Comparison of Dimensions of the Nasopharynx and Oropharynx Using Different Anatomical References: Is There Equivalence?

PURPOSE: To evaluate the equivalence of the volumes obtained using different anatomic references to measure the nasopharynx and oropharynx on cone-beam computed tomography (CBCT) scans. We hypothesized that no variations would be found in the nasopharynx and oropharynx dimensions when measured using different measurement methods. MATERIALS AND METHODS: A total of 40 CBCT scans of patients with skeletal Class I (age range, 20 to 50 years) were measured independently by 2 of us. The nasopharynx and oropharynx subregions were volumetrically measured using the adopted limits of 5 different measurement methods (3 for the nasopharynx and 2 for the oropharynx) and InVivoDental software, version 5.4 (Anatomage, San Jose, CA). The minimum area and the minimum area of localization were also evaluated. The intra- and interexaminer concordance for the measurements from the different methods were verified using the interclass correlation coefficient (ICC). The analysis of variance for repeated measures was used to compare the measurements from the 3 nasopharynx methods. The paired t test was used to compare the measurements from the 2 oropharynx methods. The statistical tests were performed at the 5% significance level using SPSS software, version 22.0 (IBM Corp, Armonk, NY). RESULTS: The intra- and interexaminer ICC values were greater than 0.8. We found a statistically significant difference in the volume measurements among the 3 nasopharynx methods (P = .001). However, no differences were found in the minimum area or minimum area of localization comparisons. Statistically significant differences were also observed for the volume, minimum area, and minimum area of localization between the 2 oropharynx methods (P = .001). CONCLUSIONS: Studies that have used different methods of measurement should not be directly compared. The different measurement methods used for nasopharynx and oropharynx evaluations should not be compared.

Chamomile infusion cryotherapy to prevent oral mucositis induced by chemotherapy: a pilot study.

PURPOSE: The aim of this study is to compare cryotherapy made only with water and cryotherapy made with chamomile infusion for prevention and reduction of intensity of oral mucositis in patients with cancer receiving 5-fluorouracil and leucovorin. METHOD: This is a randomized pilot study with two groups: cryotherapy made only with water (control group, n = 18) and cryotherapy made with chamomile infusion (chamomile group, n = 20). Both groups were instructed to swish the ice around in their oral cavity for at least 30 min during chemotherapy. Assessment of oral mucosa occurred on days 8, 15, and 22 after the first day of chemotherapy. RESULTS: Fifty percent of the patients in the control and 30 % in the chamomile group developed oral mucositis. Mouth pain score was higher in patients in the control group on all evaluations (p = 0.02 for day 8, p = 0.09 for day 15, and p = 0.14 for day 22). Patients in the chamomile group never developed mucositis with grade 2 or higher. Presence of ulceration was statistically significant on day 8 (16 % in the control vs. 0 % in the chamomile group, p = 0.10), but not in days 15 and 22, although 11 % still had ulcerations in the control group and none in the chamomile group. CONCLUSION: The occurrence of oral mucositis was lower in patients in the chamomile group than in the control group. When compared to the controls, the chamomile group presented less mouth pain and had no ulcerations. Cryotherapy was well tolerated by both groups, and no toxicity related to chamomile was identified.

The use of artificial intelligence tools in cancer detection compared to the traditional diagnostic imaging methods: An overview of the systematic reviews.

BACKGROUND AND PURPOSE: In comparison to conventional medical imaging diagnostic modalities, the aim of this overview article is to analyze the accuracy of the application of Artificial Intelligence (AI) techniques in the identification and diagnosis of malignant tumors in adult patients. DATA SOURCES: The acronym PIRDs was used and a comprehensive literature search was conducted on PubMed, Cochrane, Scopus, Web of Science, LILACS, Embase, Scielo, EBSCOhost, and grey literature through Proquest, Google Scholar, and JSTOR for systematic reviews of AI as a diagnostic model and/or detection tool for any cancer type in adult patients, compared to the traditional diagnostic radiographic imaging model. There were no limits on publishing status, publication time, or language. For study selection and risk of bias evaluation, pairs of reviewers worked separately. RESULTS: In total, 382 records were retrieved in the databases, 364 after removing duplicates, 32 satisfied the full-text reading criterion, and 09 papers were considered for qualitative synthesis. Although there was heterogeneity in terms of methodological aspects, patient differences, and techniques used, the studies found that several AI approaches are promising in terms of specificity, sensitivity, and diagnostic accuracy in the detection and diagnosis of malignant tumors. When compared to other machine learning algorithms, the Super Vector Machine method performed better in cancer detection and diagnosis. Computer-assisted detection (CAD) has shown promising in terms of aiding cancer detection, when compared to the traditional method of diagnosis. CONCLUSIONS: The detection and diagnosis of malignant tumors with the help of AI seems to be feasible and accurate with the use of different technologies, such as CAD systems, deep and machine learning algorithms and radiomic analysis when compared with the traditional model, although these technologies are not capable of to replace the professional radiologist in the analysis of medical images. Although there are limitations regarding the generalization for all types of cancer, these AI tools might aid professionals, serving as an auxiliary and teaching tool, especially for less trained professionals. Therefore, further longitudinal studies with a longer follow-up duration are required for a better understanding of the clinical application of these artificial intelligence systems. TRIAL REGISTRATION: Systematic review registration. Prospero registration number: CRD42022307403.

Radiomics in bone pathology of the jaws.

OBJECTIVE: To define which are and how the radiomics features of jawbone pathologies are extracted for diagnosis, predicting prognosis and therapeutic response. METHODS: A comprehensive literature search was conducted using eight databases and gray literature. Two independent observers rated these articles according to exclusion and inclusion criteria. 23 papers were included to assess the radiomics features related to jawbone pathologies. Included studies were evaluated by using JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. RESULTS: Agnostic features were mined from periapical, dental panoramic radiographs, cone beam CT, CT and MRI images of six different jawbone alterations. The most frequent features mined were texture-, shape- and intensity-based features. Only 13 studies described the machine learning step, and the best results were obtained with Support Vector Machine and random forest classifier. For osteoporosis diagnosis and classification, filtering, shape-based and Tamura texture features showed the best performance. For temporomandibular joint pathology, gray-level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), Gray Level Size Zone Matrix (GLSZM), first-order statistics analysis and shape-based analysis showed the best results. Considering odontogenic and non-odontogenic cysts and tumors, contourlet and SPHARM features, first-order statistical features, GLRLM, GLCM had better indexes. For odontogenic cysts and granulomas, first-order statistical analysis showed better classification results. CONCLUSIONS: GLCM was the most frequent feature, followed by first-order statistics, and GLRLM features. No study reported predicting response, prognosis or therapeutic response, but instead diseases diagnosis or classification. Although the lack of standardization in the radiomics workflow of the included studies, texture analysis showed potential to contribute to radiologists' reports, decreasing the subjectivity and leading to personalized healthcare.

A Conservative Approach for Localized Spongiotic Gingivitis Hyperplasia Using Photodynamic Therapy: A Case Report and Review of the Literature.

Objective: To describe a clinical case of successful conservative management of Localized Juvenile Spongiotic Gingivitis Hyperplasia (LJSGH) using photodynamic therapy (PDT) and reviews the current literature on this pathology. Background data: LJSGH is a recently described rare disease with controversial treatment results. As of today, 13 publications report surgical treatment approaches. The use of CO2 laser and cryotherapy was reported only in one study. The use of PDT was not previously reported. Patients and methods: A 9-year-old male patient was referred to our institution with the chief complaint of asymptomatic "inflamed gingiva" starting 1 year before. Clinical examination revealed an erythematous line accompanying the gingival contour, with a certain degree of hyperplasia. The diagnosis of LJSGH was performed based on clinical features and later confirmed histopathologically. A novel approach using PDT was then proposed. The photosensitizer was methylene blue, and a semiconductor laser diode was used. Results: One week after starting PDT, gingival hyperplasia was partially reduced. Immediately after the end of treatment, a significant reduction of gingival hyperplasia was observed. PDT proved to be safe, quick and painless, with no esthetic harm. Conclusions: This case illustrates the benefit of a more conservative approach as opposed to surgical procedure, with good clinical response and decreased morbidity over a 2-year follow-up period.

Effectiveness of FDG-PET/CT for evaluating early response to induction chemotherapy in head and neck squamous cell carcinoma: A systematic review.

BACKGROUND: F-Fluoro-Deoxy-Glucose Positron Emission Tomography with Computed Tomography (F-FDG PET/CT) may be a powerful tool to predict treatment outcome. We aimed to review the effectiveness of F-FDG PET/CT in the assessment of early response to induction chemotherapy (IC) in patients with advanced Head and Neck Squamous Cell Cancer (HNSCC) without previous treatment. METHODS: PubMed, Cochrane Library, Science Direct and Web of Science were searched to May 2016. Reference lists of the included articles and additional studies identified by one nuclear medicine expert were screened for potential relevant studies that investigated the effectiveness of F-FDG PET/CT performed before and after IC. Three authors independently screened all retrieved articles, selected studies that met inclusion criteria and extracted data. The methodology of the selected studies was evaluated by using the risk of bias checklist of the Agency for Healthcare Research and Quality (AHRQ). RESULTS: Seven out of 170 eligible studies met our inclusion criteria. A total of 207 advanced HNSCC patients were evaluated with F-FDG PET/CT at baseline and after IC in the selected articles. Six from seven studies concluded that F-FDG PET/CT allowed early evaluation response to IC and predicted survival outcomes. CONCLUSION: The present systematic review confirms the potential value of F-FDG PET/CT as a diagnostic tool for early IV response assessment in HNSCC patients. However, the lack of standard definitions for response criteria and heterogeneous IC protocols indicate the need to further studies in order to better define the role of F-FDG PET/CT in these patients.

Imaging findings of bisphosphonate-related osteonecrosis of the jaws: a critical review of the quantitative studies.

Objectives. This paper offers a critical review of published information on the imaging strategies used for diagnosing bisphosphonate-associated osteonecrosis of the jaw (BRONJ) in patients taking intravenous bisphosphonates, pointing at the different methodologies and results of existing literature. Methods. Electronic literature search was performed in order to identify as many quantitative studies that discussed the imaging findings of BRONJ up to February 2014. Initially, the search for articles was based on the following four types of imaging modalities for evaluating BRONJ: computed tomography, plain film radiographs, magnetic resonance imaging, and nuclear bone scanning. Results. Eleven out of the 79 initially selected articles met the inclusion criteria. Most of the selected articles were cross-sectional studies. Regarding the selected studies, 54.5% have used plain films radiographs and 54.5% were based on computed tomography findings. All of the selected studies showed a small number of patients and none of the selected studies have tested the accuracy of the imaging examination for evaluating BRONJ. Conclusions. This critical review showed a scarcity of quantitative studies that analyzed the typical imaging findings related to BRONJ. Further studies are necessary in order to analyze the role of different imaging techniques in the assessment of BRONJ.

Fractal dimension and mandibular cortical width in normal and osteoporotic men and women.

OBJECTIVE: To verify whether fractal dimensions (FD) on the mandibular trabecular and cortical bone and mandibular cortical width (MCW) differ between patients with normal bone mineral density (BMD) and osteoporosis. STUDY DESIGN: In this retrospective study, 133 dental panoramic radiographs from men aged >60 years and postmenopausal women with a bone densitometry report of the lumbar spine and hip classified as either normal or osteoporotic were selected. Fractal dimensions of five standardized trabecular and cortical mandibular regions of interest and mandibular cortical width were measured on the panoramic radiographs by an experienced oral radiologist, blinded to the densitometric diagnosis. The following statistical analyses were performed: ANOVA and a forward logistic stepwise regression to verify associations between dental panoramic measurements and the densitometric diagnosis. P values less than .05 indicated statistical significance. MAIN OUTCOME MEASURES: Fractal dimension and mandibular cortical width. RESULTS: Differences were found in the FD values on mandibular cortical bone and MCW between patients with normal BMD and with osteoporosis, but not in the FD values of trabecular bone. The odds of having lower mean values of MCW and FD on cortical bone were 2.16, 3125 and 1005 times in osteoporotic patients, respectively, compared with patients with normal BMD. CONCLUSION: The values of FD analysis on mandibular cortical bone and MCW were lower in women with osteoporosis. A well-adjusted logistic regression model showed that cortical bone measurements might be considered as auxiliary tools to referring patients for DXA exam.

Assessing oral brushing technique as a source to collect DNA and its use in detecting human papillomavirus.

Collecting buccal cell DNA has a number of advantages in terms of practicality and technical quality when employed for detecting human papillomavirus (HPV), arguably an important etiological factor for head and neck carcinomas. The objective of the present study was to assess oropharyngeal mucosa brushing as an effective method for collecting DNA samples and for detecting HPV. Forty-three female patients diagnosed with cervical intraepithelial neoplasia, and 21 of their spouses, both groups without clinically detectable oral lesions, were submitted to quantitative and qualitative DNA analysis obtained through buccal cell brushing, with spectrophotometry assessment and beta-globin PCR. DNA samples were also checked for the presence of HPV. Efficient collection of DNA was achieved in all the sample cases. Two samples, a male and a female (not sexual partners), showed HPV-positivity. The results revealed that the oral brushing technique is an effective method for DNA collection to detect HPV, confirming that it could usefully contribute to epidemiological studies undertaken in Brazil's Public Health System. HPV detection using PCR showed that only 3.12% of the cases were HPV-positive. Although the sample was small, our study nevertheless allowed the detection of HPV in DNA samples of oral biological material.

Teaching and learning Oral Radiology via the social medium WhatsApp / Ensinando e aprendendo radiologia oral via mídia social WhatsApp

Social media can be defined as Internet-based applications that allow the widespread creation and exchange of user-generated content. The ease with which social media can be accessed through numerous mobile devices encourages medical educators to use social media to share content with students outside the classroom. The aim of this study was to introduce WhatsApp as a teaching tool in an Oral Radiology course. The secondary objective was to assess students' attitudes towards the use of this innovative tool in teaching of dentistry. In the first semester of 2016, 30 second-year undergraduate dental students at the University of Brasília were provided with weekly quizzes via a WhatsApp discussion group. The quizzes consisted of a tomographic or radiographic image from a real clinical case and a multiple-choice question. At the end of the semester students' attitudes were assessed using a satisfaction questionnaire. The results showed that students had a positive attitude towards the use of WhatsApp and considered it had helped them to learn about Oral Radiology. In conclusion, this technology can improve the way material is taught, since educators are prepared to develop better learning environments and students are concerned about the potential use of the social media in education (AU).

Mídias sociais podem ser definidas como um grupo de aplicativos baseados em Internet que permitem a criação e troca de conteúdos gerados pelo usuário de forma bastante expandida. A facilidade de as mídias sociais serem acessadas em dispositivos móveis encoraja educadores da área de saúde a compartilhar nessas mídias conteúdos que vão além da sala de aula. O objetivo desse estudo foi introduzir a mídia social WhatsApp como uma ferramenta de ensino no curso de Radiologia Oral. Como segundo objetivo, as atitudes dos estudantes ao utilizar essa nova ferramenta durante a graduação em Odontologia foram avaliadas. No primeiro semestre de 2016, quizzes semanais foram disponibilizados em um grupo de discussão no WhatsApp, criado com 30 alunos do segundo ano de Odontologia da Universidade de Brasília. Os quizzes eram compostos por uma imagem radiográfica ou tomográfica de um caso clínico real e uma questão de múltipla escolha. Ao final do semestre, avaliou-se o comportamento dos estudantes por um questionário de satisfação. O estudo mostrou que os alunos têm atitude positiva em relação ao uso do WhatsApp e o consideraram útil para auxiliar o aprendizado de Radiologia Oral. Em conclusão, essa tecnologia é capaz de aprimorar a forma como os conteúdos são ensinados, desde que os educadores estejam preparados para desenvolver melhores ambientes de aprendizado e os estudantes estejam conscientes sobre o potencial uso das mídias sociais para educação (AU).

Oral cancer staging established by magnetic resonance imaging.

The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

Augmented reality as a new perspective in Dentistry: development of a complementary tool / Realidade aumentada como uma nova perspectiva em Odontologia: desenvolvimento de uma ferramenta complementar

The purpose of this study is to introduce a visualization and interaction tool of Augmented Reality in mobile devices using three-dimensional (3D) volumetric images from patients' real tomographic acquisition, and to describe the steps for preparing the models for such 3D visualizations. Augmented Reality was built correlating tomographic images and open-source software, in a sequence of (1) image acquired, that consists of multi-planar images that can be visualized as 3D renderings and are the basis for constructing polygonal surfaces of specific anatomic structures of interest, (2) creation of volumetric models, in which 3D volumetric model can be saved and exported as a 3D polygonal mesh in .stl file format, (3) model simplification, which must be done in order to simplify the matrix of polygonal surfaces, and reduce models' megabytes, and (4) create the augmented reality project. Once these procedures are performed, the augmented reality project can be saved and visualized in mobile devices. The volumetric model from a computed tomography acquisition is available in any mobile device screen, superimposed on a marker. This approach facilitates the visualization of the model, giving the precise location of structures and abnormalities, as supernumerary teeth, bone fractures and asymmetries. Also, the model is saved for future and multiple visualization. Augmented reality application is a new perspective in dentistry although it is in an early phase. It can be created by integrating multiple technologies and has a great potential to support learning and teaching, and improve how 3D models from medical images are seen (AU).

O objetivo desse trabalho é introduzir uma ferramenta de visualização e interação baseada em realidade aumentada (RA) em dispositivos móveis utilizando imagens volumétricas em três dimensões (3D) a partir de aquisições tomográficas reais de pacientes, e descrever os passos para o preparo dos modelos para tais visualizações tridimensionais. A RA foi construída correlacionando imagens tomográficas e programas de computador livres, na seguinte sequência: (1) imagem adquirida, que consiste em imagens mutiplanares que podem ser visualizadas como renderizações 3D e são a base para a construção de superfícies poligonais de estruturas anatômicas específicas de interesse, (2) criação dos modelos volumétricos, passo no qual o modelo 3D pode ser salvo e exportado como uma malha poligonal 3D em formato de arquivo .stl, (3)simplificação do modelo, que deve ser executada com a finalidade de simplificar a matriz de superfícies poligonais e consequentemente reduzir os megabytes do modelo, e (4) criação do projeto de realidade aumentada. Essa abordagem facilita a visualização do modelo tomográfico, dando a localização precisa de estruturas e anormalidades, como dentes supranumerários, fraturas ósseas e assimetrias. Além disso, o referido modelo pode ser salvo para múltiplias visualizações futuras. A aplicação da realidade aumentada é uma nova perspectiva em Odontologia apesar de estar em fase inicial. Pode ser criada integrando múltiplas tecnologias e apresenta grande potencial para auxiliar o ensino e a aprendizagem, e para melhorar a forma como modelos 3D originados de imagens médicas são visualizados (AU).

The importance of the dentist in the diagnosis of cowden syndrome – Case report

Cowden Syndrome is an autosomal dominant disorder characterized by the development of several hamartomas in a variety of tissues, including the skin, gastrointestinal tract, adipose tissue, and bone and connective tissues. This syndrome is associated with a high risk of developing malignancies, especially breast, thyroid and endometrium cancers. This report presents a case of a 53-year-old patient who sought assistance at the Dentistry Department of the University Hospital of Brasilia (HUB) to receive basic dental treatment. The current and past medical history and oral and facial manifestations led to the diagnosis of Cowden syndrome. This case report aims to highlight the importance of a dental surgeon in the diagnosis of this syndrome, based on the observation of oral manifestations and medical history.

A Síndrome de Cowden é uma desordem hereditária autossômica dominante, caracterizada pelo desenvolvimento de diversos hamartomas em vários tipos de tecidos, incluindo a epiderme, trato gastrointestinal, tecido adiposo e tecidos ósseo e conjuntivo. Essa síndrome é associada a um risco elevado de desenvolvimento de malignidades, especialmente câncer de mama, tireoide e endométrio. Esse relato apresenta o caso de um paciente de 53 anos de idade que procurou o Departamento de Odontologia do Hospital Universitário de Brasília (HUB) para tratamento dental básico. História médica atual e passada e manifestações orais e faciais levaram ao diagnóstico de síndrome de Cowden. Este relato de caso apresenta a importância do cirurgião-dentista no diagnóstico desta síndrome, com base na observação das manifestações orais e história médica.

Correlations between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women.

OBJECTIVES: The aim was to test for correlations of 7 panoramic radiomorphometric indices with lumbar spine and hip bone mineral densities (BMDs) and to test the accuracy of these indices for predicting osteoporosis and a T-score < or =-2.0. STUDY DESIGN: Mandibular cortical indices, simple visual estimations of cortical widths, mental and antegonial indices, antegonial depth, gonial and antegonial angles, and BMD were measured in 351 postmenopausal women. RESULTS: Associations were demonstrated between BMDs, qualitative indices, and cortical measurements. In the case of severely eroded mandibular cortices, the odds ratio (OR) for osteoporosis (according to the World Health Organization criteria) was 4.82 and the OR for a T-score < or =-2.0, the threshold to begin treatment, was 10.87. In the case of very thin mandibular cortices, the ORs were 8.02 and 5.46 for osteoporosis and a T-score < or =-2.0, respectively. The mental index cutoff for osteoporosis was 3.15 mm. CONCLUSIONS: Antegonial indices and gonial angles cannot be used as osteoporosis predictors. The most accurate indices were the mental index, mandibular cortical index, and visual estimation of cortical width.

Oral cancer staging established by magnetic resonance imaging

The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

Ressonância magnética no diagnóstico do câncer de boca: revisão da literatura e relato de caso / MRI in the diagnosis of mouth cancer: review and case report

OBJETIVO: Revisar a literatura concernente à utilização da ressonância nuclear magnética no estadiamento do câncer de boca e apresentar caso de neoplasia maligna onde a RNM contribuiu para a detecção da lesão em tecidos moles. RESULTADO E DISCUSSÃO: A RNM é a ferramenta de imagem que evolui com maior rapidez em diagnóstico na área de saúde. Suas vantagens principais são a alta resolução dos tecidos moles e ausência de risco biológico aos pacientes. Com estas qualidades, pode ser usada para detalhar a anatomia, permitindo melhor estadiamento das lesões no câncer bucal, contribuindo igualmente para o diagnóstico precoce de possíveis recidivas. No caso apresentado(neoplasia maligna de pequeno tamanho), a RNM contribuiu para a detecção da lesão em tecidos moles, na extensão da lesão e no planejamento cirúrgico.

OBJECTIVE: To review the literature about cancer staging by using magnetic resonance image (MRI) and to present a case to illustrate the utility of this image diagnosis tool. RESULTS AND DISCUSSION: MRI is the fastest evolving imaging tool for diagnosis in health area. Its main advantages include a high detail resolution soft tissue and no biological risks to patients. Thus, it can be used to evaluate the detailed anatomy of structures, allowing better staging for treatment of patients with oral cavity cancer as well as better assessment of possible post-surgical treatment and/or radiotherapy changes. Early detection of relapses is also a key advantage, which might lead to appropriate monitoring, and protocols that could greatly improve patients’welfare. The present case study illustrates the difference between the CT scan and MRI in the analysis of a small lesion, where CT scan yielded no information on clinical staging while MRI was decisive in the soft tissue injury view, extent of lesion and adequate surgical planning.

Radiografia panorâmica: instrumento auxiliar no diagnóstico da osteoporose: [revisão] / Panoramic radiograph: auxiliary tool in the diagnosis of osteoporosis: [review]

A osteoporose é considerada um problema de saúde pública pela Organização Mundial de Saúde (OMS). A identificação de indivíduos com baixa densidade mineral óssea e alto risco para fratura associada à osteoporose e o estabelecimento de estratégias específicas de prevenção de fraturas são o alicerce de qualquer programa preventivo de osteoporose. O passo seguinte a esse reconhecimento seria o encaminhamento destes indivíduos para realização de densitometria óssea, exame considerado padrão-ouro para o diagnóstico da doença. No entanto, o custo e a falta de acesso da população ao exame são fatores que dificultam a utilização da densitometria como método de rastreamento populacional para a osteoporose. A radiografia panorâmica é importante na rotina de pacientes idosos, particularmente antes da colocação de próteses totais e implantes em edêntulos. Existem medidas qualitativas e quantitativas realizadas nas radiografias panorâmicas, denominadas índices radiomorfométricos, que podem ser capazes de identificar mulheres na pós-menopausa com indicação de realização de densitometria óssea. O objetivo principal deste artigo é discutir a importância da radiografia panorâmica como ferramenta auxiliar no diagnóstico da osteoporose e de baixa densidade mineral óssea.

Osteoporosis is considered as a public health problem by World Health Organization. The identification of subjects at risk of fractures and with low bone mineral density is the basis of any preventive osteoporosis program. Then, high risk individuals should be referred for dual X-ray absorptiometry (DXA). DXA is considered the gold standard of bone mineral density assessment. Nevertheless, bone densitometry has a limited availability for routine use in population screening. Panoramic radiography is conducted routinely in elderly populations, especially for edentulous patients before treating with complete denture or implants. Some panoramic radiographic measurements, also known as panoramic radiomorphometric indices, may identify postmenopausal women that should perform bone densitometry. The main purpose of this paper is to discuss the importance of panoramic radiography as an auxiliary tool in the diagnosis of osteoporosis and low bone mineral density.

Periostite proliferativa associada a dens in dente

Proliferative periostitis is a disease characterized for successive deposition of layers of subperiosteal bone as a response reaction to a chronic inflammatory stimulation. The affected periosteum forms several rows of reactive bone that are parallel and expand the surface of the altered bone. Dens in dente is a developmental malformation resulting from invagination of the crown before calcification has occurred. They are usually diagnosed upon routine clinical and radiographic examination. An unusual case report of a mandibular dens in dente causing proliferative periostitis is presented. The source of infection was related to dens in dente in mandibular left second premolar's crown, which had apparently communication with periodontal tissues. It was successfully treated by surgical therapy with antibiotic duringthe treatment. After the extraction of the affected tooth, radiographic follow-up showed the decrease of proliferative periostitis, and remodelation of the cortical bone.

A periostite proliferativa é uma doença caracterizada por sucessivas deposições de camadas de osso subperióstica como resposta a um estímulo crônico inflamatório. O periósteo afetado forma sucessivas camadas de osso reacional paralelas entre si e expandem a superfície óssea nesse local. Dens in dente é uma alteração do desenvolvimento resultante de invaginação de esmalte para a dentina antes de sua calcificação ocorrer. Usualmente são diagnosticadas em exames clínicos-radiográficos de rotina. Um relato de caso clínico raro é apresentado sobre dens in dente na coroa do segundo pré-molar inferior causando periostite proliferativa. A fonte de infecção foi o dens in dente que tinha comunicação do meio bucal com a área do periodonto. Foi realizada a extração do dente anômalo associado com uso de antibióticos. As radiografias de controle mostraram diminuição da periostite proliferativa como remodelamento do osso cortical.