Case challenge. Chronic maxillary inflammation.

A 30-year old male was referred by a dental practitioner to the Department of Oral Radiology at the University of Lund, Sweden, for a radiological evaluation of chronic symptoms of inflammation on the right side of the maxilla. According to the patient, at age 12 he had surgery to remove a non-erupted maxillary right second premolar. Postoperatively, a draining sinus tract appeared on the buccal aspect of the alveolar process. Thirteen years later, at age 25, surgery was again performed and the sinus tract reappeared. Intermittent discharge of exudate from the sinus tract occurred since the second surgery. Clinical and radiological examinations were conducted prior to a third surgery. The clinical examination revealed pus draining from the tract located on the buccal aspect of the alveolar process between the right maxillary first molar and first premolar. The radiological examination included periapical radiographs of the right maxillary first premolar and canine, a panoramic radiograph, and frontal tomograms of the maxillary right premolar area.

Case challenge: the case of the missing root tip.

A 43-year old female had her left maxillary first molar removed by her dentist. Upon examining the tooth following the extraction, he discovered the distobuccal root was fractured. Inspection of the extraction site revealed the missing root remained in its alveolus. When attempts were made to remove the root, it suddenly disappeared. To our knowledge, no further efforts were made to locate the root. In the ensuing weeks, the patient's dentist inserted a three-unit bridge to fill the space created by the removal of the first molar. Two months after the extraction, the patient was referred to the Department of Oral Radiology at the University of Lund, Sweden, with a request for help in locating the lost root.

Ossification of the human stylohyoid ligament: a longitudinal study.

We report the results of a longitudinal radiographic study of ossification of the stylohyoid ligament in a sample of patients treated for minor malocclusions. The results suggest that the vast majority of ossified sites in the stylohyoid ligaments are established during childhood and adolescence. The mean length of the sites shows a fairly rapid, linear increase with age until the end of adolescence; any further increase is nonlinear and occurs at a much slower rate. In young individuals the ossified sites were predominant in the superior part of the ligament. With increasing age ossified sites became prevalent also in other parts of the ligament. Ossified sites in the inferior part close to the hyoid bone were more common than previously reported.

Imaging of the temporomandibular joint: a position paper of the American Academy of Oral and Maxillofacial Radiology.

Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.

Detection of small differences in mass using a direct digital dental X-ray system.

OBJECTIVES: To evaluate experimentally how in direct digital radiography heterogenous detector response may influence the depiction of small mass differences. METHODS: A step wedge of a bone-simulating resin was imaged at 70 kVp using RadioVisioGraphy ZHR 32000. Exposure time and step wedge position on the detector varied. The pixel values of the stored images of the step wedge were converted to luminance values of the displayed images. RESULTS: The relationship between pixel and luminance values was non-linear. The difference in luminance between adjacent steps varied with position of step wedge. Regardless of position, there was an increase in difference of luminance between steps with increasing exposure. A greater relative change in luminance was consequently seen in the thinner parts of the step wedge. The failure to perceive individual steps of the wedge in its thicker parts was related to insufficient relative change in luminance between steps. CONCLUSIONS: The heterogeneous response of the detector resulted in a varying ability to depict small mass changes over the detector area.

Pneumocele of the maxillary sinus: a case report and literature review.

A panoramic radiograph of a 27-year-old female who had sustained midfacial trauma incidentally revealed a greatly expanded, hyperlucent right maxillary sinus. Further radiological exploration, including tomography, demonstrated that the expansion was mainly localized to the inferomedial part of the antrum with encroachment on the nasal and oral cavities. ENT examination was unremarkable. The lesion was diagnosed as a pneumocele. No treatment was rendered. Repeated tomography nine years later showed no changes. Today, 23 years later, the patient is still asymptomatic. A literature review reveals only nine previous cases of pneumocele of the maxillary sinus.

Modern management of dental caries: the cutting edge is not the dental bur.

Treating the disease, not the symptoms, is the change in managing dental caries. As researchers supply the tools, dentists can apply more efficient and realistic methods for better patient care.

Saliva secretion from the rat submandibular gland after retrograde infusion of radiographic contrast media.

Rat submandibular saliva was collected at various times after retrograde infusion of water-soluble (Renografin 60%) or lipid-soluble (Lipiodol UF) radiographic contrast medium. Significant alterations in flow rate occurred following heavy parenchymal filling with both types of contrast media. Occasional changes in protein concentration, lactoperoxidase activity, and K+ levels were also noted. These changes were relatively mild and transient, and gland function had generally returned to normal by one wk after infusion. No alterations in glandular function were detected after infusion of contrast medium to a degree (ductal filling) comparable to that usually employed in clinical sialography.

A morphologic study of the recovery of the rat submandibular gland after retrograde infusion. I. Water-soluble radiographic contrast medium.

The recovery of the rat submandibular gland after retrograde infusion of water-soluble radiographic contrast medium was studied using an experimental model. During continuous monitoring of the developing intraglandular pressure, the glands were subjected to ductal and slight parenchymal filling or heavy parenchymal filling with the medium. The animals were killed after varying recovery periods, and the tissue was prepared for light and electron microscopic examination. Dilation of the ductal lumina, induced during ductal and slight parenchymal filling, was successively reduced and, generally, the parenchyma had a normal appearance at 30 h. In glands subjected to heavy parenchymal filling, the changes in the intralobular ducts were more pronounced and were also seen at later times after infusion. Alterations in the acini, comprising fusion of secretory granules, vacuole formation and dilation of the acinar lumina and intercellular canaliculi, were observed. At later times, atrophy of the parenchymal cells occurred together with an apparent proliferation of the connective-tissue stroma, as well as an increase in the number of small blood vessels. An inflammatory cell-infiltrate was seen in both groups of animals, but was most prominent in glands subjected to heavy parenchymal filling. The infiltrate, comprised primarily of macrophages and polymorphonuclear leukocytes, reached a peak at 20 h after infusion. At later times, mast cells and occasional eosinophils were seen. The observed alterations and the pattern of recovery are most likely due to the induced intraglandular pressure and the following inflammatory reaction. It is also possible that the changes, to some extent, are influenced by the presence of the contrast medium in the tissue.

Double-contrast tomography of the temporomandibular joint. A new technique based on autopsy specimen examinations.

Double-contrast tomography was applied to temporomandibular joint autopsy specimens. Both joint compartments were given successive injections of air-iodine contrast medium-air. Tomography was performed in lateral and a.p. projections using a multi-film cassette. The shape of the disc and joint compartments was well demonstrated. The influence of the tomographic level and the position of the condyle on the appearance of the disc was analysed.

Radiography of the temporomandibular joint utilizing oblique lateral transcranial projections. Comparison of information obtained with standardized technique and individualized technique.

An individualized technique for radiography of the temporomandibular joint utilizing oblique lateral transcranial projection is described. The patient is fixed in a cephalostat and the central ray directed through the horizontal long axis of the condyle. The information yielded when applying the individualized technique has been compared with that yielded from a standard technique and tomography. The plane of sectioning for tomography was oriented perpendicular to the horizontal long axis of the condyle. The material comprised radiographs from 30 joints. The condyle to fossa relation was studied as well as the occurence of structural changes. Neither the individualized technique nor the standardized technique gave an accurate picture of the condyle to fossa relation when compared to tomography. However, the individualized technique tended to give the same result as tomography more often. Tomography revealed the greatest number of structural changes (66) followed by individualized technique (47) and standard technique (19). Most changes were noted exclusively in one projection. A combination of individualized technique and tomography revealed more changes than a combination of tomography and standard technique.