Background: Uncinate process (UP) is a key landmark in the lateral wall of the nose which plays a vital role in the ventilation of paranasal sinuses and is also the first structure to be resected during functional endoscopic sinus surgery (FESS). The variations in this structure can lead to intraoperative and postsurgical complications during the FESS procedure. Aim: The aim of this study was to evaluate the variations of UP of ethmoid bone using cone-beam computed tomography (CBCT). Materials and Methods: Retrospective data of 100 cone-beam computed radiographic CBCT images of paranasal sinuses were evaluated using CS 3D version 3.10.12 software for variations in the superior attachment of UP (SAUP) using Landsberg and Friedman and the presence of pneumatization of UP. Out of 100 CBCT images, 56 were of males and 44 were of females. Statistical Analysis Used: Chi-square test was used for statistical analysis. Results: In our study, a total of 200 sides in 100 CBCT images were studied and Type I SAUP (51%) was observed as the most common type, followed by Type II (17%), Type IV (11.5%), Type III (10%), Type V (6.5%), and Type VI (4%) is the least common type observed. No statistically significant difference was observed among gender regarding SAUP. Pneumatization of UP was seen in 7% of cases, out of which 4% were in males and 3% were in females. Conclusion: Preoperative analysis of UP variations using CBCT can reduce intraoperative and postoperative complications during FESS with less radiation exposure.
Objectives: Multi-b-value diffusion-weighted imaging (DWI) is useful for the detection of pathological tissues. The signal decay curve of each voxel is generally analyzed using an exponential model; however, the most appropriate curve for an analysis does not necessarily follow a single function. We used model-free analysis to classify data from the inferior alveolar nerve (IAN) into clusters according to the pattern of decay curves. This clustering should be able to classify groups of voxels representing different tissue properties in the neurovascular bundle of the IAN. Materials and Methods: DWI with eight b-values was acquired from the IANs of 13 normal volunteers. K-means cluster analysis was used to classify the data. Silhouette analysis was performed to define the optimum number of clusters. The suitability of single and double exponential functions was evaluated for each cluster. The fitting and spatial distributions of parameters associated with diffusion and perfusion using the double exponential model were tested. Results: The optimum number of clusters was three. The cluster that exhibited the steepest decay curve showed a higher apparent diffusion coefficient than the others, and was affected by the perfusion component. The cluster with the most gradual decay curve showed the best fit to the double exponential function, and contained the highest volume fraction of the slow diffusion component, indicating a different distribution to the other clusters. Conclusions: Clustering of DWI was accomplished without model fitting and was presumably based on the diffusivity properties of IAN, which may be influenced by microcirculation and fascicles.
Background: The mandible is considered one of the most reliable bones available for gender discrimination. The mandibular Bonwill's triangle measurements can be used for the identification of gender either on the dry mandible or through three-dimensional imaging like computed tomography (CT) or cone-beam CT (CBCT). Aim: The aim of this study was to evaluate the mandibular Bonwill's triangle parameters using CBCT for gender determination. Materials and Methods: Morphometric analysis was performed on 80 CBCT images of Indian participants. The mandibular Bonwill's triangle parameters (C-LR, IC-L, IC-R, and semi-perimeter) were measured in the axial sections of CBCT images to predict the gender. Statistical Analysis: The Mann–Whitney test was used to compare the mean values between males and females, and the Kruskal–Wallis test was used to compare the mean values among different age groups. Results: The participants' ages ranged from 20 to 60 years, with an equal number of males (40) and females (40). The mean distance of C-LR was 106.72 mm in males and 102.59 mm in females. The mean distance of IC-L was 105.09 mm in males and 100.10 mm in females, while that of IC-R was 104.02 mm in males and 99.50 mm in females. The mean value of the semi-perimeter of the Bonwill's triangle was 157.93 mm in males and 151.09 mm in females. All these differences in variables between males and females were statistically significant. Using these variables, the overall prediction accuracy of this study was 75%, with 77.5% in males and 72.5% in females. Conclusion: The parameters of the mandibular Bonwill's triangle in the Indian population were observed to be larger in males than females. Hence, these parameters can be used for gender identification in forensic and medicolegal practice.
Introduction: The use of morphological features of the mandible is a common approach used by anthropologists and forensic dentists in the determination of sex. Among many anatomical landmarks of the skull, the mental foramen (MF) is a stable landmark on the mandible. Aim of the Study: The aim of the study was to analyze the sex-based variations of MF using cone-beam computed tomography (CBCT). Materials and Methods: This retrospective study evaluated 60 CBCT scans, retrieved from the radiological archives of our institution. MF was identified in the sagittal section of both the right and left sides. Parameters such as width of MF (W), the height of MF (H), the distance from superior border of MF to the lower border of the mandible (SMF-LM), the distance from inferior border of MF to the lower border of the mandible (IMF-LM), and the interforaminal distance (IFD) were evaluated and compared between the two groups. Statistical Analysis: The data obtained were analyzed using the SPSS 27 version software. Paired t-test was done for intragroup analysis; unpaired t-test was done for intergroup analysis. Results: The SMF-LM distance, IMF-LM distance, and the IFD were significantly greater in males compared to females. Conclusion: Based on the results of this study, the distance from MF to the lower border of the mandible and the IFD showed clear sexual dimorphism and can be used as an effective tool for sex discrimination.
Pleomorphic adenoma is a most common benign neoplasm of salivary glands that has the epithelial as well as the mesenchymal elements. The World Health Organization in 1972 defined pleomorphic adenoma as a “well-defined tumor characterized by its pleomorphic or mixed appearance.” There is intermixing of the clearly identified epithelial components with mucoid, myxoid, and chondroid components. Pleomorphic adenoma most commonly arises in the parotid or submandibular gland and infrequently occurs in minor salivary glands and presents as intraoral swellings on the palate or lip. The tumor shows a malignant transformation rate of about 9%, and a high recurrence rate has been reported. This case report highlights the clinical, radiological, and histopathological presentation of pleomorphic adenoma.
Mucormycosis is a fungal infection typically affecting diabetic or immunocompromised patients. Very few cases have been reported in the literature in the past but multiple studies have shown that it is increasing, especially in this COVID era. It is highly invasive in nature hence early diagnosis is obligatory. Radiological imaging plays an important role in its diagnosis and to evaluate the extent of disease, in turn facilitating timely intervention. The objective of this clinical report is to evaluate a case of rhino-orbital-cerebral mucormycosis that involved the medical and surgical treatment of an immunocompromised male patient. In this interventional case study, a comprehensive evaluation of presenting features and imaging diagnostic evaluation are discussed in detail.
Age is one of the essential factors which play an important role in every aspect of life. Importance of age determination is related to many fields including treatment planning and drug delivery in pediatric dentistry, orthodontics, forensic sciences, and also in individuals who provide inaccurate details of age as in cases of illegal immigrants and in the corpse of unknown identity. The age estimation methods at different stages of life consist of a physical examination, radiographic examination of the hand bones and cervical vertebrae, and dental examination using two-dimensional and three-dimensional imaging. The different dental age estimation methods used are morphological, biochemical, and radiological methods. These methods have inborn advantages and disadvantages. Other than dental age, skeletal age has also been used to determine a child's development as skeletal maturity is closely related to the craniofacial growth. Correlation of the dental and skeletal ages with the chronological age of children helps clinicians to estimate the growth left in the child and the possible treatment that can be carried out utilizing it. This article critically reviews various dental and skeletal aspects of age estimation from infancy to adulthood with its scope and limitation.
Background: Biological effects of radiation include deterministic and stochastic effects. Dental colleges still follow radiation protection principles due to guidelines laid by the Dental Council of India and the Atomic Energy Regulatory Board, but private practitioners sometimes are negligent about the significance of radiation protection. The study focuses on the awareness of radiation protection among dental practitioners based on their knowledge, attitude, and application. Aim and Objectives: The aim and objectives of this study were to evaluate the level of awareness and attitude about radiation protection among dental practitioners in Uttar Pradesh and the NCR region, India. Materials and Methods: The survey was performed on dental practitioners from UP and NCR region, India. The survey comprised two sections: one section on basic information of the dentists and their working place, consisting of two questions. The second section consisted of 21 questions regarding patient and personnel protection methods and knowledge about radiation exposure. The questionnaire was disseminated through Google Forms. Results: Among 200 dentists, 84% use Radio visual graph (RVG) in their clinics. Ninety percent of the specialists attended the basic lecture on radiation exposure, nearly 50% of the dentists use digital receptors in pediatric patients, 86% of the specialists use their hands when adjusting the X-ray tube, 98.4% of the dentists know the related complications of radiation, 46.8% of the specialists explain the radiation measures to the patients, 76.2% of the dentists use lead barriers in their clinics, and 76.2% of the clinicians often get their X-ray machines serviced yearly. Conclusion: The current study shows the utmost need for further implementation of radiation protection. The majority of dentists are negligent in practicing radiation protection procedures properly. Emphasis on radiation safety and mandatory professional education is needed.
Purpose: This work aims to determine the magnetic resonance imaging (MRI) findings of the masses seen in the head-and-neck region and the effectiveness of the MRI in separation of malignant from benign head-and-neck masses through histopathological data. Materials and Methods: This retrospective study was conducted on 86 patients who were referred with prediagnosed as mass in oral, head and neck regions for evaluation with magnetic resonance imaging. MRI images were analyzed according to homogeneity and signal intensity in T1- and T2-weighted images, contrast enhancement pattern, peripheral edge characteristic of the lesion, invasion condition, presence of cystic/necrotic content, and presence of bone involvement of head-and-neck masses. Results: The MRI features of benign and malignant head and neck masses in which signal intensity on T1-weighted MRI images, signal homogeneity on T2-weighted MRI images, contrast enhancement pattern, edge feature and presence of invasion showed a statistically significant difference to determine benignity and malignancy. However, the signal homogeneity in T1-weighted images, signal intensity in T2-weighted images, presence of cystic/necrotic content, and bone involvement did not reveal a statistically significant difference. Conclusions: Overall, our findings were consistent with the literature data. As a result of our study, we recommend that certain MRI features of head-and-neck masses (signal intensity in T1-weighted images, signal homogeneity in T2-weighted images, contrast enhancement pattern, edge feature, and presence of invasion) can be used to differentiate between benign and malignant masses.
Purpose: Skull is the most studied skeletal remaining as enamel and bones are the last ones to disintegrate after death. The clivus is one such dense part of the skull base and most of the time it is recovered intact from a damaged or incinerated skull and can be used as an indicator in identification. The present study is aimed to perform a radiomorphometric analysis of the clivus using cone-beam computed tomography (CBCT) and to assess its pertinence in age and gender estimation. Materials and Methods: The CBCT images of 254 (162 males, 92 females) subjects were obtained from New tom Giano HR (QR SRL Company, Verona, Italy) CBCT machine at 90 kVp, 6 mA for 7.2 s at the field of view (16 × 18), voxel size of 300 in the age group of 6–70 years were chosen. The clivus widths and lengths were measured using NNT software programs on axial and sagittal reconstructed images. Results: Mean clivus lengths and widths were significantly different in male and female patients. Bivariate correlations showed that there was a stronger association of the clivus lengths and widths to age when considered a linear combination as opposed to when taken individually in both female and male patients. Association between the linear combination of the clivus lengths and widths with age was found to be the highest in female patients among all the results (R = 0.553). All the above results were statistically significant (P < 0.05). Conclusion: CBCT measurements of clivus dimensions can be used reliably for anthropometric analysis as they are precisely associated with age and gender. Hence, it can be concluded that these dimensions can be used as a supplementary or only parameter when other parameters are uneventful in medicolegal cases.
Background: Recently, an automated diagnostic software called PanoSCOPE was developed. Aims: The aim of this study was to investigate whether there was any change in the mandibular cortical morphology at pre- and postdental implant operations using a computer aided diagnosis (CAD) system for panoramic radiography. Materials and Methods: Twenty patients were examined by panoramic radiography for pre- and postdental implant operations on the same date. The mandibular cortical index (MCI) and degree of deformation were analyzed using PanoSCOPE. The MCI classifications of all patients were evaluated with kappa coefficients between pre- and postdental implant operations. The degree of deformation of pre- and postdental implant operations was performed by the Pearson's rank correlation test. P value lower than 0.05 was considered statistically significant. Results: MCI of predental implant operation was Class 1: 10 cases, Class 2: nine cases, and Class 3: one case. MCI of postdental implant operation was Class 1: eight cases, Class 2: nine cases, and Class 3: three cases. The kappa coefficients between pre- and postdental implant operations were 0.746 (P < 0.001). We plotted degree of deformation of postdental implant operation (X) against degree of deformation of predental implant operation (Y) and observed a significant correlation (Y = 0.660 + 10.867 (n = 20, R2 = 0.650, P < 0.001). Conclusions: This study showed that there was no significant change in the mandibular cortical morphology at pre- and postdental implant operations using the CAD system and indicated that the CAD system can be useful for the quantitative evaluation of MCI of patients with dental implant operation.
To develop and present a checklist proposed to assist in planning, conducting, and reporting artificial intelligence (AI) studies in dentomaxillofacial radiology (CAIDMR - Checklist for AI in Dentomaxillofacial Radiology). To prepare the CAIDMR, a review was performed with searches in the PubMed, Embase, Scopus, and Web of Science databases with the descriptors of “Artificial Intelligence,” “Deep learning,” “Machine learning,” “Checklist,” “Dental,” and “Radiology,” using the PICOT strategy. In addition, pre-existing guidance documents and the AI management and ethical principles manual provided by the WHO were evaluated. After searching, 81 manuscripts were recruited: 27 from PubMed, 34 from Embase, 10 from Scopus, and 10 from Web of Science. Duplicate articles were removed. The studies were selected by reading the titles and abstracts and finally, the full article, resulting in six manuscripts for the full reading. The checklist was developed with the topic of planning and conducting research and 27 structured items for verification divided into the title, abstract, introduction, method, result, discussion, and other information. The CAIDMR is a guideline with a checklist for reports and studies on the application of AI in oral radiology.
Objectives: The objective of this study was to evaluate the diagnostic accuracy of ultrasonography (USG) if it can be used as a primary diagnostic method for maxillofacial trauma and to determine the sensitivity and specificity of USG verified with a computed tomography (CT) scan. Materials and Methods: This study was a comparative prospective study that consisted of a total of 32 patients. Patients reported to the Trauma Care and Emergency Center of KLES Dr. Prabhakar Kore Hospital with maxillofacial trauma during October 2018–September 2020 were included in the study. Following a CT scan, based on the inclusion criterion, the patient underwent an ultrasonographic examination of any maxillofacial fracture that had been confirmed by a CT scan to verify it. Sensitivity and specificity were calculated to establish the accuracy of USG. Results: A total of14 sites were selected in the maxillofacial region. Out of all the 14 anatomical landmarks, nine were able to detect all the fractures on USG with 100% sensitivity and specificity. Intracapsular condyle fractures were not seen on USG. The region where all the fractures were not identified on USG was medial wall and floor of the orbit, one nondisplaced ramus fracture. Conclusions: The overall sensitivity observed for the diagnosis of maxillofacial fracture was 85.21% and specificity observed was 100%. In conclusion, USG can be a handy, diagnostic, additional, noninvasive, and inexpensive tool in the detection of maxillofacial fractures when compared to CT in the primary health-care center. Furthermore, studies should be conducted with a considerable amount of sample size as the literature mentions limited work regarding USG as a primary technique in maxillofacial fractures detection.
Background: Ultrasound examination is one of the widespread diagnostic imaging methods and still a developing method, which underwent an intense development for biomechanical evaluation of muscles important in temporomandibular disorders, muscle injuries, and training. Aims: This study aims to analyze masseter muscle hardness with shear-wave elastography, especially comparison between during rest and contraction in young adults. Materials and Methods: Thirty-seven volunteers (20 men and 17 women; mean age 25.0 years [age 22–43 years]) were examined by shear-wave elastography with a 14-MHz linear transducer. The shear elastic modulus and thickness of masseter muscles with ultrasonography were compared between during rest and contraction, and between men and women using Mann–Whitney U-test. The statistical analysis of the relationships between contraction and during rest was compared using Wilcoxon signed-rank sum test. P < 0.05 indicates significant differences. Results: Shear elastic modulus data of masseter muscles at contraction were significantly higher than those at during rest (P < 0.001). The thickness of masseter muscles at contraction was significantly higher than those at during rest (P < 0.001). Shear elastic modulus data of masseter muscles at during rest were not a significant difference between men and women (P = 0.402). Similarly, shear elastic modulus data of masseter muscles at contraction were not a significant difference between men and women (P = 0.223). Conclusions: Shear-wave elastography could be an effective tool for the quantitative analysis of masseter muscle hardness.
Background: In recent years, an artificial intelligence (AI) software “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography was developed. Aims: The purpose of this study was to evaluate the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE. Materials and Methods: Five osteoporosis patients with antiresorptive medications administration before tooth extraction were analyzed using a computer program “DentalSCOPE” for alveolar bone density based on image density of intraoral radiography. The alveolar bone density around extraction tooth was compared to lytic and sclerotic bone reaction with the opposite side as normal region. Statistical analyses of alveolar bone density were performed with Wilcoxon rank-sum test. P < 0.05 was considered statistically significant. Results: The alveolar bone density of the opposite side as normal region (972.9 ± 74.3 mg/cm2) was significantly higher than those of lytic bone reaction (633.9 ± 114.2 mg/cm2, P = 0.043) and lower than those of sclerotic bone reaction (1144.0 ± 99.4 mg/cm2, P = 0.043). Conclusions: This study evaluated the alveolar bone density of osteoporosis patients with antiresorptive medications administration before tooth extraction using DentalSCOPE and indicated that the computer program could be useful for the evaluation of osteoporosis patients.
Objective: The aim of this study was to systematically review the literature to assess the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in oral squamous cell carcinoma (OSCC). Materials and Methods: The literature was searched using MEDLINE and ScienceDirect databases. Studies comparing fusion imaging PET/CT with other imaging modalities in the staging, identifying secondary metastasis, treatment response assessment, and follow-up of OSCC, were deemed eligible. Results: Six studies met the inclusion criteria. The average mean was found to be 85.47%, 78.80%, 78.50%, and 89.22% for sensitivity, specificity, positive predictive value (PPV), and negative predictive value, respectively. The risk of bias graph shows that there was 50% low risk of bias in selection of patients, more than 25% low risk of bias in conduct/interpretation of the index test, and > 25% risk of bias in reference standard. 18F-FDG PET/CT is a good prognostic factor for overall and progression-free survival. Conclusion: FDG PET/CT has a good diagnostic accuracy for identifying metastatic nodes, especially subcentimeter metastatic nodes that appear morphologically normal on CT images. PET/CT is promising in the diagnosis and evaluation of distant metastases and for identifying unknown and second primary malignancies. Advances in Knowledge: Fusion imaging is gaining importance with its ability to identify tumor as small as 0.5 mm and provide early diagnosis, thereby increasing quality of life of patients. PET/CT provides valuable information for therapeutic planning, therapeutic assessment, follow-up, and surveillance in the care of patients with OSCC.
Objectives: This study was designed to evaluate and compare the quantity and quality of mandibular bone in the first molar region in male type 2 diabetes mellitus (T2DM) patients with healthy controls using cone-beam computed tomography (CBCT) imaging technique. The bone characteristics in T2DM patients were correlated with diabetes duration. Materials and Methods: The study included 25 male diabetic patients and 25 nondiabetic male patients with missing mandibular 1st molar, in the age group ranging from 35 to 60 years. HDX WILL CBCT machine utilized to obtain CBCT images. Bone density and quantitative linear measurements were performed in OnDemand software, along with glycated hemoglobin levels of diabetic patients. The obtained data were subjected to statistical analysis using the SPSS software version 20.0. Results: Type 2 diabetic patients had greater bone density as compared to controls. The height of bone is less in diabetic patients than in nondiabetics, and other quantitative linear measurements were found similar in both groups. Conclusion: This study concluded that CBCT can be used in preimplant planning and helps the clinician assess bone measurements and bone density.
Introduction: Zygomatic arch (ZA) fractures are common in facial trauma. The imaging techniques for the ZA include submentovertex (SMV) and jug handle (a variation of the SMV view) views. These radiographic techniques require neck hyperextension to make the canthomeatal line parallel to the film receptor. Most of the time, these patients will be having cervical injuries also which makes these imaging techniques challenging. Aims and Objectives: This observational study aimed to estimate the efficacy of modified tangential Peeyush's technique (MTP technique) as an alternative to SMV view in patients with ZA fracture along with neck pain. Materials and Methods: A digital panoramic radiography machine and other standard equipment for radiography were used. Twenty patients with clinically diagnosed ZA fracture were selected and imaged using two different techniques, i.e., technique A (canthomeatal line to be about 30°–45° in relation to image receptor) and technique B (MTP technique). Images obtained with both techniques were evaluated for the presence of ZA fracture. The results were tabulated and compared. Results: Technique A showed partial visualization of ZA in 55% of the cases, whereas ZAs were not visualized in 45% of cases. ZA was evident in 100% of the sample selected in technique B (MTP technique). Conclusion: Modified Peeyush's tangential technique can be applied in patients having ZA fracture with neck pain.
Arteriovenous malformations (AVM) are defects in the vascular system, consisting of tangles of abnormal blood vessels (nidus), in which the feeding arteries are directly connected to venous drainage without the interposition of a capillary bed. AVM can occur anywhere in the body, most common in the brain. Other common locations are hepatic, musculoskeletal AVM, spinal AVM, pulmonary, and uterine AVM. In musculoskeletal soft tissue and joints are the more common sites. Bone AVM is very rare. The mean age is 21.86 years. The patient came with complaints of swelling in the left cheek with slight redness over the skin. There was no of history of pain. On examination, no pulsation present. Clinical diagnosis of parotid swelling was given. On USG- loculated cystic lesion in the left mandible with multiple locules and floating internal echoes. On color Doppler, internal vascularity was noted with in the cystic lesion. On computed tomography (CT) scan, a loculated cystic lesion in the enlarged left mandible – enhancement noted with in this cystic lesion – suggesting vascular channels in arterial and better seen in venous phase of contrast imaging. Patient was referred to interventional radiologist where the patient has undergone angioembolization of the AVM followed by mandibulectomy and artificial teeth fixation. As biopsy of the lesion would be dangerous due to significant hemorrhagic risk. Careful attention to the Doppler uptake in USG and contrast uptake in CT angiogram relative to nearby vessels, detection of nearby enlarged abnormal vessels, and performance of dynamic angiography to document arteriovenous shunting are crucial for appropriate management.
Background/Aim: The aim of this study was to investigate the factors contribute to the joint effusion in the patients with internal derangement on temporomandibular joint (TMJ) disorder. Methods: We reviewed the 83 TMJs that were diagnosed as internal derangement (anterior disc displacement with or without reduction) by magnetic resonance imaging. Joint effusion was diagnosed using T2-weighted images. The differences in the presence of joint effusion according to the gender, age, diagnosis, and TMJ pain were analyzed using cross-tabulation or Mann–Whitney test. The relationship between joint effusion and gender, age, diagnosis, and TMJ pain was analyzed by logistic multivariate regression analysis. Results: The presence of joint effusion was larger on anterior disc displacement without reduction (χ2[1] = 7.47, P = 0.006) and the TMJ with pain (χ2[1] = 7.50, P = 0.006). The results of logistic multivariate regression analyses indicated that the diagnosis of anterior disc displacement without reduction was significant in TMJ with joint effusion (odds ratio = 3.299, P = 0.036) and the TMJ with pain was also significant in TMJ with joint effusion (odds ratio = 4.413, P = 0.007). The gender and age showed no relationships with joint effusion. Conclusions: The results of this study made it clear that joint effusion was easier to occur in the TMJ of anterior disc displacement without reduction and in the TMJ with pain. Anterior disc displacement without reduction and TMJ pain would be related to the higher risk of joint effusion.
