Odontogenic inflammatory processes of head and neck in computed tomography examinations.

BACKGROUND: Infections of odontogenic origin are the most common cause of inflammatory disease of head and neck region. Computed tomography allows for defining localization and extent of inflammatory lesions, visualizes soft tissue involvement, presence of an abscess or an osteolytic lesion around causative tooth. THE AIM OF THIS STUDY WAS TO ASSESS PATHWAYS, BY WHICH ODONTOGENIC INFECTIONS SPREAD INTO RESPECTIVE DEEP HEAD AND NECK STRUCTURES IN COMPUTED TOMOGRAPHY EXAMINATION, TAKING INTO ACCOUNT THE FOLLOWING CRITERIA: frequency of involvement of respective deep cervical spaces, possibility to determine a probable causative tooth and concordance with the results of clinical examination. MATERIAL/METHODS: Thirty-eight patients cervicofacial inflammatory disease had undergone CT examination of head and neck region with a 64-slice CT scanner after intravenous contrast administration. RESULTS: Abscess was reported in 30 (79%) cases, while inflammatory infiltration was diagnosed in remaining 8 (21%) patients. There was full concordance between radiological report and intraoperative report In 33 cases (87%). The most commonly involved cervical space was masticator space - 31 patients (82%), followed by submandibular space - 27 patients (71%). Dental examination was impossible in 29 patient because of trismus. During analysis of CT studies we evaluated maxillary and mandibular alveolar processes for presence of osteolytic bone lesions around causative teeth roots and we found them in 30 cases (79%). In 32 cases (84%) cervicofacial infection were of mandibular odontogenic origin. CONCLUSIONS: In most cases CT study in patients suspected of odontogenic craniofacial infection revealed presence of an abscess, needing urgent surgery. Inflammatory infiltration of dental origin most frequently involves masticator space, followed by submandibular space. In most cases CT scanning allows for identification of causative teeth, especially when trismus makes detailed clinical examination impossible.

Assessment of the usefulness of X-ray myelography and magnetic resonance myelography, performed with an open low-field device, in diagnosing perinatal preganglionic injuries of the brachial plexus.

INTRODUCTION: The goal is to assess the usefulness of diagnostic imaging in diagnosing perinatal preganglionic injuries of the brachial plexus. MATERIAL AND METHODS: The clinical material included 40 children of both genders, aged 2 to 35 months. The authors analysed the results of diagnostic imaging examinations (myelography in 20 cases and magnetic resonance [MR] myelography in 20 cases), intraoperative view and clinical course. RESULTS: In 13 out of 40 (32.5%) examined children, no evidence of avulsion of the roots of the spinal nerves was found either by diagnostic imaging or during the surgery. In 3 cases (7.5%) with avulsed roots of the spinal nerves, the diagnostic imaging and intraoperative appearance were in agreement. Total agreement of the diagnostic imaging and intraoperative view was found in 40% of cases. In 9 patients (22.5%) suspected avulsion of roots of the spinal nerves was not confirmed during the surgery. However, the further clinical course of the disease in these cases indicated high probability of avulsion of roots without their pull-out from the intervertebral foramens. In the remaining cases, the findings were as follows: false positive results - 7 (17.5%), false negative results - 1 (2.5%), results underestimating injury - 3 (7.5%), results overestimating injury - 2 (5%). CONCLUSIONS: It was determined that the usefulness of pre-operative diagnostic imaging is limited. Due to the risk of occurrence of false positive and false negative results, final decisions concerning selection of the surgical technique must be based on the analysis of the intraoperative view and preoperative clinical symptoms.

Clinical and radiological features of nonfamilial cherubism: A case report.

BACKGROUND: Cherubism is an uncommon hereditary benign fibro-osseous disorder characterized by bilateral enlargement of the mandible and the maxilla that presents with varying degrees of involvement and a tendency toward spontaneous remission. On radiography cherubic lesions appear as cystic multilocular radiolucencies limited to the jaw bones. CASE REPORT: A 5-year-old boy was referred to the Department of Maxillo-Facial Surgery due to deformation of the lower and middle section of the face and displacement or absence of teeth. A panoramic radiograph and a computed tomography revealed extensive multilocular, bilateral radiolucent areas and marked bony expansion in the mandible and maxilla, with sparing of the mandibular condyles. Histopathological evaluation of an incisional biopsy of the left maxilla and genotypic characterization confirmed the diagnosis of cherubism. CONCLUSIONS: The radiologic characteristics of cherubism are not pathognomonic but the diagnosis is strongly suggested by bilateral relatively symmetric jaw involvement that is limited to the jaw bones and, together with clinical and histopathologic findings, enables the diagnosis of cherubism. Genotypic characterization confirms the diagnosis.

Analysis of metabolic changes of brain in HIV-1 seropositive patients with proton magnetic resonance spectroscopy.

BACKGROUND: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study. MATERIAL/METHODS: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm(3) (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed. RESULTS: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area. CONCLUSIONS: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV.

Efficiency of CT-angiography in the diagnosis of intracranial aneurysms.

BACKGROUND: CT-angiography is a non-invasive method, alternative to cerebral angiography in the diagnosis of intracranial aneurysms. The aim of the study was the assessment of the efficiency of CT-angiography in a large material, which has been mostly verified with angiography and/or surgery. MATERIAL/METHODS: CT-angiography was performed in 196 patients with intracranial bleeding. Seventy-three (73) patients underwent also cerebral angiography (CA), 121 were operated on, 74 of them solely on the basis of CT-angiography. A spiral CT scanning (2 mm slices, 1-1.5 pitch, 1 mm-gap reconstruction) combined with an injection of 120 mL of contrast medium (5 mL/sec) was used. Subsequently three-dimensional MIP reconstructions were received, supplemented in some cases with SSD, VRT and MPR. RESULTS: CT-angiography revealed 128 aneurysms in 106 patients, located mostly in anterior communicating, middle cerebral and internal carotid arteries. The size of most aneurysms was 6-10 mm, but nearly one-third of them did not exceed 5 mm. In the group of patients who underwent CA, there was only 1 false negative CT-angiography result, while in 7 patients CT-angiography allowed for the diagnosis of small aneurysms which were not clearly visible on CA. CT-angiography was superior to CA in assessment of aneurysm morphology by 3 independent radiologists in 17 out of 22 cases. CT-angiography findings were confirmed during surgery in all 74 patients. CONCLUSIONS: CT-angiography is highly effective in the diagnosis of intracranial aneurysms and the evaluation of their morphology. In our opinion, in most cases, CT-angiography is precise enough to plan a surgical or endovascular procedure.