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   Table of Contents - Current issue
May-August 2018
Volume 6 | Issue 2
Page Nos. 21-44

Online since Monday, August 13, 2018

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Reliability of multidetector computed tomography in rational analysis of midface fractures p. 21
Noha Abdelfattah Ahmed Madkour
Background: Motor vehicle accidents (MVAs) are the main causes of midfacial fractures in developing countries. Multidetector computed tomography (MDCT) is the principle diagnostic imaging tool in maxillofacial trauma. Multiplanar reformatted (MPR) and three-dimensional (3D)-reconstructed images provide a detailed analysis for midfacial fractures and assessment of their severity. Aim: To identify, outline, and quantify different patterns of midfacial and orbital fractures evaluated by MDCT using MPR and 3D-reconstructed images. Subjects and Methods: A total of 35 patients with midfacial and orbital trauma were included in this study referred to the Emergency Unit of Kasr Alainy University Hospital. All patients were subjected to MDCT in axial sections. MPR and 3D volume-rendering images were obtained. Statistics: A prospective descriptive study. Results: Majority (65.7%) of midfacial fractures were due to MVAs. Men represent 91% of cases. In this study, the most common facial fracture was orbital fractures (34%), followed by maxillary fractures (31%). Fifteen cases with midfacial injuries were associated with head trauma. Conclusion: MDCT with its expedient imaging capabilities provides a comprehensive analysis of midfacial fractures. MPR and 3D-reconstructed images exhibit high informative value in elucidation of midfacial and orbital fractures needed for prompt surgical management.
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Important queries for the airway analysis in cone-beam computed tomography scans: Threshold tool and voxel size protocol p. 26
Luize Severo Martins, Gabriela Salatino Liedke, Heraldo Luis Da Silveira Dias, Priscila Fernanda Da Silveira Tiecher, Nadia Assein Arus, Edwin M Ongkosuwito, Mariana Boessio Vizzotto
Context: There is an expansion of the use of cone-beam computed tomography (CBCT) for maxillofacial diagnosis. However, some researchers have demonstrated inconsistencies between the results of airway analysis tools. Aim: This study aims to analyze the threshold tool presented in postprocessing software for airway volume estimation and the influence of voxel size in these measurements. Methods: Three hundred and sixteen-selected CBCT scans (0.2, 0.25, and 0.4 voxel sizes) were retrospectively analyzed. A trained and calibrated examiner performed the volume measurements in specific sites in upper airway at 25 and chosen threshold tool using the Dolphin Software. Statistical Analysis Used: Analysis of variance (ANOVA) was used to compare the thresholds for each voxel and the differences between the preset and the chosen thresholds, while paired t-test to compare differences between the chosen thresholds for voxel size groups. Results: The threshold values range from 26 to 43. The mean of the threshold selected for voxel 0.4 was significantly lower than the mean thresholds of 0.2 mm to 0.25 mm voxel. Small volumes were obtained with the preset threshold tool for all voxel sizes when compared with the chosen threshold. The mean of differences in volumes between preset and chosen threshold decreased with the increase of voxel size. Conclusion: The voxel size protocol influenced the threshold value choice for volume measurements in upper airway analysis. The thresholds near to 30 seem better filling the airway space.
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Transmigration of the left mandibular canine observed during 2 years in cone-beam computed tomography examination p. 31
Ingrid Rozylo-Kalinowska, Katarzyna Denkiewicz, Zofia Cecherz, T Katarzyna Różyło
Transmigration is considerably a rare preeruptive dislocation of an affected tooth across the midline. Cone-beam computed tomography (CBCT) is a relatively new technology in dentomaxillofacial radiology. The aim of the study is to present a case report of progressing transmigration in an 11-year-old girl examined by means of CBCT. A 9-year-old girl was referred for CBCT twice before and during orthodontic treatment. In the baseline examination, the impacted lower left canine was impacted and incorrectly positioned, but 9 months later, the canine had already crossed the midline. In conclusion, to the authors' best knowledge, this is the first case of observation of mandibular canine transmigration by means of CBCT that allows precise evaluation of the transmigrating tooth.
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Use of advanced imaging in diagnosis of neurofibromatosis 1 p. 36
Eiti Singh, Khushboo Singh, Sunita Gupta, Mayank Shailat
Neurofibromatosis (NF) is a Mendelian disorder which is carried as an autosomal dominant trait. Two genetically distinct subtypes have been recognized, NF type 1 (NF1) and NF2. NF1 patients present with cutaneous, ocular, musculoskeletal, cardiovascular, gastrointestinal, neurologic, and dental findings but chiefly characterized by neurofibromas of central and peripheral nervous systems. Approximately 75%–80% of NF1 patients present with oral and radiographic manifestations, while 80% present with facial plexiform neurofibroma. This article aims to present a case report of NF1 diagnosed with the help of higher imaging. NF1 in a pediatric patient was diagnosed with classic findings of plexiform neurofibroma and sphenoid dysplasia diagnosed on cone-beam computed tomography (CT) and contrast-enhanced CT. Development of malignancies such as malignant peripheral nerve sheath tumors, optic gliomas, and leukemias is a major risk factor of NF1. Therefore, the use of imaging for early diagnosis of NF1 is critical.
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An unexpected finding in the frontal sinus: Cholesterol granuloma p. 42
Laura L Wuyts, Alexandra N Boogers, Lieve R Vanwalleghem, Jan W Casselman
There is a broad differential diagnosis for patients presenting with an expansile mass lesion in the frontal sinus on computed tomography. Due to the composition of granulation tissue, a cholesterol granuloma exhibits unique signal characteristics and should be considered when an expansive paranasal sinus mass with high signal intensity on both T1- and T2-weighted images is seen. A cholesterol granuloma is a benign tumor, and small lesions are mostly harmless. However, large cholesterol granuloma may cause severe morbidity and even mortality if unrecognized, by extension through the orbit and in the anterior cranial fossa, emphasizing the importance of early diagnosis and resection. We present the case of a young male with an expanding mass under the right eyebrow, proved to be a cholesterol granuloma on pathological examination. The differential diagnosis and the distinct radiological features of this rare entity are discussed.
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