Automatic and robust estimation of sex and chronological age from panoramic radiographs using a multi-task deep learning network: a study on a South Korean population.

Sex and chronological age estimation are crucial in forensic investigations and research on individual identification. Although manual methods for sex and age estimation have been proposed, these processes are labor-intensive, time-consuming, and error-prone. The purpose of this study was to estimate sex and chronological age from panoramic radiographs automatically and robustly using a multi-task deep learning network (ForensicNet). ForensicNet consists of a backbone and both sex and age attention branches to learn anatomical context features of sex and chronological age from panoramic radiographs and enables the multi-task estimation of sex and chronological age in an end-to-end manner. To mitigate bias in the data distribution, our dataset was built using 13,200 images with 100 images for each sex and age range of 15-80 years. The ForensicNet with EfficientNet-B3 exhibited superior estimation performance with mean absolute errors of 2.93 ± 2.61 years and a coefficient of determination of 0.957 for chronological age, and achieved accuracy, specificity, and sensitivity values of 0.992, 0.993, and 0.990, respectively, for sex prediction. The network demonstrated that the proposed sex and age attention branches with a convolutional block attention module significantly improved the estimation performance for both sex and chronological age from panoramic radiographs of elderly patients. Consequently, we expect that ForensicNet will contribute to the automatic and accurate estimation of both sex and chronological age from panoramic radiographs.

Surgical management and final outcomes of chondrosarcoma of the temporomandibular joint: case series and comprehensive literature review.

BACKGROUND: Surgical management for chondrosarcoma of the temporomandibular joint (TMJ) is challenging due to the anatomical location involving the facial nerve and the functional joint. The purpose of this case series was to analyze the largest number of TMJ chondrosarcoma cases reported from a single institution and to review the literature about chondrosarcoma involving the TMJ. METHODS: Ten TMJ chondrosarcoma patients at Seoul National University Dental Hospital were included in this study. Radiographic features, surgical approaches, histopathologic subtypes, and treatment modalities were evaluated. All case reports of TMJ chondrosarcoma published in English from 1954 to 2021 were collected under PRISMA guidelines and comprehensively reviewed. RESULTS: The lesions were surgically resected in all 10 patients with efforts to preserve facial nerve function. Wide excision including margins of normal tissue was performed to ensure adequate resection margins. All TMJs were reconstructed with a metal condyle except one, which was reconstructed with vascularized costal bone. At last follow-up, all patients were still alive, and there had been no recurrence. Among 47 cases (patients from the literature and our cases), recurrence was specified in 43 and occurred in four (9.5%). CONCLUSIONS: For surgical management of TMJ chondrosarcoma, wide excision must consider preservation of the facial nerve. Reconstruction using a metal condyle prosthesis and a vascularized free flap is reliable. A more conservative surgical approach correlates with a favorable prognosis for facial nerve recovery. Nevertheless, wide excision is imperative to prevent tumor recurrence. In cases in which the glenoid fossa is unaffected by the tumor, it is deemed unnecessary to reconstruct the glenoid fossa within an oncological setting.

Comparison of 2D, 2.5D, and 3D segmentation networks for maxillary sinuses and lesions in CBCT images.

BACKGROUND: The purpose of this study was to compare the segmentation performances of the 2D, 2.5D, and 3D networks for maxillary sinuses (MSs) and lesions inside the maxillary sinus (MSL) with variations in sizes, shapes, and locations in cone beam CT (CBCT) images under the same constraint of memory capacity. METHODS: The 2D, 2.5D, and 3D networks were compared comprehensively for the segmentation of the MS and MSL in CBCT images under the same constraint of memory capacity. MSLs were obtained by subtracting the prediction of the air region of the maxillary sinus (MSA) from that of the MS. RESULTS: The 2.5D network showed the highest segmentation performances for the MS and MSA compared to the 2D and 3D networks. The performances of the Jaccard coefficient, Dice similarity coefficient, precision, and recall by the 2.5D network of U-net + + reached 0.947, 0.973, 0.974, and 0.971 for the MS, respectively, and 0.787, 0.875, 0.897, and 0.858 for the MSL, respectively. CONCLUSIONS: The 2.5D segmentation network demonstrated superior segmentation performance for various MSLs with an ensemble learning approach of combining the predictions from three orthogonal planes.

Automatic classification of 3D positional relationship between mandibular third molar and inferior alveolar canal using a distance-aware network.

The purpose of this study was to automatically classify the three-dimensional (3D) positional relationship between an impacted mandibular third molar (M3) and the inferior alveolar canal (MC) using a distance-aware network in cone-beam CT (CBCT) images. We developed a network consisting of cascaded stages of segmentation and classification for the buccal-lingual relationship between the M3 and the MC. The M3 and the MC were simultaneously segmented using Dense121 U-Net in the segmentation stage, and their buccal-lingual relationship was automatically classified using a 3D distance-aware network with the multichannel inputs of the original CBCT image and the signed distance map (SDM) generated from the segmentation in the classification stage. The Dense121 U-Net achieved the highest average precision of 0.87, 0.96, and 0.94 in the segmentation of the M3, the MC, and both together, respectively. The 3D distance-aware classification network of the Dense121 U-Net with the input of both the CBCT image and the SDM showed the highest performance of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve, each of which had a value of 1.00. The SDM generated from the segmentation mask significantly contributed to increasing the accuracy of the classification network. The proposed distance-aware network demonstrated high accuracy in the automatic classification of the 3D positional relationship between the M3 and the MC by learning anatomical and geometrical information from the CBCT images.

A Life-Saving Early Diagnosis of Burkitt Lymphoma: The Role of a Dentist.

ABSTRACT: Burkitt lymphoma (BL) is a subtype of Non-Hodgkin lymphoma, considered one of the fastest growing human tumors. Due to the highly aggressive nature of BL, a prompt diagnosis and aggressive chemotherapeutic treatment are essential. However, the clinical features of BL often can mimic periodontal disease or dentoalveolar abscess. The aim of this study is to present a case of a 31-year-old male patient who was referred to the department of oral and maxillofacial surgery for severe neurosensory disturbance and pain in the lower jaw. He was misdiagnosed with periodontitis and dental abscess at the local clinic. Based on radiographic findings, he was suspected of hematopoietic malignancy. He was referred to the department of hemato-oncology and diagnosed with BL. This case highlights the essential life-saving role of a maxillofacial surgeon in the early diagnosis of a rare malignancy.

Developing a clinical presentation dental education model and a pilot test.

INTRODUCTION: Accurate clinical decision-making of dentists should be based on their knowledge and experience. In the past 10 years, interest in competency-based dentistry education has rapidly increased, but there has been little attention paid to methods of improving dental education competency. The purpose of this study was to develop a clinical presentation education model that provides opportunities for students to practice problem-solving from the moment they greet the patient so that students can obtain the practical experience of competency-based education and the effectiveness of this model can be confirmed through pilot test. METHODS: This article is divided two parts: First, developing the clinical presentation dental education model (CPDEM) and Second, a pilot study adopted CPDEM. To confirm the effectiveness of this model, the students' satisfaction, their perception of self-achievement were analysed. RESULTS: Clinical presentation dental education model has been developed to provide practice-related education experience and provide linkage between basic science and clinical science. The result of applying this education model to 10 students as a pilot test was shown an overall high satisfaction level. In addition, self-achievement students' reported of all intended competencies was higher than for non-participating students of this model. CONCLUSIONS: This study focuses on practical education centring on clinical presentation. This model could get a meaningful and realistic experiences through the practice using clinical presentation of patients, use their metacognition for organizing and memorizing the patient's case by using concept map. It can be used as a future instructional method to enhance students' competency.

Correlation between spatial resolution and ball distortion rate of panoramic radiography.

BACKGROUND: The purpose of this study was to analyze the correlation between spatial resolution and ball distortion rate of panoramic radiography and to elucidate the minimum criterion for ball distortion rate, which is very relevant to clinical readability. METHODS: Horizontal and vertical spatial resolution and ball distortion rates were calculated in the same position, such as the incisor, premolar, molar, and temporomandibular joint area with various object depths corresponding to 48 mm. Three devices were evaluated. A region showing spatial resolution above the reference standard was selected, and the ball distortion rate corresponding to the same region was divided into horizontal and vertical phantom groups. The mean and standard deviation of the obtained ball distortion rates were calculated. Student's t-test was used to statistically analyze the mean difference in ball distortion rates between vertical and horizontal phantom groups. RESULTS: In all devices, the horizontal line pair phantom, but not the vertical line pair phantom, was readable in all areas measured at the line pair value of at least 1.88 lp/mm. The line pair value tended to be higher toward the center and lower toward the outside. The ball distortion rate tended to decrease closer to the center and increased further away. In addition, ball distortion rates could not be measured at some areas as they were not recognized as balls due to the high degree of distortion at the outermost and innermost sides. The number of balls satisfying the reference value using the horizontal line pair phantom was 102 (mean of ball distortion rates, 20.98; standard deviation, 15.25). The number of balls satisfying the reference value using the vertical line pair phantom was 49 (mean of ball distortion rates, 16.33; standard deviation, 14.25). However, mean ball distortion rate was not significantly different between the two groups. CONCLUSIONS: Image layer of panoramic radiography could be evaluated by the spatial resolution using horizontal and vertical line pair phantoms and by assessing ball distortion rates through a ball-type panorama phantom. A ball distortion rate of 20% could be used as a threshold to evaluate the image layer of panoramic radiography.

Quantitative Augmented Reality-Assisted Free-Hand Orthognathic Surgery Using Electromagnetic Tracking and Skin-Attached Dynamic Reference.

The purpose of this study was to develop a quantitative AR-assisted free-hand orthognathic surgery method using electromagnetic (EM) tracking and skin-attached dynamic reference. The authors proposed a novel, simplified, and convenient workflow for augmented reality (AR)-assisted orthognathic surgery based on optical marker-less tracking, a comfortable display, and a non-invasive, skin-attached dynamic reference frame. The 2 registrations between the physical (EM tracking) and CT image spaces and between the physical and AR camera spaces, essential processes in AR-assisted surgery, were pre-operatively performed using the registration body complex and 3D depth camera. The intraoperative model of the maxillary bone segment (MBS) was superimposed on the real patient image with the simulated goal model on a flat-panel display, and the MBS was freely handled for repositioning with respect to the skin-attached dynamic reference tool (SRT) with quantitative visualization of landmarks of interest using only EM tracking. To evaluate the accuracy of AR-assisted Le Fort I surgery, the MBS of the phantom was simulated and repositioned by 6 translational and three rotational movements. The mean absolute deviations (MADs) between the simulation and post-operative positions of MBS landmarks by the SRT were 0.20, 0.34, 0.29, and 0.55 mm in x- (left lateral, right lateral), y- (setback, advance), and z- (impaction, elongation) directions, and RMS, respectively, while those by the BRT were 0.23, 0.37, 0.30, and 0.60 mm. There were no significant differences between the translation and rotation surgeries or among surgeries in the x-, y-, and z-axes for the SRT. The MADs in the x-, y-, and z-axes exhibited no significant differences between the SRT and BRT. The developed method showed high accuracy and reliability in free-hand orthognathic surgery using EM tracking and skin-attached dynamic reference.

Therapeutic effect of intraductal saline irrigation in chronic obstructive sialadenitis.

BACKGROUND: The aim of the present study was to evaluate the effectiveness of intraductal irrigation using normal saline in chronic obstructive sialadenitis. METHODS: Patients who had one of the following symptoms were recruited: pain, swelling, stiffness, and dry mouth. A total of 58 salivary glands in 33 patients were diagnosed as having sialadenitis using sialography and ultrasonography. The patients were divided into two groups (swelling group and dry mouth group), according to the major complaint. Repeated intraductal irrigation was performed on each gland. Difference of symptom severity evaluated using numerical rating scale (NRS), and ductal width measured using ultrasonography were compared between the two groups. RESULTS: The average NRS score was significantly decreased from 6.0 to 3.3 after 3-5 visits of intraductal irrigation (P < 0.05). The reduction in NRS was greater in the swelling group than in the dry mouth group, although the difference between the groups was not statistically significant. There was no change of ductal width before and after the irrigation. CONCLUSIONS: Intraductal irrigation according to this study method using normal saline is a simple treatment for the patients with chronic obstructive sialadenitis. It provides a conservative treatment option reducing the subjective symptoms.

Multislice computed tomography demonstrating mental nerve paresthesia caused by periapical infection: A case report.

Components derived from an infected lesion within the bone can spread through various passages in the mandible, particularly via the mental foramen. Radiologically, the spread of infection is typically nonspecific and challenging to characterize; however, multislice computed tomography (MSCT) can effectively detect pathological changes in soft tissues and the bone marrow space. This report describes the case of a 55-year-old woman who experienced mental nerve paresthesia due to a periapical infection of the right mandibular second premolar. MSCT imaging revealed increased attenuation around the periapical lesion extending into the mandibular canal and loss of the juxtamental foraminal fat pad. Following endodontic treatment of the tooth suspected to be the source of the infection, the patient's symptoms resolved, and the previous MSCT imaging findings were no longer present. Increased bone marrow attenuation and obliteration of the fat plane in the buccal aspect of the mental foramen may serve as radiologic indicators of inflammation spreading from the bone marrow space.

Developing evidence-based clinical imaging guidelines for the diagnosis of vertically fractured teeth.

OBJECTIVES: This study aimed to develop an evidence-based clinical imaging guideline for teeth suspected with vertical root fractures. METHODS: An adaptation methodology based on the Korean Clinical Imaging Guidelines (K-CIG) was used in the guideline development process. After searching for guidelines using major databases such as Ovid-Medline, Elsevier-Embase, National Guideline Clearinghouse, and Guideline International Network, as well as domestic databases such as KoreaMed, KMbase, and KoMGI, two reviewers analyzed the retrieved articles. The retrieved articles were included in this review using well-established inclusion criteria. RESULTS: Twenty articles were identified through an online search, of which three were selected for guideline development. Based on these three guidelines, this study developed specific recommendations concerning the optimal imaging modality for diagnosing teeth suspected of vertical root fractures. CONCLUSIONS: Periapical radiography is the preferred method for assessing teeth with mastication-related pain and suspected vertical root fractures. However, if intraoral radiographs do not provide sufficient information about root fractures, a small FOV CBCT may be considered. However, the use of CBCT in endodontically treated teeth is significantly constrained by the presence of artificial shading.

Clinical and radiological features of malformed mesiodens in the nasopalatine canal: an observational study.

OBJECTIVES: The purpose of this study is to investigate the morphological changes that occur when mesiodens is located within the nasopalatine canal, as well as clinical characteristics. METHODS: Clinical records and CT images of patients who had mesiodens in the nasopalatine canal were retrospectively analysed. In addition to demographic information, clinical symptoms and complications associated with extraction of mesiodens were recorded. Using CT images, number, location, size, and tooth morphology were evaluated. RESULTS: This study included 32 patients and 38 mesiodens within the nasopalatine canal. Supernumerary teeth exhibited a characteristic feature of thin and elongated shape in the canal (narrow width and elongation were observed in 96.6% and 53.3% of the patients, respectively). Fusion was found in 4 patients and dilaceration in 12. A complication occurred in 2 patients, which was tooth remnant, not a neurologic complication. Only 5 mesiodens could be detected in the nasopalatine canal on panoramic images. CONCLUSIONS: Morphological abnormalities in mesiodens within the nasopalatine canal were frequently detected, and these could be effectively diagnosed through 3D imaging analysis.

Automatic detection of posterior superior alveolar artery in dental cone-beam CT images using a deeply supervised multi-scale 3D network.

OBJECTIVES: This study aimed to develop a robust and accurate deep learning network for detecting the posterior superior alveolar artery (PSAA) in dental cone-beam CT (CBCT) images, focusing on the precise localization of the centre pixel as a critical centreline pixel. METHODS: PSAA locations were manually labelled on dental CBCT data from 150 subjects. The left maxillary sinus images were horizontally flipped. In total, 300 datasets were created. Six different deep learning networks were trained, including 3D U-Net, deeply supervised 3D U-Net (3D U-Net DS), multi-scale deeply supervised 3D U-Net (3D U-Net MSDS), 3D Attention U-Net, 3D V-Net, and 3D Dense U-Net. The performance evaluation involved predicting the centre pixel of the PSAA. This was assessed using mean absolute error (MAE), mean radial error (MRE), and successful detection rate (SDR). RESULTS: The 3D U-Net MSDS achieved the best prediction performance among the tested networks, with an MAE measurement of 0.696 ± 1.552 mm and MRE of 1.101 ± 2.270 mm. In comparison, the 3D U-Net showed the lowest performance. The 3D U-Net MSDS demonstrated a SDR of 95% within a 2 mm MAE. This was a significantly higher result than other networks that achieved a detection rate of over 80%. CONCLUSIONS: This study presents a robust deep learning network for accurate PSAA detection in dental CBCT images, emphasizing precise centre pixel localization. The method achieves high accuracy in locating small vessels, such as the PSAA, and has the potential to enhance detection accuracy and efficiency, thus impacting oral and maxillofacial surgery planning and decision-making.

Radiological manifestations and clinical findings of patients with oncologic and osteoporotic medication-related osteonecrosis of the jaw.

Medication-related osteonecrosis of the jaw (MRONJ) poses a challenging form of osteomyelitis in patients undergoing antiresorptive therapies in contrast to conventional osteomyelitis. This study aimed to compare the clinical and radiological features of MRONJ between patients receiving low-dose medications for osteoporosis and those receiving high-dose medications for oncologic purposes. The clinical, panoramic radiographic, and computed tomography data of 159 patients with MRONJ (osteoporotic group, n = 120; oncologic group, n = 39) who developed the condition after using antiresorptive medications for the management of osteoporosis or bone malignancy were analyzed. The osteoporotic group was older (75.8 vs. 60.4 years, p < 0.01) and had a longer duration of medication usage than the oncologic group (58.1 vs. 28.0 months, p < 0.01). Pus discharge and swelling were more common in the osteoporotic group (p < 0.05), whereas bone exposure was more frequent in the oncologic group (p < 0.01). The mandibular cortical index (MCI) in panoramic radiographs was higher in the osteoporotic group (p < 0.01). The mean sequestra size was larger in the oncologic group than in the osteoporotic group (15.3 vs. 10.6 mm, p < 0.05). The cured rate was significantly higher in the osteoporotic group (66.3% vs. 33.3%, p < 0.01). Oncologic MRONJ exhibited distinct clinical findings including rapid disease onset, fewer purulent signs, and lower cure rates than osteoporotic MRONJ. Radiological features such as sequestrum size on CT scan, and MCI values on panoramic radiographs, may aid in differentiating MRONJ in osteoporotic and oncologic patients.

CACSNet for automatic robust classification and segmentation of carotid artery calcification on panoramic radiographs using a cascaded deep learning network.

Stroke is one of the major causes of death worldwide, and is closely associated with atherosclerosis of the carotid artery. Panoramic radiographs (PRs) are routinely used in dental practice, and can be used to visualize carotid artery calcification (CAC). The purpose of this study was to automatically and robustly classify and segment CACs with large variations in size, shape, and location, and those overlapping with anatomical structures based on deep learning analysis of PRs. We developed a cascaded deep learning network (CACSNet) consisting of classification and segmentation networks for CACs on PRs. This network was trained on ground truth data accurately determined with reference to CT images using the Tversky loss function with optimized weights by balancing between precision and recall. CACSNet with EfficientNet-B4 achieved an AUC of 0.996, accuracy of 0.985, sensitivity of 0.980, and specificity of 0.988 in classification for normal or abnormal PRs. Segmentation performances for CAC lesions were 0.595 for the Jaccard index, 0.722 for the Dice similarity coefficient, 0.749 for precision, and 0.756 for recall. Our network demonstrated superior classification performance to previous methods based on PRs, and had comparable segmentation performance to studies based on other imaging modalities. Therefore, CACSNet can be used for robust classification and segmentation of CAC lesions that are morphologically variable and overlap with surrounding structures over the entire posterior inferior region of the mandibular angle on PRs.

Automatic segmentation and classification of frontal sinuses for sex determination from CBCT scans using a two-stage anatomy-guided attention network.

Sex determination is essential for identifying unidentified individuals, particularly in forensic contexts. Traditional methods for sex determination involve manual measurements of skeletal features on CBCT scans. However, these manual measurements are labor-intensive, time-consuming, and error-prone. The purpose of this study was to automatically and accurately determine sex on a CBCT scan using a two-stage anatomy-guided attention network (SDetNet). SDetNet consisted of a 2D frontal sinus segmentation network (FSNet) and a 3D anatomy-guided attention network (SDNet). FSNet segmented frontal sinus regions in the CBCT images and extracted regions of interest (ROIs) near them. Then, the ROIs were fed into SDNet to predict sex accurately. To improve sex determination performance, we proposed multi-channel inputs (MSIs) and an anatomy-guided attention module (AGAM), which encouraged SDetNet to learn differences in the anatomical context of the frontal sinus between males and females. SDetNet showed superior sex determination performance in the area under the receiver operating characteristic curve, accuracy, Brier score, and specificity compared with the other 3D CNNs. Moreover, the results of ablation studies showed a notable improvement in sex determination with the embedding of both MSI and AGAM. Consequently, SDetNet demonstrated automatic and accurate sex determination by learning the anatomical context information of the frontal sinus on CBCT scans.

Automatic detection and classification of nasopalatine duct cyst and periapical cyst on panoramic radiographs using deep convolutional neural networks.

OBJECTIVE: The aim of this study was to evaluate a deep convolutional neural network (DCNN) method for the detection and classification of nasopalatine duct cysts (NPDC) and periapical cysts (PAC) on panoramic radiographs. STUDY DESIGN: A total of 1,209 panoramic radiographs with 606 NPDC and 603 PAC were labeled with a bounding box and divided into training, validation, and test sets with an 8:1:1 ratio. The networks used were EfficientDet-D3, Faster R-CNN, YOLO v5, RetinaNet, and SSD. Mean average precision (mAP) was used to assess performance. Sixty images with no lesion in the anterior maxilla were added to the previous test set and were tested on 2 dentists with no training in radiology (GP) and on EfficientDet-D3. The performances were comparatively examined. RESULTS: The mAP for each DCNN was EfficientDet-D3 93.8%, Faster R-CNN 90.8%, YOLO v5 89.5%, RetinaNet 79.4%, and SSD 60.9%. The classification performance of EfficientDet-D3 was higher than that of the GPs' with accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.4%, 94.4%, 97.2%, 94.6%, and 97.2%, respectively. CONCLUSIONS: The proposed method achieved high performance for the detection and classification of NPDC and PAC compared with the GPs and presented promising prospects for clinical application.

Deep learning-based automatic segmentation of the mandibular canal on panoramic radiographs: A multi-device study.

Purpose: The objective of this study was to propose a deep-learning model for the detection of the mandibular canal on dental panoramic radiographs. Materials and Methods: A total of 2,100 panoramic radiographs (PANs) were collected from 3 different machines: RAYSCAN Alpha (n=700, PAN A), OP-100 (n=700, PAN B), and CS8100 (n=700, PAN C). Initially, an oral and maxillofacial radiologist coarsely annotated the mandibular canals. For deep learning analysis, convolutional neural networks (CNNs) utilizing U-Net architecture were employed for automated canal segmentation. Seven independent networks were trained using training sets representing all possible combinations of the 3 groups. These networks were then assessed using a hold-out test dataset. Results: Among the 7 networks evaluated, the network trained with all 3 available groups achieved an average precision of 90.6%, a recall of 87.4%, and a Dice similarity coefficient (DSC) of 88.9%. The 3 networks trained using each of the 3 possible 2-group combinations also demonstrated reliable performance for mandibular canal segmentation, as follows: 1) PAN A and B exhibited a mean DSC of 87.9%, 2) PAN A and C displayed a mean DSC of 87.8%, and 3) PAN B and C demonstrated a mean DSC of 88.4%. Conclusion: This multi-device study indicated that the examined CNN-based deep learning approach can achieve excellent canal segmentation performance, with a DSC exceeding 88%. Furthermore, the study highlighted the importance of considering the characteristics of panoramic radiographs when developing a robust deep-learning network, rather than depending solely on the size of the dataset.

Case series: Noninfectious myositis of temporal muscle: a report of 2 cases.

BACKGROUND: Noninfectious myositis (NIM) of the masticatory muscles is uncommon local myalgia disorder persisted by a centrally-mediated neurogenic mechanism. Due to the rarity of this condition and the lack of appropriate data regarding it, diagnosing this pathology when it affects the temporal muscle (TM) is challenging. CASE PRESENTATION: Clinical signs and symptoms, diagnostic process, and treatment outcome of 2 rare cases of NIM of the TM were presented. The signs and symptoms of the patients were not pathognomonic. There were restrictions on the mouth opening and lateral excursion of the mandible. The duration of the symptoms may not be chronic. The findings of clinical evaluation may indicate the diagnosis of anterior disc displacement (DD) without reduction of the temporomandibular joint (TMJ) and/or local myalgia. Swelling of the involved muscle could be evident and identified on palpation depending on the involved site of myositis. The axial T2-weighted magnetic resonance (MR) imaging was important for the accurate diagnosis of this rare condition. Application of non-surgical conservative treatment modalities such as administration of non-steroidal anti-inflammatory analgesics for a sufficient period of time, control of oral parafunctional habits, and jaw exercises were effective for the management of NIM of the TM. CONCLUSION: A thorough clinical examination and MR imaging including the axial T2-weighted view are required for accurate diagnosis and effective management of NIM of the TM.

Nasal cavity perforation by implant fixtures: case series with emphasis on panoramic imaging of nasal cavity extending posteriorly.

The nasal cavity is an important landmark when considering implant insertion into the anterior region of the maxillary arch. The perforation of implants into the nasal cavity may cause complications, such as implant migration, inflammation, or changes in nasal airflow; thus, precise assessment of the nasal cavity is mandatory.Three cases of nasal cavity perforation by dental implants are presented, including one case of implant fixture migration into the nasal cavity. On panoramic radiographs of the patients, the following common features were observed: the horizontal radiopaque line of the hard palate was observed to be inferior to or similar to that of the antral floor and the bone between the lateral wall of the nasal cavity and the medial wall of the maxillary sinus was emphasized in a triangular shape.When the maxillary sinus is small and alveolar bone resorption is severe, panoramic evaluation may cause overestimation of the available residual bone, particularly in the maxillary canine/premolar region. Therefore, the residual bone should be reevaluated three-dimensionally to measure the exact bony shape and volume.