[Oradlist] Another interesting case

Fri Apr 2 01:21:48 PDT 2010

I agree with Ricardo.
I was cautious in saying, but the first thing that I though  was zigmatic
air cell defect.
I do not have experience in evaluated this image in cone beam CT. But many
times I see something similiar in panoramic radiographs.

Allan.

2010/4/1 Ricardo Urzúa <ricurzua at gmail.com>

> 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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-- 
Allan
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