Postoperative CT findings of orthognathic surgery and its complications: A guide for radiologists.

Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by orthognathic surgery can improve facial esthetics, masticatory function, articulation, and breathing. The most common types of osteotomies include the combination of Le Fort I osteotomy, bilateral sagittal split mandibular ramus osteotomy, and genioplasty. High-resolution low-dose computed tomography is useful for evaluating the facial skeleton and soft tissues after surgery as well as for depicting a variety of possible complications. This article reviews the postoperative imaging findings of the most common orthognathic surgeries and their potential complications on multidetector-row computed tomography.

Ethmoidal silent sinus syndrome after nasal swab test.

This study reported the case of a healthy male in his 40s who presented with a 3-month history of frontal headache and post-nasal drip, which did not improve with oral antibiotics. One month prior to the onset of the symptoms, he underwent a nasopharyngeal swab testing for SARS-CoV-2 (which yielded a negative result) for a history of malaise and cough. The patient claimed that the swab insertion into the nasal cavity was particularly painful on the left side. Sinus computed tomography (CT) scan showed deformity of the left middle nasal turbinate with occlusion of the osteomeatal complex, resulting in ethmoid silent sinus syndrome. This study makes a significant contribution to the literature because nasopharyngeal, midturbinate and anterior nasal swabs have been recommended as initial diagnostic specimen collection methods by the US Centers for Disease Control and Prevention (CDC) for the coronavirus disease 2019. These methods require introducing an instrument into the nasal cavity, potentially leading to adverse effects due to the delicate and complex nasal anatomy. However, complications related to swab testing for respiratory pathogens have not yet been fully discussed in the literature.

Sinus computed tomography findings in patients with COVID-19.

OBJECTIVE: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease. METHODS: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity. RESULTS: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05). CONCLUSION: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

Sinus computed tomography findings in patients with COVID-19 / Achados de imagem em tomografias computadorizadas de seios paranasais em pacientes com COVID-19

ABSTRACT Objective: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease. Methods: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity. Results: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05). Conclusion: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

RESUMO Objetivo: Analisar imagens de tomografia computadorizada de seios paranasais de pacientes com a doença por coronavírus 2019, e correlacionar os achados com a doença. Métodos: Foram analisadas imagens de tomografia computadorizada de 95 pacientes submetidos a teste de reação em cadeia da polimerase para coronavírus 2 da síndrome respiratória aguda grave. Os dados clínicos foram obtidos por meio dos prontuários dos pacientes e de ligações telefônicas. A opacificação dos seios paranasais foi graduada e comparada entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave. Resultados: Vinte e oito (29,5%) dos pacientes tiveram resultado positivo para coronavírus 2 da síndrome respiratória aguda grave (idade mediana de 52 [26-95] anos) e 67, resultado negativo (idade mediana de 50 [18-95] anos). O espessamento mucoso estava presente em 97,4% dos seios maxilares, 80% das células etmoidais anteriores, 75,3% das células etmoidais posteriores, 74,7% dos seios frontais e em 66,3% dos seios esfenoidais. Mínimo ou discreto espessamento mucoso (pontuação 1) e seios com aeração normal (pontuação 0) corresponderam a 71,4% e 21,3% de todos os seios paranasais, respectivamente. A nota média de cada seio paranasal entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave foi de 0,85±0,27 e 0,87±0,38, respectivamente (p=0,74). A nota mediana de opacificação dos seios paranasais entre pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave foi de 9 (intervalo interquartil de 8 a 10), comparada a 9 (intervalo interquartil de 5 a 10) em pacientes negativos (p=0,89). Não houve diferença na nota média ajustada para idade e sexo. A congestão nasal foi mais frequente em pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave que naqueles com resultados negativos (p=0,05). Conclusão: A infecção pelo coronavírus 2 da síndrome respiratória aguda grave apresentou associação com congestão nasal, mas não mostrou correlação com espessamento mucoso dos seios paranasais.

Fighting the invisible enemy: providing support and structure to radiology resident during the COVID-19 pandemic.

The objective of this article is to share the strategy we used in order to restructure the radiology and diagnostic imaging department of a referral institution during the coronavirus disease 2019 pandemic, on the basis of the current recommendations. It is essential to integrate the work of supervisors, preceptors, and residents, maintaining communication and sharing decisions, with mutual support, as well as to determine the best strategy to be adopted in this scenario of uncertainty and constant change, while also ensuring adequate emotional support for all parties.

O objetivo deste artigo é compartilhar a estratégia de como estruturamos o departamento de radiologia e diagnóstico por imagem de uma instituição de referência na pandemia da COVID-19, baseados nas recomendações vigentes. É fundamental a integração entre supervisores, preceptores e residentes, sempre mantendo comunicação e compartilhamento das decisões, com apoio mútuo, decidindo a melhor estratégia a ser seguida neste cenário de incertezas e de mudanças contínuas, garantindo ainda suporte emocional adequado a todos.

Endolymphatic hydrops evaluation on MRI: Practical considerations.

Four-hour delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence after intravenous gadolinium-based contrast agent administration is an optimal magnetic resonance imaging technique to evaluate endolymphatic hydrops in patients with known or suspected Ménière's disease. Nonenhanced endolymphatic space surrounded by enhanced perilymphatic space is evaluated in the cochlea and vestibule separately. In cochlear hydrops, the scala media is enlarged, potentially obliterating the scala vestibuli. In vestibular hydrops, the size of the saccule becomes equal to or larger than that of the utricle; as hydrops progresses, the saccule and utricle become larger and confluent until complete obliteration of the vestibule's perilymphatic space. In patients with a unilateral clinical presentation of Ménière's disease, it is possible to depict the asymmetries of perilymph enhancement, which may be increased on the affected side and reflect a permeability alteration of the blood-perilymph barrier. In addition, endolymphatic hydrops can be observed in the asymptomatic ear of these patients with a unilateral clinical presentation, showing that Ménière's disease tends to undergo bilateral evolution over time.

The role of magnetic resonance imaging in Ménière disease: the current state of endolymphatic hydrops evaluation.

Technical advances in magnetic resonance imaging have allowed to accurately detect and grade endolymphatic space distension in Ménière disease; this was only possible in post-mortem histological studies until a few years ago. Magnetic resonance imaging rules out other causes of vertigo and hearing loss, and is able to evaluate the cochlear and vestibular compartments of the endolymphatic space using a dedicated protocol.

The role of magnetic resonance imaging in Ménière disease: the current state of endolymphatic hydrops evaluation / O papel da ressonância magnética na doença de Ménière: a avaliação da hidropsia endolinfática nos dias atuais

ABSTRACT Technical advances in magnetic resonance imaging have allowed to accurately detect and grade endolymphatic space distension in Ménière disease; this was only possible in post-mortem histological studies until a few years ago. Magnetic resonance imaging rules out other causes of vertigo and hearing loss, and is able to evaluate the cochlear and vestibular compartments of the endolymphatic space using a dedicated protocol.

RESUMO Os avanços técnicos na ressonância magnética têm permitido detectar e classificar com acurácia a distensão do espaço endolinfático na doença de Ménière; isso só era possível nos estudos histológicos post-mortem até poucos anos atrás. Além de afastar outras causas de vertigem e de perda auditiva, a ressonância magnética é capaz de avaliar os compartimentos coclear e vestibular do espaço endolinfático por meio de um protocolo dedicado.

Characteristics related to TMJ arthralgia, visualized by magnetic resonance imaging (3.0 Tesla).

PATIENTS: Six women, with ages ranging from 52 to 64 years old, clinically evaluated (Research Diagnostic Criteria for Temporomandibular Disorders) by a single examiner were submitted to MRI (3.0 T). They had only arthralgia diagnosis. The images were evaluated by two radiologists who were not informed about the patients' clinical conditions, in which discs displacements, osteophytes and morphological irregularities, as well as completely normal images, i.e., without any characteristics were identified. DISCUSSION: TMJ arthralgia can be caused by various conditions, few of which are objectively observed when investigating its causes or diagnose temporomandibular disorders (TMD). In some cases, imaging exams can detect some conditions and magnetic resonance imaging (MRI) is commonly used for this purpose. Here, the MRI (3.0 T) enabled a detailed visualization of the structures of the TMJ, allowing the characterization of the symptomology in some cases. Despite, some images were completely normal. CONCLUSION: This case report detected some features seen on the MRI that justified a clinical diagnosis arthralgia, not associated with other clinical diagnosis. However, the detailed clinical examination should be sovereign even in the face of equipment with advanced technology.

The correlation of research diagnostic criteria for temporomandibular disorders and magnetic resonance imaging: a study of diagnostic accuracy.

OBJECTIVE: The aim of this study was to evaluate the performance of research diagnostic criteria for temporomandibular disorders (RDC/TMD) as a diagnostic test for temporomandibular joint problems using magnetic resonance imaging (MRI) as the gold standard. STUDY DESIGN: Sixty-seven women were assessed with RDC/TMD (2 examiners) and underwent MRI examination (3.0 T). Images were evaluated by 2 independent radiologists blinded to the clinical diagnoses. Results were analyzed by the Catmaker system. RESULTS: Of the 67 patients, 44 were diagnosed with temporomandibular disorders (TMD) according to RDC/TMD, but 21 (32%) of the diagnoses were not confirmed by MRI. The RDC/TMD sensitivity was 83.0%, specificity was 53.0%, and the positive likelihood ratio was 1.77, whereas the negative likelihood ratio was 0.32 (P = 0.16). CONCLUSIONS: Our data suggest that RDC/TMD is a good research tool, but the high rate of false-positive results limits its use in clinical practice.

Aspectos de imagem na tendinite calcária pré-vertebral / Imaging findings in acute calcific prevertebral tendinitis

A tendinite calcária aguda pré-vertebral é uma condição benigna e rara que apresenta calcificação das fibras do músculo longo do pescoço com reação inflamatória local, sendo esta uma das formas de apresentação menos frequentes da doença por deposição de hidroxiapatita de cálcio. Manifesta-se com dor cervical aguda e/ou odinofagia, podendo ser erroneamente diagnosticada como abscesso retrofaríngeo, espondilodiscite ou alteração decorrente de trauma. Os achados radiológicos na tendinite calcária pré-vertebral são patognomônicos. O conhecimento de tais achados é muito importante, pois o correto diagnóstico possibilita a resolução precoce dos sintomas e evita intervenções desnecessárias em um paciente que apresenta afecção com boa resposta ao tratamento conservador.

Acute calcific prevertebral tendinitis is a benign and rare condition that presents calcification of the superior oblique fibers of longus colli muscle with local inflammatory reaction. Such condition is one of the less common presentations of calcium hydroxyapatite deposition disease. Clinical signs are usually acute neck pain and odynophagia, and it may be misdiagnosed as retropharyngeal abscess, spondylodiscitis or traumatic injury. The imaging findings in calcific prevertebral tendinitis are pathognomonic. The knowledge of such findings is extremely important to avoid unnecessary interventions in a patient presenting a condition with a good response to conservative treatment.