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Objective. We sought to assess the utility of panoramic radiography as an adjunct screening tool for detecting significant asymptomatic carotid artery stenosis. The specific aim was to correlate calcifications seen in the region of the carotid bifurcation with clinically relevant carotid artery stenosis as determined by duplex ultrasound (DUS). Study Design. Routine dental panoramic films of patients 55 and older (n = 778) at the University of Rochester Eastman Dental Center were retrospectively reviewed for calcifications around the carotid bifurcation. Patients with such calcifications were referred for DUS, and raw data were interpreted by a vascular surgeon blinded to the radiographic findings. Groups were compared by using the χ2 test. Results. Twenty-seven patients (3.5%) had suggestive radiographic calcifications on one or both sides, 20 of whom consented to DUS. Clinically significant carotid stenoses (>50% lumenal narrowing) were present in 50% of the sides with calcification compared with 21% of the sides without (P =.08, χ2). Three patients (15% of those screened with DUS) had stenoses greater than 80% and underwent 4 carotid endarterectomies as a direct result of screening. Conclusions. Data suggest that clinically significant stenosis may exist if calcifications are observed on panoramic radiographs. Incidental examination of this area carries a minimal cost and appears beneficial as a screening tool for carotid disease, although definitive testing must follow. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:768-73)

A case of exuberant pneumatization of the left sphenoid sinus into the pterygoid process and floor of the middle cranial fossa is presented. The fact that pneumatization of the sphenoid sinus is frequently atypical is of clinical import because there is an intimate relationship between the contents of a hyperaerated sinus and adjacent vital facial and cranial structures. It is imperative that clinicians determine the location and extent of the walls of the sphenoid sinus and its relationship to adjacent vital structures whenever endoscopic sinus surgery is contemplated to avoid morbid consequences during surgery.

Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that manifests itself uncommonly in the oral cavity because of the paucity of smooth muscle in that location. To the best of our knowledge, only 10 cases of leiomyosarcoma primary to the jawbones have been reported in the English language literature. We report the first pediatric case of leiomyosarcoma arising from the mandible. Facial asymmetry and swelling were accompanied by a rapidly growing exophytic soft tissue mass that caused buccal displacement of the mandibular left permanent first molar. The lesion, observed radiographically as an extensive ill-defined area of osteolytic alveolar destruction, perforated the lingual cortex, displaced the inferior alveolar nerve canal inferiorly, and produced a “floating-in-air” appearance of the first molar. Diagnosis of leiomyosarcoma was made after initial incisional biopsy of the lesion. A 5-cm segmental mandibulectomy and supraomohyoid neck dissection were followed by reconstruction with a dynamic mandibular reconstruction plate and placement of a multidimensional mandibular distraction device in a transport rectangle of bone to promote bifocal distraction osteogenesis. Forty millimeters of distraction (the technical limit of the device) were performed; this was followed by terminal iliac crest bone grafting. Seventeen months after the definitive surgical procedure, the patient remains free of disease. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:477-84)

A wide variety of osteoarticular pathoses plague the clinical course of many patients with Gaucher disease. Osseous lesions involving the jaws have been described, usually as isolated case reports. The purpose of this study was to ascertain the nature and extent of mandibulo-maxillofacial pathosis in 28 patients with documented Gaucher disease by means of panoramic radiography. Twenty-five of the 28 patients displayed radiographic evidence of jaw involvement. The most prevalent finding was gross widening of marrow spaces; frank radiolucencies, endosteal scalloping, cortical thinning, root resorption, and inferior displacement of the mandibular canal or effacement of its cortices were also seen. A previously unreported finding was delayed eruption of permanent teeth, which was seen in more than one half of the patients who were under 20 years of age. Osseous changes throughout the jaws may be more common than previously suspected and may alert the dentist to the presence of the disease.

Although stroke may be preventable, a major challenge is to find effective methods of detection of stroke-prone patients. Most noncardiogenic strokes occur as a result of atherosclerosis involving the proximal internal carotid artery, calcifications of which can be detected on dental panoramic radiography. This report describes the case of an asymptomatic patient whose dental radiographic findings led to carotid endarterectomy. Calcifications were viewed bilaterally in the soft tissues of the neck in the area of the carotid bifurcation on a screening panoramic radiograph of an asymptomatic 75-year-old man. Subsequent duplex Doppler ultrasound revealed extensive atherosclerotic changes bilaterally with critical stenosis (90%+) in the right internal carotid artery. Carotid digital subtraction angiography revealed a 95%+ stenosis at the origin of the right internal carotid artery. The patient underwent right carotid endarterectomy involving the internal, external, and common carotid arteries. Twelve months later the patient was alive and well. Dental panoramic radiography represents a useful imaging modality for detection of some asymptomatic stroke-prone patients. Identification of calcifications in the area of a patient's carotid vasculature should prompt expeditious referral to a physician for a cerebrovascular and cardiovascular work-up as part of an active stroke prevention strategy.

As the parapharyngeal space is difficult to examine clinically, the radiographic distinction between deep lobe parotid masses and extraparotid tumors is essential in determining the surgical approach. We describe the case of a 53-year-old woman who presented with facial pain consequent to metastatic papillary thyroid carcinoma of the parapharyngeal space. A highly unusual pattern of calcification was present in the mass as observed by panoramic radiography and computed tomography. Parapharyngeal metastasis as the presenting feature of occult thyroid carcinoma has only been described four times previously in the medical literature.

The objective of the present study was to review a series of 23 lateral periodontal cysts and 2 botryoid odontogenic cysts retrieved from the files of the State University of New York at Buffalo (SUNY) Oral Pathology Biopsy Service for epidemiologic characteristics as well as radiographic findings, clinical presentation, histopathologic features, and management. This study corroborated some previously established characteristics of the lesion but also revealed some surprising aberrations. A significant difference in the age range and mean age by gender was detected with the Student's t test within this population at the 0.05 level. The classic presentation of a lateral periodontal cyst seems to be that of an asymptomatic, small, ovoid, well-corticated radiolucency that occurs in an interradicular locus in the mandibular premolar segment of a middle-aged man. However, lateral periodontal cysts may manifest with pain and cause cortical perforation, may present as large expansile radiolucencies, may arise in the maxillary molar segment, and may develop in young females. Because of the tendency for aggressiveness of other lesions that may present with a similar picture, it is important to establish the final diagnosis of lateral periodontal cyst on a histologic basis in conjunction with the clinical and radiographic findings.

The differential diagnosis of calcified atherosclerotic plaque in the extracranial carotid vasculature includes a number of anatomic and pathologic radiopacities. Most of these are readily distinguishable on the basis of location and morphologic features. The calcified triticeous cartilage, however, can be a confounding alternative that is frequently misdiagnosed as a calcified atheroma. This paper describes the radiographic differences between these 2 entities, enabling clinicians to improve their diagnostic acumen when evaluating cervical soft tissue calcifications.