Pneumatization of the articular eminence in cone-beam computed tomography: prevalence and characteristics - literature review.

BACKGROUND: The articular tubercle is a site prone to pneumatization within the cranial bones. Knowledge of the anatomical variations of pneumatization adjacent to the temporomandibular joint (TMJ) is an important issue. Air cells exhibit decreased resistance to trauma, facilitate the spread of various pathologies in the TMJ, such as inflammation, tumours or fractures. Articular tubercle pneumatization may cause complications during TMJ surgery. Information of possible location allows to detect and conduct differential diagnosis of pneumatization of the articular tubercle (PAT) during cone-beam computed tomography (CBCT) examinations. The aim of this study is to determine the prevalence and characteristics of PAT, with respect to age, gender, location and type through assessment in CBCT images. MATERIALS AND METHODS: Articles were selected through database search (PubMed, Scopus, Google Scholar), in which the main objective was to assess the prevalence of articular tubercle pneumatization using CBCT. Search strategies included the following keywords: "pneumatized articular eminence" and "CBCT", "pneumatized articular tubercle" and "CBCT" and "zygomatic air cell defect" and "CBCT". A meta-analysis of prevalence using a random effects model was performed. RESULTS: Fifteen studies met the selection criteria. The results showed that an overall prevalence of articular tubercle pneumatization was 25.22% (n = 6393; 95% confidence interval [CI] 15.84-35.94). The occurrence of PAT in females was 25.14% (n = 3064; 95% CI 14.96-36.94). The frequency of PAT in males was 25.81% (n = 2671; 95% CI 15.30-37.99). CONCLUSIONS: There was no correlation between the frequency, location or type of PAT with age and gender.

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening.

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence and glenoid fossa-disc displacement. The aim of our study was to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open-mouth position (OMP) in both oblique sagittal and coronal planes on magnetic resonance imaging (MRI) in patients with temporomandibular disorders. Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to the RDC/TMD criteria (148 women, 43 men; aged 14-60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP. Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B = 3.118; P < .001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B = 2.200; P < .05). In conclusion, reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal planes. Multisection analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement.

Early postnatal development of the lumbar vertebrae in male Wistar rats: double staining and digital radiological studies.

The aim of the study was to evaluate the physiological developmental changes of male rats' lumbar vertebrae during the first 22 days after birth. Morphology and mineralisation of lumbar vertebrae were evaluated using double-staining and digital radiography system, which allowed vertebral width and optical density to be determined. Pup weight, crown-rump length, body mass index and vertebral width increased during postnatal period and significantly correlated with their age. Bone mineralisation, as measured by optical density, did not show any significant differences. The complete fusion of the primary ossification centres had a cranio- -caudal direction and started on day 19 after parturition but was incomplete by day 22. It could be concluded that, unlike significant age-related increase of vertebral size, mineralisation was only slightly elevated during evaluated postnatal period. The method described is supplementary to alizarin red S staining as it provides both qualitative and quantitative data on mineralisation in a similar manner to micro computed tomography but does not allow 3 dimensional and microarchitecture examination.

Radiographic appearance and clinical implications of the presence of radix entomolaris and radix paramolaris.

BACKGROUND: The variation in mandibular molars' anatomy is not as rare as it might appear to be. Depending on the location of the additional root found in a mandibular molar, it may be referred to as either radix entomolaris (RE) or radix paramolaris (RP). The aim of the study was to present radiographic appearance of RE and RP and indicate the clinical implications of its presence. MATERIALS AND METHODS: The material consisted of 3,000 panoramic and 300 periapical radiographs of first and second mandibular molars taken in the Department of Dental and Maxillofacial Radiodiagnostics of the Medical University in Lublin which were screened for RE and RP. RESULTS: Among panoramic and periapical radiographs only 14 cases of additional roots were found: 11 teeth with RE/RP in the Polish population and 3 in Taiwanese. Only 2 panoramic radiographs revealed the presence of RE and surprisingly the occurrence was bilateral. CONCLUSIONS: Dentists should not be taken by surprise at finding an additional root in mandibular molars. They should be aware of the anatomical diversity of these teeth and know how to recognise possible extra roots during radiograph reading.

Anatomical classification of the shape and topography of the operated stomach.

The aim of the study was to present the classification of anatomical variants of the operated stomach, based on radiological and historical data. Different anatomical variants of the operated organ were found in 431 out of 2034 patients examined in the years 2006-2010. Four main groups were established: abnormal position along longitudinal (I) and horizontal axis (II), as well as abnormal shape (III) and stomach connections (IV). An additional group (V) encloses mixed forms that combine features of two or more of the main groups. The first group contains the partial and total translocation of the stomach into the thoracic cavity after the partial or total oesophagectomy. Depending on the applied surgical techniques used during the total oesophagectomy, the stomach could be located anteriorly or posteriorly to the pericardial sac. An elongated and gastrectatic form often with signs of pylorostenosis is visible in patients treated by vagotomy. The consequences of fundoplication included: lack of or narrow cardiac angle, and often a mild form of stomach cascade. The most common abnormal shape of the stomach was secondary to gastrectomy and gastric bending. The final organ shape depends on the type of applied surgical procedure that maintains physiological connection with the duodenum or an un-anatomical one, mostly with the jejunal loop. In banding, the body of the stomach forms an hourglass at the level of the artificial adjustable band, typically applied in surgical treatment of obesity (slim surgery).

Mandibular inferior cortex width may serve as a prognostic osteoporosis index in Polish patients.

BACKGROUND: Panoramic radiographs are increasingly considered as a screening tool in the search for osteopaenia and osteoporosis. No information on normal ranges of radiographic parameters of the inferior cortex (IC) in Polish population has been found in literature; therefore, the objective of the study was to determine normal ranges of mandibular inferior cortex width on panoramic radiographs and to examine the influence of gender and age on these parameters. MATERIAL AND METHODS: The material consisted of 877 digital panoramic radiographs taken of patients aged 20 to 95 years (mean 48.69 years), including 467 females and 410 males. Mandibular inferior cortex width at the mental foramina was estimated, and the obtained results were subjected to statistical analysis. RESULTS: It was found that IC and mental index (MI) values in the studied group of Polish patients depended on age. As far as gender is considered, IC and MI were higher in males. When age and gender were discussed simultaneously, the highest values of IC and MI were observed in age group 30-39 years in both genders, followed by a gradual decrease with age, but this decrease was more pronounced in females. CONCLUSIONS: The elaborated norms of panoramic radiomorphometric parameters in Polish patients may serve as a source of comparison for radiological and clinical applications.

Panoramic radiomorphometric parameters in Polish patients.

Panoramic radiographs are frequently applied in dental radiodiagnostics and might serve as a tool for identification of a subject's bone mass. Only in a few publications can data on men, younger subjects and larger groups of patients be found. No such data are available for the Polish population; therefore, the aim of the study was to determine normal ranges of panoramic radiomorphometric parameters and examine the influence of gender and age on them. The material consisted of 877 digital panoramic radiographs taken in patients aged 20 to 95 years (mean 48.69 years), including 467 females and 410 males. Panoramic parameters such as mandibular height (H) and distance between inferior margin of mental foramen and inferior mandibular cortex (h), which are used for calculation of panoramic radiomorphometric indices, were estimated and the obtained results were subjected to statistical analysis. Gender influenced H and h, while it was found that H was age-dependent and h values were similar in all age groups. When age and gender were discussed simultaneously, the highest values of H were observed in the age group 30-39 years in both genders, followed by a gradual decrease with age. However, in females this decrease was more intense than in males. The elaborated norms of panoramic radiomorphometric parameters and indices in the Polish patients may serve as a source of comparison for radiological and clinical applications.

Morphology of root canals in adult premolar teeth.

The aim of the present study was to examine the morphology of root canals in premolar teeth with completely formed root apices. The material consisted of 139 extracted premolar teeth, including 83 first premolars (59.7%) and 56 second premolars (40.3%). Maxillary teeth made up 64% of the material and mandibular teeth 36%. In order to measure the actual root canal length an endodontic instrument was inserted into the root canal (in teeth with a single root canal this was instrument no. 25 and in teeth with two or three root canals no. 20) until its tip was visible in the anatomical foramen. The silicone limit was fixed at a reference point on the dental crown, and after removal of the instrument the real length was read using an endodontic ruler. The results were presented using descriptive statistical measures (mean, maximum, minimum, median value and quartiles). In order to compare mean values of root canal lengths the z test was used. Of the first maxillary premolars, 91% had two root canals and 9% had three root canals. As far as the second upper premolars are concerned, 14.7% were teeth with single root canals while as many as 85.3% were teeth with two root canals. The majority of the first lower premolars (89.3%) had one root canal and 10.7% of these teeth had two root canals. Most of the second lower premolars (68.2%) had a single root canal, while the remaining 31.8% had two root canals. None of the mandibular premolars examined had three root canals.

Application of Doppler ultrasonography in congenital vascular lesions of the head and neck.

OBJECTIVES: To evaluate the value of Doppler ultrasonography in the assessment of congenital vascular lesions of the maxillofacial region. METHODS: 27 new patients with 36 congenital vascular lesions in the maxillofacial region as well as 10 patients previously treated with cryotherapy underwent ultrasonography (US) with a 6.0-10.0 MHz broadband linear transducer (reference Doppler frequency 7.5 MHz). Initial grey-scale US was followed by Color Doppler, Power Doppler and spectral Doppler studies. The presence or absence of flow was noted. In areas of high vascularity the number of vessels within a 1 cm(2) restricted region of interest were increased by spectral Doppler. RESULTS: US allowed differentiation of seven hemangiomas from other congenital vascular lesions and thus appropriate treatment of patients. Low flow vessels were demonstrated within the scars of five lesions previously treated with cryotherapy, requiring further intervention. CONCLUSION: Doppler US is a widely available, non-invasive and relatively inexpensive technique which can be used to characterize the flow of head and neck vascular anomalies and thus differentiate hemangiomas from other vascular malformations.

Imaging diagnostic approach to tumours of ramus and angle of the mandible.

The abundance of up-to-date diagnostic equipment and imaging techniques makes it necessary to reconsider diagnostic approach to many maxillofacial disorders, including mandibular tumours, and to elaborate algorithms of radiological examinations allowing for the planning of a cost-effective treatment based on thorough diagnostics. The material was composed of 146 case records of 68 patients examined in the years 1995-2000 in the Medical University of Lublin. There were selected radiograms as well as the results of other imaging modalities of persons with clinically confirmed tumours of mandibular ramus or angle. In each case there were noted: the initial and the final diagnosis as well as the number and sequence of the performed diagnostic examinations. On the basis of the obtained results there was proposed a diagnostic algorithm in cases of mandibular angle and ramus tumours, which was presented in the form of a scheme. It was proved that conventional radiograms are still fundamental in initial selection of patients while other diagnostic imaging methods are indispensable in treatment planning.

The application of digital radiography and radiodensitometry in evaluation of chronic fibrous periapical changes of endodontically untreated teeth.

Lesions in hard tissues of teeth can be detected on radiograms only when there exists considerable decrease in mineralisation. By means of digital radiography the diagnostics of dental pathologies becomes more precise and objective. The aim of the paper was the radiodensitometric evaluation of chronic fibrous periapical changes. The material comprised 308 digital intraoral radiograms of teeth with periapical changes among which there were chosen the cases of clinically confirmed chronic fibrous periapical inflammations of endodontically untreated teeth. All radiograms were analysed in the Digora Soredex digital radiography system in gray scale, in full colour and using the tomosynthesis function. The linear measurements of root densities were carried out at the distance of 1 mm from radiological apices while the measurements of alveolar bone at the distance of 2 mm from it. Twenty-five teeth without evident periapical changes formed the control group. There were found significantly lower densities of roots and alveolar bone in the group of chronic fibrous periapical lesions in comparison with the control group. A characteristic feature of chronic fibrous periapical changes is the density of the root of an affected tooth that is higher than in acute inflammation and at the same time lower than in the control group. The radiodensitometry proved to be useful in evaluation of chronic fibrous periapical changes.

Early detection of potential impaction of permanent maxillary canines caused by resorption disorders of deciduous canines.

Maxillary canine impaction is an often-encountered dental anomaly as after the third molar it is the maxillary canine that is the most frequently impacted tooth. One of many factors causing impaction of maxillary canines is the presence of the persistent primary canine. The aim of the study was early evaluation of resorption of deciduous maxillary canines and an attempt at prediction of impaction or delayed eruption of their permanent counterparts as well as the possibility of their eruption in proper position in the dental arch. There were examined digital intraoral radiograms of 43 patients at the age from 8 to 11 years (44% boys, 56% girls). All the radiograms were taken using the Digora Soredex digital radiography system. There was observed the presence and degree of resorption of deciduous maxillary canines according to age and sex. It was evaluated whether a deciduous canine might be a mechanical obstacle for erupting the permanent tooth. It was concluded that although physiological resorption of deciduous maxillary canine begins at the age of 8, it is radiologically evident on intraoral digital X-rays taken at the age of 9-10 years. So the best time to assess a patient for potential resorption of primary canine and possibilities of eruption of its equivalent in proper position in dental arch is between the 9th and 10th year of age.

Primary adenocarcinoma of the jejunum--a case report.

A case of adenocarcinoma of jejunum is reported. Although survival figures in adenocarcinoma of the small bowel appear to correlate with early presentation, due to poor specificity of the symptoms a preoperative diagnosis is very seldom. Therefore, in order to improve the treatment outcome, the diagnosis must be done at an early stage. Thus there are discussed imaging modalities applied in diagnostics of this rare pathology.

Imaging diagnostics strategy in maxillary sinus neoplasms.

Malignant neoplasms of maxillary sinuses are a serious diagnostic and therapeutic challenge, so the objective of a clinician is the planning of a cost-effective strategy promptly leading to proper diagnosis and the onset of treatment. Thus the aim of the paper was the elaboration of diagnostic strategy in maxillary neoplasms. There were analyzed 163 case records of 78 patients with maxillofacial neoplasms. The number and sequence of the conventional radiograms as well as diagnostic imaging methods were registered. There was proposed an algorithm of application of imaging techniques in diagnostics of neoplasms of maxillary antra. It was found that conventional X-rays are still valuable in screening for sinus pathology and as indication of the necessity of performing other imaging examinations. Computed tomography and magnetic resonance are complementary in visualization of pathologic masses and bone tissue destruction.

Demographic structure of patients taking dental X-rays in the Lublin region.

Intraoral radiograms are the most often taken X-ray pictures in humans and the dose of radiation necessary for such radiogram is very low. However, there exists a considerable anxiousness in Polish society towards Roentgen radiation making patients avoid dental X-rays even when these are indispensable in dental treatment. The aim of the study was the evaluation of demographic structure of patients taking intraoral radiograms. The material consisted of 1,014 adults undergoing dental treatment, who had intraoral radiograms taken in the Department of Dental and Maxillofacial Radiology in 2000. After the informed consent the patients filled an anonymous questionnaire of standardised interview. The collected records were analyzed statistically and data such as age, sex, education, place of residence, employment and income were considered. The demographic structure of population of patients who had intraoral radiograms taken in the course of dental treatment differs considerably from the structure of the general population. These differences were marked especially when taking into account the level of education, employment and place of residence of the studied patients. Inhabitants of rural communities, people with lower level of education as well as older patients avoid taking dental radiograms irrationally fearing ionizing radiation. The economic factor is also important and influences the structure of patients in the domain of employment and income.

Visualisation of diverticula of the upper part of the alimentary tract; comparison of roentgenologic and endoscopic techniques.

Diverticula of the upper part of the alimentary tract, irrespective of their etiology, are frequently observed benign changes of the pharynx, oesophagus, stomach and duodenum. In the present work, patients of the II General Surgery Department of the Medical University of Lublin, with radiologically or endoscopically proved diverticula of the upper part of the alimentary tract, were examined. The presence of diverticula of such localisation was an indication for supplementary endoscopic or radiological examination. The localisation, size, diameter of the opening, mucosal relief of diverticula and its contiguity were checked and analysed. Our data suggest that both medical procedures are complementary to each other. All previously observed changes in diverticula of the thoracic part of the oesophagus and the infradiaphragm part of the alimentary tract were fully proved. The radiological examination gave a better view of Zenker's diverticulum, especially in short and obese patients. Sampling and better visualisation of the diverticula opening testify to the unquestionable superiority of endoscopy. However, precise evaluation by radiological process fully completes the diagnostic protocol. Both diagnostic procedures are usually supplemented by manometric examination of the oesophagus and superior and inferior oesophageal sphincters. This enables the accurate diverticula etiology to be stated.