Development and validation of a new formula for sex estimation based on multislice computed tomographic measurements of maxillary and frontal sinuses among Brazilian adults.

OBJECTIVES: To evaluate the accuracy of the measurements of the maxillary sinus (MS) and frontal sinus (FS) in sex estimation among Brazilian adults using multislice computed tomography (MCT) and to develop and cross-validate a new formula for sex estimation. METHODS: The present cross-sectional research was conducted in two phases: (1) development of a formula on the basis of the measurements of both the sinuses (50 males and 50 females); and (2) validation study (20 males and 20 females). The linear measurements (height, width and diameter) were assessed using the RadiAnt DICOM software. A new formula for sex estimation was developed (multivariate statistical approach) and validated. Receiver operating characteristic curves, area under the curve, sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio were estimated. RESULTS: Males displayed higher mean values (width, height and diameter) of the FS and MS (p < 0.05). The MS was a better predictor in sex estimation (males vs females), compared to the FS (accuracy between 61-74% and 58-69%, respectively). The distance between the right and left MS displayed the highest accuracy (74%). The sensitivity, specificity and accuracy of the new formula were 80%, 95.5% and 87.5%, respectively. 63.1% reduction was observed in the number of predictive values for sex estimation (individuals older than 30 years). CONCLUSIONS: The present MCT measurements showed a higher accuracy in the estimation of sex in males. The highest accuracy was associated with the distance between the right and left MS. The new formula displayed high precision for sex estimation.

Therapeutic effects of andiroba (Carapa guianensis Aubl) oil, compared to low power laser, on oral mucositis in children underwent chemotherapy: A clinical study.

ETHNO-PHARMACOLOGICAL RELEVANCE: The Carapa guianensis Aubl, popularly known as andiroba, is a large tree of the Meliaceae family, commonly found in the Amazon region. The oil extracted from its seeds is recognized in traditional medicine and has high anti-inflammatory and analgesic potential, which are the basic prerequisites for a therapeutic agent that can be used in the treatment of oral mucositis (OM). Moreover, the aforementioned oil has antimicrobial, antiallergic, and parasiticidal actions and is effective in the management of cutaneous and muscular dysfunctions. AIM OF THE STUDY: To evaluate the therapeutic effects of andiroba gel (Carapa guianensis Aubl) on the symptomatology and evolution of OM in children with leukemia who underwent chemotherapy and to compare it to the effects of low power laser. MATERIALS AND METHODS: This randomized, double-blind clinical trial involved 60 patients of both genders with leukemia, with age ranging from six to twelve years. The patients were divided into two study groups: the andiroba group (n = 30) and the laser group (n = 30). The level of pain experienced by the patients was assessed using the Wong-Baker visual analog scale and the degree of severity of OM was assessed using a table, recommended by the World Health Organization, that depicts the degrees of severity of OM. The data obtained were analyzed using the Mann-Whitney test, with statistical significance indicated by a P value less than or equal to 0.05. RESULTS: A statistically significant reduction in the degree of OM was observed on the fourth, fifth, and sixth days and in the pain scores on the second, third, and fourth days in the andiroba group after the manifestation of OM, compared to the laser group. CONCLUSIONS: The use of andiroba oil effectively reduced the severity of OM and relieved pain, which resulted in a decrease in the severity of signs and symptoms in the patients in the andiroba group, compared to the laser group.

Bioactive glass granules S53P4 in osteotomy Le Fort I.

We evaluated bioactive glass graft (S53P4) in patients undergoing Le Fort I osteotomy, with non-grafted patients as controls. Computed tomography facial scans of the 25 patients submitted for Le Fort I were divided into two groups: Group 1-S53P4 group and Group 2-without grafting. CT scans were analyzed in the immediate postoperative period (T1) and 6 months later (T2), for linear bone gap measurements, tomographic radiodensity and behavior of the maxillary sinus. A Kruskal-Wallis test on bone gap data adopted α significance levels (p ≤ 0.05). The Friedman test (p ≤ 0.05) was used to evaluate sinus reaction cores. For gap measurements, we observed a decrease in median data between T1 and T2 in both groups, with statistical significances observed between groups in T0; G1 presented statistical difference in its two studied times (p ≤ 0.0001). For bone density, the studied data behaved inversely. G1's bone density decreased from T1 to T2, whereas in G2 there was an increase from T1 to T2. S53P4 did not elicit increased reactions and/or sinus infections in the G1 group (p ≥ 1.00). S53P4 did not impact on Le Fort I osteotomies as a coadjuvant and a favorable factor in bone formation, and appeared innocuous in the maxillary sinus.

Role of hypoxia-related proteins in adenoid cystic carcinoma invasion.

BACKGROUND: Among cancers affecting the oral cavity, adenoid cystic carcinoma (ACC) is a relatively common malignant neoplasm. It has high rates of metastasis and recurrence and is associated with significant morbidity. During the progression of ACC, the oxygen concentration is reduced in specific areas of the tumour microenvironment, leading to intratumoural hypoxia. The expression of NOTCH1, a disintegrin and metalloproteinase 12 (ADAM-12), hypoxia-inducible factor 1 alpha (HIF-1α), and heparin-binding epidermal growth factor (HB-EGF) under hypoxic conditions has been implicated in invadopodia formation, tumour invasiveness, and metastasis. The aim of this study was to analyse the expression of these proteins to elucidate the mechanisms underlying ACC invasiveness. METHODS: Fifteen ACC samples and 10 normal-looking salivary gland (SG) samples were used to investigate the expression of these proteins by immunohistochemistry. Primary antibodies against NOTCH1, ADAM-12, HIF-1α, and HB-EGF were used. RESULTS: The immunoexpression of all proteins was higher in ACC samples than in SG samples (p < 0.05). CONCLUSIONS: There was increased expression of proteins associated with hypoxia and tumour invasiveness in ACC samples, which indicates a possible role of these proteins in the biological behaviour of this tumour.

Sex estimation using paranasal sinus discriminant analysis: a new approach via cone beam computerized tomography volume analysis.

Sex estimation is an important step for subject identification in forensic medicine, to which paranasal sinuses may contribute, as they remain intact even upon severe damage to the skull and other bones. Cone beam computerized tomography (CBCT) is an excellent tool in the examination of these structures. The present study aimed to evaluate the maxillary, frontal and sphenoidal sinuses through a discriminant analysis to determine the sex correlations with foramen magnum measurements were also assessed. Two-hundred cranial CBCT scans were analysed. The volume of the maxillary, frontal and sphenoidal sinuses were measured using the ITK-SNAP software (4.0.2). Student's t test and the Mann-Whitney test were applied for the descriptive analysis of independent samples, and data were subjected to discriminant analysis. The volumes of the maxillary, frontal and sphenoidal sinuses of female subjects were smaller than those of male subjects (p < 0.001). Upon summing up the volumes of the evaluated paranasal sinuses, the chances to correctly determine an individual's gender are 96.2% and 92.7% for males and females, respectively. When correlating said values with foramen magnum measurements, sex identification chances increase to 100%. Thus, adult paranasal sinus volumes analysed by CBCT may be useful for sex identification when summed together and correlated with foramen magnum measurements.

Evaluation of mandibular odontogenic keratocyst and ameloblastoma by panoramic radiograph and computed tomography.

OBJECTIVES:: The purpose of this study was to describe and compare the main imagenological features of mandibular ameloblastomas and odontogenic keratocyst (OKC) using panoramic radiograph (PR) and CT. METHODS:: The sample consisted of nine cases of ameloblastomas and nine cases of OKC. PR and CT images were analyzed according to shape, internal structure, borders, associated unerupted tooth, root resorption, expansion and perforation of cortical bones. RESULTS:: PR evaluation allowed the identification of the lesion's location, presence of sclerosis in the periphery, presence of associated non-erupted tooth and expansion of the mandible's lower border cortical bone. CT was more accurate than PR in the assessment of the lesion shape, presence of inner bone septa, root resorption, buccolingual expansion and rupture of cortical bone. Most cases of ameloblastoma and OKC presented buccolingual expansion and erosion of cortical bone. Only ameloblastomas showed tooth root resorption. CONCLUSIONS:: Although PR is very helpful and widely used, CT provides more precise information on buccolingual expansion, calcification, bone septa, perforation of cortical bones and tooth resorption, features that are frequently underdescribed in the literature, particularly in OKC.

Frequency of the Loss of Heterozygosity of the NF2 Gene in Sporadic Spinal Schwannomas.

BACKGROUND/AIM: Individuals with type 2 Neurofibromatosis are predisposed for the appearance of schwannomas. In the present study we analyzed the loss of heterozygosity and mutations in the NF2 gene in patients with sporadic Schwannoma without Neurofibromatosis type 2. MATERIALS AND METHODS: We analyzed 39 patients with sporadic spinal schwannoma. We quantified the number of alleles by FISH and sequenced the NF2 gene. RESULTS: We identified 16/39 patients with point mutations and/or LOHs in the tumor samples analyzed. The LOHs were found in 7/39 patients. Two homozygous mutations were detected in 4/39 tumors, and the presence of the mutation in heterozygosis was revealed in 3/39 patients. In two tumors, we detected the loss of one allele of the NF2 gene, with no mutation. CONCLUSION: The genetic alterations observed in the NF2 gene indicated that spinal schwannomas are associated with genetic alterations also found in other schwannomas and type 2 Neurofibromatosis, which reinforces the etiological role of this gene.

Therapeutic effect of andiroba oil (Carapa guianensis Aubl.) against oral mucositis: an experimental study in golden Syrian hamsters.

OBJECTIVES: The aim of this study was to investigate the healing activity of andiroba (Carapa guianensis Aubl.) against oral mucositis (OM) induced by 5-fluorouracil in golden Syrian hamsters. MATERIALS AND METHODS: A total of 122 animals were randomized and divided into six groups: andiroba oil 100%, andiroba oil 10%, andiroba oil 10% refined, no treatment group, all n = 28; and negative control (NC) and cyclophosphamide (CPA) groups, both n = 5. OM was induced by intraperitoneal administration of 60 mg/kg 5-FU on days 0, 5 and 10 followed by mechanical trauma on the oral mucosa on days 1 and 2. From day 1 to day 15, the animals of the andiroba group were treated three times a day. On days 4, 8, 12 and 15, the mucosa was photographed and removed for clinical and histopathological analysis. The bone marrow of the femur was removed and the micronucleus test was performed to evaluate the cytotoxicity and genotoxicity. The data were subjected to analysis of variance, followed by the Tukey and Bonferroni test. RESULTS: Treatment with 100% andiroba oil reduced the degree of OM compared to that reported in the other groups (p < 0.05). Andiroba oil at both concentrations was not cytotoxic, but treatment with 100% andiroba oil showed a genotoxic potential (p < 0.001). CONCLUSIONS: Frequent administration of andiroba oil accelerated the healing process in an experimental model of 5-fluorouracil-induced OM. However, the genotoxicity of andiroba in other cell systems and under other conditions are being tested. CLINICAL RELEVANCE: The use of andiroba in topical form may be associated with reduced intensity of OM. Seek therapeutic alternatives to minimize the pain and suffering that these side effects cause cancer patients is an important scientific step.

Anatomical relation between nasal septum deviation and oropharynx volume in different facial patterns evaluated through cone beam computed tomography.

INTRODUCTION: The objective of this study was to establish the anatomical relation between nasal septum deviation (NSD) and oropharynx volume in different facial patterns using cone beam computed tomography (CBCT). METHODS: Ninety CBCT examinations were analyzed. InVivoDental software was used to evaluate cephalometric image reconstructions in terms of facial type, determined from cephalometric measurements indicative of growth direction; the presence of NSD was also evaluated. ITK-SNAP software was employed for delimitation of the oropharynx. Intra-examiner error methods were recorded. The results were subjected to parametric and non-parametric tests using Bioestat 5.0. RESULTS: A comparison of facial types revealed a significantly lower prevalence of NSD in the dolichofacial group compared with the brachyfacial and mesofacial groups (P = 0.0101 and 0.0149, respectively). In the total sample, there was a very strong positive relation between the presence of NSD and oropharynx space volume (P = 0.0162). The oropharynx volume was larger in all facial patterns in the presence of NSD. CONCLUSION: The presence of NSD was not associated with facial type, although the oropharynx volume in patients with NSD increased. Therefore, deviation of the septum influences oropharynx volume.

Cone-Beam Computed Tomography Findings in the Early Diagnosis of Calcified Atheromas.

PURPOSE: Computed tomograms of the mandibles of 285 patients with indications for dental implants were evaluated at a private clinic. MATERIALS AND METHODS: This study involved the evaluation of 285 cone-beam computed tomograms of patients 50 to 75 years of age who were referred to the clinic for the evaluation for implant placement images with visible C3 and C5 vertebrae that were obtained using the same I-Cat tomographic device (Imaging Sciences-Kavo, Hatfield, PA). Atheromas in the carotid space were visualized using paraxial images. RESULTS: Data were analyzed using Student t and χ2 tests, with a significance level of a P value less than or equal to .05. Atheromas in the carotid space were observed in 17.89% of patients; a significant difference in the incidence of atheromas was observed between men (24.27%) and women (14.29%; P = .034). However, no significant correlation was found between the frequency of occurrence of atheromas and the affected side of the carotid bifurcation (right or left) in women (P = .431) or men (P = .558). CONCLUSION: Based on these results, cone-beam computed tomography could be a useful tool for the diagnosis of atheroma.

Formation of ghost images due to metal objects on the surface of the patient's face: A pictorial essay.

Panoramic radiographs are a relatively simple technique that is commonly used in all dental specialties. In panoramic radiographs, in addition to the formation of real images of metal objects, ghost images may also form, and these ghost images can hinder an accurate diagnosis and interfere with the accuracy of radiology reports. Dentists must understand the formation of these images in order to avoid making incorrect radiographic diagnoses. Therefore, the present study sought to present a study of the formation of panoramic radiograph ghost images caused by metal objects in the head and neck region of a dry skull, as well as to report a clinical case n order to warn dentists about ghost images and to raise awareness thereof. An understanding of the principles of the formation of ghost images in panoramic radiographs helps prevent incorrect diagnoses.

Anatomical study of the canalis sinuosus in 100 cone beam computed tomography examinations.

OBJECTIVE: To identify and describe the morphology and location of the canalis sinuosus (CS) and make correlations with gender, age, and distance of this canal to important adjacent structures on the region, thus mapping the anatomy of this structure. METHODOLOGY: A total of 100 cone beam computed tomography (CBCT) examinations were collected from the files of a dental clinic in the Municipality of Belém, Pará, Brazil, and analyzed to identify the site of bifurcation, the diameter of CS right after such bifurcation and in its terminal portion as well as the direction of its course and the distance to the alveolar bone crest region. The anatomical views were evaluated using InVivoDental software on sagittal, axial, and coronal sections, and the results were submitted to Fisher's exact test, Kendall correlation coefficients, Mann-Whitney tests, and T tests. RESULTS: CS was present in 88 % of the sample. There were no statistically significant changes in the presence of CS regarding gender, age and direction of course. A strong positive correlation between CS's diameter on its initial and terminal portions was observed (p < 0.0001). There was a statistically significant change in the distance to alveolar bone crest related to gender, which is higher in men (p = 0.0303). CONCLUSION: In the sample, CS was frequent and similar in both genders, with course distance to the alveolar bone crest and termination in different locations that ought to be analyzed on CBCT prior to surgical procedures.

Utilização da tomografia computadorizada para o diagnóstico da articulação temporomandibular / Use of CT for diagnosing temporomandibular joint

A tomografia computadorizada desempenha um papel importante no diagnóstico de anomalias e condições patológicas da ATM, permitindo a visualização completa da região articular, fornecendo um diagnóstico mais preciso. Para avaliação das imagens tomográficas é necessário que o profissional tenha o conhecimento da anatomia seccional da região articular, para que o mesmo reconheça as alterações estruturais. Assim, foi exposto e descrito neste trabalho as características tomográficas de normalidade, alterações morfológicas e condições patológicas mais encontradas na região da articulação temporomandibular. Sendo a tomografia computadorizada um exame de imagem superior aos métodos convencionais de imagem para ATM, pois permite uma visualização tridimensional adequada e apurada de todos os detalhes ósseos sem a limitação das sobreposições, fornecendo o tamanho e formato real das estruturas anatômicas, alterações morfológicas e condições patológicas.

The computed tomography plays an important role in the diagnosis of anomalies and pathological conditions of the TMJ, providing a complete visualization of joint region, providing a more accurate diagnosis. For evaluation of the images is necessary to the professional the knowledge of sectional anatomy of the joint region, so he can recognize the structural changes. Therefore, it was explained and described in this study the characteristics of normal CT, morphological and pathological conditions commonly found in the region of the temporomandibular joint. The Computed tomography is an imaging exam superior than the conventional imaging exam for TMJ, because it allows an adequate and accurate three-dimensional visualization of all details of the bone, without the limitation of overlap, providing the real size and shape of the anatomical structures, morphological changes and pathological conditions.

Clinical and radiographic features of Hutchinson-Gilford progeria syndrome: A case report.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare dysmorphic syndrome characterized by several features of premature aging with clinical involvement of the skin, bones, and cardiovascular system. HGPS has an estimated incidence of one in four million to one in eight million births. The main clinical features of HGPS include short stature, craniofacial dimorphism, alopecia, bone fragility, and cardiovascular disorders. The most frequent cause of death is myocardial infarction at a mean age of 13 years old. Dental manifestations include delayed development and eruption of teeth, discoloration, crowding and rotation of teeth, and displaced teeth. Cone beam computed tomography images revealed the absence of the sphenoid, frontal, and maxillary sinus, flattening of the condyles and glenoid fossa, and bilateral hypoplasia of the mandibular condyles. The disease is caused by mutations in lamin A/C (LMNA). Here, we present a case report of an 11-year-old boy with classical features of HGPS, which was caused by a de novo germ-line mutation (C1824T, G608G) in exon 11 of the LMNA gene. Some uncommon HGPS-associated features in our patient, such as alterations in the facial sinuses and hypoplasia of the condyles, contributed to the expansion of the phenotypic spectrum of this syndrome from a dentomaxillofacial perspective.

Prevalence of calcified carotid artery atheromas in panoramic radiographs of HIV-positive patients undergoing antiretroviral treatment: a retrospective study.

OBJECTIVE: This study investigated the prevalence of calcified carotid artery atheromas (CCAAs) in panoramic radiographs of HIV-positive patients. STUDY DESIGN: A retrospective cross-sectional study was performed to evaluate the presence of CCAA in 300 panoramic radiographs. Qualitative variables were compared using the χ(2) test or Fisher exact test, as needed. The Mann-Whitney or Student t test was used for the quantitative variables. RESULTS: In the studied group, 8.2% presented CCAA. Among these patients, most used lopinavir/ritonavir (P = .0459), had a greater mean age (P = .0081), and displayed a lower nadir CD4 (P = .0195). The use of lopinavir/ritonavir increased the chances of CCAA by approximately 2.8-fold compared with those who did not use medication (odds ratio, 2.79; 95% confidence interval, 1.12-6.95; P = .045). CONCLUSIONS: The variables that were associated with the identification of CCAA are compatible with the known atherogenic risk factors in patients with HIV.

Melanotic neuroectodermal tumor of infancy in an African-indigenous patient from the Amazon: a case report.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare condition that occurs normally in the anterior maxilla of infants aged <1 year. The use of clinical and imaging tools for MNTI is extremely important to prevent problems with function as well as the aesthetic features in a breastfeeding child. Brazil is a multiethnic country with a poor epidemiological policy and little data to track the incidence of certain diseases, including MNTI. It is important to study this pathology with ethnicity as a factor to improve the current epidemiological programs and establish better post-treatment management. This paper describes a case of a 2-month-old male of African-indigenous descent and Brazilian Amazon residency, who presented to our unit in 2009 with a history of an expanding mass involving the anterior maxilla. Clinical and computerized tomography scans were used to diagnose the mass as MNTI, which was removed by total excision. A biopsy later confirmed the MNTI diagnosis.

Dentomaxillofacial manifestations of mucopolysaccharidosis VI: clinical and imaging findings from two cases, with an emphasis on the temporomandibular joint.

OBJECTIVES: Using a clinical survey, panoramic, cone-beam computed tomography (CBCT), and magnetic resonance (MR) imaging, this study was conducted to ascertain primary maxillofacial abnormalities in patients with mucopolysaccharidosis VI (MPS VI). STUDY DESIGN: Two patients previously diagnosed with MPS VI underwent clinical and imaging surveys (panoramic radiographs, CBCT, and MR imaging). RESULTS: Jaw involvement was present in all patients. The most prevalent findings were enlarged marrow spaces, osteopenia, dentigerous cyst-like follicles, effacement of the jaw structures, and osteosclerosis. This is the first study to describe temporomandibular joint (TMJ) involvement for MPS VI. CONCLUSIONS: CBCT and MR imaging were needed to observe features that were not clear in conventional radiographs. Both patients reported symptoms in the TMJ and demonstrated involvement during their examinations. A multicenter study is necessary to better document maxillofacial involvement in MPS VI.

A experiência do SIG: diagnóstico bucal / The experience of the oral diagnosis Special Interest Group

A criação de Grupos de Interesse Especial (SIG, no acrônimo em inglês) nasceu de uma iniciativa da Rede Universitária de Telemedicina (RUTE), visando a colaboração remota entre profissionais da saúde. Nos SIGs, profissionais de saúde discutem temas específicos através de interação virtual. Este relato visa apresentar objetivos e modelos de funcionamento do SIG – Odontologia – Diagnóstico Bucal.

The Special Interest Groups (SIG) emerged from an initiative of Telemedicine University Network in Brazil, which aims remote collaboration between health professionals on the discussion of specific topics through virtual interaction. This report presents the objectives and operating model of SIG - Oral Diagnosis.

Treatment of central giant cell lesions using bisphosphonates with intralesional corticosteroid injections.

Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. Recently, bisphosphonates have been used to treat central giant cell lesions. A case of a 36-year-old male with a central giant cell lesion crossing the mandibular midline was treated with intralesional corticosteroids combined with alendronate sodium for the control of systemic bone resorption. The steroid injections and the use of bisphosphonates were stopped after seven months when further needle penetration into the lesion was not possible due to new bone formation. After two years, the bony architecture was near normal, and only minimal radiolucency was present around the root apices of the involved teeth. The patient was followed up for four years, and panoramic radiography showed areas of new bone formation. Thus far, neither recurrence nor side effects of the medication have been detected.

Complicação sistêmica de angina de Ludwig: relato de caso / Systemic complication of Ludwig's angina: case report

Objetivo: relatar um caso clínico de complicação sistêmica de Angina de Ludwig. Relato do caso: homem de 25 anos,atendido no Pronto Socorro Municipal de Belém apresentando aumento de volume na região cervical e sintomatologiana região submandibular. Após realização de exames clínicos e radiográficos contatou-se que a infecção tinha origemodontogênica. Durante a internação, a infecção disseminou-se para o mediastino e para os rins ocasionando nefropatiacrônica bilateral. O paciente obteve alta melhorado, sendo encaminhado para hemodiálise. Considerações finais: a anginade Ludwig deve ser diagnosticada e tratada o mais breve possível já que pode evoluir para complicações sistêmicas.

Objective: report a case of systemic complication of Ludwig?s Angina. Case report: a man of 25 years sought carein Pronto Socorro Municipal of Belém presenting a volume increase in symptoms in the neck and submandibularregion. After clinical and radiographic examination contacted that the infection was odontogenic origin. Duringhospitalization, the infection spread to the mediastinum and the bilateral kidneys causing chronic nephropathy.Thepatient was discharged improved and was reffered for hemodialysis. Final considerations: the Ludwig?s Anginashould be diagnosed and treated as soon as possible as it can progress to systemic complications