Soft Tissue Calcifications in the Head and Neck Region.

This article provides an overview of the soft tissue calcifications in the head and neck region as noted on dental imaging, with particular focus on the radiographic appearance of these entities..

Morphometric and morphological evaluation of mastoid emissary canal using cone-beam computed tomography.

OBJECTIVES: This study aimed to determine mastoid emissary canal's (MEC) and mastoid foramen (MF) prevalence and morphometric characteristics on cone-beam computed tomography (CBCT) images to underline its clinical significance and discuss its surgical consequences. METHODS: In the retrospective analysis, two oral and maxillofacial radiologists analyzed the CBCT images of 135 patients (270 sides). The biggest MF and MEC were measured in the images evaluated in MultiPlanar Reconstruction (MPR) views. The MF and MEC mean diameters were calculated. The mastoid foramina number was recorded. The prevalence of MF was studied according to gender and side of the patient. RESULTS: The overall prevalence of MEC and MF was 119 (88.1%). The prevalence of MEC and MF is 55.5% in females and 44.5% in males. MEC and MF were identified as bilateral in 80 patients (67.20%) and unilateral in 39 patients (32.80%). The mean diameter of MF was 2.4 ± 0.9 mm. The mean height of MF was 2.3 ± 0.9. The mean diameter of the MEC was 2.1 ± 0.8, and the mean height of the MEC was 2.1 ± 0.8. There is a statistical difference between the genders (p = 0.043) in foramen diameter. Males had a significantly larger mean diameter of MF in comparison to females. CONCLUSION: MEC and MF must be evaluated thoroughly if the surgery is contemplated. Radiologists and surgeons should be aware of mastoid emissary canal morphology, variations, clinical relevance, and surgical consequences while operating in the suboccipital and mastoid areas to avoid unexpected and catastrophic complications. CBCT may be a reliable imaging diagnostic technique.

Mönckeberg Medial Arteriosclerosis in a Geriatric Patient with Chronic Kidney Disease and Poorly Controlled Diabetes Reporting for a Dental Recall Visit.

Mönckeberg medial arteriosclerosis is a condition characterized by the calcification of the tunica media layer of the blood vessels that are visible on plain radiography or sectional tomography. In dentistry, a properly acquired panoramic radiograph may show the condition incidentally. It is also known as medial arterial calcinosis and can be associated with diabetes mellitus or chronic kidney disease. This condition is different from the more common atherosclerosis where the tunica intima remains unaffected, and the diameter of the vessel lumen is preserved. Dental treatment can be performed when the patient is stable with medically controlled diabetes.

Nasopharynx evaluation in children of unilateral cleft palate patients and normal with cone beam computed tomography.

OBJECTIVE: This study aimed to examine the morphological characteristics of the nasopharynx in unilateral Cleft lip/palate (CL/P) children and non-cleft children using cone beam computed tomography (CBCT). METHODS: A retrospective study consisted of 54 patients, of which 27 patients were unilateral CL/P, remaining 27 patients have no CL/P. Eustachian tubes orifice (ET), Rosenmuller fossa (RF) depth, presence of pharyngeal bursa (PB), the distance of posterior nasal spine (PNS)-pharynx posterior wall were quantitatively evaluated. RESULTS: The main effect of the CL/P groups was found to be effective on RF depth-right (p < 0.001) and RF depth-left (p < 0.001). The interaction effect of gender and CL/P groups was not influential on measurements. The cleft-side main effect was found to be effective on RF depth-left (p < 0.001) and RF depth-right (p = 0002). There was no statistically significant relationship between CL/P groups and the presence of bursa pharyngea. CONCLUSIONS: Because it is the most common site of nasopharyngeal carcinoma (NPC), the anatomy of the nasopharynx should be well known in the early diagnosis of NPC.

Frequency of spontaneous osteosarcomatous transformation of craniofacial fibrous dysplasia: a systematic review.

OBJECTIVE: A systematic review was undertaken to examine the spontaneous of craniofacial fibrous dysplasia (FD) into osteosarcoma (OS). STUDY DESIGN: Five databases were searched, and data were evaluated in 2 subsets: (1) frequency analysis involving only cross-sectional studies that specifically examined patients for osteosarcomatous transformation, thereby allowing a calculation of the frequency of transformation of craniofacial FD, and (2) case analysis of case reports and case series of FD that underwent osteosarcomatous transformation. Quality assessment of the studies in the frequency and case analyses was performed. RESULTS: Seven cross-sectional studies involving 779 patients in the frequency analysis documented transformation of craniofacial FD into OS in 13 patients, for a frequency of 1.67%. Of the 18 separate cases of osteosarcomatous transformation in the case analysis, 11 (61.1%) occurred in females, 11 (61.1%) developed from monostotic FD, and 7 (38.9%) arose in the mandible, with 5 in the maxilla (27.8%) and 6 (33.3%) in other craniofacial sites. The mean age of the patients at the time of malignant diagnosis was 36.4 years, with an average of 11.3 years from FD diagnosis to the appearance of OS. The quality of the articles ranged from fair to excellent. CONCLUSIONS: The risk of osteosarcomatous transformation of craniofacial FD is low, but the possibility of transformation should be taken into consideration by clinicians, as this will guide treatment and follow-up regimens.

Mönckeberg's medial arteriosclerosis in the oral and maxillofacial region: A pilot study.

OBJECTIVE: To evaluate the prevalence of medial vascular calcifications in the oral and maxillofacial region and their association with systemic diseases. MATERIALS AND METHODS: The study included 211 consecutive patients with systemic diseases (January 2015-May 2016). Medical history and radiographic images were evaluated. Univariate analysis (t-test) was performed for continuous variables (age). The Chi square test was applied for the categorical variables (Mönckeberg medial arteriosclerosis [MMA], gender). RESULTS: There was a 6.2% prevalence of MMA. The mean age of patients with MMA was 65.46 ± 13.38. The prevalence of kidney disease in patients with MMA was significantly higher than in those without MMA (p < 0.001). This finding was maintained even after adjusting for other systemic diseases (OR = 31.84 [8.63-136.78]). CONCLUSION: A significant prevalence of MMA in kidney disease patients was observed in this pilot study.

Convolutional Neural Network Performance for Sella Turcica Segmentation and Classification Using CBCT Images.

The present study aims to validate the diagnostic performance and evaluate the reliability of an artificial intelligence system based on the convolutional neural network method for the morphological classification of sella turcica in CBCT (cone-beam computed tomography) images. In this retrospective study, sella segmentation and classification models (CranioCatch, Eskisehir, Türkiye) were applied to sagittal slices of CBCT images, using PyTorch supported by U-Net and TensorFlow 1, and we implemented the GoogleNet Inception V3 algorithm. The AI models achieved successful results for sella turcica segmentation of CBCT images based on the deep learning models. The sensitivity, precision, and F-measure values were 1.0, 1.0, and 1.0, respectively, for segmentation of sella turcica in sagittal slices of CBCT images. The sensitivity, precision, accuracy, and F1-score were 1.0, 0.95, 0.98, and 0.84, respectively, for sella-turcica-flattened classification; 0.95, 0.83, 0.92, and 0.88, respectively, for sella-turcica-oval classification; 0.75, 0.94, 0.90, and 0.83, respectively, for sella-turcica-round classification. It is predicted that detecting anatomical landmarks with orthodontic importance, such as the sella point, with artificial intelligence algorithms will save time for orthodontists and facilitate diagnosis.

Oroantral communication, its causes, complications, treatments and radiographic features: A pictorial review.

PURPOSE: An oroantral communication (OAC) is an abnormal space between the maxillary sinus and oral cavity. The causes, complications, treatment, and radiographic features of OAC in 2-dimensional and 3-dimensional imaging modalities are discussed. MATERIALS AND METHODS: This pictorial review presents a broad spectrum of imaging findings of OAC. Representative radiographs depicting OAC were chosen from our database. PubMed was used to conduct a comprehensive literature search of OAC. RESULTS: Characteristic features of OAC include discontinuity of the maxillary sinus floor, thickening of the maxillary sinus mucosa, or a combination of both. Two-dimensional imaging modalities are the method of choice for identifying discontinuities in the maxillary sinus floor. However, 3-dimensional imaging modalities are also essential for determining the status of soft tissue in the maxillary sinus. CONCLUSION: The integration of 2-dimensional and 3-dimensional imaging modalities is crucial for the correct diagnosis and comprehensive treatment of OAC. However, the diagnosis of OAC must be confirmed clinically to prevent unnecessary mental and financial burdens to patients.

Rhinolith: An incidental radiographic finding.

Rhinoliths are foreign bodies composed of mineralised deposits in the nasal cavity that are rarely encountered in routine dental practice. The current report presents a case of a 77-year-old female patient who visited a dental treatment centre for a routine dental check-up and prophylaxis. On the clinical examination, the patient did not report any breathing difficulty, nasal obstruction, or any form of discharge. Panoramic radiography showed a horizontally magnified radiopaque structure in the right nasal fossa region. Cone-beam computed tomography (CBCT) revealed a hyperdense entity with a laminated presentation in the right nasal fossa. The hyperdense entity was diagnosed as a rhinolith based on the radiographic findings. Although the patient was asymptomatic, a referral was made to an ear, nose, and throat surgeon for a further evaluation. This report highlights the importance of CBCT imaging in the diagnosis of soft-tissue calcifications.

Radiology of Dental Caries.

Dental caries is a dynamic, preventable, reversible, complex biofilm-mediated, multifactorial disease that involves a series of demineralization/neutrality/remineralization of dental hard tissue in primary and permanent dentition. An imbalance in the continuum with a net demineralization over time results in the initiation of caries lesions. Visual inspection and intraoral radiographs are vital in caries detection, although they are of suboptimal sensitivity for early caries lesions. Shifting toward a conservative, noninvasive approach to caries management has resulted in the development of innovative-sensitive technologies. These newer techniques may serve as adjunct for the dental practitioner in detecting earliest changes in tooth structure.

The Digital Clone: Intraoral Scanning, Face Scans and Cone Beam Computed Tomography Integration for Diagnosis and Treatment Planning.

The purpose of this article is to synthesize different technologies that are available for the creation of a virtual patient, "the digital clone" because the data can be used for diagnosis as well as treatment planning. The role of facial scans, 3-dimensional intraoral scans as well as the cone beam computed tomography in the creation of a digital clone is discussed in detail. A step-by-step guide is created for the reader for integration of the intraoral scan data with the cone beam computed tomography Dicom data to create a digital clone.

Delayed diagnosis of a primary intraosseous squamous cell carcinoma: A case report.

Primary intraosseous squamous cell carcinoma is a rare malignant central jaw tumor derived from odontogenic epithelial remnants. Predominantly, it affects mandible, although both jaw bones may be involved. This report describes a 60-year-old man who was initially misdiagnosed with a periapical infection related to the right lower wisdom tooth. After four months, the patient presented to a private dental clinic with a massive swelling at the right side of the mandible. Panoramic radiographs and advanced imaging revealed a lesion with complete erosion of the right ramus, which extended to the orbital floor. A biopsy from the mandibular angle revealed large pleomorphic atypical squamous cells, which is the primary microscopic feature of a poorly differentiated squamous cell carcinoma.

Radiographic Diagnosis of Fibrous Dysplasia in Maxilla.

Fibrous dysplasia is a rare bone disorder characterized by the replacement of normal bone by abnormal fibrous tissue. Here we present a 16-year-old female with a fibrous dysplasia in the maxilla and obliteration of the sinus in the same side. Cone beam computed tomography scan revealed a mixed radiopacity that extended from the alveolar crest of the right posterior teeth to the right orbital floor in the superior-inferior direction. The radiopaque areas had homogenous ground glass appearance. There is a loss of bone trabeculation, thinning of the cortical boundaries but still intact, and a loss of the lamina dura around the right posterior permanent teeth. The radiographical features of the lesion were indicative of fibrous dysplasia in the maxilla.

Osteoma Cutis and Tonsillolith: A Cone Beam Computed Tomography Study.

In this study, we report a rare case of osteoma cutis (OC) and tonsillolith, diagnosed using cone beam computed tomography. The dystrophic calcifications in the face and tonsils were incidentally found during examination of the patient's scan with no relation to the main chief complaint. The diagnosis was OC, combined with dystrophic calcification of the tonsils. It is important to mention that OC is a rare soft-tissue ossification of cutaneous tissue, typically on the face and clinically asymptomatic. It may be primary but the majority of cases are secondary. Incidental finding of OC and tonsilloliths on a two-dimensional dental radiograph does not provide sufficient information concerning the location of these calcifications. Thus, cone beam computed tomography (CBCT) provides critical information for the diagnosis of asymptomatic OC lesions not available through any other means of clinical detection.

An Immature Ten-year Long-standing Case of Ossifying Fibroma.

Ossifying fibroma is a rare benign bone neoplasm common in middle age, with definite female predominance. Here, we describe a case of an ossifying fibroma in a 36-year-old female, with a right facial deformity. The lesion had been present for almost 10 years. The panoramic image showed a multilocular appearance with scattered radiopacities. Advanced imaging revealed an expansile multilocular lesion with multiple small radiopaque foci and a few dense radiopaque masses. A histopathological examination confirmed the diagnosis. The case represents a non-aggressive form of an immature ossifying fibroma.

Radiographic Diagnosis of a Central Giant Cell Granuloma Using Advanced Imaging: Cone Beam Computed Tomography.

Central giant cell granuloma (CGCG) is a benign non-neoplastic, proliferative intraosseous lesion of the jaw with an unknown etiology often diagnosed during the first two decades of life. The true nature of this lesion is controversial and remains elusive. Here, we report a case of central giant cell granuloma, diagnosed using cone-beam computed tomography (CBCT). A 21-year-old female presented to the clinic complaining of a painless swelling involving the right side of the mandible that had started one year previously. A CBCT scan revealed a well-defined, multilocular radiolucent lesion on the right side of the mandible extending from the molar region to the ramus with wispy septations. Wispy septations and undulating borders are some of the characteristic radiographic features of a central giant cell granuloma. The patient underwent an excisional biopsy. The biopsy revealed multinucleated giant cells in a fibrous stroma confirming our radiographic diagnosis of a central giant cell lesion.

Rare finding of Eustachian tube calcifications with cone-beam computed tomography.

Soft tissue calcification is a pathological condition in which calcium and phosphate salts are deposited in the soft tissue organic matrix. This study presents an unusual calcification noted in the cartilaginous portion of the Eustachian tube. A 67-year-old woman presented for dental treatment, specifically for implant placement, and cone-beam computed tomography (CBCT) was performed. The CBCT scan was reviewed by a board-certified oral and maxillofacial radiologist and revealed incidental findings of 2 distinct calcifications in the cartilaginous portion of the Eustachian tube. To the authors' knowledge, no previous study has reported the diagnosis of Eustachian tube calcification using CBCT. This report describes an uncommon variant of Eustachian tube calcification, which has a significant didactic value because such cases are seldom illustrated either in textbooks or in the literature. This case once again underscores the importance of having CBCT scans evaluated by a board-certified oral and maxillofacial radiologist.

Evaluation of canalis basilaris medianus using cone-beam computed tomography.

The aim of this report is to present two cases of canalis basilaris medianus as identified on cone-beam computed tomography (CBCT) in the base of the skull. The CBCT data sets were sent for radiographic consultation. In both cases, multi-planar views revealed an osseous defect in the base of the skull in the clivus region, the sagittal view showed a unilateral, well-defined, non-corticated, track-like low-attenuation osseous defect in the clivus. The appearance of the defect was highly reminiscent of a fracture of the clivus. The borders of osseous defect were smooth, and no other radiographic signs suggestive of osteolytic destructive processes were noted. Based on the overall radiographic examination, a radiographic impression of canalis basilaris medianus was made. Canalis basilaris medianus is a rare anatomical variant and is generally observed on the clivus. Due to its potential association with meningitis, it should be recognized and reported to avoid potential complications.

Non-Hodgkin's Lymphoma in the Oral Cavity.

We report a case of a diffuse large B-cell lymphoma of the maxilla. A patient presented with diffuse swelling of the right maxillary region following the extraction of an upper right maxillary tooth. The patient was referred for cone beam computed tomography (CBCT) to visualize the area in question in three dimensions. A massive destructive maxillary lesion was noted on CBCT examination suggestive of an aggressive lesion highly suspicious for a malignancy. A subsequent biopsy and immunochemistry were useful in confirming the diagnosis.

Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature.

The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.