ABSTRACT
Actinomycotic osteomyelitis of the maxilla presenting with oroantral communication is very rare, herein we report the first case of this condition in association with myiasis. A 50-year-old man reported chronic sinusopathy and a non-healing maxillary lesion, with 30 years of evolution, presenting occasional nasal and intraoral purulent discharge, with foul smell, and recurrent episodes of larvae presence. Cone beam computed tomography showed a large hyperdense image inside the left maxillary sinus, with focal areas with soft tissue density, and extensive discontinuity of the maxillary sinus floor, confirming the oroantral fistula. The necrotic tissue curetted during surgery presented hard consistency, and dark greenish color, and was submitted for histopathological analysis. Microscopically, necrotic bone, masses of filamentous bacteria colonie s, compatible with actinomycosis, and large rhomboidal structures surrounded by eosinophilic capsule - suggestive of larvae, were observed. The diagnosis of actinomycotic osteomyelitis with presence of structures compatible with larvae was established.
La osteomielitis actinomicótica del maxilar que se presenta con comunicación oroantral es poco frequente. En este trabajo reportamos el primer caso de esta condición en asociación con miasis. Un hombre de 50 años que refiere sinusopatía crónica y lesión maxilar que no cicatriza, de 30 años de evolución, presenta secreción ocasional purulenta nasal e intraoral, con mal olor y episodios recurrentes de presencia de larvas. La tomografía computarizada de haz cónico mostró una gran imagen hiperdensa en el interior del seno maxilar izquierdo, con áreas focales con densidad de partes blandas y una extensa discontinuidad del piso del seno maxilar, lo que confirma la fístula oroantral. El tejido necrótico legrado durante la cirugía presentó consistencia dura, coloración verdosa oscura, y fue remitido para análisis histopatológico. Microscópicamente se observó hueso necrótico, masas de colonias de bacterias filamentosas compatibles con actinomicosis y grandes estructuras romboidales rodeadas de cápsula eosinofílica sugestiva de larvas. Se estableció el diagnóstico de osteomielitis actinomicótica con presencia de estructuras compatibles con larvas.
ABSTRACT
ABSTRACT The aim of this study was to evaluate the influence of spatial resolution (line pairs per millimetre - lp/mm) on the diagnosis of simulated external root resorption (ERR) in multirooted teeth by using digital periapical radiography. Forty human mandibular molars (80 roots) were used. The roots were divided into the following groups (n = 10): control without root filling (WORF), control with root filling (WRF), small ERRWORF, small ERRWRF, moderate ERRWORF, moderate ERRWRF, extensive ERRWORF and extensive ERRWRF. Four digital radiographs (phosphor storage plates - PSP system) were taken of each tooth in three angulations. The PSPs were scanned with 10, 20, 25 and 40 lp/mm. All images were assessed by three endodontists who used a fivepoint scale for presence and absence of ERR and classified its location (cervical, middle or apical third). ROC curves and oneway ANOVA were performed (p < 0.01). Diagnosis of ERR in nonrootfilled teeth showed higher values of sensitivity for 20 lp/mm and higher values of both specificity and accuracy for 40 lp/mm. In rootfilled teeth, sensitivity and accuracy were higher for 25 lp/mm and spatial resolution had no influence on specificity. The best resolution for diagnosis of small and extensive ERR was 25 lp/mm, whereas for moderate ERR, it was 40 lp/mm. Cervical ERR was the most difficult to diagnose, regardless of the spatial resolution. Higher spatial resolutions have improved the radiographic diagnosis of simulated ERR in multirooted teeth and this should be considered when performing digital radiographs.
RESUMO O objetivo deste estudo foi avaliar a influência do número de pares de linhas em radiografia intraoral digital, na precisão da detecção de reabsorção radicular externa. Quarenta molares inferiores (n=80 raízes) foram submetidos ao preparo químico mecânico e em então, metade da amostra foi obturada. Em seguida, as raízes dos dentes foram aleatoriamente divididas de acordo com o tamanho da reabsorção radicular a ser simulada e com a presença e ausência de tratamento endodôntico. As RRE foram realizadas com brocas esféricas diamantadas de tamanhos 1/2, 1, 2. Executouse radiografias digitais por meio do sistema de aquisição semidireto com a utilização de placas de fósforo fotoestimuladas (PSP). Em cada dente, incidências orto, mésio e distorradial foram repetidas quatro vezes, para que pudessem ser digitalizadas com resoluções de 10, 20, 25, 40 pl/mm. Após análise, verificouse que dentes obturados apresentaram menores valores de sensibilidade com 10, 20 e 25 pl/mm e maiores valores de especificidade e acurácia para as mesmas resoluções. Dentes sem obturação registraram maiores valores de sensibilidade para resolução 20 e menor para 40; no entanto, a especificidade e a acurácia, foram maiores com 40 e menores em 10. Em RRE pequena, as resoluções 10 e 25 pl/mm foram respecti vamente menos e mais acuradas; RRE média, foi maior com 40 pl/mm e RRE grandes foram melhores identificadas com 25. Correlacionando acertos no diagnóstico com localização das RRE, verificouse que o terço cervical apresentouse menos detectável. Concluiuse que resolução espacial influenciou a detecção de RRE simuladas em radiografias periapicais digitais.