblastomatous component intermixed with an extensive clear cell component. A total of 12 reports have been published on the histological etiology for CCAM; however, no reports have made regarding the detailed computed tomography and/or magnetic resonance imaging features of tumors of this type. The present study describes a case of a well-circumscribed 20-mm radiolucent lesion of the anterior mandible that was misdiagnosed as a clear cell odontogenic carcinoma. The study describes the detailed radiological characteristics of a case of CCAM.

Simultaneous occurrence of keratocystic odontogenic tumor and ameloblastoma in the mandible: A case report.

Keratocystic odontogenic tumors (KCOTs) and ameloblastomas are benign odontogenic tumors that primarily occur in the molar region of the mandible. However, it is uncommon for these tumors to arise simultaneously in a patient's jaw. The present study reported the diagnostic process and features of a rare case of the simultaneous occurrence of KCOT and ameloblastoma in the mandible of a 45-year-old male. Image-based diagnosis was challenging due to several conditions, including the intactness of the teeth and bone cortex as well as the sizes and locations of the lesions. Based on radiographic evidence, the patient was initially misdiagnosed and underwent a biopsy for a radicular cyst and a simple bone cyst prior to the correct diagnoses of KCOT and ameloblastoma, respectively. In addition, the present study discussed the diagnostic process of the present case and reviewed previous literature regarding the simultaneous occurrence of benign tumors of the jaw.

The expression of cytokeratin in keratocystic odontogenic tumor, orthokeratinized odontogenic cyst, dentigerous cyst, radicular cyst and dermoid cyst.

The epithelial lining of odontogenic keratocysts exhibits either parakeratosis or orthokeratosis. In 2005, the WHO classified odontogenic keratocysts with parakeratosis as keratocystic odontogenic tumors (KCOT). Odontogenic keratocysts with orthokeratosis were not classified as odontogenic tumors, but instead referred to as orthokeratinized odontogenic cysts (OOC). To clarify the difference between these two lesions, we investigated their biological characteristics using immunohistochemical studies for cytokeratins (CK) in KCOT and OOC as well as in dentigerous cysts (DC), radicular cysts (RC) and dermoid cysts (DMC). We examined twenty-five cases of KCOT, fifteen cases each of OOC, DC and RC, and ten cases of DMC. We studied the immunohistochemical expression of CK10, 13, 17 and 19. To evaluate the immunohistochemical staining pattern, we divided the epithelial lining of the lesions into three layers (surface layer: su, spinous layer: sp, basal layer: ba). For CK10, most OOC and DMC specimens of su and sp were positive. For CK13 and 19, most KCOT, DC and RC specimens of su and sp were positive. For CK17, most KCOT specimens of su and sp were positive. The percentages of total CK expression of su and sp, and ba of CK19 differed significantly between the lesions (P < 0.001). These results support the hypothesis that OOC originate from not the odontogenic apparatus, but the oral epithelial component.

CT and MR images of pleomorphic adenoma in major and minor salivary glands.

PURPOSE: To investigate the CT and MR imaging features of pleomorphic adenoma in the head and neck area. MATERIALS AND METHODS: Our materials of this study consisted of 50 pleomorphic adenomas from 50 patients which were all histopathologically diagnosed. The CT and MR images were retrospectively evaluated. The following features were evaluated: the detectability of the lesion, the tumor margin, the border of the lesion, the aspect of the lesion, the contrast between the lesion and surrounding tissue, the signal intensity of the lesion, the enhancement of contrast medium, the aspect of the lesion after the injection of contrast medium, the detectability of the capsule, and the detectability of bone resorption of the lesion. RESULTS: The tumor detectabilities were 77% on axial plain CT images and 90% on axial CE CT images, respectively. On CT images, pleomorphic adenoma tended to show a well-defined margin, a smooth border, an inhomogeneous aspect, a low or high contrast, and intermediate or high signal intensity. After contrast medium administration, pleomorphic adenoma tended to show a slightly high enhancement and either an inhomogeneous or a periphery enhancement on the CE CT images. The capsule could be hardly detected on CT images. The tumor detectabilities were 86% on axial T1-weighted MR images, 88% on axial T2-weighted MR images, and 85% on axial CE T1-weighted MR images, respectively. On MR images, pleomorphic adenomas tended to show well-defined margin, a lobulate border, an inhomogeneous aspect, a high contrast, and intermediate or high signal intensity. After contrast medium administration, pleomorphic adenoma tended to show a high enhancement and either an inhomogeneous or a periphery enhancement on MR images. The capsule could be detected in many cases on MR images. CONCLUSIONS: It was possible to detect the capsule in pleomorphic adenoma using MR images. The pleomorphic adenomas in head and neck area should be evaluated with MR images.