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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 retrospective analysis of panoramic radiographs from patients with head and neck cancer, taken prior to radiation therapy, revealed a prevalence of carotid calcifications of 12.6% in men aged 50–59 years, but only 3.3% in women of the same age. By age 70–79 years, the prevalence of calcified carotid atheromas was similar for both genders. Evaluation of the image layer characteristics of a prototype Instrumentarium OP 100D digital panoramic X-ray machine shows this unit to be suitable for detection of calcifications, within the carotid artery at the region of the bifurcation.

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.

Oral and maxillofacial radiology is the specialty concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders, and conditions of the oral and maxillofacial region. Of all the recognized specialties, it is one of two devoted almost entirely to diagnosis rather than therapeutic intervention. There are five programs in the United States and Canada offering certificates of proficiency, masters, or PhD levels of training, and all are over-subscribed with applicants. Recent significant developments in technology, especially cone beam computer tomography, have created important new services for patients at the same time increasing the need for better training and clinical guidelines.

The American Academy of Oral and Maxillofacial Radiology (AAOMR) is the professional organization representing oral and maxillofacial radiologists in the United States. The Academy is a nonprofit professional society the primary purposes of which are to advance the science of radiology, improve the quality and access of radiologic services to the patient, and encourage continuing education for oral and maxillofacial radiologists, dentists, and persons practicing oral and maxillofacial imaging in allied professional fields. The AAOMR embraces the introduction of cone beam computed tomography (CBCT) as a major advancement in the imaging armamentarium available to the dental profession. The AAOMR is currently in the process of developing a position paper on appropriate application of CBCT to provide evidence-based guidelines. In the interim, the Executive Committee (EC) of the AAOMR considers it necessary to provide an opinion document addressing the principles of application of CBCT as it relates to acquisition and interpretation of maxillofacial imaging in dental practice.

Panoramic radiography is commonly used by dentists as a diagnostic tool. The known prevalence range of positive incidental carotid artery calcifications in the general dental population is 2% to 5%, with a population older than 55 representing the higher end of the range. Dentists are expected to identify medical conditions while providing dental care and to refer patients for follow-up medical care. In this case report, incidental carotid artery calcifications were identified on routine panoramic radiographs obtained for oral health reasons. A 69-year-old white man who was under surveillance for carotid stenosis and risk for stroke had a routine panoramic radiograph made for oral health reasons. Positive carotid calcification findings on a panoramic radiograph were found to be in accord with a subsequent duplex ultrasound examination.

The oral and maxillofacial manifestations of some occult systemic disorders may be identified during the provision of dental care. Medical conditions so identified should be referred to a physician for confirmation by appropriate test and indicated therapy. Atherosclerosis at the bifurcation of the carotid artery is a common cause of stroke, and, when such lesions are calcified, they may easily be identified on a panoramic radiograph since the carotid bifurcation lies within the field of a properly performed X-ray.To examine the degree to which this finding is recognized by the dental community, the authors conducted a PubMed review to find publications that detailed the identification of carotid artery calcifications on panoramic radiographs.Between 1981-2003, there were 39 peer-reviewed dental manuscripts and 29 pertinent abstracts reporting the observation of incidental carotid calcifications visible on routine panoramic radiographs. These studies documented a 3% to 5% prevalence of carotid artery calcifications in the general dental population, with higher percentages occurring in patients having medical illnesses associated with advanced atherosclerosis.The widespread recognition that calcifications seen in the region of the carotid bifurcation can identify a population at increased risk of stroke supports the practice of routinely examining this area during review of panoramic radiographs. Since a panoramic radiograph is often obtained for dental reasons, in many instances, further examination of the area of the carotid bifurcation is essentially cost-free, and can serve to prolong lives and bring significant savings in overall health care costs by assisting in the prevention of critical events such as strokes.

Objective: To evaluate the effectiveness of the American Academy of Oral and Maxillofacial Radiology-sponsored training packet for identification of carotid artery calcifications on panoramic radiographs. Study Design: Two examiners, who completed the training (trainees), examined 778 panoramic radiographs. The sample included 298 men, with a mean age of 66, and 480 women, with a mean age of 68. Findings were compared with those obtained by an oral and maxillofacial radiologist. A kappa statistic was used to determine agreement between the 2 trainees. The positive predictive value (PPV) of the program was estimated by comparing the trainees rating of disease status with an expert in case identification. Results: Examiners 1 and 2 identified 99 and 78 positive cases, respectively. A kappa statistic of 0.87 (95% CI, 0.81-0.92) was obtained, indicating good interexaminer agreement. The expert identified 27 positive cases, resulting in a PPV of 34.6% (95% CI, 24.4-46.3). Conclusion: Although the training packet offers valuable training, it does not provide a high PPV, suggesting the need to modify it or to seek an expert opinion before classification of a patient as having calcification on a panoramic radiograph.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:111-7)

To determine overall prevalence of maxillary antral pseudocysts and the effect of seasonal variation, allergies, asthma and current smoking status.Panoramic radiographs of 1175 dental clinic outpatients were examined. Data on the prevalence of allergies, asthma and smoking status was obtained from the medical records and age- and gender-matched controls. chi-square tests were used to determine the relationship between these factors and seasonal variation in prevalence.Pseudocysts were found in 114 (9.7%) patients. Eleven patients (9.7%) reported a history of environmental allergies, nine (7.9%) were asthmatic and 21 (19.6%) current cigarette smokers. Compared with controls, the association between each of these findings and the presence of pseudocysts was not significant. 44.3% of the pseudocysts were detected in November, December and January compared with only 8.6% in April, May and June: this variation was significant (alpha = 0.01).The marked increase in the prevalence of pseudocysts during cold winter months supports the concept that seasonal variation may be related to an increased incidence in viremias or irritation from dry forced air heating during this period.

Panoramic radiographs of 3.6 percent of 1,175 newly accepted dental school patients displayed calcifications in the area of the carotid vasculature. The authors interviewed the patients with calcifications to determine whether they exhibited any recognized atherosclerosis, risk factors. One patient had symptoms of atherosclerosis, and a statistically significant correlation was found for obesity among the patients interviewed. The authors concluded that panoramic radiography is useful for identifying some asymptomatic patients with carotid calcifications. These patients should be referred to their physicians promptly for a cerebrovascular work-up as part of an active stroke-prevention strategy.

The attenuation number of the TMJ disk was measured in direct sagittal computerized tomograms (CTs) of eight fresh TMJ autopsy specimens. The CT attenuation number was correlated to histologic observations of hyalinization, calcification, and cartilaginous metaplasia of the disk. Correlations were found between high CT attenuation numbers and the presence of hyalinization, calcification, and foci of cartilaginous metaplasia in the disks. The results suggest that the high CT attenuation number of a disk might be associated with hyalinization, calcification, and metaplastic cartilage formation.