Radiographic evaluation of pneumatized articular eminence in a group of Turkish children

Temporal bone pneumatization: A scoping review on the growth and size of mastoid air cell system with age

The interest in the mastoid air cell system arose from the association between temporal bone aeration and otitis media. Its size and growth have been considered when planning chronic and middle ear surgeries. The objective of this review was to explore the literature on the size of mastoid air cells with age, highlighting various growth rates reported and mapping out areas yet to be fully understood for further research. A three-step systematic search was conducted for available literature on the subject matter viz; Google Scholar, Medline, Cochrane Library, and PubMed. Eligibility criteria guided the study selection, and eligible studies were subjected to appraisal using screening and quantitative criteria of mixed-method appraisal tool. A data extraction form was developed to extract information from eligible studies. Nine studies met the eligibility criteria. 55.6% of the included studies were conducted among the east and south Asian population, 33.3% were conducted among Scandinavians, and 11.1% in South America. Age groupings varied among studies; 33.3% utilized 1-year age grouping, 33.3% utilized 5-year age grouping, 11.1% utilized 10-year age grouping. In reporting the size of mastoid air cells across age groupings, 66.7% utilized area, 22.2% utilized volume, while 11.1% utilized both area and volume. Findings from this review showed that the mastoid air cells’ size with respect to age differs among populations of different origins. The most common measurements were the area of air cells. The highest growth rate was reported up to 30 years. Findings also show the influence of sex on the size of mastoid air cells and growth rate with age, as females were reported to have larger air cells with rapid growth until puberty. However, the male mastoid air cell system continues a steady growth after puberty and becomes larger. Information still lacks in the volume of air cells in pediatric pneumatization.

Patterns of pneumatization of the tympanic plate

OBJECTIVE

This study aimed to investigate the prevalence of tympanic plate (TP) pneumatisation as well as the various potential patterns.

METHODS

A retrospective study involving the archived Cone-Beam Computed Tomography (CBCT) files of 70 patients was performed to investigate anatomical variations of TP pneumatisation.

RESULTS

Forty-eight TPs were found to be non-pneumatised, while 92 were found to contain at least peritubal air cells. Twenty patients (28.5%) did not present any variety of TP pneumatisation, while 36 patients (51.4%) exhibited a symmetrical pattern of pneumatisation.

CONCLUSION

Aside from those patients who lacked TP pneumatisation, the peritubal pneumatisation pattern was found to be the most common. Further, bilateral symmetry was found to occur in more than half of all cases. CBCT is a powerful diagnostic tool, although appropriate knowledge of the anatomical possibilities remains mandatory for adequate surgical planning.

Temporal bone pneumatization in patients with dentofacial deformities: cone beam computed tomography study

Pneumatization in the osseous components of the temporomandibular joint (TMJ) may represent a complicating factor in TMJ surgery. This study determined the prevalence and characteristics of pneumatized articular eminence (PAE) and pneumatized glenoid fossa (PGF) using cone beam computed tomography (CBCT) scans of patients with and without dentofacial deformities. The CBCT of 587 asymptomatic patients (216 class I, 179 class II, 192 class III) were assessed to determine PAE and PGF. Age, sex, laterality, and type (uni/multilocular) of pneumatization were recorded. Differences were tested using the χ² test and binary logistic regression models (P<0.05). Overall, 63.7% of patients presented some pneumatization: 15.5% presented both PAE and PGF, 0.9% presented only PAE, and 47.4% presented only PGF. The multilocular type was more frequent in both PAE and PGF (P<0.001). There was a significant difference regarding dentofacial deformity for PAE (P=0.021), with a higher frequency in class I. There were no differences according to sex, age, or laterality. The absence or lower frequency of pneumatization in class II and III patients may indicate continuous remodelling of the joint, which is submitted to abnormal occlusion forces. This knowledge is helpful for TMJ surgery planning, particularly as patients with dentofacial abnormalities may more often be candidates for TMJ surgery.

Prevalence of pneumatization of the articular eminence and glenoid fossa viewed on cone-beam computed tomography examinations in a Turkish sample

OBJECTIVE

The aim of this study is to evaluate the prevalence of the pneumatization of the articular eminence and glenoid fossa (PAT and PGF, respectively) using cone-beam computed tomography (CBCT).

METHODS

CBCT images of 1000 patients (511 females and 489 males) representing 2000 regions of interest (the glenoid fossa and articular eminence of each patient) were examined retrospectively with regard to age, gender, laterality, and type of pneumatization. The mean age of the female patients was 39.66 and that of males was 39.79. Suitable images from patients aged 16 years and over found in the archives of CBCT images were included in the study. The data were assessed using IBM SPSS 20 and statistical comparisons between two categorical variables were conducted using Chi square tests.

RESULTS

It was observed that 14.7% of the patients had PAT and 47.1% had PGF. There was no significant difference in PAT and PGF prevalence between ages, age ranges, and gender in our study (p > 0.5).

CONCLUSIONS

It is important to evaluate the pneumatic cells in the articular eminence and glenoid fossa regions before surgery. It was also found that CBCT is more helpful in detecting pneumatization than plain film.

Prevalence and characteristics of pneumatizations of the articular eminence and roof of the glenoid fossa on cone-beam computed tomography

OBJECTIVE

The aim of this study was to determine the prevalence and characteristics of pneumatization of the articular tubercle (PAT) and pneumatization of the roof of the glenoid fossa (PRGF) in a large population using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This study was designed to evaluate the CBCT images of 1000 patients. The prevalences of the pneumatizations by age, sex, locularity, and laterality were determined. The significance of differences between variables was evaluated by the Chi-square test and analysis of variance.

RESULTS

PAT was detected in 28.4% of the zygomatic bone sides and PRGF in 29.6%. Bilateral PAT was detected in 176 (17.6%) patients and bilateral PRGF in 195 (19.5%). The mean age of patients with PAT was 47.33 years and that of patients with PRGF was 45.62 years. Multilocular appearance was observed significantly more often than unilocular type for both pneumatizations (p < 0.01). Unilateral PAT cases were slightly, but significantly, higher than bilateral PAT cases (p = 0.047), while no significant difference was observed between unilateral and bilateral PRGF cases.

CONCLUSIONS

In conclusion, PAT and PRGF can be assessed more accurately on CBCT images than on plain radiographs. During routine radiological investigations, maxillofacial radiologists should be aware of zygomatic air cells.

Prevalence and Characteristics of Articular Eminence Pneumatization: A Cone-Beam Computed Tomographic Study

Purpose

The temporal bone represents a variety of pneumatization patterns with clinical significance for planning surgical procedures in this area. The purpose of the present study was to assess the prevalence and characteristics of the glenoid fossa and articular eminence pneumatization and to classify the pattern of pneumatization using CBCT images.

Methods

CBCT images of 327 patients (654 temporal bones) were evaluated to determine pneumatized articular eminence prevalence and characteristics. Gender, age, laterality, type and grade of pneumatization were recorded for the left and right sides. Chi-square test was used to evaluate the relationship between pneumatized articular tubercle and gender, grade and type.

Results

PAT was identified in 251 (76.7%) patients of whom 139 (55.4%) were male and 112 (44.6%) were female with a mean age of 30.31 ± 10.32 years. Bilateral PAT occurred in 175 (69.7%) patients. Three hundred and ninety-six (93%) of areas were multilacunar, and 30 (7%) were unilacunar. Of 654 areas, 228 (34.8%) had grade 0, 299 (45.7%), grade 1, 92 (14.1%), grade 2 and 35 (5.4%), grade 3. No statistically significant correlation was found between prevalence of pneumatization, gender, type and grade.

Conclusion

The present study emphasized the need to assess PAT before surgical intervention of TMJ. CBCT provides reliable and accurate information to determine the characteristics, the exact extension of pneumatization and its relationship to the adjacent structures. The preoperative temporal bone CBCT is a crucial component of the evaluation of PAT in patients candidate for surgical intervention of TMJ.

Zygomatic Air Cell Defect - Magnetic Resonance Imaging of the Temporomandibular Joint Compared with Panoramic Radiographs

SUMMARY – The aim of the study was to analyze zygomatic air cell defect (ZACD) incidence using magnetic resonance imaging (MRI) and validity of panoramic radiograph as a comparative method of ZACD diagnostics. The connection between ZACD incidence, age, left/right temporomandibular joint (TMJ) and comorbidity with diagnosis of TMJ disorder was analyzed. Panoramic radiographs and MRIs of 140 TMJs of 70 consecutive patients with previously confirmed TMJ diagnosis were compared in the study. A grading system (4-point scale from ‘0’ for absence to ‘3’ for most extended pneumatization) was used to determine low signal on MRIs as pneumatization of temporal bone. ZACD was diagnosed in 22 joints of 15 patients (incidence, 20.4%), with seven patients having bilateral appearance. In the joints of nine patients, ZACD was identified as extensive according to the grading scale. The validity of ZACD findings on panoramic radiographs compared with MRI findings yielded 0.45 sensitivity and 0.98 specificity. There was no relation (p>0.05) between comorbidity of ZACD and TMJ disorder, either by age or side of the body. More prevalent ZACD in our MRI analysis than in other researches based on panoramic radiographs could be explained by the expected superimposed osseous structures in the area of articular eminence.

Preauricular pilomatricoma: An uncommon entity in a dental pediatric patient

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Pilomatricomas are common lesions although rarely encountered in dental practice. Dental professionals especially oral surgeons and pediatric dentists should be aware of the condition during their practice.

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Common differential diagnosis of preauricular pilomatricoma does not involve temporomandibular joint disease. This condition should be added to differential diagnosis.

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Meticulous examinations should be made and misdiagnosis with temporomandibular joint disease should be eliminated.

Introduction

Pilomatricomas are benign follicular skin appendage tumors, commonly occurring in children and young adults. Most patients admit to dermatologists to seek treatment and are well known by them; however, dental professionals, especially pediatric dentists are not familiar with these tumors.

Presentation of case

This report presents a 16-year-old female with preauricular pilomatricoma, located beneath the overlying skin of the temporomandibular region. Clinical examination revealed an asymptomatic lump, the overlying skin revealed no abnormalities. Patient was unaware of the lesion.

Discussion

Pilomatricomas are commonly encountered in the maxillofacial region, although not considered in differential diagnosis by dental professionals. They usually present as, asymptomatic, subcutaneous masses; although symptomatic cases have been reported. In literature, common differential diagnosis for head and neck pilomatricoma includes sebaceous cyst, ossifying hematoma, giant cell tumor, chondroma, dermoid cyst, foreign body reaction, degenerating fibroxanthoma, metastatic bone formation, and osteoma cutis. We are of the opinion that temporomandibular joint disease should also be considered in differential diagnosis for preauricular pilomatricoma.

Conclusion

Pediatric dentists should be aware of the condition and consider it in the differential diagnosis of pediatric conditions involving the temporomandibular joint.

Pneumatization of the zygomatic process of temporal bone on computed tomograms

PURPOSE

Zygomatic air cells (ZAC) are a variant of temporal bone pneumatization that needs no treatment. However, ZAC can have an impact on surgical procedures in the temporo-mandibular joint region. Recent reports suggest that computed tomography will disclose more ZAC than can be diagnosed on panoramic radiography. The aim of this study was to analyze ZAC prevalence on CT in a population that was not pre-selected by admission to a dental clinic. Furthermore, an extensive literature review was performed to assess the prevalence of ZAC and to address the impact of imaging technique on the definition of the item.

MATERIAL AND METHODS

Digitalized cranial CTs of 2007 patients were retrospectively analyzed. The Frankfort horizontal was used to define a ZAC on sagittal CTs.

RESULTS

In this study group, 806 were female (40.16%) and 1,201 were male (59.84%). Mean age was 49.96 years in the whole group (female: 55.83 years, male: 46.01 years). A ZAC was diagnosed in 152 patients (female: 66, male: 86). Unilateral ZAC surpasses bilateral findings (115 vs. 37 patients). ZAC were diagnosed in children 5 years of age and older. Sectional imaging techniques show a better visualization of the region of interest. However, presently an increase of ZAC prevalence attributable to imaging technique cannot conclusively be derived from the current literature. The normal finding of a ZAC on radiograms is a sharply defined homogenous transparent lesion restricted to the zygomatic process of the temporal bone that has no volume effect on the shape of the process.

CONCLUSION

ZAC is an anatomical variant of the temporal bone that has come into focus of maxillofacial radiology due to its noticeable aspect on panoramic radiograms. The harmless variant can be expected in about one in thirteen individuals undergoing facial radiology. Panoramic radiograms appear to be sufficient to present ZAC of relevant size. However, in preparation for surgical procedures affecting the articular eminence the application of sectional images is recommended.

Evaluation of pneumatization in the articular eminence and roof of the glenoid fossa with cone-beam computed tomography

BACKGROUND

Detection of air cavities, so called pneumatizations, nearby to the temporomandibular joint (TMJ) area is important, as they represent sites of minimal resistance and facilitate the spread of various pathologies into the joint as inflammation, tumor or fractures and serve as a possible complicating factor in TMJ surgery.

AIMS

To determine the prevalence of pneumatization of the articular eminence (PAT) and roof of the glenoid fossa (PRGF) using cone-beam computed tomography (CBCT).

STUDY DESIGN

Cross-sectional study.

METHODS

Acquired images of 111 patients (222 TMJs) were evaluated. The presence of pneumatization was recorded at the articular eminence and roof of the glenoid fossa. Age and gender were recorded for all patients and type (unilocular or multilocular) and laterality were noted for the cases of pneumatization.

RESULTS

The mean age of the study group was 48.86±18.31 years. Among all the patients, 73 (65.8%) had PAT, while 13 (11.7%) had PRGF. Forty-two (37.8%) of the patients had PAT bilaterally; whereas 3 of them (2.7%) presented PRGF bilaterally. The percentage of PAT was higher for females (73.6%) than males (51.3%) (p<0.05).

CONCLUSION

CBCT images are an accurate and reliable means of detection of the exact size and type of pneumatization and the relationship of pneumatization to the adjacent tissues. This is especially significant before a surgical intervention is planned in this region, in order to make a sound diagnosis.

Prevalence and characteristics of pneumatized articular tubercle: First large series in Iranian people

Purpose

This study was performed to determine the prevalence and characteristics of pneumatized articular tubercle or eminence among a defined group of Iranian people.

Materials and Methods

Digital panoramic radiographs of 1694 patients in the Department of Oral and Maxillofacial Radiology, Hamadan Dental School, Iran were evaluated retrospectively to detect the above lesion. Finally, 1563 radiographs were selected according to inclusion criteria. Then, a review was done of 10 large case series found using a MEDLINE search of the literature. Chi-squared test was used to analyze the differences in variables such as age, gender, laterality, and locularity in our case series.

Results

The average age of our samples was 32.6±7.63 years. Pneumatized articular tubercle was found in 98 cases, representing a prevalence of 6.2% with a mean age of 22.8±7.9 and a range of 8 to 60 years. Sixty-four (65.3%) pneumatized articular tubercles were unilateral, with 30 lesions on the right and 34 on the left side. Bilateral lesions were found in 34 (34.7%) patients. 52 (53.06%) of the pneumatized articular tubercles were of the unilocular type and 46 (46.94%) were multilocular. The results showed no statistically significant differences regarding age (p=0.454), gender (p=0.634), laterality (p=0.252), or locularity (p=0.807) among the samples.

Conclusion

Among ten large case series from other countries, the prevalence of pneumatized articular tubercle (6.2%) in Iranian patients was higher than that of all eight of the case series that used the same detection method as the present study of panoramic radiography.

The prevalence, radiographic appearance, and characteristics of zygomatic air cell defects (ZACDs) in symptomatic temporomandibular joint disorder patients in North Indian population

PURPOSE

Although the incidence of zygomatic air cell defects (ZACDs) is significantly low in general population, still they pose as a risk factor during surgical procedures like eminectomies and eminoplasties because there is a risk of spread of infection intracranially. Furthermore, such procedures are more common in TMD patients. With this fact in mind, this study was designed to find out the prevalence, radiographic appearance, and characteristics of zygomatic air cell defects in diagnosed symptomatic temporomandibular joint disorder patients.

METHOD

The study comprised of evaluation of panoramic radiographs of 70 temporomandibular joint disorder (TMD) patients in the age range of 18-30 years selected on the basis of Research Diagnostic Criteria (RDC/TMD). The radiographs were evaluated regarding the presence, variations, and characteristics of ZACDs. Groups were compared by χ (2) analysis.

RESULTS

ZACDs were identified in 21 TMD subjects out of 70, giving an overall prevalence of 30 %. Out of 21 ZACDs, nine were in males (42.8 %) and 12 were in females (52.38 %). ZACDs were unilateral in ten TMD patients (47.61 %) and were bilateral in 11 patients (52.38 %).

CONCLUSION

It can be concluded that the number of ZACDs is surprisingly more in diagnosed TMD patients. This strengthens the need for thorough preoperative imaging evaluation of ZACDs in such patients. Further longitudinal studies are required to find out the long-term effect of ZACDs on symptomatic as well as non-symptomatic TMD subjects. This may prove helpful to appreciate that whether ZACDs have any role in the development TMDs and vice versa. As with many TMD studies, caution should be exercised in interpreting these results until further studies have been carried out on this topic. Ideally, some prospective randomised evaluations with "hard" evidence of the diagnosis with MRI support.

Temporal bone pneumatisation: a computed tomography study of pneumatized articular tubercle

AIM

To determine the prevalence and characteristics of pneumatized articular tubercle (PAT) at computed tomography (CT), and to determine whether the presence of PAT is a predictor of larger pneumatized spaces of temporal bone.

MATERIALS AND METHODS

A retrospective study was performed using axial, sagittal and coronal CT images of 225 patients who attended a private medical imaging centre. Age and gender were recorded for all patients and, for cases of PAT, laterality and types were also recorded. Temporal bone pneumatization was recorded based on three reference structures on axial images. The Chi-square and Mann-Whitney U-tests were used.

RESULTS

Of the 225 patients, 43 (9.55%) had PAT, of whom 24 were female and 19 were male. This difference was not statistically significant (p > 0.05). The age range of the patients with PAT was 8-67 years. Of the 43 patients, 24 had unilateral and 19 had bilateral PAT. Fifteen cases of PAT were unilocular and 28 were multilocular. Cases of PAT showed larger pneumatized spaces of other parts of the temporal bone (p = 0.0001).

CONCLUSION

It is possible that PAT is a more frequent condition than is commonly perceived. The degree of pneumatization of temporal bone can be estimated by the evaluation of the air cells around the articular tubercle. CT is highly recommended in patients with PAT undergoing surgical treatment to determine the exact size and relationship of PAT to other parts of temporal bone.

Accuracy of digital panoramic radiography in the diagnosis of temporal bone pneumatization: a study in vivo using cone-beam-computed tomography

PURPOSE

The objective of the study was to determine the diagnostic accuracy of panoramic radiographs in the evaluation of pneumatization of the temporal bone, with confirmation of the diagnosis by cone-beam-computed tomography (CBCT) images.

METHODS

Images of 200 patients' digital panoramic radiographies and CBCT were examined by three evaluators regarding the presence or absence of pneumatization on temporomandibular joint (TMJ) fossa and/or articular eminence. When present, the defect was classified as uni- or multilocular, and as unilateral or bilateral. Areas under the ROC curve were compared to assess the accuracy of panoramic radiograph.

RESULTS

The values obtained in the comparisons ranged from Az = 0.67 to 0.55 (Az = area under the ROC curve).

CONCLUSIONS

The panoramic radiograph, is not the exam of choice for detecting the presence of these air cells based on its medium to low accuracy for diagnosis of pneumatized articular eminence and TMJ fossa when compared to CBCT.

Zygomatic air cell defect: a panoramic radiographic study of a North Indian population

AIM

The aim of the present study was to determine the prevalence, radiographic appearance, and characteristics of zygomatic air cell defects (ZACD) in digital panoramic radiographs in a North Indian population.

METHODS

The dental panoramic radiographs of 800 outpatients were selected from the records of the department, and were examined retrospectively to evaluate the variations and characteristics of ZACD. Groups were compared by χ(2) analysis for the presence of ZACD.

RESULTS

ZACD were identified in 46 of 800 patients, giving an overall prevalence of 5.7%. Patients with ZACD were aged 4-60 years, with a mean age of 31.43 years. Most patients with ZACD were in their thirties. ZACD showed a no gender predilection; 29 of 46 patients were male (63.4%), and 17 were female (36.6%). Thirty cases (65.2%) of ZACD were unilateral, with 20 cases occurring on the right side. In 16 cases (34.8%), ZACD was bilateral. Forty four of the defects were unilocular, and two of the defects were multilocular.

CONCLUSION

Digital panoramic radiographs are considered better than conventional panoramic radiographs in locating ZACD. Further, the presence of ZACD might be valuable for age estimations, to some extent. Further studies are required to investigate the pneumatization of articular eminence before puberty.

Prevalence and characteristics of pneumatization of the temporal bone evaluated by cone beam computed tomography

The aim of this study was to determine the prevalence and characteristics of pneumatization of the glenoid fossa and articular eminence by means of cone beam computed tomography (CBCT) images. CBCT images of 658 patients (1316 joints) were evaluated to determine pneumatization in the articular eminence (PAT) and roof of the glenoid fossa (PGF). Age and gender were recorded for all patients and, for the cases of pneumatization, laterality and type (unilocular or multilocular) were noted. Its prevalence was correlated with gender, age and laterality by statistical analyses. 21.3% of individuals presented with PAT and 38.3% presented with PGF. Considering the temporomandibular joint, PAT was in 15.5% and PGF in 30.2%. Of PAT cases, 54.3% were unilateral and 45.7% bilateral; 3.4% were unilocular and 96.6% were multilocular. In the PGF cases, 42.5% were unilateral and 57.5% bilateral; 0.02% was unilocular and 99.8% were multilocular. There was no statistical difference regarding gender and age; but there was statistical difference regarding laterality, with higher frequency on the left side. In conclusion, there was a significant prevalence of PAT and PGF in the studied population; their prevalence seems higher than has been previously supposed.

Pneumatization of the articular eminence on cone beam computed tomography: prevalence, characteristics and a review of the literature

OBJECTIVES

The aim of this study was to determine the prevalence and characteristics of pneumatized articular eminence (PAT) by cone beam CT (CBCT) and to present a review of the PAT literature.

METHODS

A retrospective study was performed using sagittal and coronal CBCT images of 514 patients in the Department of Oral and Maxillofacial Radiology, Ataturk University, Turkey. Age and gender were recorded for all patients and, for the cases of PAT, laterality and types were also recorded. The χ(2) test was used.

RESULTS

Of the 514 patients, 41 (8.0%) had PAT, of whom 25 were female (61.0%) and 16 were male (39.0%). This difference was not statistically significant (P > 0.05). The age range of the patients with PAT was 15-62 years (mean 30.6 ± 11.4). Of the 41 patients, 31 (75.6%) had unilateral and 10 (24.4%) had bilateral PAT. 17 (41.5%) PATs were unilocular and 24 (58.5%) were multilocular.

CONCLUSIONS

It is possible that PAT is a more frequent condition than is commonly perceived. In differential diagnosis of suspected cases or in cases for which surgical treatment is planned, panoramic radiographs should be supplemented with CBCT.

Zygomatic air cell defect: A panoramic radiographic study of a south Indian population

AIMS

To determine the prevalence, patterns of occurrence and variations of zygomatic air cell defects (ZACDs) using panoramic radiographs.

METHODS AND MATERIALS

Dental panoramic radiographs of 600 outpatients were examined to evaluate the variations and characteristics of ZACDs.

RESULTS

ZACDs were identified in 15 subjects out of 600, giving an overall prevalence of 2.5%. Seven ZACDs were seen in males and eight in females. Among the 15 ZACDs, nine were unilateral and six were bilateral.

CONCLUSION

The overall prevalence of ZACD is relatively low in south Indian population and careful radiographic evaluation is needed to detect these entities.