[Oradlist] Another interesting case

Thu Apr 1 19:19:55 PDT 2010

Sharon, I believe that the image in the zigomatic arch, is a zigomatic air
cell defect. This has been described in some papers as *Zygomatic* air cell
defect (ZACD). Prevalence and characteristics in a dental clinic outpatient
population. *L. C. Carter, A. D. Haller, A. D. Calamel and A. C. Pfaffenbach
.Dentomaxillofacial Radiology, Vol 28, Issue 2 116-122, Copyright © 1999 by
British Institute of Radiology* Ricardo Urzúa
Prof Radiology Universidad del Desarrollo
Santiago, Chile

2010/4/1 Matteson, Stephen R <MATTESON at uthscsa.edu>

>  Hi, that would help, when you can.
> Steve
>  ------------------------------
>  *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.
>
> Sharon
>
>
> 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?
> thanks,
>
> 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
> obtained.
>
> 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
> anything).
>
> Thank you.
>
> Sharon
>
> *****************************
> 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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