Ultrasonography as a complementary exam in the diagnosis of oral arteriovenous malformation.

The Doppler ultrasonography (DU) in cases of arteriovenous malformations (AVMs) is not widely use by dentists and there are a lack of information on the topic in the literature. AVM is common in the region of the head and neck and are commonly confused with hemangiomas (congenital). Appropriate classification is essential for therapeutic decision. The diferential diagnosis is based on clinical history, diascopy, and, if necessary, diagnostic imaging. This article present two cases of oral AVM in which DU was crucial in detecting a venous and/or arterial component in purplish lesions in the tongue and buccal mucosa, with positive diascopy. In our cases, after DU, we found a predominance of blood component within the lesion and therefore both patients were referred to the head and neck surgeon for surgical removal of the lesion. Only in the presence of a venous component does outpatient treatment become feasible. Given the predominance of the arterial component, outpatient procedures are contraindicated. Therefore DU is an important supplementary test, being of great importance in the clinical decision and treatment plan for oral AVMs and should become a routine part of the dentist front of vascular lesions of medium to large size.

Is podoplanin expression associated with the proliferative activity of ameloblastomas?

OBJECTIVES: The aim of this study was to investigate the relationship between podoplanin expression and proliferative activity of ameloblastomas and remnants of the odontogenic epithelium from dental follicles (DF) of unerupted teeth. SUBJECTS AND METHODS: Thirty-three paraffin-embedded ameloblastomas and thirty-two DF obtained of unerupted teeth were analyzed by immunohistochemistry using anti-human podoplanin and anti-Ki-67 antibodies. Podoplanin expression in odontogenic epithelial cells was evaluated using a scoring method, and the Ki-67 labeling index was determined by the percentage of positive odontogenic cells. RESULTS: All ameloblastomas displayed podoplanin expression in ameloblast-like cells of the epithelial islands. Membranous expression of podoplanin in ameloblastomas was stronger than in the remnants of odontogenic epithelium (P = 0.001). Statistically significant difference was observed between the cytoplasmic and membranous expression of podoplanin in the remnants of odontogenic epithelium (P = 0.001). The index of epithelial odontogenic proliferative activity, verified by Ki-67 expression, was higher in ameloblastomas vs remnants of odontogenic epithelium (P < 0.001). No statistically significant correlation was identified between podoplanin and the cellular odontogenic proliferative activity in meloblastomas and DF (P > 0.05). CONCLUSIONS: These results provide evidence that there is no connection between podoplanin immunostaining and odontogenic cellular proliferative activity and suggest a role for membranous podoplanin expression in the local invasion of ameloblastomas.

The image of the hard palate/nasal fossa floor in panoramic radiography: the controversy is over.

OBJECTIVE: The aim of this investigation was to obtain further information about the anatomic structures involved in the formation of the upper image of the hard palate/nasal fossa floor (HP/NFF). STUDY DESIGN: Three dry human skulls underwent ostectomies along the HP midline (ie, the area of the junction of the nasal septum with the nasal fossa floor) and along posterior portions of the HP/NFF (ie, the horizontal plates of the palatine bones and part of the palatine processes of the maxillae). The radiographs were digitized and preostectomy and postostectomy optical densities were measured. Preostectomy and postostectomy optical densities were also measured. RESULTS: Partial disappearance of the upper image occurred after ostectomy of the junction of the nasal septum with the NFF. Total disappearance occurred only after bilateral ostectomy of the posterior portions of the HP/NFF. The mean increases in regional optical density in terms of pixel gray level after the ostectomies were 70.44%, 72.27%, and 51.40%. CONCLUSIONS: The junction of the nasal septum with the NFF and the posterior portions of the HP/NFF form the upper image of the HP/NFF. Most of the image is real, although a small part is a ghost image of the horizontal plates of the palatine bones and of the posterior region of the palatine processes of the maxillae.

Radiographic image of the hard palate and nasal fossa floor in panoramic radiography.

OBJECTIVE: The aim of this investigation was to report on the radiographic interpretation of the hard palate and nasal fossa floor in panoramic radiographs by studying different skulls, x-ray machines, and head positions in relationship to the Frankfort plane before and after ostectomy. STUDY DESIGN: Twenty dry human skulls were radiographed with three different panoramic x-ray machines in three different positions. Three of the skulls were submitted to different ostectomies. RESULTS: Multiple images of the hard palate and nasal fossa floor were present in 96.12% of the radiographs. Single images (3.88%) occurred only in the "chin up" position. CONCLUSIONS: The lower image represents the nasal fossa floor, especially its lateral and anterior limits. The upper images are double real images mainly formed by the junction of the nasal septum with the nasal fossa floor and possibly by posterior parts of the hard palate and nasal fossa floor. All images overlap in the "chin up" position becoming a single image. The most common shape of the anatomic landmark was wide angle "W" (58.33%). Other shapes present in positions "chin up" and "chin down" indicate patient positioning errors. The x-ray machines did not influence the results.

Gastroesophageal reflux disease: New oral findings.

OBJECTIVE: The objective of this study was to investigate the effects of gastroesophageal reflux disease (GERD) on dentition, salivary function, and oral mucosa. STUDY DESIGN: Thirty-one patients with esophagitis underwent medical evaluation, which included taking their medical history, performing both an esophagogastroduodenoscopy and esophagus biopsy, and conducting a stomatologic examination. The latter consisted of an extraoral and intraoral physical examination, saliva tests (flow, buffer capacity, and pH), and biopsy and morphometry of the palatal mucosa, as well as taking a history of the patients' habits. Fourteen healthy volunteers from the same population were used as a control group. RESULTS: No relationship between GERD and changes in the oral cavity was shown by saliva tests, oral clinical examination, or histopathologic examination of the palatal mucosa. However, morphometric analysis of the palatal epithelium showed a statistically significant difference between the patients with GERD and the control group. CONCLUSIONS: GERD is associated with microscopic alterations in the palatal mucosa (epithelial atrophy and increased fibroblast number), which are only detected by morphometry.

A contribution to the diagnosis of the small dentigerous cyst or the paradental cyst.

The aim of this study was to verify the relationship between the radiographically measured width of the pericoronal space (PS) and the microscopic features of the follicle in order to contribute to the diagnosis of small dentigerous cysts and paradental cysts. One hundred and thirty unerupted teeth (UT) and thirty-five partially erupted teeth (PET) were radiographed and extracted. The radiographic analysis consisted of measuring the width of the PS. The results of the radiographic analysis were compared with those of the histopathologic examination of the dental follicle. The width of the PS ranged from 0.1 to 5.6 mm. The most frequently observed lining of the follicles was a reduced enamel epithelium (REE) (68.4%) in UT and a hyperplastic stratified squamous epithelium (HSSE) (68.5%) in PET. Inflammation was present in 36.1% of the UT and in 82.8% of the PET. There was a statistically significant association between the presence of stratified squamous epithelium (SSE) and PS enlargement for UT (p < 0.05). There was a tendency of association between inflammation and PS enlargements in PET and, possibly, in UT, despite the absence of statistical significance. Surgically, we did not detect bone cavitation or luminal cystic contents in pericoronal spaces smaller than 5.6 mm. We suggest that the first radiographic diagnosis for a PS enlargement, in most of the routine clinical cases, should be of "inflammation of the follicle". The hypothesis of "dentigerous cyst" or "paradental cyst" is suggested as a second diagnosis. The final differential diagnosis between a small dentigerous or a paradental cyst and a pericoronal follicle depends on clinical and/or surgical findings, such as the presence of bone cavitation and cystic content.

SH3BP2-encoding exons involved in cherubism are not associated with central giant cell granuloma.

Central giant cell granuloma (CGCG) is a benign lesion with unpredictable biological behaviour ranging from a slow-growing asymptomatic swelling to an aggressive lesion associated with pain, bone and root resorption and also tooth displacement. The aetiology of the disease is unclear with controversies in the literature on whether it is mainly of reactional, inflammatory, infectious, neoplasic or genetic origin. To test the hypothesis that mutations in the SH3BP2 gene, as the principal cause of cherubism, are also responsible for, or at least associated with, giant cell lesions, 30 patients with CGCG were recruited for this study and subjected to analysis of germ line and/or somatic alterations. In the blood samples of nine patients, one codon alteration in exon 4 was found, but this alteration did not lead to changes at the amino acid level. In conclusion, if a primary genetic defect is the cause for CGCG it is either located in SH3BP2 gene exons not yet related to cherubism or in a different gene.

Chronic sinusitis unresponsive to medical therapy: a case of maxillary sinus actinomycosis focusing on computed tomography findings.

Actinomycosis of the paranasal sinuses is a rare occurrence and its clinical presentation does not suggest a specific diagnosis. Therefore, actinomycosis should be included in the differential diagnosis of neoplasms and granulomatous lesions of the head and neck region. However, the differentiation from a malignant neoplasm is not easy because the radiological findings are frequently similar and positive cultures are difficult to obtain. This report highlights the clinical progress of paranasal actinomycosis associated with some computed tomography findings that can be extremely helpful in the correct diagnosis. The characteristics of the disease are described and the relevant literature is discussed.

[Radiographic interpretation of experimentally produced bone lesions in dry human mandibles. 2]. / Contribuição a interpretação radiográfica de lesões ósseas produzidas experimentalmente em mandíbulas humanas secas. (Parte II).

Bone defects comparable to clinical situations were simulated in a group of dry human jaws, using stell fissure and round burs of different sizes. The closen areas were previously photographed, radiographed and used as control. The bone defects were also photographed and radiographed in each stage of the experiments. A radiograph was always taken as a contrast. The final results were: the contrasting "mésio-distal" destruction on part of the interradicular septal only became evident when in reached the internal surface of the tongue and/or inner-ear cortices; the manifestation of radiographics images of the artefacts confined to the cortex bone depended directly on the depth and amplitude of the same; the defects produced into the alveolar edge did not present any X-ray alterations that could be perceived on the level of the architectural pattern of the cancellous bone. However, one could detect at least the image of a growing rupture of the cortex of the alveolar edge; the use of a varying kilovoltages did not influences the appearance, or lack of it, of the bone defects.

Contribution of radiographs to the diagnosis of naso-alveolar cyst.

Eight cases of nasoalveolar cyst are reported; seven of these cases demonstrated radiographically identifiable changes. The literature is reviewed, and clinical and cytologic characteristics of the lesions are discussed. The importance of radiographs in the diagnosis of nasoalveolar cysts is emphasized.

Spontaneous resolution of simple bone cysts.

OBJECTIVE: To determine whether spontaneous resolution of simple bone cysts (SBC) is possible. METHODS: Ten patients were diagnosed as SBC on clinical and radiographic criteria and followed up for 1 to 7 years (mean 3.8). The degree of resolution was assessed subjectively by four radiologists and objectively by changes in the grey level histogram. RESULTS: All cases remained asymptomatic over the follow-up period. One of the lesions was considered static, two were increased, six remodeled and one resolved. The mean difference in grey levels between the lesion and the contralateral normal mandible decreased in 8 out of 10 cases. CONCLUSION: It is probable that SBC resolves spontaneously. A protocol for clinical and radiographic diagnosis and follow-up is proposed.

Simple bone cyst versus odontogenic keratocyst: differential diagnosis by digitized panoramic radiography.

OBJECTIVES: To identify the contour and pixel grey levels of simple bone cyst (SBC) and odontogenic keratocyst (OKC) images that might contribute to differentiating between the two lesions. METHODS: Panoramic radiographs of 32 SBC and 20 OKC were digitized and analysed by six examiners. The contours of the images were classified as indistinct, distinct without a sclerotic border, and distinct with a sclerotic border. The presence or absence of scalloping and the pixel grey levels of the radiolucent part of the images were also determined. RESULTS: The sclerotic border was more frequent in the OKC, especially in the posterior segment (P = 0.0301). The presence of scalloping was more frequent in the superior segment of the SBC (P = 0.0295). The pixel values were higher in the OKC than in the SBC images (P = 0.00134). CONCLUSIONS: Details about the contour and pixel grey levels of OKC and SBC assist in the diagnosis of these lesions.

[Radiographic study of the applicability of three anatomical landmarks in transcranial radiography of the temporomandibular joint]. / Estudo radiográfico da aplicabilidade de três pontos de reparo anatômicos nas radiografias transcranianas da articulação temporomandibular.

The variability of the angles formed between the long axis of the right and left condyles and the midsagittal plane, as well as the applicability of three anatomic landmarks--zigoma, gonion and base of the mandible, for transcranian radiographs of the TMJ were studied. The radiographic method used in this study was the HIRTZ axial projection. The results of the measurements showed a great variation in the angle formed by the long axis of the condyles and the midsagittal plane, from 48 degrees-79 degrees (x = 63.73 degrees) for the right side, from 50 degrees-80 degrees (x = 67.43 degrees) for the left side. It was also observed that the use of the three anatomic landmarks must not be generalized, being more precisely indicated for tapering head and face.

An anatomical and radiographic study of medial depression of the human mandibular ramus.

OBJECTIVES: To determine the prevalence of the medial depression of mandibular ramus (MDMR) in dry human mandibles and in clinical panoramic radiographs and to compare the prevalence in dentoskeletal deformities with Angle Class I occlusion. METHODS: Two hundred and fifty-one dry skulls and three groups of patients were used for this study: Group 1 consisted of 1358 panoramic radiographs from a general population, Group 2, 426 radiographs from individuals with Angle class I occlusion and Group 3283 individuals with dentoskeletal deformities. The prevalence of MDMR was determined in the skulls and each group and the shape from the radiographs alone. RESULTS: The prevalence of MDMR in dry mandibles was 33.9% (bilateral in 13.1% and unilateral in 20.8%). MDMR was found in 276 radiographs (20.3% - Group 1 - bilateral in 40% and unilateral in 59.5%). MDMR was more common in Group 3 compared with Group 2 (chi(2)=35.98 P<0.01). A triangular MDMR was the most frequent (39.7%). CONCLUSION: MDMR is a relatively common finding in panoramic radiographs. Patients with dentoskeletal deformities have a higher prevalence of MDMR and this should be taken into consideration if orthognathic surgery is proposed.