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Cone-Beam Computed Tomography-Sialography (Sialo-CBCT) is used to demonstrate salivary ductal structure. This study aimed to conduct a volumetric analysis of the anatomical morphology of Normal-Appearing Glands (NAGs) in parotid sialo-CBCT. Our retrospective study included 14 parotid sialo-CBCT scans interpreted as NAGs in 11 patients with salivary gland impairment. The main duct length and width, as well as number and width of secondary and tertiary ducts were manually evaluated. We found that the main parotid duct showed an average width of 1.39 mm, 1.15 mm, and 0.98 mm, for the proximal, middle and distal thirds, respectively. The arborization pattern showed approximately 20% more tertiary (average number 11.1 ± 2.7) than secondary ducts (average number 9.0 ± 2.4) and approximately 8% narrower tertiary ducts (average width 0.65 ± 0.11 mm) compared to the secondary ducts (average width 0.77 ± 0.14 mm). Our anatomical analysis of NAGs in parotid sialo-CBCT demonstrated progressive narrowing of the main duct and increasing arborization and decreasing lumen size starting from the primary to the tertiary ducts. This is the most updated study regarding the anatomy of the parotid glands as demonstrated in sialo-CBCT. Our results may provide clinicians with the basic information for understanding aberration from normal morphology, as seen in salivary gland pathologies as well facilitate planning of treatment strategies, such as minimally invasive sialo-endoscopies, commonly practiced today.
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OBJECTIVES: To develop an automated deep-learning algorithm for detection and 3D segmentation of incidental bone lesions in maxillofacial CBCT scans. METHODS: The dataset included 82 cone beam CT (CBCT) scans, 41 with histologically confirmed benign bone lesions (BL) and 41 control scans (without lesions), obtained using three CBCT devices with diverse imaging protocols. Lesions were marked in all axial slices by experienced maxillofacial radiologists. All cases were divided into sub-datasets: training (20,214 axial images), validation (4530 axial images), and testing (6795 axial images). A Mask-RCNN algorithm segmented the bone lesions in each axial slice. Analysis of sequential slices was used for improving the Mask-RCNN performance and classifying each CBCT scan as containing bone lesions or not. Finally, the algorithm generated 3D segmentations of the lesions and calculated their volumes. RESULTS: The algorithm correctly classified all CBCT cases as containing bone lesions or not, with an accuracy of 100%. The algorithm detected the bone lesion in axial images with high sensitivity (95.9%) and high precision (98.9%) with an average dice coefficient of 83.5%. CONCLUSIONS: The developed algorithm detected and segmented bone lesions in CBCT scans with high accuracy and may serve as a computerized tool for detecting incidental bone lesions in CBCT imaging. CLINICAL RELEVANCE: Our novel deep-learning algorithm detects incidental hypodense bone lesions in cone beam CT scans, using various imaging devices and protocols. This algorithm may reduce patients' morbidity and mortality, particularly since currently, cone beam CT interpretation is not always preformed. KEY POINTS: ⢠A deep learning algorithm was developed for automatic detection and 3D segmentation of various maxillofacial bone lesions in CBCT scans, irrespective of the CBCT device or the scanning protocol. ⢠The developed algorithm can detect incidental jaw lesions with high accuracy, generates a 3D segmentation of the lesion, and calculates the lesion volume.
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Aprendizado Profundo , Humanos , Algoritmos , Tomografia Computadorizada de Feixe Cônico/métodos , Processamento de Imagem Assistida por ComputadorRESUMO
OBJECTIVE: To assess the combination of salivary gland intraductal irrigations (IG) followed by sialoendoscopy irrigations (SI) of the parotid gland on the improvement of salivary gland secretory dysfunction (SGSD). METHODS: We retrospectively analyzed the records of SGSD patients who underwent major salivary gland IG followed by SI during 2014-2020. Records included demographics, systemic background, signs, and symptoms. Improvement was assessed by comparing the mean unstimulated and stimulated whole salivary flow rate (UWSF, SWSF) from the baseline point (before IG procedure) to the last point (after SI) using repeated measures. The between-subjects effects of various factors and covariants were analyzed using repeated measures ANCOVA. RESULTS: One hundred patients were included with an age range of 15-83 years (mean age of 60.1 ± 13.1 years). Improvement was detected on UWSF measurements (p = 0.031, F = 3.83), but not on SWSF measurements (p = 0.165, F = 1.85). The between-subjects effects on UWSF measurements were statistically significant for sex (p = 0.003, F = 9.526) and salivary gland manipulators use (p < 0.001, F = 15.107) and for the interaction between sex and salivary gland manipulators use (p- = 0.002, F = 9.709). Results of long-term follow-up for 10.87 ± 11.79 months after the SI procedure demonstrated sustained improvement in UWSF measurements (p = 0.011, F = 4.91). CONCLUSIONS: The combination of IG followed by SI increases UWSF salivary secretion in SGSD patients for a relatively extended duration.
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BACKGROUND: Iodinated contrast media allergy is considered as a strong contra-indication for performing sialography. There is little evidence to support this approach. OBJECTIVE: To evaluate the rate of iodinated contrast media (ICM) allergy in subjects undergoing sialography and to assess the risk for allergic responses in patients with a previous diagnosis of allergy. METHODS: We retrospectively reviewed sialo-CBCT studies performed from 2014 to 2019. During the study period we implemented a protocol for performing sialo-CBCT in patients with a prior diagnosis of allergy: 1) Clinical data were collected from a questionnaire and medical records. 2) No premedication was administered but, instead, oxygen, epinephrine and a resuscitation cart were accessible. 3) Following the procedure, each patient was observed for one hour and contacted by telephone 24 hrs later. RESULTS: No allergic responses were documented in the medical records of 1515 subjects following sialo-CBCT studies, including 13 individuals previously diagnosed with ICM allergy. Investigation of the subgroup with prior allergy disclosed that the range of injected volume was between 2 ml to 6.2 ml per patient and that complete secretion of ICM was detected in 7 of 13 patients. In the remainder of subjects, retention rates of 5-50% were observed. CONCLUSIONS: Allergic reactions are exceedingly rare following sialo-CBCT studies regardless of a previous diagnosis of allergy. Pre-medication with corticosteroids and antihistamines is usually not warranted.
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Hipersensibilidade a Drogas , Hipersensibilidade , Humanos , Meios de Contraste/efeitos adversos , Sialografia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Estudos RetrospectivosRESUMO
PURPOSE: To determine the immediate pain-relieving effect of photobiomodulation therapy (PBMt) in patients with oral ulcers of chronic graft-versus-host disease (cGVHD) refractory to first line therapy with topical corticosteroids. METHODS: This retrospective study included all patients who underwent PBMt for pain relief of refractory oral cGVHD lesions. PBMt was applied using an intraoral approach to all sites with mucosal lesions, using a 940 nm InGaAsP diode laser device, with the following parameters: pulsed modulation (duty cycle of 50%), power 0.7 W, illuminated spot size 7.1 cm2, irradiance 98.6 mW/cm2, and irradiation time 90 s per point. Pain was self-assessed using a 0-to-10 scale immediately before and after PBMt. RESULTS: Data from eleven patients with a total of 56 PBMt sessions were analyzed. In 48 (85.7%) sessions, the patients reported less pain immediately after treatment, with a reduction of ≥ 50% of the initial pain level in 43 (76.8%) sessions. Mean pre- and post-treatment pain levels were 5.20 ±2.7 and 1.38 ±2.1, respectively (p < 0.001), i.e., a post-treatment reduction of 73.4% of the initial pain level. The benefits of the treatment remained for a mean of 6.50 ±5.4 days (range of 2 to 14 days). No adverse effects were reported. CONCLUSIONS: PBMt seems to be a promising treatment modality for refractory oral cGVHD lesions as a rapid pain reliever with relatively long-lasting effects.
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Dor Crônica/radioterapia , Doença Enxerto-Hospedeiro/complicações , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Úlceras Orais/complicações , Manejo da Dor/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doença Crônica , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia. METHODS: A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I2 . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols. RESULTS: Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion. CONCLUSIONS: This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.
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Luxações Articulares , Transtornos da Articulação Temporomandibular , Protocolos Clínicos , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Transtornos da Articulação Temporomandibular/diagnóstico por imagemRESUMO
OBJECTIVE: Sjogren's syndrome (SjS) causes salivary gland impairment leading to oral dryness. Parotid sialo-cone-beam computerized tomography (sialo-CBCT) demonstrates ductal architecture and to a lesser extent gland activity. This study characterizes radiographic features of patients suspected for SjS and looks for a possible correlation with the diagnosis of SjS. METHODS: The clinical and radiographic data of suspected SjS/dry mouth patients referred for sialo-CBCT in 2011-2014 were reviewed retrospectively. Two observers studied the scans for various radiographic features including duct morphology, level of branching, ductopenia and sialectasia. These features were analysed taking the specific clinical data and two sets of SjS criteria: The 2002 American-European Consensus Group (AECG) and the 2012 American College of Rheumatology (ACR) Group. RESULTS: Sialo-CBCT scans of 67-referred patients suffering from dry mouth (115 parotid glands) were included. Intraradiographic association was found between ductopenia and all other radiographic parameters. Minimal, yet important, radiographic differences were found between left and right parotid glands. AECG-confirmed-SjS patients showed strong correlation with radiographic features, whereas ACR 2012-confirmed-SjS patients did not. CONCLUSION: Sialo-CBCT demonstrates novel radiographic features which may clarify the diagnosis of SjS. Further studies are needed to determine the role of sialo-CBCT in diagnosis of SjS.
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Tomografia Computadorizada de Feixe Cônico , Glândula Parótida/diagnóstico por imagem , Glândulas Salivares/diagnóstico por imagem , Síndrome de Sjogren/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVES: To assess the effect of major salivary gland intraductal irrigations (IGs) to relieve mouth dryness. METHODS: We retrospectively analyzed the records of patients with mouth dryness who underwent major salivary gland IG during 2013-2015. Records included demographics, medical background, dry mouth etiologies and symptomatology, and results of sialometry and sialo-cone-beam computerized tomography. Subjective improvement following the IG procedure (yes/no) and sustained subjective improvement (mouth dryness relief for ≥1 month) were recorded. Objective improvement was assessed by comparing the mean unstimulated (USF) and stimulated (SSF) whole salivary flow (WSF) rate before and after the IG. RESULTS: Seventy-four patients were included [mean age: 59.08 ± 12.46 years]. Improvement was detected in the USF (p = .027), but not in the SSF (p = .878). Fifty-five (84.6%) noted subjective improvement, while 10 (15.4%) did not. Subjective improvement was positively associated with the USF following IG (p = .037), with salivary gland swelling episodes (p = .033), and with difficulties in swallowing dry foods (p = .014). Of those with subjective improvement, 45 (81.8%) reported sustained improvement, which was positively associated with lack of a gritty eye sensation (p = .042) and abnormal sialo-CBCT findings (p = .001). CONCLUSIONS: Major salivary gland IG is a simple and safe procedure that may relieve dry mouth for a relatively extended duration. Further studies are needed to confirm these preliminary findings and assess their underlying mechanisms.
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Irrigação Terapêutica/métodos , Xerostomia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Saliva , Glândulas Salivares , Salivação , Taxa Secretória , Resultado do TratamentoRESUMO
Two major arms of the inflammatory response are the NF-κB and c-Jun N-terminal kinase (JNK) pathways. Here, we show that enteropathogenic Escherichia coli (EPEC) employs the type III secretion system to target these two signalling arms by injecting host cells with two effector proteins, NleC and NleD. We provide evidence that NleC and NleD are Zn-dependent endopeptidases that specifically clip and inactivate RelA (p65) and JNK, respectively, thus blocking NF-κB and AP-1 activation. We show that NleC and NleD co-operate and complement other EPEC effectors in accomplishing maximal inhibition of IL-8 secretion. This is a remarkable example of a pathogen using multiple effectors to manipulate systematically the host inflammatory response signalling network.
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Escherichia coli Enteropatogênica/fisiologia , Infecções por Escherichia coli/imunologia , Proteínas de Escherichia coli/imunologia , Interações Hospedeiro-Patógeno , Proteínas Quinases JNK Ativadas por Mitógeno/imunologia , NF-kappa B/imunologia , Apoptose , Escherichia coli Enteropatogênica/imunologia , Proteínas de Escherichia coli/genética , Expressão Gênica , Células HeLa , Humanos , Interleucina-8/genética , Interleucina-8/imunologia , Proteína Quinase 9 Ativada por Mitógeno/imunologia , Fator de Transcrição RelA/imunologia , Transcrição Gênica , Fator de Necrose Tumoral alfa/imunologiaRESUMO
The worldwide prevalence of leishmaniasis is increasing because of ecologic changes and increased medical profession awareness. Furthermore, solitary cases have been recently reported in Western countries. The authors describe the epidemiology, mode of transmission, and diagnosis of leishmaniasis and present 4 oral cases treated with systemic, localized, or combined therapy. The authors suggest that clinicians should maintain a high index of suspicion for atypical, resistant, oral and perioral lesions in individuals with a history of traveling in certain geographic regions. After diagnosis, treatment should be determined jointly by experts from the fields of oral and maxillofacial surgery, oral medicine, and dermatology based on leishmaniasis species and clinical presentation.
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Antiprotozoários/uso terapêutico , Leishmaniose/diagnóstico , Doenças da Boca/parasitologia , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Animais , Gluconato de Antimônio e Sódio/uso terapêutico , Diagnóstico Diferencial , Doenças Endêmicas , Feminino , Humanos , Leishmania braziliensis/isolamento & purificação , Leishmania infantum/isolamento & purificação , Leishmania major/isolamento & purificação , Leishmaniose/tratamento farmacológico , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Doenças Labiais/tratamento farmacológico , Doenças Labiais/parasitologia , Masculino , Doenças da Boca/tratamento farmacológico , Adulto JovemRESUMO
PURPOSE: This study addressed the challenge of detecting and classifying the severity of ductopenia in parotid glands, a structural abnormality characterized by a reduced number of salivary ducts, previously shown to be associated with salivary gland impairment. The aim of the study was to develop an automatic algorithm designed to improve diagnostic accuracy and efficiency in analyzing ductopenic parotid glands using sialo cone-beam CT (sialo-CBCT) images. METHODS: We developed an end-to-end automatic pipeline consisting of three main steps: (1) region of interest (ROI) computation, (2) parotid gland segmentation using the Frangi filter, and (3) ductopenia case classification with a residual neural network (RNN) augmented by multidirectional maximum intensity projection (MIP) images. To explore the impact of the first two steps, the RNN was trained on three datasets: (1) original MIP images, (2) MIP images with predefined ROIs, and (3) MIP images after segmentation. RESULTS: Evaluation was conducted on 126 parotid sialo-CBCT scans of normal, moderate, and severe ductopenic cases, yielding a high performance of 100% for the ROI computation and 89% for the gland segmentation. Improvements in accuracy and F1 score were noted among the original MIP images (accuracy: 0.73, F1 score: 0.53), ROI-predefined images (accuracy: 0.78, F1 score: 0.56), and segmented images (accuracy: 0.95, F1 score: 0.90). Notably, ductopenic detection sensitivity was 0.99 in the segmented dataset, highlighting the capabilities of the algorithm in detecting ductopenic cases. CONCLUSIONS: Our method, which combines classical image processing and deep learning techniques, offers a promising solution for automatic detection of parotid glands ductopenia in sialo-CBCT scans. This may be used for further research aimed at understanding the role of presence and severity of ductopenia in salivary gland dysfunction.
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This study aimed to analyze the types and frequencies of panoramic technical errors in pediatric patients with special needs, as compared to matching images of patients with normal developmental patterns. Panoramic images of 100 pediatric patients, with equal numbers of either special needs or healthy controls, referred to our Oral Maxillofacial Imaging unit, were retrospectively examined by four blinded observers for the presence of four common technical errors: palatoglossal air space, movement, positioning errors, and foreign bodies appearance. In addition, they subjectively determined the image quality on an ordinal scale. The statistical examination included inter-observer correlation and correlations between demographic factors (age, gender, developmental status) and the number and types of errors. The frequencies of demonstrated errors were, in descending order: movement, positioning, palatoglossal air space, and foreign bodies' appearance. The special needs group images showed significantly more errors and were rated as low-quality radiographs. Younger patients in both groups showed more movement and positioning errors. Technical errors in panoramic images of patients with special needs were more frequently found. Therefore, increased awareness of the staff and appropriate pre-imaging instructions to the patients, are required when imaging pediatric patients, especially those with special needs.
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Corpos Estranhos , Língua , Humanos , Criança , Estudos Retrospectivos , Radiografia Panorâmica/métodos , Radiografia Dentária DigitalRESUMO
OBJECTIVES: When performing CBCT sialography (sialo-CBCT), space-occupying lesions may be identified incidentally. The objective was to describe their radiologic-clinical-histopathologic correlations. METHOD AND MATERIALS: The archive of sialo-CBCT scans was retrospectively searched for suspected space-occupying lesions. Based on the scan and clinical-histopathologic data, the cases were divided into "pathologic" vs "normal," "intra-parenchymal" vs "extra-parenchymal," and "benign" vs "malignant." Two precalibrated, blinded radiologists performed a survey of the radiographic features of each scan. Cohen kappa, chi-square, Kruskal-Wallis, and Mann-Whitney tests assessed inter-observer agreement and radiologic-clinical-histopathologic correlations. RESULTS: In total, 27 (1.5%) suspected space-occupying lesions were found in 1,758 reports. Full follow-up data were available for 15 cases: four were "malignant," six were "benign," and the remaining five were "normal." Kappa showed substantial inter-observer agreement (0.8 to 1.0). Constant swelling correlated with "pathologic" cases (P = .003). Lesion diameter was greater in "pathologic" than "normal" (P < .001) cases, with a cut-off of 12.6 mm. Clinical and radiographic features were similar in "benign" and "malignant" lesions. "Intra-parenchymal" and "extra-parenchymal" space-occupying lesions correlated with "no-fill-region" (P = .01) and "main-duct-displacement" (P = .002), respectively. CONCLUSIONS: Suspected space-occupying lesions in sialo-CBCT with a diameter greater than 12.6 mm are likely to be "pathologic." No radiographic features were able to differentiate between "malignant" and "benign" space-occupying lesions.
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Tomografia Computadorizada de Feixe Cônico , Glândulas Salivares , Sialografia , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Estudos Retrospectivos , Glândulas Salivares/diagnóstico por imagem , Sialografia/métodos , Tomografia Computadorizada de Feixe Cônico EspiralRESUMO
While saliva regulates the interplay between the microbiota and the oral immune system, the mechanisms establishing postnatal salivary immunity are ill-defined. Here, we show that high levels of neutrophils and neonatal Fc receptor (FcRn)-transferred maternal IgG are temporarily present in the neonatal murine salivary glands in a microbiota-independent manner. During weaning, neutrophils, FcRn, and IgG decrease in the salivary glands, while the polymeric immunoglobulin receptor (pIgR) is upregulated in a growth arrest-specific 6 (GAS6)-dependent manner independent of the microbiota. Production of salivary IgA begins following weaning and relies on CD4-help, IL-17, and the microbiota. The weaning phase is characterized by a transient accumulation of dendritic cells capable of migrating from the oral mucosa to the salivary glands upon exposure to microbial challenges and activating T cells. This study reveals the postnatal mechanisms developed in the salivary glands to induce immunity and proposes the salivary glands as an immune inductive site.
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Microbiota , Receptores de Imunoglobulina Polimérica , Camundongos , Animais , Saliva , Glândulas Salivares , Imunoglobulina GRESUMO
The postnatal interaction between microbiota and the immune system establishes lifelong homeostasis at mucosal epithelial barriers, however, the barrier-specific physiological activities that drive the equilibrium are hardly known. During weaning, the oral epithelium, which is monitored by Langerhans cells (LC), is challenged by the development of a microbial plaque and the initiation of masticatory forces capable of damaging the epithelium. Here we show that microbial colonization following birth facilitates the differentiation of oral LCs, setting the stage for the weaning period, in which adaptive immunity develops. Despite the presence of the challenging microbial plaque, LCs mainly respond to masticatory mechanical forces, inducing adaptive immunity, to maintain epithelial integrity that is also associated with naturally occurring alveolar bone loss. Mechanistically, masticatory forces induce the migration of LCs to the lymph nodes, and in return, LCs support the development of immunity to maintain epithelial integrity in a microbiota-independent manner. Unlike in adult life, this bone loss is IL-17-independent, suggesting that the establishment of oral mucosal homeostasis after birth and its maintenance in adult life involve distinct mechanisms.
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Células de Langerhans , Microbiota , Adulto , Humanos , Interleucina-17 , Homeostase , Imunidade Adaptativa , Placa AmiloideRESUMO
The complex host-pathogen interplay involves the recognition of the pathogen by the host's innate immune system and countermeasures taken by the pathogen. Detection of invading bacteria by the host leads to rapid activation of the transcription factor NF-kappaB, followed by inflammation and eradication of the intruders. In response, some pathogens, including enteropathogenic Escherichia coli (EPEC), acquired means of blocking NF-kappaB activation. We show that inhibition of NF-kappaB activation by EPEC involves the injection of NleE into the host cell. Importantly, we show that NleE inhibits NF-kappaB activation by preventing activation of IKKbeta and consequently the degradation of the NF-kappaB inhibitor, IkappaB. This NleE activity is enhanced by, but is not dependent on, a second injected effector, NleB. In conclusion, this study describes two effectors, NleB and NleE, with no similarity to other known proteins, used by pathogens to manipulate NF-kappaB signaling pathways.
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Ativação Enzimática/fisiologia , Infecções por Escherichia coli/metabolismo , Proteínas de Escherichia coli/metabolismo , NF-kappa B/metabolismo , Transdução de Sinais/fisiologia , Fatores de Virulência/metabolismo , Western Blotting , Escherichia coli Enteropatogênica/metabolismo , Células HeLa , Humanos , Proteínas I-kappa B/metabolismo , Transporte Proteico/fisiologia , TransfecçãoRESUMO
Sialography combined with cone beam computerized tomography (sialo-CBCT) is an imaging technique that demonstrates the ductal system of the major salivary glands and allows evaluation of gland function. This review describes the sialo-CBCT technique, terminology, common pitfalls and limitations, as well as radiographic features and suggested pathogenicity of various salivary gland disorders, based on 1,758 sialo-CBCT examinations conducted over the last decade in one institution, and the current literature. The adoption of standardized terminology is proposed to prevent miscommunication, facilitate formulation of differential diagnoses, and thereby promote patient management: (1) Sialo-CBCT requires specific training, and operator experience is required for adequate glandular filling with minimal extravasation; (2) Limit injection-to-scan time to avoid pre-mature emptying; (3) The sialo-CBCT report should include a description of the morphology of the primary duct as well as the secondary, tertiary, and descending branches, the maximal branching level, the presence of sialectasis, overall glandular size, and parenchymal findings; (4) Functional evaluation is based on assessment of iodine clearance in the post evacuation image; (5) Sialectasis and ductopenia are the main findings in Sjogren syndrome and recurrent juvenile parotitis; (6) Sialodochitis with or without fillings defects or hyperdense calcifications characterize obstructive sialadenitis and sialolithiasis; (7) The findings following radioactive-iodine-induced damage are similar to obstructive sialadenitis, with atrophy in late stages; (8) In chronic graft-versus-host disease (cGVHD), variable presentations of ductopenia, sialectasis, and sialodochitis may be evident; (9) The red flags indicating a space-occupying lesion include areas of no filling, splaying of ducts, and primary duct deviation.
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Sialadenite , Tomografia Computadorizada de Feixe Cônico Espiral , Humanos , Padrões de Referência , Glândulas Salivares , Sialadenite/diagnóstico por imagem , SialografiaRESUMO
OBJECTIVES: The aims of this study were to identify radiographic features that distinguish osseous dysplasia-related osteomyelitis (OD-related OM) from OD without OM and to detect possible causes of OD-related OM. STUDY DESIGN: Seventeen OD cases with and without OM were examined on planar and volumetric (cone beam computed tomography or multidetector computed tomography) imaging. Cases were divided into 3 groups based on clinical data: symptomatic OM, incidental (asymptomatic) OM, and control (OD without OM). Images were reviewed by 3 precalibrated observers, blinded to clinical information, for OD characteristics (location and extent); radiographic features of OD-related OM; and possible causes. Radiographic features of OD-related OM chosen by at least 2 observers were statistically analyzed within and between groups. RESULTS: Discontinuity of the cortical plates, widening of the radiolucent rim, decreased attenuation of the radiolucent rim, and sequestrum formation were significantly more common in symptomatic and incidental OM groups than in the control group (P ≤ .05). Two causes, atrophy of the edentulous ridge and presence of a periapical lesion, were also correlated with OD-related OM (P ≤ .05, P ≤ .01, respectively). CONCLUSIONS: Radiographic features can distinguish OD-related OM from OD. Familiarity with these radiographic features and possible causes may help improve the identification of secondarily infected OD.
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Osteomielite , Osso e Ossos , Tomografia Computadorizada de Feixe Cônico , Humanos , Hiperplasia , Osteomielite/diagnóstico por imagemRESUMO
Postnatal host-microbiota interplay governs mucosal homeostasis and is considered to have life-long health consequences. The intestine monolayer epithelium is critically involved in such early-life processes; nevertheless, the role of the oral multilayer epithelium remains ill defined. We demonstrate that unlike the intestine, the neonate oral cavity is immensely colonized by the microbiota that decline to adult levels during weaning. Neutrophils are present in the oral epithelium prenatally, and exposure to the microbiota postnatally further recruits them to the preamble neonatal epithelium by γδT17 cells. These neutrophils virtually disappear during weaning as the epithelium seals. The neonate and adult epithelium display distinct turnover kinetics and transcriptomic signatures, with neonate epithelium reminiscent of the signature found in germ-free mice. Microbial reduction during weaning is mediated by the upregulation of saliva production and induction of salivary antimicrobial components by the microbiota. Collectively, unique postnatal interactions between the multilayer epithelium and microbiota shape oral homeostasis.
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Carga Bacteriana , Mucosa Bucal/imunologia , Mucosa Bucal/microbiologia , Neutrófilos/imunologia , Receptores de Antígenos de Linfócitos T gama-delta/imunologia , Saliva/microbiologia , Animais , Animais Recém-Nascidos/crescimento & desenvolvimento , Animais Recém-Nascidos/microbiologia , Interleucina-17/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Mucosa Bucal/citologia , Mucosa Bucal/crescimento & desenvolvimento , Células Th17/imunologiaRESUMO
OBJECTIVES: The aim of this study was to develop a computer vision algorithm based on artificial intelligence, designed to automatically detect and classify various dental restorations on panoramic radiographs. STUDY DESIGN: A total of 738 dental restorations in 83 anonymized panoramic images were analyzed. Images were automatically cropped to obtain the region of interest containing maxillary and mandibular alveolar ridges. Subsequently, the restorations were segmented by using a local adaptive threshold. The segmented restorations were classified into 11 categories, and the algorithm was trained to classify them. Numerical features based on the shape and distribution of gray level values extracted by the algorithm were used for classifying the restorations into different categories. Finally, a Cubic Support Vector Machine algorithm with Error-Correcting Output Codes was used with a cross-validation approach for the multiclass classification of the restorations according to these features. RESULTS: The algorithm detected 94.6% of the restorations. Classification eliminated all erroneous marks, and ultimately, 90.5% of the restorations were marked on the image. The overall accuracy of the classification stage in discriminating between the true restoration categories was 93.6%. CONCLUSIONS: This machine-learning algorithm demonstrated excellent performance in detecting and classifying dental restorations on panoramic images.