Assessment of the relationship between size, shape and volume of the sella turcica in class II and III patients prior to orthognathic surgery.

PURPOSES: The main purpose of this study was to assess the measurements and shape of the sella turcica by using cone beam computed tomography (CBCT) and to associate the data to skeletal class II and class III patients, including correlations with gender, age and measurements of the anterior cranial base. MATERIAL AND METHODS: A trained examiner specialist in dental radiology selected and evaluated randomly 95 CBCT images of pre-orthognathic surgery patients, 60 (63.2%) being female and 35 (36.8%) male with age between 16 and 57 years. All images were evaluated to determine the size, shape and volume of the sella turcica. The anterior cranial base, represented by the S-N line (sella-nasion), was also measured. RESULTS: Of these 95 patients, 48 (50.5%) had class III facial skeletal pattern, whereas 47 (49.5%) had class II. No statistically significant differences were found between class II and class III patients in the measurements and shape of the sella turcica (P > 0.05). The diameter and volume of the sella turcica had higher values in female patients, whereas the measurements of the anterior cranial base were higher in males (P < 0.05). CONCLUSION: Therefore, one can conclude that measurements of the sella turcica are not reliable parameters to evaluate whether a class II or class III patient will or will not need orthognathic surgery.

A Combined Strategy to Improve the Development of a Coral Antivenom Against Micrurus spp.

Accidents involving Micrurus snakes are not the most common ones but are noteworthy due to their severity. Victims envenomed by Micrurus snakes are at high risk of death and therefore must be treated with coral antivenom. In Brazil, the immunization mixture used to fabricate coral antivenom contains Micrurus frontalis and Micrurus corallinus venoms, which are difficult to be obtained in adequate amounts. Different approaches to solve the venom limitation problem have been attempted, including the use of synthetic and recombinant antigens as substitutes. The present work proposes a combined immunization protocol, using priming doses of M. frontalis venom and booster doses of synthetic B-cell epitopes derived from M. corallinus toxins (four three-finger toxins-3FTX; and one phospholipase A2-PLA2) to obtain coral antivenom in a rabbit model. Immunized animals elicited a humoral response against both M. frontalis and M. corallinus venoms, as detected by sera reactivity in ELISA and Western Blot. Relevant cross-reactivity of the obtained sera with other Micrurus species (Micrurus altirostris, Micrurus lemniscatus, Micrurus spixii, Micrurus surinamensis) venoms was also observed. The elicited antibodies were able to neutralize PLA2 activity of both M. frontalis and M. corallinus venoms. In vivo, immunized rabbit sera completely protected mice from a challenge with 1.5 median lethal dose (LD50) of M. corallinus venom and 50% of mice challenged with 1.5 LD50 of M. frontalis venom. These results show that this combined protocol may be a suitable alternative to reduce the amount of venom used in coral antivenom production in Brazil.

A combined strategy to improve the development of a coral antivenom against Micrurus spp

Accidents involving Micrurus snakes are not the most common ones but are noteworthy due to their severity. Victims envenomed by Micrurus snakes are at high risk of death and therefore must be treated with coral antivenom. In Brazil, the immunization mixture used to fabricate coral antivenom contains Micrurus frontalis and Micrurus corallinus venoms, which are difficult to be obtained in adequate amounts. Different approaches to solve the venom limitation problem have been attempted, including the use of synthetic and recombinant antigens as substitutes. The present work proposes a combined immunization protocol, using priming doses of M. frontalis venom and booster doses of synthetic B-cell epitopes derived from M. corallinus toxins (four three-finger toxins-3FTX; and one phospholipase A2-PLA2) to obtain coral antivenom in a rabbit model. Immunized animals elicited a humoral response against both M. frontalis and M. corallinus venoms, as detected by sera reactivity in ELISA and Western Blot. Relevant crossreactivity of the obtained sera with other Micrurus species (Micrurus altirostris, Micrurus lemniscatus, Micrurus spixii, Micrurus surinamensis) venoms was also observed. The elicited antibodies were able to neutralize PLA2 activity of both M. frontalis and M.corallinus venoms. In vivo, immunized rabbit sera completely protected mice from a challenge with 1.5 median lethal dose (LD50) of M. corallinus venom and 50% of mice challenged with 1.5 LD50 of M. frontalis venom. These results show that this combined protocol may be a suitable alternative to reduce the amount of venom used in coral antivenom production in Brazil.

A combined strategy to improve the development of a coral antivenom against Micrurus spp

Accidents involving Micrurus snakes are not the most common ones but are noteworthy due to their severity. Victims envenomed by Micrurus snakes are at high risk of death and therefore must be treated with coral antivenom. In Brazil, the immunization mixture used to fabricate coral antivenom contains Micrurus frontalis and Micrurus corallinus venoms, which are difficult to be obtained in adequate amounts. Different approaches to solve the venom limitation problem have been attempted, including the use of synthetic and recombinant antigens as substitutes. The present work proposes a combined immunization protocol, using priming doses of M. frontalis venom and booster doses of synthetic B-cell epitopes derived from M. corallinus toxins (four three-finger toxins-3FTX; and one phospholipase A2-PLA2) to obtain coral antivenom in a rabbit model. Immunized animals elicited a humoral response against both M. frontalis and M. corallinus venoms, as detected by sera reactivity in ELISA and Western Blot. Relevant crossreactivity of the obtained sera with other Micrurus species (Micrurus altirostris, Micrurus lemniscatus, Micrurus spixii, Micrurus surinamensis) venoms was also observed. The elicited antibodies were able to neutralize PLA2 activity of both M. frontalis and M.corallinus venoms. In vivo, immunized rabbit sera completely protected mice from a challenge with 1.5 median lethal dose (LD50) of M. corallinus venom and 50% of mice challenged with 1.5 LD50 of M. frontalis venom. These results show that this combined protocol may be a suitable alternative to reduce the amount of venom used in coral antivenom production in Brazil.

Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study.

OBJECTIVES: To compare peripheral bone mineral density alterations among Brazilian postmenopausal women from three ethnic groups considering age and body mass index influence; to correlate their bone mineral density with the mandibular cortical index (MCI); and to evaluate the influence of age, body mass index and ethnicity in the MCI using risk factor analysis. BACKGROUND: Osteoporosis risk is known to have ethical influences. However, little is known about the differences in ethnicity in radiomorphometric indices. MATERIALS AND METHODS: A total of 150 postmenopausal women with different ethnicities (Caucasian, Asian and Afro-descendant) who underwent peripheral dual X-ray absorptiometry and panoramic examination were included. Bone mineral density and MCI were assessed. Adjusted odds ratio analyses were performed on bone density and MCI considering the effect of age, ethnicity and body mass index. The correlations between the MCI and the dual X-ray absorptiometry results were made. RESULTS: Old age, low body mass index and non-Afro-descendant were associated with low bone density. Compared with Afro-descendants, Asians and Caucasians have higher chances of having decreased bone mass. For the MCI, statistical analysis showed that age is the only variable associated with osteoporotic alterations in the mandible. Furthermore, an inverse correlation was found between the MCI and the T-scores. CONCLUSION: Bone density is higher in Brazilian Afro-descendant women than in Caucasians and Asians. Patient's age is associated with bone density and the MCI. The mandibular cortical index is inversely correlated with the peripheral densitometry results within the study ethnic population.

Ultrasound evaluation of intra-osseous cavity: A preliminary study in pig mandibles.

AIMS: To assess the role of ultrasonography as a possible tool for diagnosis of intra-osseous lesions. METHODS: Our sample comprised five macerated pig jaws. The regions of bony crypts of third molars were examined on both sides, totaling 10 examinations. The degrees of difficulty for both ultrasound image visualization and bone translucency were rated by two groups of evaluators (i.e. dental radiologists and physician ultrasonographers). RESULTS: Our results showed that it is possible to detect images of the intra-osseous cavity at a low-degree difficulty by using both radiographic and ultrasonic techniques (46.6% and 43.3%, respectively). However, the crypts were not fully detected by both groups (16.6% and 13.3%, respectively). CONCLUSIONS: We concluded that ultrasonography is a useful method for evaluation of intra-osseous lesions in jaws, provided that the cortical bone is thin enough to allow ultrasound waves to pass through.

Ultrasound analysis of mental artery flow in elderly patients: a case-control study.

OBJECTIVES: Mental artery flow decreases with age and may have an aetiological role in alveolar ridge atrophy. The aim of this study was to identify factors associated with alterations of mental artery flow, assessed by ultrasonography. METHODS: This case-control study was conducted on elderly patients (aged above 60 years) at the beginning of dental treatment. Intraoral B-mode Doppler ultrasonography was used to assess mental artery flow. The cases were defined as patients with a weak/absent ultrasound signal, whereas the controls presented a strong ultrasound signal. Demographics and radiographic findings (low bone mineral density on dual-energy X-ray absorptiometry and mandibular cortical index on panoramic radiographs) were analysed as risk factors for weak/absent ultrasound signal and were calculated as adjusted odds ratios (AORs) with 95% confidence intervals (CIs) using conditional logistic regression. In addition, the Student's t-test was used to compare the mean alveolar bone height of the analysed groups. A p-value <0.05 was considered statistically significant. RESULTS: A total of 30 ultrasound examinations (12 cases and 18 controls) were analysed. A weak/absent mental artery pulse strength was significantly associated with edentulism (AOR = 3.67; 95% CI = 0.86-15.63; p = 0.046). In addition, there was a significant difference in alveolar bone height between edentulous cases and controls (p = 0.036). CONCLUSIONS: Within the limitations of this study, the present results indicate that edentulism is associated with diminished mental artery flow, which, in turn, affects alveolar bone height.

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

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.

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

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.

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.