Pott's Puffy Tumor, a Forgotten Complication of Sinusitis: Report of Two Cases.

Pott's puffy tumor (PPT) is a life-threatening complication of infectious sinusitis/osteomyelitis of the frontal bone. It occurs due to infection or trauma and is often seen in late childhood and adolescence. If left untreated for a protracted period, intracranial complications such as epidural abscess, subdural empyema, meningitis, and a cerebral abscess may occur. The diagnosis is often confirmed with CT. Prompt medical and surgical treatment is mandatory as there is the potential for significant morbidity if not quickly diagnosed and treated. This paper presents two cases of PPT manifested in patients with hemi pansinusitis.

Incidental findings based on anatomical location and clinical significance in CBCT scans of dental implant patients.

OBJECTIVE: Several incidental findings with varying degrees of clinical significance are often found on cone beam computed tomography (CBCT) scans of the maxillofacial skeleton acquired for dental procedures. The present study analyzed CBCT scans of dental implant therapy patients to identify incidental findings and assign those findings an appropriate clinical significance. METHOD AND MATERIALS: A total of 500 CBCT scans of patients were evaluated for this study. The incidental findings recorded in different anatomical regions were assigned a clinical significance score of mild, moderate, or severe. These findings were further segregated based on age and sex to evaluate specific trends for prevalence of incidental findings and their clinical significance. RESULTS: Out of the 298 intracranial findings, four were categorized as moderate. Out of 407 sinonasal findings, 19 were categorized as severe. Most (43%) of the airway findings were classified as mild. Among the cervical vertebrae findings the severe category included degenerative changes and vertebral-body fusion along with other degenerative changes. Most (259 [51.8%]) of the vascular findings were categorized as severe. CONCLUSION: Patients referred for dental implant treatment present with a myriad of incidental radiographic findings in the head and neck region. It is important that care providers recognize and understand these findings so appropriate care and timely intervention may be initiated.

Squamous cell carcinoma arising within a maxillary odontogenic keratocyst: A rare occurrence.

Squamous cell carcinoma (SCC) arising within the lining of an odontogenic keratocyst (OKC) is a rare occurrence. Although potentially locally destructive, OKC is a benign odontogenic process that typically presents with clinical and radiographic features characteristic of a benign intraosseous neoplasm. We present the clinical and radiographic features of a maxillary mass that demonstrated SCC arising from the lining of an OKC. Although the initial clinical and radiographic presentation suggested an infection or malignant neoplasm, biopsies revealed an infiltrative well-differentiated SCC contiguous with and arising from the focus of a pre-existing OKC. The patient subsequently underwent a type II hemi-maxillectomy with neoadjuvant chemoradiation. This report discusses the clinical and radiographic features associated with intraosseous malignancies, especially those arising from an otherwise benign odontogenic lesion. While the majority of OKCs are benign, the current report illustrates the potential for carcinomatous transformation within the lining of an OKC.

CBCT evaluation of buccal bone regeneration in postmenopausal women with and without osteopenia or osteoporosis undergoing dental implant therapy.

STATEMENT OF PROBLEM: Because alveolar bone augmentation in women with osteoporosis/osteopenia has an uncertain prognosis, objective and reliable methods should be used to study standard surgical approaches. PURPOSE: The purpose of this clinical study was to evaluate bone regeneration 9 months after bone augmentation and implant placement in postmenopausal women with different levels of systemic bone health by using cone beam computed tomography (CBCT) and to test proof of concept for this measurement approach. MATERIAL AND METHODS: A subset of 14 participants was analyzed in a best practice study of postmenopausal women receiving dental implants and simultaneous horizontal ridge augmentation. Women were categorized as osteopenic/osteoporotic or normal based on the results of preoperative dual-energy x-ray absorptiometry. All implant study sites received a particulate graft and/or buccal plate expansion. The study sites were evaluated with CBCT preoperatively, immediately postoperatively, and 9 months postoperatively. Nonparametric statistics were used for all analyses. The related samples Wilcoxon signed rank test was used to assess the differences in bone width between time points (α=.05 for all tests). RESULTS: After 9 months, 13 out of 14 participants showed increased bone width compared to the preoperative baseline measurements. The increase was statistically significant for the participants with osteoporosis/osteopenia (P=.007), but not for those with normal bone health (P=.066). The CBCT scans showed that mineralized tissue buccal to the implant surface had the radiographic appearance of mature bone. CONCLUSIONS: CBCT showed evidence of bone regeneration, with an increase in alveolar ridge width in postmenopausal osteopenic/osteoporotic women subsequent to surgical reconstruction.

Calcification of the stylohyoid ligament in panoramic radiography and cone beam computed tomography among patients referred for dental implant treatment planning.

BACKGROUND: Calcification of the stylohyoid ligament (SHL) is a common condition noted as an incidental finding in routine radiographic examination. Due to proximity with important neurovascular structures, elongation and calcification may sometimes lead to dysphagia and pain. The objective of this study was to evaluate the incidence of calcified SHL detected on cone beam computed tomography (CBCT) scans and panoramic radiographs (PR) in patients referred for dental implant therapy. METHODS: Retrospective analysis of 30 patients referred for dental implants to the Department of Oral and Maxillofacial Radiology at the University of Connecticut School of Dental Medicine was done. Patients were imaged using Hitachi CB MercuRay CBCT machine, and PRs were obtained using Planmeca panoramic machine. CBCT reconstructions and panoramic images were evaluated for the incidence and pattern of SHL calcification. RESULTS: Nineteen patients (63.3%) had calcified SHLs, 16 of whom were reported to have bilateral involvement. PR was unable to show complete calcification of the ligament in any of the cases, whereas CBCT showed evidence of complete calcification when present (14 cases). CONCLUSION: CBCT was more accurate in determining the pattern and extent of calcification of the SHL in patients undergoing implant treatment planning.

Clival lesion incidentally discovered on cone-beam computed tomography: A case report and review of the literature.

An osteolytic lesion with a small central area of mineralization and sclerotic borders was discovered incidentally in the clivus on the cone-beam computed tomography (CBCT) of a 27-year-old male patient. This benign appearance indicated a primary differential diagnosis of non-aggressive lesions such as fibro-osseous lesions and arrested pneumatization. Further, on magnetic resonance imaging (MRI), the lesion showed a homogenously low T1 signal intensity with mild internal enhancement after post-gadolinium and a heterogeneous T2 signal intensity. These signal characteristics might be attributed to the fibrous tissues, chondroid matrix, calcific material, or cystic component of the lesion; thus, chondroblastoma and chondromyxoid fibroma were added to the differential diagnosis. Although this report was limited by the lack of final diagnosis and the patient lost to follow-up, the incidental skull base finding would be important for interpreting the entire volume of CBCT by a qualified oral and maxillofacial radiologist.

The relationship between implant stability and bone health markers in post-menopausal women with bisphosphonate exposure.

OBJECTIVES: The authors assessed the relationship between implant stability and bone turnover markers in patients with and without a history of bisphosphonate (BP) exposure for treatment of osteopenia/osteoporosis. MATERIALS AND METHODS: One dental implant site was evaluated in 58 post-menopausal women with a spectrum of bone health in a "best practice" prospective cohort study. Each site had a previous or simultaneous bone augmentation procedure. BP exposure at enrollment was categorized as "never" or "past/current" exposure. Implant stability was assessed by resonance frequency analysis (RFA ISQ) at surgery and 8 weeks post-implant. Bone turnover markers, C-telopeptide collagen crosslinks (sCTX) and procollagen -1 N-terminal telopeptide (P1NP), were measured pre-treatment, 1, and 8 weeks following implant surgery. RESULTS: Mean age was 62.4 ± 6.8 years; 66 % were osteopenic/osteoporotic. Average RFA ISQ at placement for all participants was 63.5 ± 11.3, at 8 weeks post-surgery 74.2 ± 9.4 (p < 0.01). Among "past/current" BP users, there was a significant negative correlation between RFA ISQ values at 8 weeks post-implant placement and sCTX and P1NP values at 1 week (ρ = -.65 and ρ = -.55, respectively; p < 0.01) and 8 weeks (ρ = -.64 and ρ = -.52, respectively; p < 0.05). CONCLUSION: RFA ISQ values increased between implant placement and 8 weeks post-surgery demonstrating successful osseointegration. Lower bone turnover was associated with better implant stability among patients with a history of BP exposure. CLINICAL RELEVANCE: Further investigation of the relationship between BP exposure and implant stability is warranted in a larger population, as results may strongly impact on clinical practice decisions.