Evaluation of panoramic radiomorphometric indices related to low bone density in sickle cell disease.

SUMMARY: In sickle cell disease, erythroid hyperplasia causes trabecular destruction leading to low bone density. This condition could be suspected by the radiomorphometric indices and your diagnosis becomes relevant in a multidisciplinary context of health care for sickle cell subjects, providing prognostics and contributing to determine adequate therapeutic and preventive actions. INTRODUCTION: The aim of this study was to assess the risk of low bone density in subjects with sickle cell disease (SCD) through analysis of panoramic radiographic exams by radiomorphometric indices. METHODS: Seventy-eight Brazilian subjects with SCD took part in this study and were subdivided into four groups: (I) 31 SCD subjects aged under 40 years; (II) 13 SCD subjects aged 40 years or more; (III) 12 normal subjects aged under 40 years; and (IV) 22 normal subjects aged 40 years or more. In the panoramic radiographs, the mandibular cortical index (MCI) classification, increased spacing of the trabecular bone, panoramic mandibular index (PMI), and mental index (MI) were evaluated. Exact Fisher's test was used to compare age between the different groups. Descriptive analysis of the data was performed to evaluate the simple visual estimation of low bone density (increased bone trabecular space and MCI), and a one-way analysis of variance (Bonferroni criteria) was used to compare the means of the quantitative indices (PMI and MI). The significance level was p < 0.05. RESULTS: In the MCI classification, C2 was more prevalent, especially in groups I and IV. Increased spacing of the trabecular bone was more frequent in groups I and II. MI did not show a statistically significant difference among the groups. PMI showed a statistically significant difference only between groups III and IV. CONCLUSIONS: The radiomorphometric indices applied in the present study can be used on panoramic radiographs to detect the presence of low bone density in SCD subjects.

Hybrid lesion: central giant cell granuloma and benign fibro-osseous lesion.

Hybrid lesions comprise elements of different pathologies in one lesion. Hybrid lesions comprising central giant cell granulomas (CGCG) with fibro-osseous components are rare, with only six maxillomandibular cases reported in the literature. We report a case of a hybrid lesion in a 38-year-old woman who presented with a swelling in the mandibular parasymphysis, on the left side. Panoramic and occlusal radiographs and CT showed a mixed lesion with expansion of the buccal cortical plate that pointed to the diagnosis of ossifying fibroma (OF). Complete excision of the lesion was performed, and the anatomopathological examination showed features of both CGCG and a fibro-osseous lesion. Clinical, imaging and histopathological features indicate a hybrid lesion of CGCG and OF. The patient remains asymptomatic after 30 months of follow-up.