Diffuse idiopathic skeletal hyperostosis (DISH): Detection on dental radiologic examinations in two older adults and overview of the literature

BACKGROUND

Diffuse idiopathic skeletal hyperostosis (DISH) is a potentially serious osteopathic disorder associated with coalescing ossifications of the anterior vertebrae and may be concomitant with a constellation of symptomatology and systemic comorbidities. There is limited dental literature describing this finding on panoramic radiographs and cone beam computed tomography (CBCT) scans.

CASE PRESENTATIONS

Two case reports of DISH are provided. One patient manifested extensive ossifications along the cervical vertebrae and consequent episodes of dysphagia and hoarseness. The other affected patient's cervical ossification was found at an earlier stage of formation and without symptomatology. Panoramic radiography, cervical spine radiography, and CBCT examinations have been provided.

CONCLUSION

Attending dental healthcare practitioners should carefully evaluate all areas of interest and surrounding fields of view when taking panoramic radiographs and CBCT scans for manifestations of DISH and other potential disorders of the cervical vertebrae. A suspected radiologic finding of DISH should prompt timely referral for comprehensive medical assessment to mitigate neurologic deficits and other comorbidities.

Hypoglossal nerve stimulator on extraoral radiography and cone beam computed tomography scan: Case report

BACKGROUND

The hypoglossal nerve stimulator (HNS) device has been employed in some patients with refractory or unsatisfactory outcomes to chronic obstructive sleep apnea management. The objective of this article is to increase recognition of the radiologic appearances of this device within the head and neck region, as seen on extraoral radiographic and cone beam computed tomography (CBCT) images.

CLINICAL PRESENTATION

A 55-year-old man, refractory to a multitude of apneic medical therapies, underwent a series of preorthognathic radiologic studies. Notably, an implanted HNS lead and ribbon electrodes appeared as hyperdense structures on the panoramic radiograph, lateral cephalogram, and CBCT scan.

CONCLUSION

This article provides various radiologic views of the primary components of an HNS. Clinicians should be able to recognize the presence of neurostimulator devices used for management of chronic sleep apnea within the radiologic field of view of examinations of the head and neck.

A Replicable and Reproducible Digital Method for Quantifying Maxillary Sinus Airway Changes after Sinus Lifts Using the Lateral Window Approach Technique-A Retrospective Study

In the present retrospective study, we aimed to assess the replicability and reproducibility of a novel digital measurement technique for analyzing the volumes of the left and right maxillary sinuses and the nasal and maxillary sinus airway complex after a sinus lift procedure using the lateral window approach, to provide an accurate measurement technique for easily applying in clinical practice and to allow pre-operative assessment of maxillary sinus lift surgery, avoiding complications and making surgery more predictable. Material and Methods: Thirty patients with partially edentulous posterior maxilla were selected and submitted to bilateral sinus lift using the lateral window approach technique, with grafting materials selected and submitted to cone beam computed tomography (CBCT) scans, both pre- and postoperatively. Then, datasets were uploaded to therapeutic digital planning software to measure the volume of the right and left maxillary sinuses and the nasal and maxillary sinus airway complex. Gage R&R statistical analysis was performed to assess the replicability and reproducibility of the digital measurement technique. Results: The variability attributable to the novel digital measurement technique was 3.4% for replicability and 3.4% for reproducibility of the total variability of the samples. Conclusion: The novel digital method proposed is a replicable and reproducible technique for analyzing the volume of the right and left maxillary sinuses and the nasal and maxillary sinus airway complex after a sinus lift using the lateral window approach technique, allowing an accurate pre-operative assessment of maxillary sinus lift surgery, avoiding complications and making surgery more predictable.

Three-dimensional evaluation of the alar cinch suture after Le Fort I osteotomy

Orthognathic surgery has an influence on the overlying soft tissues of the translated bony maxillomandibular complex. Improvements in both function and facial appearance are the goals of surgery. However, unwanted changes to the soft tissues, especially in the nose region, frequently occur. The most common secondary change in the nasolabial region is widening of the alar base. Various surgical techniques have been developed to minimize this effect. The purpose of this study was to evaluate the changes in the nasal region due to orthognathic surgery, especially the alar width and nasal volume, using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Twenty-six patients who underwent a Le Fort I advancement osteotomy between 2006 and 2013 were included. From 2006 to 2010, no alar base cinch sutures were performed. From 2010 onwards, alar base cinch sutures were used. Preoperative and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets, and the alar base width and nose volume were analyzed. No difference in alar base width or nose volume was observed between patients who had undergone an alar cinch and those who had not. Postoperatively the nose widened and the volume increased in both groups.