Hair artefacts in the head and neck region

Unexpected metallic foreign bodies on panoramic scans - a narrative review

BACKGROUND

The digital panoramic radiograph (orthopantomogram, OPG) is the standard radiographic technique for basic diagnostics in dental practice. A correctly taken image provides a good overview of teeth and jaw, whereas radiopaque foreign materials, e. g. metal, can obscure relevant findings.

METHODS

A literature review on unexpected metallic foreign bodies in OPG was performed to determine the spectrum of metallic foreign bodies that may cause radiopaque areas on panoramic radiographs in routine clinical use.

RESULTS AND CONCLUSION

A total of 37 different unexpected metallic foreign bodies were found. They can be categorized as jewelry, clothing, personal protective equipment, medical devices, iatrogenic foreign bodies, and rare incidental findings. Radiopaque foreign materials in the OPG are often relatively easy to recognize as artifacts because of their location, and they are avoidable in most cases. If unclear, a three-dimensional radiograph was helpful for determining the location. Radiopaque areas caused by foreign bodies can lead to misinterpretation or partial or complete non-evaluability and should therefore be avoided.

KEY POINTS

· The OPG is the standard radiograph for dentists, oral surgeons, and oral and maxillofacial surgeons.. · Foreign bodies made of metal can lead to non-evaluability of panoramic radiographs. Based on a review of the literature and exemplary radiographs, this article provides an overview of rare but typical metallic foreign bodies in OPG, thus addressing the problem of the subfield of radiography by making radiologists more familiar with these images.. · The spectrum of unexpected metallic foreign bodies includes unremoved earrings with the typical ghost images on the contralateral side, piercings, hearing aids, acupuncture needles, rare iatrogenic foreign bodies, incidental findings in infants in the nose and external auditory canal, vascular clips after surgical interventions, and ritual subcutaneous foreign materials..

CITATION FORMAT

· Brauer HU, Bartols A, Hellmann D et al. Unexpected metallic foreign bodies on panoramic scans - a narrative review. Fortschr Röntgenstr 2023; 195: 809 - 818.

Radiographic presentation of artifactual dyed hair on lateral cephalograms, chemical processing, and forensic application: Novel case report

Forensic assessment employs an array of methods to identify human remains. Radiologic examinations with panoramic radiographs, computed tomography scans, Waters view, and nuclear magnetic resonance imaging may offer evidentiary clues in challenging cases, such as mass disasters. In these cases, alternative forensic tools are used to narrow lists of target victims using their biological features. This study aims to I) report on the unusual radiographic aspect of chemicals used for hair dyeing, and II) discuss the potential forensic application of this finding for human identification. The case depicts an asymptomatic 14-years-old female who presented for orthodontic therapy. During radiographic examination on a lateral cephalogram, numerous thin radiopaque streaks were visible, extending to the posterior neck between the occipital region of the skull base and vertebra C6. Clinical investigations revealed that these were artifactual hair images (possibly documented for the first time in the scientific literature). Inductively coupled plasma mass spectrometry (ICP-MS) analysis of the patient's scalp hair was performed for 10 heavy metals, including zinc, copper, iron, chromium, nickel, cadmium, tin, lead, antimony, and bismuth. Eight of these metals were detected at normal levels, ranging from 160 parts per million (ppm) for zinc to less than 1 ppm for nickel, cadmium, tin, lead, and antimony. Conversely, slightly elevated levels of chromium at 0.41 ppm and bismuth at 0.025 ppm were found in the hair sample. The distinctive radiographic presentation of artifactual hair images combined with the chemical properties of hair exposed to dye products may provide useful traces for human identification, especially in mass disasters.

Gold-wire artifacts on diagnostic radiographs: A case report

This report described a case in which diagnostic radiographs showed irregular dense radiopaque strings and curved lines in the head and neck area. These artifacts could lead to misinterpretation since they may obscure anatomical structures and/or mask critical structures/pathologies. A more detailed history of the patient indicated that these strings originated from a facelift procedure in which a gold-wire technique was used. Considering that such intervention may cause a radiodiagnostic burden, it should be included in the anamnesis prior to radiography.

Artefact in a panoral radiograph: a short communication

Artefacts in dental radiographs are not uncommon findings. In some cases, however, such film faults might lead to difficult or even wrong diagnoses. In this brief report, the authors present a case where a small piece of paper cast a foreign body-like image onto a panoral radiograph. The importance of proper techniques and film handling when taking radiographs cannot be over-emphasised.

Soft tissue augmentation of the cheeks detected on intra- and extraoral radiographs: a case report

Augmentation material used in plastic surgery such as facelift procedures can be radiopaque and thus become visible on extra- and intraoral radiographs. These objects may obscure anatomical structures and mask critical findings, therefore leading to potential misinterpretation of otherwise successful images. The present report describes a case in which the radiographic intra- and extraoral data are partly masked by a superimposed radiopaque mesh, which was suspected to originate from a facelift procedure. A gold thread lift was confirmed by the plastic surgeon.