Malignant lesions in the anterior maxilla

Delaying Intraoral Radiographs during the COVID-19 Pandemic: A Conundrum

Background

The COVID-19 pandemic has made dentists very assiduous about cross-infection during dental treatment, thereby delaying dental radiographs for treatment. However, patients needing dental emergency treatment in the ongoing pandemic require relevant intra/extraoral dental radiography for adequate diagnosis and treatment planning.

Methods

This article is aimed at adding to the hot debate: Is delay for intraoral radiographs justified or a possible proxy? As a narrative review, it provides an insight into the reasons for delaying intra-oral dental radiographs during in the pandemic and options of the nontraditional radiographic techniques available until the pandemic subsides. Discussion and Conclusion. Cross-contamination concerns through respiratory droplets grow while using intraoral film holders that stimulate gag reflex, coughing, saliva secretion, and if proper disinfection protocols are not applied. Since the patients' acquiring emergency dental treatment cannot be neglected, the return-to-work guidelines by the health regulatory bodies urge to prioritize extraoral radiographic imaging techniques to curb the infection, offering the best diagnostic efficacy. The dental professionals can consider cone-beam computed tomography (CBCT) scans and sectional dental panoramic radiographs (SDPRs), followed by a risk assessment for COVID-19, a safer modality in reducing cross-contamination and assuring an innocuous environment for both patient and coworkers.

Maxillofacial lymphomas

Lymphomas affecting the bones of the jaws, although less frequent than carcinomas, can both present radiologically as carcinomas in addition to the more frequent "periapical-radiolucencies-of-inflammatory-origin" (PRIOs). Certainly those lymphomas arising within the maxillary alveolus have a short period of prior awareness before presentation, denoting an aggressive process. Half are provisionally diagnosed as carcinomas and the other half as PRIOs. Failure of the latter to respond to appropriate treatment, compels prompt and appropriate investigation for a malignancy. Further distinction of the malignancy into carcinoma and lymphoma is necessary, because the treatment of carcinomas is radical, achieved mainly by resection plus radiotherapy, whereas treatment of lymphomas relies on chemotherapy and in some cases, radiotherapy. The few reported cases that have been subject to cross-sectional imaging and reporting by radiologists has only appeared relatively recently. These cases reveal roles for cone-beam computer tomography, computed tomography and magnetic resonance (MR). Ultimately the diagnosis is dependant on a biopsy from the most representative area/s and the treatment plan upon the diagnosis and extent of the disease defined by the imaging.

Guidelines for oral and maxillofacial imaging: COVID-19 considerations

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the current coronavirus disease 2019 (COVID-19) pandemic, is not only highly infectious but can induce serious outcomes in vulnerable individuals including dental patients and dental health care personnel (DHCPs). Responses to COVID-19 have been published by the Centers for Disease Control and Prevention and the American Dental Association, but a more specific response is required for the safe practice of oral and maxillofacial radiology. We aim to review the current knowledge of how the disease threatens patients and DHCPs and how to determine which patients are likely to be SARS-CoV-2 infected; consider how the use of personal protective equipment and infection control measures based on current best practices and science can reduce the risk of disease transmission during radiologic procedures; and examine how intraoral radiography, with its potentially greater risk of spreading the disease, might be replaced by extraoral radiographic techniques for certain diagnostic tasks. This is complemented by a flowchart that can be displayed in all dental offices.

Malignant Lesions Mimicking Endodontic Pathoses Lesion: A Systematic Review

INTRODUCTION

Malignant nonendodontic periapical lesions represent a rare diagnosis, in which few case have been reported about this condition. Due to the low occurrence and little exploration of this subject, serious errors of diagnosis are observed in the oral medicine services. In this sense, the purpose of the present review was to integrate the information on the record published on malignant lesions that mimic endodontic pathoses into a comprehensive analysis of their clinical, radiologic, and histopathologic features.

METHODS

An online search was made in March 2020 in the following databases: Pubmed, Web of Science, and Scopus. Eligibility criteria included publications having enough clinical, radiologic, and histopathologic information to confirm the diagnosis. Data were assessed descriptively.

RESULTS

Forty-nine publications from 16 countries comprising 60 cases were included. There is a nearly equal occurrence rate between males and females (male/female ratio is 49.15%/50.84%) with a mean age of 46.56 years. The lesions were more prevalent in the posterior mandibles (40.69%), and, radiographically, they were unilocular radiolucent. Histopathologic analysis showed metastasis (26.67%) as the most prevalent lesion followed by salivary gland malignant disease (25%).

CONCLUSIONS

The present systematic review revealed several histologic types of malignant periapical lesions that could be mimicking endodontic pathoses. Because these lesions usually do not show clinical or radiologic features of malignant alteration, clinicians should consider these hypotheses in their routine.