The purpose of the present study was to test the applicability of cone beam computed tomography (CBCT) to evaluate the integrity of the cortical sinus close to periapical lesions. Two observers analyzed samples of 64 alveoli of first molar roots in macerated swine maxillas prepared with perchloric acid to simulate periapical lesions. The specimens were evaluated using CBCT (55-mm high and 100-mm diameter cylinder at 0.2-mm voxel resolution) for the presence of oroantral communication (OAC) caused by the simulated lesions. Sensitivity, specificity, and accuracy were calculated. Fair values were obtained for accuracy (66%-78%) and good values for specificity (70%-98%), whereas the values for sensibility showed relevant variation (41%-78%). For this reason, the interobserver agreement score was weak. CBCT proved capable of evaluating the integrity of the cortical sinus (absence of oroantral communication) when it lies close to an apical periodontitis lesion. However, the low interobserver agreement reflects the difficulty in performing diagnoses when OAC is adjacent to a periapical lesion, using the acquisition protocol adopted in this research. This could be attributed to the high level of image noise.

The purpose of this study was to evaluate which post-processing imaging protocol would be better to analyze the additional mental foramen (AMF) in preoperative planning with cone-beam computed tomography (CBCT) exams, and to test reproducibility of measurements, using open source software (OsiriX). The software was used to detect the cases of AMF from among 58 exams for dental implant planning in edentulous mandible areas-three cases were found. The case images were submitted to qualitative analysis using 2D orthogonal MPR, 3D-MPR and 3D volume rendering protocols by two oral and maxillofacial radiologists. Quantitative analysis used the 3D-MPR protocol; the closed polygon tool measured the mental foramen (MF) and the AMF areas; the length tool measured the distance between foramina. The measurements were performed independently by the examiners, at two different times. Intra- and interexaminer agreement was assessed using the intraclass correlation coefficient. The panoramic view did not show the MF and the AMF clearly. The AMF could be detected in the parasagittal view. 2D Orthogonal MPR was effective to observe the AMF in some cases. The 3D-MPR and 3D view protocols were the most effective to locate and analyze the AMF. In conclusion, a 3D view improves visualization when anatomical points are not clearly visible. 3D-MPR was considered a more effective post-processing imaging protocol to observe foramina relationships. The high reproducibility of measurements for anatomical MF variations was established using specific tools featured in open source software for CBCT. OsiriX is realistic and recommended for preoperative planning.

There are many studies that compare the accuracy of multislice (MSCT) and cone beam (CBCT) computed tomography for evaluations in the maxillofacial region. However, further studies comparing both acquisition techniques for the evaluation of simulated mandibular bone lesions are needed. The aim of this study was to compare the accuracy of MSCT and CBCT in the diagnosis of simulated mandibular bone lesions by means of cross sectional images and axial/MPR slices. Lesions with different dimensions, shape and locularity were produced in 15 dry mandibles. The images were obtained following the cross sectional and axial/MPR (Multiplanar Reconstruction) imaging protocols and were interpreted independently. CBCT and MSCT showed similar results in depicting the percentage of cortical bone involvement, with great sensitivity and specificity (p < 0.005). There were no significant intra- or inter-examiner differences between axial/MPR images and cross sectional images with regard to sensitivity and specificity. CBCT showed results similar to those of MSCT for the identification of the number of simulated bone lesions. Cross sectional slices and axial/MPR images presented high accuracy, proving useful for bone lesion diagnosis.

Osteocondroma de côndilo mandibular é raro na região craniofacial. Este artigo descreve um caso de osteocondroma de côndilo mandibular em uma mulher de 20 anos que foi encaminhada ao nosso serviço apresentando assimetria facial, desvio de mento, mordida cruzada para o lado contralateral, alterações na morfologia condilar, limitação de abertura bucal e maloclusão. Tomografia computadorizada foi realizada para melhor avaliação da condição patológica da ATM. Devido à base no exame clínico, histórico do paciente e exames complementares, foi estabelecida uma hipótese de osteocondroma. Um procedimento de condilectomia utilizando abordagem preauricular com uma total remoção da lesão foi executado. Após três anos de acompanhamento pós-operatório e ortodôntico, o paciente está livre dos sintomas e tem uma abertura normal sem desvio de padrão durante a abertura.

Osteochondroma of the mandibular condyle has been found in the oral and maxillofacial region rarely. This paper describes a case of osteochondroma of the mandibular condyle in a 20-year-old woman, who was referred to our service with facial asymmetry, prognathic deviation of chin, cross-bite to the contralateral side, changes in condylar morphology, limited mouth opening, and malocclusion. Computed tomography (CT) was performed for better evaluation to the pathological conditions on the temporomandibular joint. Based on the clinical examination, patient history, and complementary exams, the hypothesis of osteochondroma was established. Condylectomy was performed using a preauricular approach with total removal of the lesion. After 3 years of postoperative follow up and orthodontic therapy, the patient is symptom-free, and has normal mouth opening with no deviation in the opening pattern.

Conventional radiography has shown limitation in acquiring image of the ATM region, thus, computed tomography (CT) scanning has been the best option to the present date for diagnosis, surgical planning and treatment of bone lesions, owing to its specific properties. OBJECTIVE: The aim of the study was to evaluate images of simulated bone lesions at the head of the mandible by multislice CT. MATERIAL AND METHODS: Spherical lesions were made with dental spherical drills (sizes 1, 3, and 6) and were evaluated by using multislice CT (64 rows), by two observers in two different occasions, deploying two protocols: axial, coronal, and sagittal images, and parasagittal images for pole visualization (anterior, lateral, posterior, medial and superior). Acquired images were then compared with those lesions in the dry mandible (gold standard) to evaluate the specificity and sensibility of both protocols. Statistical methods included: Kappa statistics, validity test and chi-square test. Results demonstrated the advantage of associating axial, coronal, and sagittal slices with parasagittal slices for lesion detection at the head of the mandible. RESULTS: There was no statistically significant difference between the types of protocols regarding a particular localization of lesions at the poles. CONCLUSIONS: Protocols for the assessment of the head of the mandible were established to improve the visualization of alterations of each of the poles of the mandible's head. The anterior and posterior poles were better visualized in lateral-medial planes while lateral, medial and superior poles were better visualized in the anterior-posterior plane.

Oral cancers have a tendency to invade the surrounding bone structures, and this has a direct influence on the treatment management and on outcomes. The objective of this study was to correlate the clinical parameters (location, clinical presentation and TNM staging) of oral malignant tumors that can be associated with a potential of bone invasion and determine the accuracy of clinical examination to predict bone involvement, using computed tomography (CT). Twenty five patients, with oral malignant tumors were submitted to clinical and CT examinations. CT was considered the standard parameter to evaluate the presence of bone involvement. Clinical assessment of location, presentation form and TNM staging of the tumors were then compared to the CT findings in predicting bone involvement. Bone involvement was observed in 68% of the cases. It was predicted that tumors located in the retromolar trigone and hard palate, with a clinical aspect of infiltrative ulcer or nodule and classified in stage IV had a high potential to cause bone involvement. The clinical examination assessment of these tumors showed to be a valuable tool to predict bone invasion, with high sensitivity (82%) and specificity (87.5%), based on the results found in the CT images. No statistical significance was found between the CT and clinical examinations regarding bone involvement. The identification of some clinical parameters such as location, clinical presentation, and TNM stage, associated with a detailed clinical examination, was considered a valuable tool for the assessment of bone destruction by oral malignant tumors.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of relative measurements from the roof of the mandibular canal to the alveolar crest in multislice (multidetector) computed tomography (MDCT) and single-slice computed tomography (SSCT). MATERIAL AND METHODS: The sample consisted of 26 printed CT films (7 SSCT and 19 MDCT) from the files of the LABI-3D (3D Imaging Laboratory) of the School of Dentistry of the University of São Paulo (FOUSP), which had been acquired using different protocols. Two observers analyzed in a randomized and independent order a series of 22 oblique CT reconstructions of each patient. Each observer analyzed the CT scans twice. The length of the mandibular canal and the distance between the mandibular canal roof and the crest of the alveolar ridge were obtained. Dahlberg test was used for statistical analysis. RESULTS: The mean error found for the mandibular canal length measurements obtained from SSCT was 0.53 mm in the interobserver analysis, and 0.38 mm for both observers. On MDCT images, the mean error was 0.0 mm in the interobserver analysis, and 0.0 and 0.23 mm in the intraobserver analysis. Regarding the distance between the mandibular canal roof and the alveolar bone crest, the SSCT images showed a mean error of 1.16 mm in the interobserver analysis and 0.66 and 0.59 mm in the intraobserver analysis. In the MDCT images, the mean error was 0.72 mm in the interobserver analysis and 0.50 and 0.54 mm in the intraobserver analysis. CONCLUSION: Multislice CT was demonstrated a more accurate method and demonstrated high reproducibility in the analysis of important anatomical landmarks for planning of mandibular dental implants, namely the mandibular canal pathway and alveolar crest height.

A tomografia Computadorizada é a técnica de escolha no exame de lesões ósseas orais e maxilo-faciais porque proporciona a visualização de tecidos duros e moles em aquisição única e sem sobreposição de estruturas adjacentes. Este exame oferece um avanço significativo na detecção de lesões maxilo-faciais, com excelente resolução anatômica. O objetivo desta pesquisa foi avaliar a validade de dois protocolos, em secções axiais, em lesões simuladas de mandíbula. Dois protocolos de TC foram obtidos em mandíbulas secas em que foram feitas perfurações, simulando lesões. Dois observadores previamente calibrados avaliaram as imagens seguindo parâmetros diversos. Como resultados pudemos observar que a sensibilidade e a especificidade foram de 100% para detecção de lesões para ambos os protocolos, mas a detecção do número de lojas das lesões multiloculares e a localização e detecção de invasão medular obtiveram valores reduzidos em sua validade, o que foi influenciado pelo protocolo de aquisição. Concluiu-se que secções axiais e reconstruções mais finas foram mais efetivas na detecção de invasão medular precoce e de lojas tumorais. Protocolos mais espessos não foram considerados apropriados para a detecção de lesões multiloculares e estágios iniciais de invasão medular.

Computed tomography is the choice technique to assess oral and maxillofacial osseous lesions because it provides hard and soft tissues visualization in one examination without superimposition of surrounding structures. This examination offers a significant advance in maxillofacial lesions detection with an excellent anatomic resolution. The aim of this research was to evaluate the validity of two protocols, in axial sections, in simulated mandibular lesions. Two CT protocols were obtained in dry mandibles in which perforations were done simulating lesions. Two observers, previously calibrated, evaluated the images according to different parameters. The results indicated that the sensitivity and specificity in lesion detection were 100% for both protocols, but the detection of loci number of multilocular lesions and the location and detection of medullar invasion obtained reduced validity values, which were influenced by the acquisition protocol. We concluded that thinner axial slices and reconstructions were more effective in detecting early medullar invasion and loci number. Thicker protocols were not considered appropriate to detect multilocular lesions and early stages of medullar invasion.

OBJECTIVE: The objective of this study was to demonstrate the sensitivity and specificity of multislice computed tomography (CT) for diagnosis of orbital fractures following different protocols, using an independent workstation. MATERIALS AND METHODS: CT images of 36 patients with maxillofacial fractures (symptomatic to orbit region) who were submitted to multislice CT scanning were analyzed, retrospectively. The images were interpreted based on 5 protocols, using an independent workstation: 1) axial (original images); 2) multiplanar reconstruction (MPR); 3) 3D images; 4) association of axial/MPR/3D images and 5) coronal images. The evaluated anatomical sites were divided according to the orbital walls: lateral (with or without zygomatic frontal process fracture); medial; superior (roof) and inferior (anterior, medial). The collected data were analyzed statistically using a validity test (Youden's J index; p<0.05). The clinical and/or surgical findings (medical records) were considered as the gold standard to corroborate the diagnosis of the anatomical localization of the orbital fracture. RESULTS: 3D-CT scanning presented sensitivity of 78.9%, which was not superior to that of MPR (84.0%), axial/MPR/3D (90.5%) and coronal images (86.1%). On the other hand, the diagnostic value of axial images was considered limited for orbital fractures region, with sensitivity of 44.2%. CONCLUSIONS: Except for the axial images, which presented a low sensitivity, all methods evaluated in this study showed high specificity and sensitivity for the diagnosis of orbital fractures according to the proposed methodology. This protocol can add valuable information to the diagnosis of fractures using the association of axial/MPR/3D with multislice CT.

O côndilo mandibular bífido (BMC) é uma entidade incomum descrita na literatura e de etiologia controversa. Apesar da ausência de sintomatologia clínica, o radiologista deve estar alerta e deve ter conhecimento a respeito desta anormalidade, bem como suas implicações funcionais e mudanças morfológicas. A anquilose de articulação temporomandibular é uma patologia incapacitante com envolvimento do côndilo mandibular, fossa articular e base do crânio. A associação entre côndilo mandibular bífido e anquilose temporomandibular é rara e deve ser avaliada cuidadosamente. O objetivo deste artigo é relatar um caso simultâneo de côndilo mandibular bífido (BMC) e anquilose temporomandibular e descrever seus achados em tomografia computadorizada (CT).

Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings.

OBJETIVO: Os autores estabeleceram uma metodologia para avaliar carcinoma espinocelular de cabeça e pescoço, identificando e distinguindo áreas de grande atividade metabólica dentro da neoplasia, associando dados simultaneamente adquiridos, obtidos por diferentes modalidades de aquisição de imagens, combinando informações metabólicas e anatômicas num único exame. MATERIAIS E MÉTODOS: A população estudada consistiu de 17 pacientes com carcinoma espinocelular pertencentes aos arquivos do Departamento de Imagem do Hospital do Câncer, São Paulo. As imagens de tomografia computadorizada (TC) e da tomografia por emissão de pósitrons (PET) com 2-[F-18]-fluoro-2-deoxi-d-glucose (18F-FDG-PET) foram simultaneamente adquiridas utilizando aparelho não dedicado. Os dados originais foram transferidos para uma estação de trabalho independente com o programa Entegra 2NT para gerar a fusão de imagens da PET e TC. RESULTADOS: Os achados foram definidos como positivos na presença de focos com aumento da concentração do radiofármaco em áreas não relacionadas à sua distribuição normal. CONCLUSÃO: A fusão de imagens simultaneamente adquiridas num único exame (18F-FDG-PET e TC) possibilitou o mapeamento topográfico metabólico das lesões estudadas e foi possível localizar áreas de maior atividade metabólica dentro do próprio tumor, verificando recidivas ou metástases, possibilitando aumentar as opções quanto ao planejamento radioterápico ou cirúrgico.

OBJECTIVE: The authors have established a methodological approach to evaluate head and neck squamous cell carcinoma aiming at identifying and distinguishing high metabolic activity inside the lesion, combining in a single examination, functional, metabolic and morphological data simultaneously acquired by means of different non-dedicated positron emission tomography (PET)-computed tomography (CT) device. MATERIALS AND METHODS: The study population included 17 patients with head and neck squamous cell carcinoma submitted to a non-dedicated 18F-FDG-PET imaging at Department of Diagnostic Imaging of Hospital do Câncer, São Paulo, SP, Brazil. CT and 18F-FDG-PET images were simultaneously acquired in a non-dedicated device. The original data were transferred to an independent workstation by means of the Entegra 2 NT software to generate PET-CT imaging fusion. RESULTS: The findings were defined as positive in the presence of a well defined focal area of increased radiopharmaceutical uptake in regions not related with the normal biodistribution of the tracer. CONCLUSION: The fusion of simultaneously acquired images in a single examination (18F-FDG-PET and CT) has allowed the topographic-metabolic mapping of the lesion as well as the localization of high metabolic activity areas inside the tumor, indicating recidivation or metastasis and widening the array of alternatives for radiotherapy or surgical planning.

Um caso de fratura múltipla de mandíbula foi diagnosticado em um cão sem raça definida. Após exame clínico, radiografias extra-orais foram utilizadas para se avaliar a extensão do traumatismo, mas uma completa visualização da extensão das fraturas estava dificultada pela grande sobreposição de estruturas do crânio. A tomografia computadorizada foi então realizada para colaborar na identificação de todos os focos de fratura, de suas exatas localizações, da presença de fragmentos e de suas posições, mostrando-se superior ao exame radiográfico na realização de um diagnóstico preciso.

A multiple mandible fracture was diagnosed in a mixed breed dog. After clinical examination, extra-oral radiographs were used to evaluate the trauma but, a complete visualization of the fractures extension was difficult due to the great of structures of cranium. Then, the computed tomography was accomplished to help and to find all osseous tissues fractured, their exact location, existent fragments and their positions; being superior to the radiograph exam in the accurate diagnosis realized.

A síndrome de Apert, também denominada acrocefalossindactilia tipo I, é uma disostose craniofacial de caráter hereditário autossômico dominante. Caracteriza-se por distúrbio severo de desenvolvimento na região craniofacial, incluindo sinostose bilateral da sutura coronal, associada a hipoplasia maxilar, exoftalmia, hipertelorismo e sindactilia simétrica de mãos e pés. O presente trabalho tem por objetivo o estudo de pacientes portadores da síndrome de Apert, não-operados, correlacionando os achados clínicos com os obtidos por meio da tomografia computadorizada (TC). Foram analisados 5 pacientes, sendo todos submetidos ao exame clínico e à tomografia computadorizada. Reconstruções tridimensionais (3D-TC) foram obtidas a partir de um tomógrafo helicoidal, utilizando uma estação de trabalho independente, para avaliação das alterações craniofaciais provocadas pela síndrome. A análise clínica determinou que sindactilia de mãos e pés, pseudofenda na linha média do palato e hipoplasia da maxila são achados observados em todos os pacientes. A 3D-TC mostrou que algumas alterações como sinostose bilateral das suturas coronais, defeito na linha média da calvária e redução na dimensão ântero-posterior da fossa craniana anterior, média e posterior estavam presentes em todos os casos. A combinação e correlação entre os achados clínicos e os observados na 3D-TC pode ser útil na avaliação das alterações observadas na síndrome de Apert, possibilitando melhora no estudo do paciente e promovendo informações importantes no diagnóstico, planejamento terapêutico e acompanhamento cirúrgico.

Apert syndrome, or acrocephalosyndactyly type I, is a craniofacial dysostosis, an autosomal dominant condition characterized by severe developmental disturbances of the craniofacial region including bilateral coronal synostosis associated with midface hypoplasia, exophthalmia, hypertelorism, and symmetric syndactyly of the hands and feet. The aim of this study is to assess the clinical and computed tomography imaging patterns of non-operated patients with Apert syndrome, correlating the bone abnormalities of the cranium, face and the skull base. The study population consisted of 5 patients with Apert syndrome. As part of the craniofacial assessment of the imaging center's routine, all patients underwent clinical evaluation and CT (computed tomograph) exam. Three-dimensional images were generated from helical CT scans, using an independent workstation, to evaluate the craniofacial abnormalities of the syndrome. Clinical exam determined that syndactyly of the hands and feet, pseudocleft in the midline palate and midface hypoplasia were features observed in all of the Apert patients. 3D-CT showed that some abnormalities such as bilateral coronal synostosis, calvarial midline defect and reduction in the antero-posterior dimension of the anterior, medial and posterior cranial fossae were present in all cases. In conclusion, the correlation of clinical and CT imaging findings can be useful to assess the main features observed in Apert patients, improving the criteria for examining the patient and diagnosing this condition, and contributing to the therapeutic planning and surgical follow-up.