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Background More than four million people today live with Hansen’s disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen’s disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen’s disease. Methods This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60–89) years, age at diagnosis 20 (6–43) years and time since diagnosis 46 (26–70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including “saddle nose” (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion Until Hansen’s disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.

To characterize maxillofacial, otorhinolaryngological and oral manifestations of Hansen’s disease (HD), we conducted a cross-sectional study in 21 current patients attending the Unidade Básica de Saúde de Jardim América, Espírito Santo, Brazil and 16 former patients resident at Pedro Fontes Hospital using data from computed tomography imaging, rhinoscopy, and oroscopy. Maxillofacial characteristics were compared with 37 controls. Differences in bone alterations across the three groups were determined mainly by severe resorption/atrophy being more frequent in former HD patients, with severe resorption/atrophy of the anterior alveolar process of maxilla in 50.0% (8/16) of former patients, 28.6% (6/21) of current patients and 10.8% (4/37) of controls and of nasal bones and aperture in 31.3% (5/16) of former patients compared with 0/21 current patients and two controls. There were no substantial differences in otorhinolaryngological and oroscopic findings between the two patient groups. HD patients had more tooth loss than the age-matched control group. Maxillofacial, otorhinolaryngological and oroscopic finding scores were strongly correlated only in current HD patients. Correlation between otorhinolaryngological and maxillofacial scores suggests that protocols for HD patient assessment and follow-up could include otorhinolaryngological evaluation, with radiological imaging where necessary, subject to replication of our findings in a larger study.

Psychotic Disorders: Comprehensive Conceptualization and Treatments emphasizes a dimensional approach to psychosis that cuts across a broad array of psychiatric diagnoses from schizophrenia to affective psychosis and organic disorders like epilepsy and dementias. Written by an international roster of over seventy leading experts in the field, this volume comprehensively reviews, critiques, and integrates available knowledge on the etiology, mechanisms, and treatments of psychotic disorders, and outlines ways forward in both research and clinical practice towards more objective, mechanistically-based definitions of psychotic disorders. Chapters address topics such as psychosis phenomenology, biomarkers and treatments, the overlaps and interfaces between psychiatric disorders within the psychosis dimension, and novel disease definitions. The book also incorporates findings on potential mechanisms, bridges between various system levels and their interactions, as well as the potential role in causation and/or mediation in psychotic disorders. Covering a broad array of treatment approaches and concluding with a section of forward perspectives, Psychotic Disorders aspires to stimulate new knowledge, generate novel frameworks, and carry new directions forward on psychotic disorders.

Dental disease is a frequent finding on head and neck images, especially in the context of emergencies, and can be a challenge for radiologists who are inexperienced with findings of dental trauma or disease. Dental abnormalities can be subtle and therefore must be included in the systematic approach to these images. Although dedicated dental images are not acquired in most emergency cases, the teeth are included on many different images of the head and neck, and their initial evaluation seldom requires a specific protocol. The high prevalence of craniofacial trauma, sinus infection, and maxillomandibular procedures, among other conditions, frequently requires interpretation of dental images in daily emergency practice. The imaging findings can be categorized into infection, trauma, and complications of procedures, although sometimes these categories can overlap. Such categories can help the radiologist decide which imaging protocol and dynamic maneuvers should be used and are also useful when reading images and proposing differential diagnoses. Familiarity with the imaging findings of dental emergencies improves the radiologist's diagnostic confidence and role in guiding patient care, avoiding progression to life-threatening conditions, and reducing aesthetic problems, dental loss, and related conditions. Information about the imaging protocols is provided, the relevant anatomy of the teeth and related structures is reviewed, and the key imaging findings of dental emergencies are presented.©RSNA, 2019.

Four-hour delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence after intravenous gadolinium-based contrast agent administration is an optimal magnetic resonance imaging technique to evaluate endolymphatic hydrops in patients with known or suspected Meniere's disease. Nonenhanced endolymphatic space surrounded by enhanced perilymphatic space is evaluated in the cochlea and vestibule separately. In cochlear hydrops, the scala media is enlarged, potentially obliterating the scala vestibuli. In vestibular hydrops, the size of the saccule becomes equal to or larger than that of the utricle; as hydrops progresses, the saccule and utricle become larger and confluent until complete obliteration of the vestibule's perilymphatic space. In patients with a unilateral clinical presentation of Meniere's disease, it is possible to depict the asymmetries of perilymph enhancement, which may be increased on the affected side and reflect a permeability alteration of the blood-perilymph barrier. In addition, endolymphatic hydrops can be observed in the asymptomatic ear of these patients with a unilateral clinical presentation, showing that Meniere's disease tends to undergo bilateral evolution over time.

Studies evaluating radiologic aspects, local complications, and structural alterations of the paranasal sinus in patients with mucosal leishmaniasis (ML) are lacking. The aim of this study was to analyze alterations of the paranasal sinuses in patients with ML by using computed tomography (CT) scans. This prospective study evaluated 26 patients in Brazil with ML from December 2008 through June 2009. All patients underwent CT scans of the paranasal sinuses. Paranasal thickening was observed in 25 patients (96%). Nasal perforation was observed in 17 patients (65%). Those patients who received re-treatment showed more abnormalities on CT scan than cured patients (P < 0.05). Complications of ML are not limited to the nasal mucosa but extend to the paranasal sinuses. Mucosal thickening, opacified air cells, bony remodeling, and bony thickening caused by inflammatory osteitis of the sinus cavity walls are CT findings suggestive of chronic sinusitis.

Background/Objectives Mucosal leishmaniasis (ML) is a progressive disease that affects cartilage and bone structures of the nose and other upper respiratory tract structures. Complications associated with ML have been described, but there is a lack of studies that evaluate the structural changes of the nose and paranasal sinuses in ML using radiological methods. In this study, we aimed to assess the opacification of the paranasal sinuses in patients with treated ML and any anatomical changes in the face associated with ML using multidetector computed tomography scans (MDCT) of the sinuses. We compared the findings with a control group. Methodology/Principal Findings We evaluated 54 patients with treated ML who underwent CT scans of the sinuses and compared them with a control group of 40 patients who underwent orbital CT scans. The degree of sinus disease was assessed according to the Lund-Mackay criteria. Forty of the 54 patients with a history of ML (74.1%) had a tomographic score compatible with chronic sinusitis (Lund-Mackay ≥4). CT scans in the leishmaniasis and control groups demonstrated significant differences in terms of facial structure alterations. Patients from the ML group showed more severe levels of partial opacification and pansinus mucosal thickening (42.6%) and a greater severity of total opacification. Patients from the ML group with a Lund-Mackay score ≥4 presented longer durations of disease before treatment and more severe presentations of the disease at diagnosis. Conclusion/Significance CT scans of the sinuses of patients with ML presented several structural alterations, revealing a prominent destructive feature of the disease. The higher prevalence in this study of chronic rhinosinusitis observed in CT scans of patients with treated ML than in those of the control group suggests that ML can be considered a risk factor for chronic rhinosinusitis in this population (p, Author Summary Mucosal leishmaniasis (ML) is mainly caused by the agent Leishmania (V.) brasiliensis and usually occurs months or years after symptomatic or asymptomatic skin infection. Approximately 5% of patients with untreated cutaneous leishmaniasis will develop ML, a presentation that causes significant morbidity in patients. This important but often neglected anthropozoonosis also presents direct health care costs and several indirect losses in terms of impaired daily functioning. In this study, we aimed to assess the degree of opacification of the paranasal sinuses in patients with treated ML and any anatomical changes in the face associated with ML using multidetector computed tomography scans (MDCT) of the sinuses. We compared the findings in this population with those from a control group. We evaluated 54 patients with treated ML who were subjected to MDCT of the sinuses and compared them with a control group of 40 patients who underwent MDCT of the orbit. CT scans of the sinus of patients with ML presented several structural alterations, revealing a prominent destructive feature of the disease. The higher prevalence of chronic rhinosinusitis observed in CT scans of patients with treated ML in this study also suggests that ML can be considered a risk factor for chronic rhinosinusitis in this population.