[Oradlist] Another interesting case

Matteson, Stephen R MATTESON at uthscsa.edu
Thu Apr 1 14:45:17 PDT 2010

Hi, that would help, when you can.
From: oradlist-bounces at lists.ucla.edu [oradlist-bounces at lists.ucla.edu] On Behalf Of Brooks, Sharon [slbrooks at umich.edu]
Sent: Thursday, April 01, 2010 4:31 PM
To: oradlist
Subject: Re: [Oradlist] Another interesting case

It is a standard powerpoint file. I don’t have the original images on my office computer and the scanner computer is down a floor and around the corner. I can try pasting the pictures into a Word document (tomorrow) if that will help.


On 4/1/10 5:18 PM, "Matteson, Stephen R" <MATTESON at uthscsa.edu> wrote:

Hi Sharon,  I am interested in the zygomatic arch you recently posted on ORAD, however, I am unable to open the image file.  Would you send me the file in some other format for me to try?

hope all is well in your world.

steve Matteson

From: oradlist-bounces at lists.ucla.edu [oradlist-bounces at lists.ucla.edu] On Behalf Of Brooks, Sharon [slbrooks at umich.edu]
Sent: Thursday, April 01, 2010 1:53 PM
To: oradlist
Subject: [Oradlist] Another interesting case

As long as we are sharing interesting cases, I have one that I would like
some opinions on.

The patient is a 66 year old Chinese male. The CBCT scan of the maxilla was
done for implant planning purposes. I noted an incidental lesion in the
right zygoma, round, very well defined. There is also an asymmetry in the
maxilla and maxillary sinus on the same side, with that side being smaller
than the left. There is no similar lesion in the left zygoma.

I have no history on this patient, other than that he wants implants in the
maxillary anterior. Clinically I did not notice a facial asymmetry but he
has a very full face with all muscles of mastication very prominent due to a
serious bruxing habit. A facial asymmetry was not obvious either on a 3D
rendering showing skin.

The lesion does not appear to be an air cell, given its density. However, my
impression is something developmental or a result of some (unknown) trauma,
rather than a cyst or neoplasm. However, I don't see anything like it in any
of the references I have.

As an interesting aside in this case, the patient was referred for the
maxillary scan by our graduate prosthodontic program. They do all their
implant cases with the Nobel Biocare process, which requires that the
patient wear a specially marked imaging stent during the scan. A second scan
is made of the stent alone.

Two months ago he had been referred to our dental school oral surgery
department for "implants". The surgeon who saw him referred him to the
hospital dentistry clinic for a CBCT. (no imaging guide, no idea about the
Nobel Biocare system, big miscommunication between departments since the
prosthodontist was interested in having the surgeon do soft-tissue grafting
only, not the implants).

I had a chance to see that hospital scan today and the lesion looks
identical (only two months difference so no surprise there). What was a
surprise is that they did a gigantic scan, from above the top of the head
well down into the neck - for maxillary implants!

The hospital dentistry program is also having their CBCT scans read by
medical radiology. I saw the report on this fellow:

"Clinical indication: bone evaluation for teeth #8 and 9 implant placement.

Technique: Utilizing the low radiation dose MiniCAT scanner (actually an
E-Woo), noncontrast axial images through the maxillofacial bones were

Impression: The paranasal sinuses are clear. Absent anterior maxillary
teeth, with bone loss/thinning of the anterior alveolar ridge. Right
mandibular premolar is absent.

Note: as this study was performed on a low radiation dose scanner (radiation
dose reduced by 80-90% vs conventional Ct scanning), evaluation of
structures outside the paranasal sinuses (including orbits, brain, deep
face, neck, subcutaneous and skin regions, et al) is non-diagnostic; if a
pathologic process is of concern in any of those regions, scanning on a
conventional CT scanner should be performed."

They did not comment on the lesion in the zygoma. Granted that they had only
the axial images, the axial plane is the one where I first saw the lesion
and the facial asymmetry.

Any comments? I have to make a recommendation about what we do next, if

Thank you.


Sharon L. Brooks, DDS, MS
Diplomate, American Board of Oral and Maxillofacial Radiology
University of Michigan School of Dentistry
Department of Periodontics and Oral Medicine
Ann Arbor, MI 48109-1078 USA
Tel: +1 734-764-1595   Fax +1-734-764-2469
slbrooks at umich.edu
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