Abstract Objective: Oral Squamous Cell Carcinoma (OSCC) is conventionally treated by surgical resection, and positive surgical margins strongly increase local recurrence and decrease survival. This study aimed to evaluate whether a Three-Dimensional Segmentation (3DS) image of OSCC confers advantage over Multiplanar Reconstruction (MPR) of OSCC using images of computed tomography scan in surgical planning of tumor resection. Methods: Twenty-six patients with locally advanced OSCC had tumor morphology and dimensions evaluated by MPR images, 3DS images, and Surgical Pathology Specimen (SPS) analyses (gold standard). OSCC resection was performed with curative intent using only MPR images. Results: OSCC morphology was more accurately assessed by 3DS than by MPR images. Similar OSCC volumes and dimensions were obtained when MPR images, 3DS images and SPS measurements were considered. Nevertheless, there was a strong correlation between the OSCC longest axis measured by 3DS and SPS analyses (ICC = 0.82; 95% CI 0.59–0.92), whereas only a moderate correlation was observed between the longest axis of OSCC measured by MPR images and SPS analyses (ICC = 0.51; 95% CI 0.09–0.78). Taking only SPS with positive margins into account, MPR images and 3DS images underestimated the tumor’s longest axis in eight out of 11 (72.7%) and 5 out of the 11 (45.5%) cases, respectively. Conclusion: Our data present preliminary evidence that 3DS model represents a useful tool for surgical planning of OSCC resection, but confirmation in a larger cohort of patients is required. Level of evidence: Laboratory study.

Abstract Asymptomatic Apical Periodontitis is essentially an inflammatory disease of microbial aetiology. Association and function of the cell components involved, or specific inductive factors and growth mediators associated with development, maintenance and resolution of the periapical lesions are still unknown. The objective of this study was to evaluate the concentration of Regulatory T cells (FoxP3+; Treg), Langerhans cells (CD1a+; LC) and mast cells in asymptomatic apical periodontitis. 73 cases were selected: 30 periapical granulomas, 29 radicular cysts and 14 residual cysts. All groups were submitted to morphological analysis for classification of inflammatory infiltrate and thickness of the epithelial lining as well as to immunohistochemical analysis for detection of LC and Treg cells. Toluidine blue staining was used for detecting mast cells. Analysis showed higher mean numbers of LC (8.2 cells/0.2mm2), and Treg cells in radicular cysts (5.910 cells/0.2mm2). As for mast cells, it was found that radicular cysts had a higher mean number of these cells compared to other periapical lesions (12.68 cells/0.2mm2). The association between thickness of the epithelial lining and inflammatory cells showed that the presence of hypertrophic epithelium in radicular cysts presented higher density of LC. The number of LC and Treg cells play an important role in the control of the inflammatory micro-environment in periapical granulomas and radicular cysts, respectively. The presence of mast cells in radicular cysts may be associated with progression of the lesion. Knowledge regarding the inflammatory cell profile is therefore essential for a better understanding of the pathogenesis of asymptomatic periapical periodontitis.

RESUMO A hipertrofia massetérica é uma condição benigna, assintomática e rara, caracterizada pelo desenvolvimento excessivo do músculo masseter, que geralmente resulta em queixas estéticas. São sempre recomendados os exames de imagem para diagnóstico diferencial de patologias na região parotídea-massetérica. Neste trabalho objetiva-se a caracterização da imagem da hipertrofia massetérica através do relato de dois casos clínicos combinando diferentes modalidades de imagem: radiografia panorâmica, ressonância magnética, tomografia computadorizada, ultra-sonografia e volumetria 3D. Dois indivíduos do sexo masculino sem história familiar de hipertrofia massetérica foram encaminhados para um centro de diagnóstico em radiologia dentomaxilofacial devido ao aumento do volume facial bilateral na região massetérica. As imagens da radiografia panorâmica mostraram um aumento do ângulo mandibular bilateral em ambos os casos. Usando tomografia computadorizada, foi demonstrada hipertrofia muscular massetérica bilateral nos pacientes, e a varredura de ressonância magnética e ultra-sonografia foram realizadas para melhor visualização e medição. A avaliação volumétrica em 3D da musculatura mostrou-se como ferramenta adicional para avaliar o estado dos músculos masseteros em pacientes com hipertrofia massetérica. Portanto, a associação de exames de imagem permitiu realizar a caracterização da imagem da hipertrofia massetérica com presença de exostose óssea.

Abstract Masseteric hypertrophy is a benign condition, asymptomatic and rare, characterized by the excessive development of the masseter muscle, which usually results in aesthetic complaints. The imaging exams for differential diagnosis of pathologies in the parotid-masseteric region is always recommended. This work aims the imaging characterization of masseteric hypertrophy through the report of two clinical cases combining different imaging modalities: panoramic radiography, magnetic resonance imaging, computed tomography, ultrasonography and 3D volumetry. Two male subjects with no family history of masseteric hypertrophy were referred to a diagnostic center in dentomaxillofacial radiology due to an increase in bilateral facial volume in the masseteric region. Images of the panoramic radiography showed an increase of the bilateral mandibular angle in both cases. Using computerized tomography, bilateral masseter muscle hypertrophy was demonstrated in the patients, and magnetic resonance scan and ultrasound examination were performed for better visualization and muscle measurement. 3D volumetry assessment of musculature showed as additional tool to evaluate the status of the masseter muscles in patients with Masseteric hypertrophy. Therefore, the association of imaging examinations allowed to perform the imaging characterization of masseteric hypertrophy with presence of bone exostosis.

RESUMO Objetivo: Investigar e quantificar achados incidentais em exames de tomografia computadorizada de feixe cônico realizadas unicamente para fins ortodôntico. Métodos: Foram incluídos os exames de tomografia de feixe cônico com finalidade de diagnóstico ortodôntico no período de novembro de 2011 a abril de 2014 (n=202) avaliados por dois examinadores e os dados coletados classificados em cinco grupos diferentes. Foi realizada análise exploratória dos dados através do cálculo de média, desvio padrão, frequência e porcentagem. A associação entre o local do achado e o gênero foi verificada através do teste exato de Fisher. Resultados: Foi encontrado um total de 227 achados; o grupo com maior número de achados foi o de origem dental (n=157), seguido do grupo de vias aéreas (n=46), de crânio (n=16) e de ATM (n=8). Exames sem nenhum achado representaram 20% do total. Os sujeitos com menores médias de idade foram encontrados no grupo de vias aéreas. A prevalência de alterações tomográficas incidentais em pacientes ortodônticos é alta. Conclusão: Um cuidadoso diagnóstico das imagens de tomografia de feixe cônico além da região de interesse ortodôntica é indispensável para prevenir patologias ocultas. Estudos adicionais podem ser realizados para avaliar qual a influência desses achados no tratamento ortodôntico.

ABSTRACT Objective: The aim of this retrospective study was to determine and quantify incidental findings in CBCT scans taken exclusively for orthodontic purposes. Methods: A total of 202 scans were evaluated by two examiners and classified into five different groups. Results: A total of 227 incidental findings were found in a sample of patients aged 5-58 years old. The highest number of findings was of dental origin (n = 157), followed by airway (N = 46), skull (N = 16) and ATM (n = 8). Scans with no incidental finding accounted for 20% of the examinations. Subjects having lower mean age were found in the group of airway findings. The prevalence of incidental findings in the current study was consistent with the literature, thus corroborating their high frequency. Orthodontists who make use of CBCT are responsible for assessment of all data. Conclusion: The precise evaluation of incidental findings may help in the early diagnosis, treatment and patient monitoring. Further studies should be conducted to assess the influence of these findings on the orthodontic treatment.

OBJECTIVES: To study pre and postoperative WMA in MTLE patients. METHODS: We performed Voxel-Based Morphometry (VBM) with volume of interest (VOI) in 69 controls (mean age, 34.3±11.1 years) and 67 operated patients (mean age, 34.1±10.4 years) with unilateral MTLE. 34 became seizure-free (SzFree-Group), 23 improved (Engel IB-IIA [Partial recovery-group]) and 10 did not improve (Engel III-IV [Failure-Group]). All had pre and postoperative MRIs (one year minimum). We flipped MRIs of right MTLE patients in order to avoid right-to-left analysis cancelation. VBM was performed on SPM2/MATLAB7.0 with individual masks for surgical lacunae and 1% false-discovery-rate to control for multiple comparisons. We used MARSbar <www.marsbar.sourceforge.net> routine to select ROIs and t-test for statistical analyses. RESULTS: Mean postoperative follow-up was 60.2 (±SD 30.7) months. On baseline MRI, SzFree-Group showed White Matter Atrophy (WMA) involving temporal lobes [TL], ipsilateral occipital, parietal and frontal regions, with areas of significant recovery of WMA on postoperative MRI. Partial recovery-Group presented a more restricted pattern of WMA, involving ipsilateral temporal lobe, contralateral superior temporal gyrus and few areas in bilateral cingulated and orbitofrontal areas. In this group we also identified areas with relative increase of WM after surgery. By contrast, Failure-Group showed more widespread bi-hemispheric areas of WMA on baseline MRI without postoperative improvement. CONCLUSIONS: Although we have identified some differences in baseline WMA, we were unable to correlate a more widespread pattern with a worse prognosis, as SzFree-Group, also presented a bilateral distribution of WMA. The recovery of WMA in SzFree-Group and Partial recovery-group is in agreement with previous MRS and PET studies and suggests that a network of neuronal dysfunction in MTLE can be, at least in part, reversible after successful postoperative seizure control.