Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs.

OBJECTIVE: The aim of this study is to present a comparison between panoramic radiographs and USG imaging with a focus on revealing the advantages of USG over radiographs, and to show the distribution of calcifications detected in USG by considering the age and gender. METHODS: A total of 148 patients with soft tissue calcifications as seen on panoramic radiographs were examined with USG imaging. Sialoliths, carotid artery calcifications, tonsilloliths, phleboliths and lymph node calcifications were examined in terms of anatomical localization, distribution and shape. RESULTS: In the USG evaluation of these 148 patients, soft tissue calcifications were observed in 113 (76.4%) patients. The mean age of the patients with calcification was 55.6 ± 13.1 (min: 22-max: 77). Bilateral calcifications were detected in 25 (22.1%) patients, whereas unilateral calcifications were found in 88 (77.9%) patients. While the rates of tonsilloliths, sialoliths, phleboliths, and lymph node calcifications were statistically similar in male and female patients, the rate of carotid artery calcifications was found to be higher in men than in women (P = 0.017). No statistical significance was found between age groups in terms of the formation of soft tissue calcifications (P = 0.117). CONCLUSIONS: Panoramic radiographs may mislead clinicians in the diagnosis and differential diagnosis of soft tissue calcifications in the head and neck region due to the presence of distortion, superpositions, metal artefacts, and ghost images. USG is an important diagnostic tool in determining the localization of soft tissue calcifications that can be confused on two-dimensional radiographs, their relationship with neighboring structures, and defining calcification. It can be used safely in the detection of soft tissue calcifications as it provides dynamic imaging without the use of radiation or contrast material compared to other advanced imaging methods.

Erbium, chromium:Yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser versus diode laser in the treatment of pericoronitis.

Background: There are limited number of studies about the lasers used for the treatment of pericoronitis infection. Aim: To compare the Er, Cr:YSGG laser and diode laser applications clinically in the treatment of pericoronitis infection. Patients and Methods: Sixty patients with pericoronitis infection were divided into three groups using block randomization: Er, Cr:YSGG + antibiotic group, n = 20 (mean age: 24.20 ± 6.13; 14 females, 6 males); diode group + antibiotic, n = 20 (mean age: 23.45 ± 2.96; 14 females, 6 males); and antibiotic, n = 20 (mean age: 22.45 ± 3.02; 11 females, 9 males). In addition, laser application was performed for patients in the Er, Cr:YSGG and diode laser groups on the 1st and 2nd days until the extraction day. Tooth extractions were performed on the 3rd day for all patients. Patients' pain (with visual analog scale [VAS]), lymphadenopathy, and local edema were clinically evaluated in the first 3 days and on the 7th day of treatment. Results: Pain score on the 2nd day of treatment was determined to be significantly lower in the Er, Cr:YSGG + antibiotic laser group as compared with the other two groups (P = 0.019). Although regression of lymphadenopathy on the 3rd day was highest (P = 0.025) in the Er, Cr:YSGG group, there was no significant difference between the groups regarding local edema. Conclusion: Er, Cr:YSGG laser improved the healing process in the treatment of pericoronitis and made an important contribution to the treatment.

Next-generation sequencing-assisted diagnosis of a case of leprosy misdiagnosed as erythema multiforme.

BACKGROUND: Leprosy is a chronic infectious disease caused by Mycobacterium leprae or Mycobacterium lepromatosis that is mainly transmitted through droplets from the nose and mouth of untreated patients. Owing to the lack of specific serological markers and clinical manifestations, leprosy can be easily confused with other skin lesion-related diseases and is difficult to distinguish. CASE PRESENTATION: This study introduces and summarises the diagnosis and treatment process of a case of leprosy misdiagnosed as erythema multiforme for a long time. A 43-year-old female was admitted to our hospital because of "repeated fever with superficial lymphadenopathy and systemic rash in May". The diagnosis of the patient was based on the two main clinical characteristics of superficial lymphadenopathy and systemic pleomorphic erythema by using a combination of multiple samples of lymph nodes and skin, routine pathological examination, immunohistochemistry, acid-fast, silver hexamine, periodic acid-Schiff (PAS) staining, and second-generation gene sequencing of fresh biopsy tissue. The patient was treated with dapsone, rifampicin, and clofazimine at the Institute of Dermatology and Venereal Diseases. After treatment for 1 year, her temperature returned to normal, the area of facial erythema decreased, and the volume of axillary lymph nodes had gradually reduced. CONCLUSIONS: In conclusion, special pathological staining and second-generation gene sequencing show promising advantages in distinguishing leprosy from other skin lesion-related diseases.

Ossifying fibrous epulis as an IgG4-related disease of the oral cavity: a case report and literature review.

BACKGROUND: Fibrous sclerosing tumours and hypertrophic lesions in IgG4-related disease (IgG4-RD) are formed in various organs throughout the body, but disease in the oral region is not included among individual organ manifestations. We report a case of ossifying fibrous epulis that developed from the gingiva, as an instance of IgG4-RD. CASE PRESENTATION: A 60-year-old Japanese man visited the Department of Oral and Maxillofacial Surgery, Gunma University Hospital, with a chief complaint of swelling of the left mandibular gingiva. A 65 mm × 45 mm pedunculated tumour was observed. The bilateral submandibular lymph nodes were enlarged. The intraoperative pathological diagnosis of the enlarged cervical lymph nodes was inflammation. Based on this diagnosis, surgical excision was limited to the intraoral tumour, which was subsequently pathologically diagnosed as ossifying fibrous epulis. Histopathologically, the ossifying fibrous epulis exhibited increased levels of fibroblasts and collagen fibres, as well as infiltration by numerous plasma cells. The IgG4/IgG cell ratio was > 40%. Serologic analysis revealed hyper-IgG4-emia (> 135 mg/dL). The patient met the comprehensive clinical diagnosis criteria and the American College of Rheumatology and European League Against Rheumatism classification criteria for IgG4-RD. Based on these criteria, we diagnosed the ossifying fibrous epulis in our patient as an IgG4-related disease. A pathological diagnosis of IgG4-related lymphadenopathy was established for the cervical lymph nodes. Concomitant clinical findings were consistent with type II IgG4-related lymphadenopathy. CONCLUSIONS: A routine serological test may be needed in cases with marked fibrous changes (such as epulis) in the oral cavity and plasma cells, accompanied by tumour formation, to determine the possibility of individual-organ manifestations of IgG4-related disease.

Combined seronegativity in Sjögren's syndrome.

OBJECTIVES: To describe the clinical spectrum of Sjögren's syndrome (SS) patients with combined seronegativity. METHODS: From a multicentre study population of consecutive SS patients fulfilling the 2016 ACR-EULAR classification criteria, patients with triple seronegativity [anti-Ro/SSA(-), anti-La/SSB(-), RF(-) and ANA(+)] and quadruple seronegativity [anti-Ro/SSA(-), anti-La/SSB(-), RF(-) and ANA(-)] were identified retrospectively. Both groups were matched in an 1:1 ratio with 2 distinct control SS groups: i) classic anti-Ro/SSA seropositive patients [SS(+)] and ii) classic anti-Ro/SSA seropositive patients with negative rheumatoid factor [SS(+)/RF(-)] to explore their effect on disease expression. Clinical, laboratory and, histologic features were compared. A comparison between triple and quadruple seronegative SS patients was also performed. REESULTS: One hundred thirty-five SS patients (8.6%) were identified as triple seronegative patients and 72 (4.5%) as quadruple. Triple seronegative patients had lower frequency of peripheral nervous involvement (0% vs. 7.2% p=0.002) compared to SS(+) controls and lower frequency of interstitial renal disease and higher prevalence of dry mouth than SS(+)/RF(-) controls. Quadruple seronegative patients presented less frequently with persistent lymphadenopathy (1.5% vs. 16.9 p=0.004) and lymphoma (0% vs. 9.8% p=0.006) compared to SS(+) controls and with lower prevalence of persistent lymphadenopathy (1.5% vs. 15.3% p=0.008) and higher frequency of dry eyes (98.6% vs. 87.5% p=0.01) and autoimmune thyroiditis (44.1% vs. 17.1% p=0.02) compared to SS(+)/RF(-) SS controls. Study groups comparative analysis revealed that triple seronegative patients had higher frequency of persistent lymphadenopathy and lymphoma, higher focus score and later age of SS diagnosis compared to quadruple seronegative patients. CONCLUSIONS: Combined seronegativity accounts for almost 9% of total SS population and is associated with a milder clinical phenotype, partly attributed to the absence of rheumatoid factor.

Silicone-induced lymphadenopathy mimicking recurrence of breast cancer on positron emission tomography-computed tomography, correctly diagnosed on ultrasound.

Silicone-induced lymphadenopathy is a rare complication associated with silicone breast implants. It is usually asymptomatic and found incidentally during imaging. We report a case of silicone lymphadenopathy in a patient who had undergone a mastectomy and breast reconstruction for breast cancer. During follow-up, a positron emission tomography-computed tomography examination revealed lymph nodes that were suspicious for cancer recurrence. However, sonography was able to correctly diagnose silicone-induced lymphadenopathy and exclude cancer metastasis.

Silicone Adenopathy and Intractable Axilary Pain after Breast Implant Augmentation - Case Report.

Introduction: Silicone lymphadenophaty (siliconoma) is a rare complication secondary to breast implant augmentation or breast reconstruction surgery. Although it is usually linked to the age of the implant, the predominant etiology is multifactorial. Herein, we report a case of extensive siliconoma in the axilla in the hope that our experience will contribute to clinical decision making. Case presentation: We report the case of a 41-year-old woman with intense pain in her right axilla 20 years after breast augmentation surgery. Analgesics were of limited use and the pain became debilitating over time. After a thorough physical examination, imaging studies found three central axillary lymph nodes with a "snowstorm" appearance, suggestive of silicone lymphadenopathy. A complete excision of the lessions was performed with resolution of pain on follow-up. Subsequent histological analysis showed lymph nodes containing large doplets of silicone. Conclusions: General and plastic surgeons must remain aware as silicone adenopathy can be causative of anxiety and significant local symptoms among patients. Thorough investigations are needed in order to exclude malignancies and provide an optimal treatment strategy.

Prevalence of soft tissue calcifications in the maxillofacial region detected by cone beam CT.

OBJECTIVE: To determine the prevalence of soft tissue calcifications in cone beam computed tomography (CBCT) scans with different fields of view (FOV) and to assess its relation with the clinical relevance of the CBCT findings. MATERIAL AND METHODS: One thousand CBCT scans were grouped according to FOV's size and region scanned (MX-FOV, maxilla; MD-FOV, mandible; and MM-FOV, maxilla/mandible) and evaluated for the presence of soft tissue calcifications. Laterality and length of the elongated styloid processes (ESP) were also assessed. RESULTS: Eight hundred and eighty-two soft tissue calcifications were detected in 626 (62.6%) patients. MM-FOV presented the highest prevalence (76.8%), followed by MD-FOV (60.6%) and MX-FOV (57.2%). ESP and tonsillolith were the most frequent calcifications. Calcifications requiring treatment or not and those in need of follow-up accounted for 6.9%, 92.7%, and 0.3% of cases, respectively. There was no association between calcifications and subjects' gender or age (p > .05). Most cases of ESP occurred bilaterally and were longer in males (p < .05). CONCLUSIONS: There is a high prevalence of soft tissue calcifications in CBCT, and ESP and tonsilloliths are the most common types in all evaluated FOVs. While most cases do not require treatment, we emphasize the importance of detailed CBCT assessment for its diagnosis.

Detection of Pathologically Proven Silicone Lymphadenopathy: Ultrasonography Versus Magnetic Resonance Imaging.

OBJECTIVES: To compare the abilities of ultrasonography (US) and magnetic resonance imaging (MRI) in diagnosing silicone lymphadenopathy. METHODS: Consecutive patients with silicone breast implants who underwent axillary and intramammary lymph node core needle biopsies were retrospectively collected (December 2011-May 2017). Ultrasonographic examinations were analyzed for the presence of the US snowstorm sign, and MRI examinations were evaluated for the presence of the silicone signal. A pathologist reviewed all biopsied specimens. Ultrasonographic and MRI evaluations were compared to pathologic results. The sensitivity and specificity in diagnosing silicone lymphadenopathy were calculated for the snowstorm sign on US and the MRI silicone signal. RESULTS: Forty-one lymph node biopsies were included: 8 (19.5%) silicone-containing lymph nodes, 29 (70.7%) reactive nodes, and 4 (9.8%) malignant nodes. All nodes were evaluated by US, and 18 of 41 (43.9%) were evaluated by MRI. Seven of 8 (87.5%) silicone-containing nodes showed the snowstorm sign compared to none (0.0%) of the reactive or malignant nodes (P = .0001). One of 5 (20.0%) silicone-containing nodes evaluated by MRI showed the silicone signal compared to none (0.0%) of the reactive or malignant nodes (P = .278). The sensitivity and specificity of the snowstorm sign for diagnosing silicone lymphadenopathy were 87.5% and 100%, respectively, whereas those of the MRI silicone signal were 20.0% and 100%, respectively. CONCLUSIONS: The US snowstorm sign is much more sensitive for silicone lymphadenopathy than the MRI silicone signal. In cases of suspected silicone lymphadenopathy, the use of US in addition to MRI should be contemplated.

Assessment of Third Molar Impaction Pattern and Associated Clinical Symptoms in a Central Anatolian Turkish Population.

OBJECTIVES: The purpose of this study was to assess the pattern of third molar impaction and associated symptoms in a Central Anatolian Turkish population. MATERIAL AND METHODS: A total of 2,133 impacted third molar teeth of 705 panoramic radiographs were reviewed. The positions of impacted third molar teeth on the panoramic radiographs were documented according to the classifications of Pell and Gregory and of Winter. The presence of related symptoms including pain, pericoronitis, lymphadenopathy and trismus was noted for every patient. Distributions of obtained values were compared using the Pearson χ2 test. Nonparametric values were analyzed using the Mann-Whitney U test and Kruskal-Wallis test. RESULTS: The mean age of the subjects was 30.58 ± 11.98 years (range: 19-73); in a review of the 2,133 impacted third molar teeth, the most common angulation of impaction in both maxillaries was vertical (1,177; 55%). Level B impaction was the most common in the maxilla (425/1,037; 39%), while level C impaction was the most common in the mandible (635/1,096; 61%). Pain (272/705; 39%) and pericoronitis (188/705; 27%) were found to be the most common complications of impaction. Among 705 patients (335 males, 370 females), pericoronitis was more prevalent in males (101; 30%) and usually related to lower third molars (236; 22%). The retromolar space was significantly smaller in females (p < 0.05). Moreover, there was a significant difference in retromolar space for the area of jaw (maxillary: 11.3 mm; mandibular: 14.2 mm) and impaction level (A: 14.7 mm; B: 11.1 mm; C: 10.3 mm; p < 0.05). CONCLUSION: The pattern of third molar impaction in a Central Anatolian Turkish population was characterized by a high prevalence rate of level C impaction with vertical position. Pain and pericoronitis were the most common symptoms usually associated with level A impaction and vertical position.

HIV-associated salivary gland disease--clinical or imaging diagnosis?

OBJECTIVES: This work aimed at studying the salivary gland disease (SGD) as it relates to associated factors, such as persistent generalised lymphadenopathy (PGL), lymphocytic interstitial pneumonia (LIP), clinical and immunological features of AIDS, and salivary flow rate and pH, as well as at exploring the relationship between the clinical diagnosis and the imaging diagnosis by ultrasound (US) examination of the parotid glands. METHODS: Information regarding the observation of parotid gland enlargement, PGL, LIP, and clinical and immunological features of AIDS was gathered from medical records, and a saliva sample for unstimulated salivary flow rate and pH measurement was collected from 142 children aged 3 through 10 years treated at the Department of Infectious Diseases of Joana de Gusmão Children's Hospital, Florianópolis, SC, Brazil. High-resolution ultrasonography was performed in 58 children. Pearson's chi-square test and t-test were used to evaluate the association between the variables. RESULTS: A significant association was found between SGD and LIP. Ultrasound revealed a 50% higher incidence of SGD that was not reported in the patients' records. CONCLUSION: US examination proved to be essential for the correct diagnosis and monitoring of the progression of HIV/SGD.

Prevalence, clinical characteristics, and management of silicone lymphadenopathy: A systematic review of the literature.

INTRODUCTION: Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has rapidly increased in popularity since the 2000s. Silicone lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce. METHODS: SL-related search terms were used to find articles in 3 databases. Of 598 articles, 101 studies met the inclusion criteria. Demographics, clinical presentation, workup, and management data were analyzed. RESULTS: Of 279 cases of SL and 107 with information on initial diagnosis, 35 (33%) were incidental. The most common symptom was painless lymphadenopathy, followed by painful lymphadenopathy. 251 (95%) and 13 (5%) patients had silicone and saline implants, respectively. 149 (68%) patients had implant rupture. Axillary lymphadenopathy was the most affected region (136 cases, 72%), followed by internal mammary (40 cases, 21%), cervical/supraclavicular (36 cases, 19%), and mediastinal (24 cases, 13%) regions. 25% of patients underwent fine-needle aspiration, 12% core needle biopsy, and 59% excisional biopsy. 32% of cases underwent explantation and/or implant exchange. The most common indication for surgery was implant rupture. Histology showed multinucleated giant cells, large histiocytes, and silicone accumulation. CONCLUSIONS: SL is a complication associated with breast implants. The majority of patients are asymptomatic, and most cases are managed conservatively. Minority need a biopsy and surgical interventions due to abnormal imaging, persistent symptoms, and/or implant rupture. Workup and management should be tailored to the patient.

Oral lesions in human monkeypox disease and their management.

OBJECTIVE: The current outbreak of human monekypox (MPX) in several endemic and non-endemic regions in 2022 has generated significant international attention. Despite the early classification as zoonotic, MPXV has demonstrated the potential for human-to-human transmission through close contact with lesions, body fluids, respiratory droplets, and contaminated materials. Therefore, our objective was to elaborate on the oral lesions in human MPX and their management. MATERIALS AND METHOD: Articles published up to August, 2022, were screened to identify relevant studies in humans that reported oral lesions in MPX. RESULTS: Oral lesions have been found to manifest differently and transform from vesicles to pustules, accompanied by umbilication and crusting within four weeks. Along with fever and lymphadenopathy, these lesions may develop in the oral cavity and then spread to the skin surrounding the extremities in a centrifugal pattern. In some patients, the oropharyngeal and perioral lesions were the initial presentations. CONCLUSIONS: The oral lesions of MPX infection and its management strategies are relevant for dentists. Dental practitioners may be the first to detect the initial lesions of MPX. Therefore, high alertness should be there, especially while examining patients with fever and lymphadenopathy. It is also essential to thoroughly examine the oral cavity for macular and papular lesions in oral mucosa, tongue, gingiva, and epiglottis. Symptomatic and supportive care of oral lesions is recommended.

Detecting lymphadenopathy affected by peri-implantitis using diffusion-weighted magnetic resonance imaging.

PURPOSE: This study aimed to assess peri-implantitis-induced lymphadenopathy on diffusion-weighted imaging (DWI). METHODS: This retrospective study was conducted from October 2017 to March 2020 in patients with and without peri-implantitis who underwent magnetic resonance imaging (MRI). Patients in the peri-implantitis group had radiographically confirmed loss of alveolar bone > 2.0 mm and clinical findings such as bleeding on probing, suppuration of tissues surrounding the teeth, probing-pocket depth of > 4 mm, pain on implant function, and clinical implant mobility, whereas those without peri-implantitis had none of the abovementioned clinical findings. The Mann-Whitney U test was used to compare groups, using lymph node (LN) short-axis diameters and apparent diffusion coefficients (ADCs) as the criterion variables and presence or absence of peri-implantitis as the explanatory variable. Receiver operating characteristic (ROC) analysis was done to investigate the effectiveness of LN size and ADC use in detecting peri-implantitis-induced lymphadenopathy. Statistical significance was established at P < 0.05. RESULTS: There were 66 lymph nodes from 12 patients analyzed. The mean LN size and ADC were significantly higher in patients with peri-implantitis than in those without (P < 0.01). ROC curve analysis showed cut-off LN sizes of 4.78 and 4.84 mm and cut-off ADCs of 1.12 and 1.09 for lymphadenopathy affected by peri-implantitis corresponding to levels IB and II, respectively. CONCLUSIONS: Cervical lymphadenopathy may be an inflammatory finding associated with peri-implantitis.