Spiral CT scanning and curved tomography in localization of mandibular canal in relation to lower third molar

Accurate radiographic assessment is a must in cases of impacted lower third molars with proximity to mandibular canal to avoid the high risk of neurovascular bundle injury during surgical removal. This study was conducted as an attempt to assess the relation of horizontally impacted lower third molar to mandibular canal using curved tomography [panoramic radiography] and spiral CT scanning. Fifteen patients were comprised in this study. They were all suffering from horizontally impacted lower third molar. Images of both modalities were qualitatively and quantitatively analyzed to reveal relation of the molar to the canal. Out of our results: [1] The most common radiographic features strongly linked to intimate relation [40% of the cases] and highly predicting of contact between horizontally impacted lower third molar and canal are: superimposition of roots on canal and presence of roots just touching the superior border of the canal. [2] Majority of the investigated teeth were not in contact with the canal [60%]. The mandibular canal was most often inferior or buccal or inferiobuccaly to the roots of the horizontally impacted lower third molars. It could be concluded from this study that whenever one of the radiographic criteria predicting close proximity of molar to canal is evident on panoramic radiograph, CT should be performed to clear out the exact location of the canal. Spiral CT allows faster scanning, more resolution and a high degree of accuracy when planning removal of third molar in proximity to the canal, making it possible to formulate a more precise diagnosis and treatment plan

Clinicoradiological evaluation of rare orbital injuries

AIM OF THE WORK: We aimed at recording rare cases with different orbital injuries and studying the difficulties in their diagnosis and management. PATIENT AND METHODS: A retrospective review of six cases of rare orbital injuries. All cases shared in visual impairment and some cases had either proptosis or enophthalmos. All cases underwent full history taking including type and mechanism of trauma, complete ophthalmic examination and computerized tomography [CT] examination. Clinical diagnosis was not conclusive. Accurate diagnosis was only achieved by CT. Management was different depending on each condition. One case had pure medial wall blow out fracture with the displaced globe traversing ethmoidal cells into nasal cavity, another one had bilateral medial wall blow in fracture with nasal fracture, two cases had intra orbital FBs; one of them had very large neglected woody FB and the other had gun shot passed through optic canal into middle cranial fossa, one had neglected orbital hematoma which changed into hematic cyst, and the last case had iatrogenic medial wall injury. CONCLUSION We concluded that in rare orbital injuries, we should not rely on clinical assessment only and CT is very essential diagnostic tool for such cases also there is no fixed role for surgery but it moulds itself according to each condition