An approach to the diagnostic imaging of jaw lesions, dental implants, and the temporomandibular joint.

This article is an overview of three complex and often confusing areas of diagnostic imaging. It provides the reader with a starting point and a frame of reference from which to proceed when confronted with either an unknown jaw lesion, evaluating a potential dental implant patient, or a patient with TMJ internal derangement.

Anatomy of the mandible, temporomandibular joint, and dentition.

This article provides an overview of the normal gross anatomy and physiology of the mandible, TMJ, as well as a working overview of normal dental anatomy. The appearances of a number of important anatomic structures and features on plain film, computed tomography, reformatted computed tomography, and magnetic resonance imaging studies are presented.

Ki- 1-positive anaplastic large cell lymphoma of the masticator space with intracranial extension.

Ki- 1-positive anaplastic large cell lymphoma (ki- 1 ALCL) is a recently recognized form of non-Hodgkin lymphoma occurring predominantly in the skin and/or peripheral lymph nodes. We report the clinical, pathologic, and radiographic findings of a case of Ki- 1 ALCL arising within the masticator space and extending intracranially into the epidural space.

Lesions of the jaws.

Jaw lesions are relatively common findings on imaging studies of the lower face. The intent of this article is to present an approach to the diagnosis of lesions involving the maxilla and mandible based on their radiographic appearance and location. The radiographic and computed tomographic appearances of a number of lesions occurring in the maxilla and mandible are presented.

Role of diagnostic imaging in evaluation of the dental implant patient.

Dental implants have become an accepted form of permanent tooth replacement. Nearly all implants currently being placed are of the osseointegrated type. These typically consist of three parts: a fixture, an abutment, and a screw or threaded rod. The fixture, usually composed of titanium, can be placed in either a surgically created site in the alveolar ridge or a fresh extraction socket. Diagnostic imaging can play an important role in evaluating patients with such implants. Useful imaging studies include plain panoramic radiography, computed tomography, and computer-reformatted cross-sectional, panoramic, and three-dimensional imaging. Advanced imaging studies can be used to determine the suitability of implant placement, appropriate sites for implant placement, the size of the implant that can be placed, and the need for preimplantation ridge surgery. Postoperatively, advanced imaging studies can show failure of an endosseous implant to osseointegrate, improper placement of an implant, and violation of important structures.

Advances in maxillofacial imaging.

The maxillofacial region, extending from the base of the skull to the hyoid bone, is one of the most anatomically complex regions of the body. This area contains elements and organs belonging to a number of different systems that can be affected by a variety of local and systemic pathologic processes. Diagnostic imaging has assumed a central role in the evaluation of this region. In the following monograph, we present the reader with an overview of contemporary maxillofacial imaging, focusing on three areas: recent technical advances that impact on the diagnosis of the maxillofacial region, the appearances of various maxillofacial lesions on different imaging modalities, and an overview of the role of diagnostic imaging in the evaluation of the orthognathic patient. In the first section, we focus on recent technical advances in diagnostic imaging as they relate to the maxillofacial region. Imaging modalities discussed include panoramic radiography and three-dimensional imaging. We also examine the uses of recently developed computed tomography software for the evaluation of the dental implant patient and discuss the roles of both noninteractive and interactive software in this process. The second section focuses on the radiographic appearance of a number of common lesions involving the maxillofacial region. In this section, we use the gamut approach to examine a number of developmental, inflammatory, neoplastic, metabolic, and traumatic lesions or disorders. In the last section, we briefly review the subject of orthognathic surgery and the role of diagnostic imaging in the preoperative and postoperative evaluation of the orthognathic patient. The radiographic appearance of some of the more commonly performed midfacial osteotomies are presented.

The role of computed tomography in the evaluation of cemento-osseous lesions.

The role of computed tomography (CT) and CT numbers in the evaluation of fibro-osseous and cementum-containing lesions is discussed. The computed tomographic findings in a case of cemento-ossifying fibroma involving the maxilla and maxillary sinus are presented.

Aneurysm of intrapetrous carotid artery: CT and angiographic findings.

Congenital aneurysms of the petrous segment of the internal carotid artery are rare. We report the CT, digital subtraction, and routine arteriographic findings in a case.

An unusual cause of facial trismus in a child: report of case.

Nasopharyngeal carcinoma should be considered in the differential diagnosis of facial pain, especially in patients of Asian descent. The foregoing case describes an unusual cause of a symptom often associated with temporomandibular joint dysfunction. It also emphasizes the need to eliminate an underlying neoplastic process when dealing with patients who have temporomandibular joint dysfunction or who have atypical facial pain. Malignancies of the temporomandibular joint and the periarticular area, although rare, do occur. This case shows the usefulness of computed tomography in the evaluation of a patient with temporomandibular joint dysfunction.

Collagen gel in osseous defects. A preliminary study.

In a preliminary study, the effects of a biodegradable collagen gel on the healing of osseous defects were examined. Histologic and biochemical observations made on the seventh day after placement revealed that the collagen gel is well tolerated by the recipient and might be an effective stimulator of the formation of reparative bone. However, between the seventh and fourteenth days after placement, the deposition of reparative osseous tissues at the site of implant was significantly retarded. The possible implication of these findings is discussed.