Imaging features of sublingual dermoid cysts: a report of four cases.

Dermoid cysts of the floor of the mouth are rare lesions presumed to be caused by entrapment of germinal epithelium during the closure of the mandibular and hyoid branchial arches. They usually manifest as nonpainful swelling. Developmental cysts are histopathologically classified into 3 types: epidermoid, dermoid, and teratoid. An ultrasound scan is commonly used as the first choice to investigate a lesion. Other imaging methods, such as the US, CT, and MRI, are used for differential diagnosis. This article's aim is to present the imaging findings of 4 cases of sublingual dermoid cysts and to review the literature.

A radiological evaluation of the effects of edentulousness on the temporomandibular joint.

BACKGROUND: The articular eminence of the temporomandibular joint is an anatomical structure exposed to functional loads resulting from masticatory forces. Tooth loss may change the biomechanics of the masticator system, and the articular eminence can be affected by this change. OBJECTIVE: The aim of this study is to examine the relationship between the edentulousness and the articular eminence inclination of the temporomandibular joint. METHODS: The articular eminence inclination was measured in panoramic radiographs in the right and left temporomandibular joint on a total of 100 patients (50 dentate and 50 edentulous). The articular eminence inclination of dentate and edentulous patients was compared, as well as the influence of gender and duration of edentulousness. RESULTS: The mean articular eminence inclination value in the dentate group (42.6 ± 4.30 ) was higher than that of the edentulous group (35.1 ± 4.70 , P < .001). Although there was no significant difference between males and females in the dentate group with regard to articular eminence inclination (42.0 ± 4.70 and 42.9 ± 4.10 , respectively, P = .373), in the edentulous group, males had higher values as compared to females (37.1 ± 4.70 and 34.2 ± 4.50 , respectively, P = .003). Finally, the duration of edentulousness and the degrees of articular eminence inclination values did not show positive correlations (P = .782). CONCLUSION: According to the results of this study, we found that edentulous patients had lower articular eminence inclination than dentate patients, and it was more prominent in female than male patients.

Effectiveness of digital subtraction radiography in detecting artificially created osteophytes and erosions in the temporomandibular joint.

PURPOSE: Erosions and osteophytes are radiographic characteristics that are found in different stages of temporomandibular joint (TMJ) osteoarthritis. This study assessed the effectiveness of digital subtraction radiography (DSR) in diagnosing simulated osteophytes and erosions in the TMJ. MATERIALS AND METHODS: Five intact, dry human skulls were used to assess the effectiveness of DSR in detecting osteophytes. Four cortical bone chips of varying thicknesses (0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm) were placed at the medial, central, and lateral aspects of the condyle anterior surface. Two defects of varying depth (1.0 mm and 1.5 mm) were created on the lateral, central, and medial poles of the condyles of 2 skulls to simulate erosions. Panoramic images of the condyles were acquired before and after artificially creating the changes. Digital subtraction was performed with Emago dental image archiving software. Five observers familiar with the interpretation of TMJ radiographs evaluated the images. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of the imaging methods. RESULTS: The area under the ROC curve (Az) value for the overall diagnostic accuracy of DSR in detecting osteophytic changes was 0.931. The Az value for the overall diagnostic accuracy of panoramic imaging was 0.695. The accuracy of DSR in detecting erosive changes was 0.854 and 0.696 for panoramic imaging. DSR was remarkably more accurate than panoramic imaging in detecting simulated osteophytic and erosive changes. CONCLUSION: The accuracy of panoramic imaging in detecting degenerative changes was significantly lower than the accuracy of DSR (P<.05). DSR improved the accuracy of detection using panoramic images.

Calcification of the submandibular gland in a patient with chickenpox.

The pneumonia virus of chickenpox is now known to cause scattered calcified foci in the lungs, however to our knowledge, recent literature has not discussed calcification in the salivary glands. A 15-year-old boy consulted the department of radiology because of a swelling on the right side of the submandibular area. Radiological assessment included an ultrasonography and computerized tomography scan of the neck area, which demonstrated intraparenchymal amorph calcification, with approximately 13 mm diameter in the right submandibular gland. General condition and oral intake was good without distress in the patient, and hence he was discharged on the seventh day of follow-up treatment.

Venous malformation with multiple phleboliths: A case report.

Venous malformations are congenital, abnormally formed vessels, present at birth. They do not undergo regression with the growth of the patient. Due to the stagnation of blood flow in venous malformations, thrombosis and phlebolith formation may occur. Phleboliths are calcified thrombi which radiographically must be differentiated from calcified lymph nodes, sialoliths, foreign bodies, and other radiopacities. We report an extensive venous malformation in a 19-year-old woman with panoramic radiography demonstrating multiple phleboliths. Magnetic resonance imaging revealed the extension of the lesion into the hard palate and the masseter muscles superiorly, extending from the oropharynx to the tongue, inferiorly reaching the right clavicula and spreading between the right sternocleidomastoid muscle and strap muscles of the neck. The article is presented because the presence of phleboliths demonstrated on panoramic radiography is rarely described in the literature.

Palate Lymphoma: CT Findings.

OBJECTIVE: Non-Hodgkin lymphomas (NHL) in the palate are very rare. We aimed to investigate the CT appearance of lymphoma in the palate to improve diagnostic quality and review the literature on NHL. MATERIALS AND METHODS: The study retrospectively included patients with histopathologically confirmed lymphoma who were treated at our hospital between 2008 and 2015. We examined CT features, including tumor location, appearance, margins, and involvement of the surrounding tissues. RESULTS: Records were available for eight cases of lymphoma over the study period. Of these, two were in the soft palate and six in the hard palate. Median age at presentation was 63 years. Seven of the eight were diffuse large B cell lymphoma and one was T cell lymphoma. Hard palate lymphoma on CT showed bone destruction and spread to the maxillary arch and maxillary sinuses, whereas soft palate lymphoma spread to the surrounding parapharyngeal area and did not show bone destruction. CONCLUSION: We describe CT findings of palate lymphoma, which are important for treatment planning.

Imaging a dermatosis with dental radiographs: A case report of facial osteoma cutis.

Osteoma cutis is a condition that generally presents with true bony deposits in the skin. Although the pathogenesis of osteoma cutis is not clear, it supposes that certain preexisting conditions like acne vulgaris may contribute to generating these ossifications. These osteomas are usually asymptomatic and do not require any treatment unless they cause cosmetic issues. Rarely, this dermatologic condition may be observed in dental practices and it may be difficult to understand and diagnose the clinical and radiographic findings of this disease. In the current case, the diagnosis of osteoma cutis and the special sub-type multiple miliary osteoma of the face was made after considering the patient's history and the clinical and radiographic examinations. In order to contribute to the understanding of the diagnosis, the etiology, imaging modalities, and treatment of this rare disease, we present a case report of a 60-year-old woman with incidentally recognized multiple radiopaque microspheres that presented on intraoral radiographs, a panoramic radiograph, and CT scan. General practitioners should have some knowledge regarding the clinical and radiographic findings of this disease. They may be the first person to identify the condition and may play an important role in explaining the findings or cosmetic problems of their patients. This knowledge is also required for the necessary consultations and treatment of the patient.

Arteriovenous malformations in the differential diagnosis of palatal swellings.

An arteriovenous malformation (AVM) is composed of abnormal communications between arteries and veins without the normal intervening capillary bed. AVM of the head and neck is a rare vascular anomaly. We present here an unusual case of AVM with the size of 4x3 cm at the left posterior palatal area. Incisionel biopsy revealed AVM. Resection of the lesion following angiography was suggested to the patient however, he refused the treatment. The patient was considered to be under control. AVM should always be kept in mind in the differential diagnosis of palatal swellings.

Comparing the Effect of Different Voxel Resolutions for Assessment of Vertical Root Fracture of Permanent Teeth.

BACKGROUND: The teeth with undiagnosed vertical root fractures (VRFs) are likely to receive endodontic treatment or retreatment, leading to frustration and inappropriate endodontic therapies. Moreover, many cases of VRFs cannot be diagnosed definitively until the extraction of tooth. OBJECTIVES: This study aimed to assess the use of different voxel resolutions of two different cone beam computerized tomography (CBCT) units in the detection VRFs in vitro. MATERIALS AND METHODS: The study material comprised 74 extracted human mandibular single rooted premolar teeth without root fractures that had not undergone any root-canal treatment. Images were obtained by two different CBCT units. Four image sets were obtained as follows: 1) 3D Accuitomo 170, 4 × 4 cm field of view (FOV) (0.080 mm(3)); 2) 3D Accuitomo 170. 6 × 6 cm FOV (0.125 mm(3)); 3) NewTom 3G, 6˝ (0.16 mm(3)) and 4) NewTom 3G, 9˝ FOV (0.25 mm(3)). Kappa coefficients were calculated to assess both intra- and inter-observer agreements for each image set. RESULTS: No significant differences were found among observers or voxel sizes, with high average Z (Az) results being reported for all groups. Both intra- and inter-observer agreement values were relatively better for 3D Accuitomo 170 images than the images from NewTom 3G. The highest Az and kappa values were obtained with 3D Accuitomo 170, 4 × 4 cm FOV (0.080 mm(3)) images. CONCLUSION: No significant differences were found among observers or voxel sizes, with high Az results reported for all groups.

CT Imaging of Craniofacial Fibrous Dysplasia.

Fibrous dysplasia is a benign fibroosseous bone dysplasia that can involve single (monostotic) or multiple (polyostotic) bones. Monostotic form is more frequent in the jaws. It is termed as craniofacial fibrous dysplasia, when it involves, though rarely, adjacent craniofacial bones. A 16-year-old girl consulted for a painless swelling in the right posterior mandible for two years. Panoramic radiography revealed ground-glass ill-defined lesions in the three different regions of the maxilla and mandible. Axial CT scan (bone window) showed multiple lesions involving skull base and facial bones. Despite lesions in the skull base, the patient had no abnormal neurological findings. The lesion was diagnosed as fibrous dysplasia based on radiological and histopathological examination. In this paper, CT findings and differential diagnosis of CFD are discussed. CT is a useful imaging technique for CFD cases.

Evaluation of simulated periodontal defects via various radiographic methods.

OBJECTIVES: The aim of this study was to compare the diagnostic accuracy of conventional films and direct digital radiographs (DDR), in the determination of the depth and type of simulated periodontal intrabony defects. MATERIALS AND METHODS: Three types of periodontal intrabony defects (one, two, and three walled) were artificially created in dry mandibles. Standard radiographic images were taken with Ultraspeed, Ektaspeed, Insight films, and DDR. The radiographic images were evaluated by three oral radiologists to identify the type and depth of these defects on the radiographs. RESULTS: The average measured depth of the defects on the dry mandibles was 7.85 mm. The average depth of the type 1 defect on the radiographs was 7.19 mm, type 2 was 7.18 mm, and type 3 was 7.15 mm. The average depth of the defects via the Ultraspeed film was 7.15 mm, Ektaspeed film was 7.17 mm, Insight film was 7.19 mm, and DDR was 7.20 mm. Type 1, type 2, and type 3 defect depth measurements showed 8.9, 9.7, and 16.3% understated, respectively (p < 0.01). The accurate estimation rates of type 1, type 2, and type 3 defects were 93.8, 53, and 25.4%, respectively. CONCLUSIONS: Both radiographic techniques have the same diagnostic value and display the minor destructive changes in the bone. As the number of osseous walls increases, it becomes difficult to determine the defect type and morphology. Further research is needed to monitor the intrabony defects, with less radiation exposure. CLINICAL RELEVANCE: The accurate identification of defect type and depth depends on the number of walls, not the imaging methods.

An unusual case of ameloblastoma observed in the left anterior mandible.

AIM: To report a small intaalveolar ameloblastoma which resembled cystic lesion, and to emphasize the value of Computed tomography (CT) in radiographic examination. BACKGROUND: Ameloblastoma is a slow-growing, locally invasive odontogenic neoplasm that accounts for approximately 10% of all tumors detected in the jaws. Radiographically, those tumors are usually well-defined. Computerized tomography is highly recommended to confirm the diagnosis. CASE DESCRIPTION: A 48-year-old female attended with a chief complaint of painless swelling in the left anterior of mandible, 1 month duration. In intraoral examination, non-fluctuant, immobile, approximately 1 × 1 cm in dimension, painless, swelling which had a bone-like hardness and located in the mandibular canine region was detected. Panoramic radiography revealed a well circumscribed unilocular radiolucent lesion located in the inter-radicular area of left mandibular lateral and canine teeth. In CT examination it was realized that the lesion was multilocular. Histopathological examination of the biopsy specimen was reported as ameloblastoma. CLINICAL SIGNIFICANCE: It is extremely difficult to find such an ameloblastoma in small dimension in alvolar bone.

Oral findings of rothmund-thomson syndrome.

Rothmund-Thomson syndrome (RTS) is an extremely rare genetic condition exhibiting some dermatological, craniofacial, ophthalmological, and central nervous system abnormalities. It has an autosomal, recessive inheritance and its signs begin at childhood. Essential dermatological alteration is poikilodermatosis. A large head with an frontal bossing and broad low nasal bridge has been described in patients with RTS. Bilateral juvenile cataract is a characteristic finding of patients with RTS. Most of the patients have been markedly short and the growth retardation has been proportionate. Mental retardation is a rare condition. An 11-year-old girl who had been previously diagnosed with RTS was consulted with a chief complaint of delaying in tooth eruption. Intraoral examination revealed median rhomboid glossitis in addition to hyperkeratotic tongue. This report aimed to not only present intraoral findings of RTS, but also to demonstrate the lingual findings of a patient with RTS.

Clinical and radiological aspects of rhinoliths: report of five cases.

Rhinoliths are calcified masses in the nasal cavity caused by the deposition of nasal, lacrimal, and inflammatory mineral salts by accretion around an endogenous or exogenous nidus. Rhinoliths can be seen as incidental findings on panoramic radiography, although they typically appear blurred due to remaining outside the focus. Therefore, rhinoliths may be difficult to recognize; this difficulty can lead to misdiagnosis. Computed tomography (CT)/cone beam CT (CBCT) scans are generally necessary to define the precise location and to make a differential diagnosis. This article describes radiologic features of five cases of rhinoliths that were detected incidentally on panoramic radiographs. CT or CBCT images were obtained before removing the rhinoliths.

Graft necrosis occurred after iliac crest reconstruction after mandibular segmental resection of ameloblastoma.

Ameloblastoma is an uncommon benign odontogenic neoplasm of the maxillofacial region constituting less than 1% of tumors of the oral cavity. Ameloblastomas have been categorized broadly into 3 biologic variants: cystic (unicystic), solid, and peripheral. Unicystic ameloblastoma is a rare and less aggressive variant of ameloblastoma. The aim of this report is to describe a case of cystic ameloblastoma treated with segmental resection and iliac graft reconstruction. The possible reasons of graft failure seen in our patient at the early stage of the healing were also discussed.

Intramuscular hemangioma presenting with multiple phleboliths: a case report.

A rare case of intramuscular hemangioma of the masseter muscle with multiple phleboliths is described, highlighting features evident in plain radiography, ultrasound, and magnetic resonance imaging (MRI). A 21-year-old woman presented with a complaint of swelling of the right masseter muscle. A plain radiograph from the soft tissue of the right cheek showed a large number of round, target-like radiopacities that varied in size. Ultrasound revealed a lobulated cystic lesion in the right masseter muscle with increased echogenicity. MRI showed a space-occupying lesion in the right masseter muscle, which was isointense on T1-weighted image close to the muscle tissue and hyperintense on T2-weighted image, containing fields with no signal septations. A plain soft tissue radiograph can demonstrate phleboliths and aid in the diagnosis of an intramuscular hemangioma. In addition, nonionized techniques such as ultrasound and MRI can provide useful information to clinicians regarding the location of calcifications and the structure of masses.

A retrospective study of the prevalence and characteristics of dens invaginatus in a sample of the Turkish population.

OBJECTIVE: The purpose of this study was to assess the prevalence of dens invaginatus and to classify the types of dens invaginatus in a sample of the Turkish population. STUDY DESIGN: A retrospective study was performed using periapical and panoramic radiographs of 5355 patients who presented to the Department of Oral Diagnosis and Radiology at the Ondokuz Mayis University Dentistry Faculty between January 2009 and December 2010. Maxillary and mandibular anterior teeth were evaluated for the presence and characteristics of dens invaginatus. Statistical evaluation of the presence of dens invaginatus related to gender was performed by the Pearson chi-squared test. RESULTS: Dens invaginatus was observed in 116 of 4556 subjects, with a frequency of 2.5%. There was only one periapical lesion in teeth with type I dens invaginatus, but 8.1% of patients with type II and 87.5% of patients with type III dens invaginatus had apical periodontitis at the time of referral. There were 116 (72%) females and 32 (27%) males with dens invaginatus. CONCLUSION: This data represents the only study carried out in a large population in Turkey, and no dens invaginatus was found in mandibular teeth. The most commonly observed type of dens invaginatus was type I (69.8%).

Keratocystic odontogenic tumor: case report with CT and ultrasonography findings.

Keratocystic odontogenic tumor (KCOT) is a benign odontogenic tumor with a potentially aggressive and infiltrative behavior. KCOT is most commonly occurred in mandible and demonstrate a unilocular, round, oval, scalloped radiolucent area, while large lesions may appear multilocular. An important characteristic of KCOT is its propensity to grow in an antero-posterior direction within medullary cavity of bone causing minimal expansion. Definitive diagnosis relies on histological examination. In this report, a KCOT that had an expansion both buccal and lingual cortical bone is described including its features in computed tomography and ultrasonographic exams. The lesion was removed surgically via an intraoral approach under local anesthesia and histologically reported as a KCOT.

Radiographic evaluation of alveolar ridge heights of dentate and edentulous patients.

OBJECTIVE: To evaluate the reduction of residual alveolar ridge height on panoramic radiographs and the differences between denture wearers and non-denture wearers. MATERIALS AND METHODS: The study consisted of 147 individuals (74 men and 73 women) [50 were denture wearers and 50 non-denture wearers (examination groups) and 47 of them were dentate (control group)]. Individuals having diseases impacting on bone were excluded. Vertical measurements were made at 15 sites (central incisors, first premolars and molars at the left and right of both jaws and the distance between the zygoma/orbit). MANOVA (multi-variate analysis of variation) was used for the statistical analysis of the results. RESULTS: There were significant differences between the alveolar ridge heights of dentate and edentulous groups (p < 0.001). Between the denture wearer and the non-denture wearer groups, there was significant difference in the lower jaw (p < 0.001), but no significant difference in the upper jaw (p = 0.635). There were also differences between men and women (p < 0.005) and upper and lower jaws at every measurement sites (p < 0.01). CONCLUSION: Reduction in residual alveolar ridge height was in close relation with gender, denture usage and edentulousness.

Postpubertal nonfamilial cherubism and teeth transposition.

Cherubism is a rare, nonneoplastic, fibro-osseous disease. It is an autosomal-dominant disorder in which the normal bone is replaced by cellular fibrous tissue and immature bone. It is genetically inherited, although many nonfamilial cases have been reported. Cherubism is a bone disease clinically characterized by bilateral, painless enlargements of the jaws. The mandible is the most severely affected craniofacial component, in which uncontrolled growth of the malady deteriorates the aesthetic balance of the face. A malocclusive and abnormal dentition, worse in the mandible, can be seen. Histopathologically, numerous randomly distributed multinucleated giant cells and vascular spaces within a fibrous connective tissue stroma with or without eosinophilic collagen perivascular cuffing were apparent. The appearance of the affected children is normal at birth. Between the ages of 2 and 7 years, swellings within the mandibular body or tuberosities of maxilla appear. This article relates to a postpubertal nonfamilial cherubism case that was noticed with multiple radiolucencies in radiographic examination and its effects on teeth.