Perception of professionals in the assessment of coronoid hyperplasia by computed tomography

ABSTRACT

Coronoid Hyperplasia (CH) is a non-neoplastic and relatively rare enlargement of the coronoid process that may limit mandibular movement as a consequence of the close association between the hyperplastic coronoid process and the anterior region of the zygomatic bone. Computed tomography (CT) is extremely useful for the observation of this association and plays an important role in diagnosing and planning surgical treatment. Once the CT scan is performed, the data can be viewed in many different arrangements, including multiplanar (MPR) and 3D rendering, although the resolution of the latter may not be as good as that of the former. Our aim is to analyze the importance of and preference for multiplanar and 3D reconstruction images for diagnosing and interpreting Coronoid Hyperplasia (CH), by comparing the opinions of oral surgeons and oral radiologists who analyzed both temporomandibular joints (TMJ) in 20 patients. Three images of each TMJ comprised the set of scans (MPR, 3D reconstructions with maximum intercuspation and 3D reconstructions with maximum mouth opening). After each analysis, the members of the two groups answered a questionnaire about the usefulness of each examination and classified the association between the head of mandible and mandibular fossa. Hypomotility was present in 55.2%. Both groups stated that both MPR and 3D reconstructions, particularly the latter, were fundamental for diagnosing CH and that they would request them in order to interpret CH correctly. The examiners were found to differ significantly regarding their opinion of MPR; only radiologists considered MPR to be less elucidative for the diagnosis of CH.

RESUMO

A Hiperplasia Coronoide (HC) e um aumento nao-neoplasico e relativamente raro do processo coronoide que pode limitar o movimento mandibular, como consequencia da intima relacao entre o processo coronoide hiperplasico e a regiao anterior do osso zigomatico. A tomografia computadorizada (TC) e extremamente util para a observacao dessa relacao, desempenhando assim um papel importante no diagnostico e planejamento do tratamento cirurgico. Uma vez que a TC e realizada, os dados podem ser vistos em muitos arranjos diferentes, incluindo o multiplanar (MPR) e a reconstrucao em 3D, no entanto, a resolucao desta ultima pode nao ser tao boa quanto a primeira. Nosso objetivo e analisar a importancia e a preferencia por reconstrucoes de imagens multiplanares (MPR) e 3D para diagnosticar e interpretar a Hiperplasia Coronoide (HC), comparando cirurgioes buco-maxilo-faciais com radiologistas orais. Ambas as articulacoes temporomandibulares (ATM) de 20 pacientes foram analisadas pelos 2 grupos. Tres imagens de cada ATM compreenderam o conjunto de exames (MPR, reconstrucoes 3D em maxima intercuspidacao e reconstrucoes 3D com abertura maxima da boca). Apos cada analise, os grupos responderam a um questionario sobre a utilidade de cada exame e classificou a relacao entre a cabeca da mandibula e da fossa mandibular. A Hipomobilidade esteve presente em 55,2%. Ambos os grupos afirmaram que tanto MPR e as reconstrucoes em 3D, especialmente a ultima, foram fundamentais para diagnosticar CH e as requisitariam para interpretar a HC corretamente. Foi encontrada uma diferenca significativa entre os examinadores sobre a MPR; apenas o grupo de radiologistas considerou que este exame nao e tao elucidativo para o diagnostico da CH.