Multiple Myeloma with Primary Manifestation in the Mandible.

Multiple myeloma (MM) is a malignant neoplasm of plasma cell origin. It usually has a multicentric origin within the bone. It contributes to about 1% of all malignancies and 15% of all hematologic malignancies. There is a monoclonal proliferation of abnormal plasma cells in this disease that results from a single malignant precursor that has undergone an uncontrolled mitotic division. Later, these cells produce one type of immunoglobulin light chain, either kappa or lambda. We present a case of a 46­year­old male patient who presented with a swelling of the mandible. The punched-out radiolucencies in the skull radiograph and the immunohistochemistry confirmed the case as MM.

Diagnostic Value of Extraoral Periapical Radiograph in Comparison to Intraoral Periapical Radiograph: A Cross-sectional, Institutional Study.

BACKGROUND: Radiographs form an invaluable adjunct in diagnosis, treatment planning, and postoperative evaluation during patient management in the dental office where intraoral periapical (IOPA) radiographs are the ones most commonly used. However, certain conditions render the placement of film difficult. In such cases, a panoramic radiograph may be taken, but it has the disadvantage of higher radiation exposure and cost. Extraoral periapical (EOPA) technique allows radiographs to be taken on an IOPA film by placing it extraorally. We aimed to evaluate its diagnostic accuracy compared to intraoral bisecting angle technique. MATERIALS AND METHODS: Forty-five patients were randomly selected. Ninety radiographs were taken; two for each patient. First image was obtained by intraoral bisecting angle technique and second by EOPA technique. A scale was devised for the comparison of radiographs taken by the two techniques. Two experienced oral radiologists rated them based on the scale followed by statistical analysis. RESULTS: Patients reported increased compliance with the EOPA technique. 84.40% of the EOPA radiographs (EOPARs) were diagnostically acceptable; sensitivity and specificity was 84% and 55%, respectively. CONCLUSION: EOPAR is beneficial in cases where intraoral film placement is difficult, and a radiograph is necessary for patient management, even though it demonstrates comparatively lesser diagnostic accuracy.

Prevalence of Ponticulus Posticus on Lateral Cephalometric Radiographs, its Association with Cervicogenic Headache and a Review of Literature.

OBJECTIVES: The aim of this study was to calculate the prevalence of ponticulus posticus (a small bony bridge on the dorsal aspect of the atlas on lateral digital cephalometric radiographs) and classify it into a complete ring or an incomplete ring. The study also investigated its association with the presence or absence of cervicogenic headache in the examined population; a literature review of ponticulus posticus is also presented. METHODS: The presence and types of ponticuli posticus were investigated on 500 digital lateral cephalograms and the same patients were questioned for a history of cervicogenic headache. RESULTS: In 500 patients, 79 ponticulus posticus (34 complete and 45 incomplete) were identified on the lateral cephalograms; therefore, the prevalence was 15.8%. The distribution of the type of ponticulus posticus was 13.1% in males and 17.9% in females in the studied sample. The overall prevalence of cervicogenic headache was 6% in the studied sample with a significant association between cervicogenic headache and type of ponticulus posticus. CONCLUSIONS: The study shows that ponticulus posticus is not a rare finding and its association with unexplainable headache, neck pain, and other symptoms as well as its importance and implications during management of cervical spine surgical procedures, especially those requiring lateral mass screw placements in the atlas, imply that radiologists and dentists in general should closely inspect the vertebral region on a lateral cephalogram.

Nevoid Basal Cell Carcinoma Syndrome - Clinical and Radiological Findings of Three Cases.

Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder, characterized by skeletal anomalies and multiple keratocystic odontogenic tumors of the jaws. The skeletal anomalies of this syndrome are mandibular prognathism, bossing of frontal and parietal bones, high-arched palate, and bifid rib. We report three cases with NBCCS, emphasizing the clinical and radiographic findings, the importance of the early diagnosis of NBCCS, and a preventive multidisciplinary approach in the management of NBCCS.

Non-Familial Cherubism with Bilateral Maxilla and Mandible Involvement - Clinicoradiographic Findings.

Cherubism is a self-limiting non-neoplastic autosomal dominant fibro-osseous syndrome of the jaws. It is occasionally manifested before the age of two years. It occurs in children and more often in boys. It is characterized by notable clinical bilateral swelling of the cheeks due to a bony enlargement of the jaws that impart a characteristic 'cherubic' look. Regression occurs in the course of puberty leaving a few facial deformities and malocclusion. Cherubism might occur in solitary cases or in several members of the family, often in many generations. The reported case is an example of solitary sporadic occurrence within a family, which is a rarely documented condition in the literature.

Sexual dimorphism of foramen magnum using Cone Beam Computed Tomography.

OBJECTIVES: The aim of this study was to evaluate whether the foramen magnum (FM) dimensions could be used for sex determination using the Cone Beam Computed Tomography (CBCT). METHODS: Two hundred and sixty six CBCT full Field Of View (FOV) scans (111 males and 115 female subjects) of the skull were retrospectively selected and the FM length, width measured on reconstructed axial cross section by two observers using the CS 3D imaging software at a slice thickness of 300 µm and the FM area subsequently calculated using two established formulae by Routal and Teixeira. All data were subjected to descriptive and discriminant functional analysis to validate the expression of sexual dimorphism in the metric parameters of FM. RESULTS: Using the FM dimensions the overall accuracy rate of sex determination was 66.4%. Out of these, 70.3% of males and 62.6% of females were sexed correctly. The best parameter for sex determination was the Area of the FM. In addition, the accuracy rate of sex prediction using the Area dimensions (Teixeira's formula) was 66.4%, same as that of all the four FM parameters used together. CONCLUSION: This study validates that there is statistically significant expression of sexual differences in the foramen magnum region, which may prove useful and reliable in predicting sex in partial skull remains by discriminant function analysis when other methods tend to be inconclusive. It suggests the reliability, usability and accuracy of CBCT in forensic identification.