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Objective. In this study, we have introduced a case in which the effective blood oxygenation level-dependent signal on functional magnetic resonance imaging (fMRI) was altered by the improvement of periodontal tissue and occlusal function in a patient with periodontitis Stage II Grade B. Material and Methods. A 61-year-old female patient requiring periodontal treatment was diagnosed as having periodontitis Stage II Grade B via clinical and radiographic examinations. Her past medical history included type 2 diabetes, hypertension, and hyperlipidemia. Following the patient’s informed written consent, the periodontal initial treatment provided to the patient included tooth brushing instruction and scaling and root planing; however, occlusal adjustment was not performed at this stage. Occlusal force and fMRI results were also evaluated at the initial and reevaluation examinations. Results. After the periodontal initial treatment had been performed, it was noted that the patient’s periodontal tissue and occlusal force had improved. It was also evident from fMRI that cerebral blood flow had been activated in the insula, primary motor cortex, and premotor cortex. Conclusion. This result suggested that the periodontal ligament had recovered and the periodontal ligament neuron had been further subjected to clenching in the insula so that the muscle spindle sensation impacted the motor cortex.

The aim of this study was to evaluate whether a balanced steady-state free-precession (SSFP) sequence with a time–spatial labeling inversion pulse (time–SLIP) without contrast medium could elucidate branches of the lingual and facial arteries on the lingual aspect of the mandible as a potential technique for preventing severe complications in dental implantation surgery. In this study, magnetic resonance angiography (MRA) using SSFP with a time–SLIP was evaluated in 40 subjects. The outline and course of branches of the lingual and facial arteries near the mandible were assessed clinically in the same subjects against contrast-enhanced computed tomography (CT) images as the gold standard. The submental, sublingual, and deep lingual arteries could be visualized via MRA in 16, 20, and 16 of the 40 subjects, respectively. The major axes of the respective arteries were approximately 24, 24, and 16 mm. The outline and course of all visualized arteries coincided with those on CT. MRA using SSFP with a time–SLIP appears to have potential as a non-contrast technique for visualizing branches of the lingual and facial arteries on the lingual aspect of the mandible. Information regarding the outline and course of these arteries as obtained using this MRA technique could assist in preventing severe complications in dental implantation surgery.

The purpose of this study was to elucidate the imaging characteristics of the gubernaculum tracts in successional teeth related to fused deciduous teeth on computed tomography. The imaging findings of 15 gubernaculum tracts in successional teeth related to fused deciduous teeth were retrospectively analyzed using cone-beam computed tomography or multidetector computed tomography. In cases without a congenitally defected successor, the two gubernaculum tracts of two successional teeth related to fused deciduous teeth were fused into one. Gubernaculum tracts (GTs) in mesial successors were vertical, but in distal successors they were inclined to mesial. The major abnormalities of the successional teeth related to fused deciduous teeth were delayed eruption and delayed formation. No inclined mesial successors were found, whereas most of the distal successors were inclined to mesial along with the inclined GT. The gubernaculum tracts of successors with a congenital defect of the other successors were vertical, and such successors had no abnormalities. The present study showed the imaging characteristics of gubernaculum tracts in successional teeth related to fused deciduous teeth. The abnormal eruption of successional teeth related to fused deciduous teeth may be associated with the characteristics of their gubernaculum tracts.

Background Tonsilloliths are related clinically to halitosis and tonsillar abscess. However, the dynamics of tonsilloliths over time are unknown. The aim of the study was to evaluate change in the characteristics of tonsilloliths in a time-dependent fashion by follow-up computed tomography (CT). Methods Tonsilloliths were analyzed in 326 CT scan pair sets of initial and at least two follow-up CT examinations of patients with whole palatine tonsils and various diseases of the oral and maxillofacial regions. Results Over the follow-up period, 12.1% of tonsilloliths disappeared. Approximately 26.1% of tonsilloliths changed in size during follow-up, mostly increasing in size. In tonsilloliths that showed enlargement, the mean (± standard deviation) growth rate was 0.61 ± 0.41 mm per year. Approximately 37.3% of tonsilloliths changed position during the follow-up period; of these, movement was toward the respiratory tract in 92% at a mean rate of − 1.38 ± 1.59 mm per year. The calcification levels of almost all tonsilloliths showed dynamic change: HU number increased in 84.3% and decreased in 12.7% of tonsilloliths over the follow-up period. The mean rate of HU increase was 63.8 ± 96.3 HU/year, and the mean rate of HU decrease was − 38.4 ± 66.8 HU/year. Conclusions The calcification levels of all tonsilloliths showed dynamic fluctuation, and a tendency for excretion of tonsilloliths from the body. Their dynamics over time suggest that tonsilloliths may be in a permanently active phase which functions to remove foreign matter.

To assess the mandibular cortical width (MCW) and morphology of the mandibular inferior cortex (MIC) on panoramic views from a large sample of males and females in various age groups by using an automated morphometric grading system for assisting osteoporosis screening. Furthermore, possible predictors and concrete cut-off values to identify the risk for osteoporosis were evaluated.MCW, MIC, tooth loss (TL), and alveolar bone loss (ABL) were retrospectively evaluated in 700 panoramic images from dental patients in Hong Kong using commercially available software. To estimate possible predictors for identifying the risk of osteoporosis, age, TL, and ABL were evaluated with the receiver operating characteristic (ROC) curves for each gender separately.The age groups 60s (sixties), 70s and 80s showed statistically significant gender differences. For example, a smaller MCW and more MIC Class 3 were found in females. Furthermore, females exhibited a statistically significant increase in TL in the age groups 50 years and above. In males, age, TL or ABL did not correlate with MCW, whereas in females it statistically significantly did. Meanwhile, the correlation between ABL and MCW and MIC was weak for both genders. Concrete cut-off values to identify patients at risk of osteoporosis were 60.15 years and 3.5 missing teeth in females, and 72.55 years in males.Age and tooth loss were related to MCW and MIC in the population investigated. An age of ≥60 as well as more than 3.5 teeth lost seem to be indicators for a risk of osteoporosis in Chinese females based on panoramic views using artificial-intelligence-based software.

Objective The aim of this study was to evaluate the characteristics of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values of ranulas. In addition, to elucidate DWI findings and ADC values of other representative masses in and around the floor of the mouth. Study Design DWI findings and ADC values in 35 patients with ranulas and 33 patients with other masses were retrospectively reviewed with a central focus on cystic masses or lesions that may have cyst-like components in and around the floor of the mouth based on the diagnosis of each respective disease. Results Ranulas were all well-defined, homogeneous masses with high signal intensity on DWI. The mean ± standard deviation ADC value of the 35 ranulas was 2.59 ± 0.31 × 10−3 mm2/s. There was a significant difference in ADC values between simple and plunging ranulas. On DWI, most other masses were heterogeneous, and most ADC values, except those for thyroglossal duct cysts, hemangiomas, and pleomorphic adenomas, were significantly lower than those for ranulas. Conclusions The characteristic DWI and ADC findings of ranulas can be determined accurately, and these data can be significantly useful in the differential diagnosis of many kinds of diseases in and around the oral floor.

Numerous studies, including our own, have revealed that positron emission tomography–computed tomography (PET/CT) using fluorine-18-labeled fluoro-2-deoxy-d-glucose (18F-FDG) is effective for the diagnosis of oral cancers. Large amounts of new information about primary tumors and metastatic lymph nodes have been acquired, and the use of 18F-FDG PET/CT has been shown to improve diagnostic precision in determining both the pathological characteristics of primary oral cancers and the presence of metastatic lymph nodes. However, substantial variations in 18F-FDG uptake in the oral and maxillofacial regions have been identified, and the differential diagnosis of some oral cancers and metastatic lymph nodes remains difficult for radiologists. Therefore, based on the previous research, the aim of the present study was to review the basic and important points regarding the diagnosis of primary oral cancers and metastatic lymph nodes using 18F-FDG PET/CT.

Objective The aim of this study was to evaluate whether a new cine-magnetic resonance imaging (CMRI) technique might be useful for evaluating swallowing function in patients with different types of oral cancers by assessing 12 CMRI-related parameters. Study Design In total, 111 patients with oral cancers were evaluated. We examined whether visualization of fluid flow and determination of flow direction to the trachea or the esophagus were possible with CMRI. We evaluated the correlations between CMRI-related parameters and self-reported dysphagia scores as the status of dysphagia, T classification groups as tumor staging for preoperative patients, alterations in CMRI-related parameters between pre- and postoperative patients, and the degree of invasiveness of oral cancer surgery. Results We could judge the flow direction to the esophagus on CMRI in all 111 patients. Six CMRI-related parameters showed significant correlations with dysphagia status. Increases in CMRI-related parameters were significantly related to deterioration of swallowing status, as shown by a decrease in self-reported dysphagia scores, advances in the T classification, and degree of invasiveness of oral cancer surgery. Conclusions The results of the present study suggest that CMRI can be used to directly visualize swallowing dynamics and objectively evaluate the swallowing complaints of patients with oral cancer.

Objectives To elucidate the characteristics of the gubernaculum tracts (GTs) in maxillary anterior teeth with normal or delayed eruption and in mesiodens by using multidetector computed tomography and cone beam computed tomography. Study Design The characteristics of GTs in maxillary anterior teeth of 205 patients with impacted mesiodens were retrospectively analyzed by using multidetector computed tomography and cone beam computed tomography. The GTs of teeth with normal or delayed eruption and the GTs of mesiodens were examined. Results The detection ratio of GTs in impacted mesiodens and anterior teeth with delayed eruption was significantly lower than in teeth with normal eruption. A significant difference in the angulation was found between normal and delayed eruptions. Almost all detectable GTs in the inverted mesiodens were derived from the incisive canal, while the remaining were from the alveolar crest. The connecting area of major GTs to tooth in inverted mesiodens was the cervical or root area, but in all other anterior teeth, it was the crown area. Conclusions GTs of inverted mesiodens may exhibit characteristics that are different from those of normal GTs when the teeth and/or the palate are developing.

The aim of this study was to determine whether the evaluation of neurovascular compression (NVC) using new criteria on magnetic resonance (MR) cisternography improves the prediction of the curative effects of carbamazepine (CBZ) in trigeminal neuralgia (TN). In this study, a new analysis of NVC using MR cisternography was performed retrospectively for 280 patients with clinical signs and symptoms suggesting TN. The new analysis examined whether the site of the NVC was less than 3mm from the edge of the exit point and within the first third of the root entry zone on MR cisternography. Prediction of the curative effects of CBZ using the new evaluation of distance to the NVC improved on the predictive ability of the previous method of calculating the NVC volume (Mantel-Haenszel coefficient, P 5mm3. The evaluation of NVC on MR cisternography using this new approach appears to be more useful than the previous method for predicting the initial treatment response in patients with TN.

Background: 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG) accumulations are commonly seen in the neck-related muscles of the surgical and non-surgical sides after surgery with neck dissection (ND) for oral cancers, which leads to radiologists having difficulty in diagnosing the lesions. To examine the alterations in 18 F-FDG accumulation in neck-related muscles of patients after ND for oral cancer. Material and Methods: 18 F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) in neck-related muscles were retrospectively analyzed after surgical dissection of cervical lymph nodes in oral cancers. Results: According to the extent of ND of cervical lymph nodes, the rate of patients with 18 F-FDG-PET-positive areas increased in the trapezius, sternocleidomastoid, and posterior neck muscles of the surgical and/or non-surgical sides. In addition, SUVmax of 18 F-FDG-PET-positive areas in the trapezius and sternocleidomastoid muscles were increased according to the extent of the ND. Conclusions: In evaluating 18 F-FDG accumulations after ND for oral cancers, we should pay attention to the 18 F-FDG distributions in neck-related muscles including the non-surgical side as false-positive findings

Objectives The purpose of this study was to identify the spatial relationship and/or association between odontomas and the gubernaculum tract or the dental sac and the characteristic findings for radiographic diagnosis of odontomas. Study Design The visualizations of the odontomas and the gubernaculum tract were retrospectively analyzed using cone beam computed tomography or multidetector computed tomography. Results Most of odontomas were within the gubernaculum tract or dental sac of unerupted permanent teeth on computed tomography. In some odontomas, the gubernaculum tract existed as a well-defined low density tract extending from the top of odontomas on computed tomography. Conclusions A close spatial relationship and/or association between odontomas and the gubernaculum tract or dental sac on computed tomography may be used as one of the criteria for radiographic diagnosis of odontomas. Development of odontomas may be associated with the gubernaculum tract or dental sac of unerupted permanent teeth.

In recent years, dysphagia is problem among elderly people. Therefore, it is necessary to accurately evaluate swallowing function in order to prevent swallowing disorder beforehand or to detect it early, and it is considered that evaluation of swallowing function using MRI is useful, and the demand for development of CAD system using MRI is increasing. In order to accurately analyze the swallowing motion, automatic extraction of the region of interest by the image analysis method is necessary. In this paper, as a pretreatment of a method for automatic extraction of esophageal region on dental MR image, we develop automatic extraction method of spinal candidate region. We first extract the posterior region of the spine and then extract the intervertebral disc region. Then we perform the detection of the anterior region of the spine and finally we extract the region between the anterior region of the spine and the posterior region of the spine as a spinal region. The proposed method was applied to 5 cases of dental MR images, and the results of TP 91.2 [%] and FP 8.8 [%] are obtained.

A Stafne bone defect is a static bone depression in the mandible that is commonly observed in cortical bone near the mandibular angle. We herein present a rare case in which static bone depressions attached to the three major salivary glands were observed on panoramic radiography and computed tomography (CT). The three static bone depressions in the mandible were visualized on a panoramic radiograph and CT as oval radiolucent masses in a 68-year-old man. The CT numbers in the bone depressions ranged from 10 to 50 HU, and they were close to those of the respective salivary glands. Based on the CT numbers, the areas in the bone depressions were determined to be a normal parotid gland, sublingual gland, and submandibular gland. The patient underwent a follow-up examination and did not request further consultation.

The mechanism of late implant failure is unclear. This study examined the association between sclerosing cancellous bone images and the risk of late implant failures using multi-detector row computed tomography (CT) imaging data. We performed a case–control study. The study group consisted of consecutive patients with implant failures treated at Kyushu Dental University between 2001 and 2016. CT data for late failure of 36 implants in 16 patients were available. The study cohort consisted of 16 patients with 36 late failed implants and 28 patients with 113 successful implants. The mean survival rate was 6.9 months for early implant failure, 76.6 months for late failure with marginal bone resorption, inflammation symptoms, and so-called peri-implantitis, and 95.0 months for late failure caused by implant fracture. The mean HU value for cases in the control group was 507 compared with 1231 for cases with late failure implants. Logistic regression was used for analysis. There were signs of high radiodensity of peri-implant cancellous bone when comparing adjusted radiodensity per 100 HU using CT data (OR 2.35; 95% CI 1.73–3.20; p

Objectives The aim of this study was to determine the usefulness of evaluating the function of swallowing before and after surgery in patients with tongue cancer by using T2-weighted sequences of high-speed continuous magnetic resonance imaging (HSCMRI). Study Design The imaging findings and related parameters on HSCMRI along with those on routine MRI examinations before and after surgery were examined in 19 patients with tongue cancer. In addition, changes in various parameters during 1 year after surgery were evaluated in 10 patients. Results In most patients examined, the direction of flow to the esophagus could be seen on HSCMRI before and after surgery. Significant correlations were observed among 4 parameters and in the responses to a dysphagia questionnaire. Conclusions The results of the present study suggest that the dynamics of swallowing can be directly visualized on HSCMRI by using 4 parameters that permit the evaluation of changes before and after surgery, and this enables objective evaluation of patients' swallowing complaints.

Objective: The aim of this study was to examine whether a decreased occurrence rate of adverse drug reactions (ADRs) to contrast media in contrast-enhanced CT and MRI was attributable to appropriate criteria for patients with some diseases. A secondary aim was to elucidate safety profiles for contrast media and factors influencing the occurrence of ADRs. Methods: Clinical data of patients who underwent contrast-enhanced CT (5576 cases) or MRI (3357 cases) were retrospectively analyzed to evaluate rates of ADRs to contrast media, symptoms of ADRs, treatments for ADRs, and differences in medical history, blood test results, and other factors between patients with and without ADRs in a dental hospital. Results: The rate of ADRs to contrast media was 0.54% for CT and 0.09% for MRI. The most frequent ADRs in contrast-enhanced CT or MRI were nausea and vomiting as physiologic reactions. Two serious reactions were seen for CT, but none for MRI. Significant differences between patients with and without ADRs were seen in liver function according to blood tests for CT, and in digestive disorders elicited from medical interviews for MRI. Conclusion: The lower occurrence rate of ADRs to contrast media in dental hospitals could be due to the adoption of appropriate criteria for patients with some diseases undergoing enhanced CT or MRI. Complete suppression of ADRs to contrast media for CT or MRI is unrealistic, so attention is warranted for patients with decreased liver function when performing enhanced CT, and for patients with digestive disorders when performing enhanced MRI.

We report a rare case of multiple complex odontomas and the subsequent occurrence of an ossifying fibroma at the same site as one of the removed odontomas. A 3-year-old Japanese boy presented three complex odontomas at the unerupted deciduous first and second molars and permanent first molar on the left side of the mandible. The two odontomas at the deciduous teeth were immediately extirpated, and, after 2 years of follow-up, the odontoma at the unerupted permanent first molar was removed. At the age of 7 years, a small odontoma surrounding the deciduous second molar emerged as a recurrence. When the patient was 9 years old, an ossifying fibroma occurred near the apex of the first premolar, i.e., the site where one of the original odontomas existed. Furthermore, a small radiopaque mass over the crown of the unerupted permanent second molar was observed at the age of 10 years; this mass was probably an additional fourth complex odontoma. This is not only a rare case report of ossifying fibroma associated with multiple complex odontomas but also a valuable time course observation of the development of such odontogenic tumors.

Objectives: To elucidate the predisposing factors and clinical characteristics related to the occurrence of stitch abscess after surgery in patients with oral squamous cell carcinoma (SCC). Patients and Methods: The subjects were 232 patients who underwent excision and/or reconstruction and/or neck dissection for oral SCC using silk sutures for high ligation of the blood vessels. Detection rates and characteristics of patients with stitch abscess were retrospectively evaluated by comparing patients with and without stitch abscesses after surgery diagnosed by ultrasonography and findings of various modalities in 232 patients. Several echogenic dots with subtle acoustic shadows in a hypoechoic mass were identified as the characteristic findings of stitch abscess on US. The patient groups with and without stitch abscess were compared with respect to various factors to identify those that predispose to the occurrence of stitch abscess. The factors analyzed included patients’ sex and age, chemotherapy treatment, radiotherapy treatment, the presence of a history of allergy, and blood test results. Results: A significant correlation was found between the occurrence of stitch abscess and age, liver function abnormalities on blood tests, and the presence of a history of allergy. Multiple stitch abscesses clearly tended to occur more often than single ones in patients with stitch abscess. Conclusions: The occurrence of stitch abscesses was related to age, liver dysfunction, and/or the presence of allergies. When diagnosing stitch abscess, the occurrence of multiple stitch abscesses is important. Key words:Stitch abscess, oral cancer, predisposition, characteristics, squamous cell carcinoma.

This review article provides doctors and dentists with an introduction to the clinical applications and sig- nificance of magnetic resonance cisternography (MRC) for the evaluation of neurovascular compression of the trigeminal nerve in patients with trigeminal neu- ralgia (TN). Specifically, the method and characteris- tics of MRC are first explained using the relevant MR sequences. Next, clinical applications for the diagnosis of TN are discussed. Finally, the significance and util- ity of MRC for effective treatment of patients with TN, such as carbamazepine administration and/or local anesthetic blocks, are presented.

Objectives To elucidate whether fluorine-18-labeled ( 18 F) fluoro-2-deoxy- d -glucose (FDG) accumulation can reflect the extent of periodontal inflammation, periapical inflammation, or dental caries. Study Design 18 F-FDG accumulations on positron emission tomography (PET)-computed tomography (CT) were retrospectively compared with the size of the bone resorption areas caused by periodontal inflammation, periapical inflammation, or dental caries on panoramic radiographs, CT, and magnetic resonance imaging (MRI) in 44 subjects. Results A significant correlation was found between the size of the bone resorption area caused by periodontal ( r = 0.595, P r = 0.560, P 18 F-FDG accumulation. A significant correlation was found between the periodontal ( r = 0.622, P r = 0.394, P 18 F-FDG accumulation. The SUVmax of 18 F-FDG around most teeth with caries was under 1.5. Conclusions 18 F-FDG accumulation reflects the extent of dental inflammation, not dental caries.

The paper explains the alterations of the temporomandibular joint (TMJ) visualized by magnetic resonance imaging (MRI) according to the growth and development of schoolchildren. Appearance and disappearance of a “double contour-like structure” (DCLS) of the mandibular condyle on MRI according to the growth and development of schoolchildren were demonstrated. In addition, possible constituents of DCLS and the significance of detection of DCLS on MRI were also speculated. The relationship between red marrow and yellow marrow in the articular eminence of temporal bone, the disappearance of DCLS, and alterations of the mandibular condyle have been elucidated.

Our aim was to find out whether the quality of bone around the inferior alveolar nerve is correlated with neurosensory disturbance to the nerve after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Computed tomograms (CT) were taken of 35 patients with mandibular prognathism and 35 without. To assess the density of bone around the inferior alveolar nerve, the width of the buccal cortical bone in the mandibular second molar regions was measured on CT. The Hounsfield units (HU) in the same regions were also measured. The number of HU in the mandible around the second molar regions was significantly higher (p

Objectives The aim of this study was to evaluate the 3-dimensional images of thinner main peripheral vessels in oral and maxillofacial regions made without contrast medium by using a new technique, fresh blood imaging (FBI). A second objective was to discern arteries from veins by using the combination of FBI with the subtraction technique. Study design Images from FBI were compared with those from 3-dimensional phase-contrast magnetic resonance angiography (MRA) of blood vessels in 20 healthy subjects. All images were scored for visualization and image quality of the main blood vessels. In addition, appropriate flow-spoiled gradient pulses were applied to differentiate arteries from veins in the peripheral vasculature using a combination of FBI sequences and subtraction between systole- and diastole-triggered images. Results The scores of MRA using FBI for the visualization of thin blood vessels were significantly better than those using phase contrast, whereas scores for the visualization of main blood vessels were equal. Additionally, we succeeded in our initial attempt to differentiate arteries from veins with a reasonable acquisition time. Conclusions Our initial experience shows that FBI could be a useful method to identify 3-dimensional vasculature and to differentiate arteries from veins among thinner peripheral vessels in the oral and maxillofacial regions without using contrast medium.

Objective The aim of this study was to evaluate the effect of altering changing head and body positions on the 2- and 3-dimensional (3D) configuration of the oropharynx with jaw protrusion. Study design Twelve healthy individuals (8 male, 4 female) with no history of sleep disturbances were invited to participate. For each subject, an acrylic splint was made with the mandible in protruded position. Subjects were imaged using magnetic resonance imaging in 4 different jaw, head, and body positions: 1) supine without protrusion; 2) supine with jaw protrusion; 3) supine with head rotation and jaw protrusion; and 4) laterally recumbent position with jaw protrusion. The 2- and 3D images of the upper airway in different positions were reconstructed by using a free DICOM reconstruction software. The dimension changes (anteroposterior and lateral dimensions, cross-sectional area, and volume) of the oropharynx (divided into retropalatal region and retroglossal region) were calculated and analyzed. Statistical analyses were performed using the Bartlett test and 1-way analysis of variance with α = .05. Results Compared with nonprotruded position, dimensions of the oropharynx for both retropalatal region and retroglossal regions were found to be greater than with jaw protrusion. Head and body positions had little effect on configuration of the oropharynx with jaw protrusion in either 2- or 3D. The only change noted was a greater anteroposterior dimension of retropalatal region with head rotation and lateral supine position compared with the supine position. Conclusions Head and body positions have little effect on 2- and 3D airway dimensions on supine patients with jaw protrusion.

To elucidate the relationship between the anatomic position of the inferior alveolar nerve (IAN) at the mandibular second molar and the occurrence of neurosensory disturbances of the IAN after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Also, the present study evaluated the difference in anatomic position of the IAN between patients with and without mandibular prognathism.Computed tomography images were taken of 28 patients with mandibular prognathism and 30 without prognathism. On these scans, the IANs from the mandibular second molar region to the mandibular foramen in the mandibular ramus were identified. The present study was designed as a cross-sectional study. The distance from the buccal aspect of the IAN canal to the outer buccal cortical margin of the mandible in the mandibular second molar regions was measured on the computed tomography images. Also, the linear distance between the superior aspect of the IAN canal and the alveolar crest in these regions was calculated. In addition, we investigated the presence or absence of contact between the IAN canal and the inner buccal cortical margin of the mandible from the mandibular second molar to the mandibular foramen in the mandibular ramus. Next, we examined whether neurosensory disturbances occurring after SSRO were related to the position of the IAN at the mandibular second molar.A significant difference was found in the occurrence of neurosensory disturbances of the IAN after SSRO between men and women (χ(2) test, P.05). For the distance from the buccal aspect of the IAN canal to the outer buccal cortical margin of the mandible in the mandibular second molar region, a significant difference was found between groups with and without neurosensory disturbances (Student's t test, P.01). The shorter the distance from the buccal aspect of the IAN canal to the outer buccal cortical margin, the more frequent the occurrence of neurosensory disturbances of the IAN.The present results have demonstrated that gender and the anatomic position of the IAN canal at the mandibular second molar are significantly related to the occurrence of neurosensory disturbances of the IAN after SSRO. Therefore, surgeons should clearly inform patients of the increased possibility of neurosensory disturbances after SSRO when the patients are female and are found to have a shorter distance from the buccal aspect of the IAN canal to the outer buccal cortical margin.

Purpose Exact estimation of tumor thickness and the status of the resection margin in tongue carcinoma are important prognostic factors for local recurrence, subclinical nodal metastasis, and survival. This study aims to evaluate the accuracy of intraoral ultrasonography-guided measurement of tumor thickness and define an adequate intraoperative resection margin in squamous cell carcinomas of the tongue. Materials and Methods In this prospective study, 13 patients with presurgical, biopsy-proven, clinical T1N0 or T2N0 tongue squamous cell carcinomas who underwent a partial glossectomy were examined preoperatively with ultrasonography to assess tumor thickness under general anesthesia. Nine cases underwent resection by a conventional method, whereas we introduced elastic needles with a metal core to mark a deep surgical margin of 10 mm from the deepest tumor invasion front under ultrasonographic monitoring as a new technique in the remaining 4 cases. Each resected specimen was immediately immersed in gelatin solution while maintaining its original shape and orientation and was placed under refrigeration to solidify. Ultrasonographic observations of the gelatin-embedded specimens were performed from the superior surface of the gelatin block. Results Very fine ultrasonographic images of the resected specimen could be easily obtained without any special skills, and surgical clearance could be verified intraoperatively. The ultrasonographic tumor thickness measurements corresponded well with those of histologic sections, with a consistency ratio of 91.4% to 98.2% (Pearson correlation coefficient = 0.981, P Conclusion Intraoperative ultrasonography is a reliable method to objectively evaluate tumor thickness and surgical margin clearance.

Objective The objective of this study was to evaluate the clinical significance of ultrasonography (US) for screening for thyroid gland diseases when surveying the cervical lymph nodes to detect metastasis in subjects with oral squamous cell carcinoma (SCC). Methods The detection rates and characteristics of abnormal thyroid findings detected by US in 301 subjects with oral SCC were analyzed. Subjects with abnormal findings were referred to thyroid specialists and the diagnoses and treatments from these specialists were noted. The ratio of subjects who consulted a thyroid specialist after indications of thyroid gland abnormalities to analyze subject compliance was also examined. Follow-up examinations were regularly conducted to assess any changes in the thyroid gland. Results Of the 301 subjects with oral SCC, 91 had abnormal thyroid gland findings on US. As subject age increased, the rate of detection of abnormal thyroid gland findings on US significantly increased. The rate of detection of abnormal findings in women by US was significantly higher than that in men, but the male-to-female ratio was lower compared with that in previous reports. It was demonstrated that oral SCC in the floor of the mouth was associated with the highest prevalence of abnormal findings in the thyroid gland (40%), followed by oral SCC of the maxillary gingiva (39%). Of the 91 subjects with abnormal findings, 10 showed enlargement in the size of the lesion on follow-up examination with US. Eleven subjects with no abnormal findings on initial examination showed abnormal findings on follow-up examination. Conclusion The results suggest that subjects with oral SCC have a relatively high rate of abnormal findings in the thyroid gland that can be detected by US. Scans that include the thyroid gland should be performed when surveying cervical lymph nodes for metastasis during US examination. Particular attention should be paid to thyroid gland–related diseases in older men who have oral cancer and to thyroid gland abnormalities if patients had oral SCC in the floor of the mouth or of the maxillary gingiva. It is recommended that follow-up US examinations be regularly performed in cases of oral SCC.

Various modalities are available for the diagnosis of diseases affecting the oral and maxillofacial regions. The currently used imaging modalities include intra-oral radiographs, panoramic radiographs, magnetic resonance imaging (MRI), computed tomography (CT) including cone-beam (CB) CT, ultrasonography (US), and nuclear medicine including positron emission tomography (PET). In the present review, we describe the application and significance of each modality in the diagnostic process of oral and maxillofacial diseases. Keywords: Panoramic radiograph, cone beam CT, MRI, PET-CT, US, imaging, oral and maxillofacial. INTRODUCTION The discovery of the X-ray by WC Roentgen in 1895 be-gan the history of diagnostic imaging of the human body, including that of oral and maxillofacial regions. Since then, a number of diagnostic imaging modalities have been devel-oped. Different modalities are applied for the diagnosis of diseases in oral and maxillofacial regions, and many reports have suggested the usefulness of intra-oral radiographs, panoramic radiographs, magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography (US), and nu-clear medicine including positron emission tomography (PET). In the present review, we introduce the applications of each modality and explain the significance of its image in the diagnosis of oral and maxillofacial diseases. The present review discusses the diagnosis of medical diseases using dental panoramic radiographs, the diagnostic significance of computed tomography (CT) including multi detector CT (MDCT) and cone-beam (CB) CT, the application of mag-netic resonance imaging (MRI) for various kinds of oral-related diseases, and computer simulations for dental implant and orthognathic surgery planning using data of helical CT images. The usefulness of ultrasonography (US) for viewing surface soft tissues such as salivary glands, tongue, and lymph nodes, and the advantages and limitations of positron emission tomography (PET) with fluorine-18-labeled fluoro-2-deoxy-D-glucose (18FDG) are also described.

Background Dentists need to be aware of the relationship between malignancies and paresthesia or complete loss of sensation in a jaw segment. In particular, dentists should be aware of numb chin syndrome (NCS) and its clinical manifestations, as well as the limitations of using panoramic radiographs to detect the causative malignancy. Case Descriptions The authors report two cases of paresthesia in the mental region. No lesions were readily apparent on the patients' panoramic radiographs. To exclude the presence of disease in the mandible that could have been responsible for the NCS, the authors obtained computed tomographic (CT) images. They identified metastases to the mandible from primary malignant tumors elsewhere in the body. Clinical Implications To prevent misdiagnosis of NCS, dentists need to be aware of the clinical manifestations of NCS, the need for CT imaging, the shortcomings of panoramic radiographs and the value of obtaining detailed and accurate medical and dental histories from patients.

The aim was to evaluate the utility of dynamic magnetic resonance (MR) sialographic images as a diagnostic tool for patients with xerostomia as chief complaint.Various parameters of dynamic MR sialographic images from 40 healthy volunteers were compared with those from 28 patients having dry mouth as chief complaint. Dynamic MR sialographic images were acquired using a 1.5-T full-body MR system and 2-dimensional fast asymmetric spin-echo (2D-FASE) sequences. Acquisition of the optimal section using 2D-FASE sequencing with single-section acquisition of thick sections was repeated every 30 s before and after a few drops of 5% citric acid was placed on the tongue. Student t test was used to examine differences between the healthy volunteer and patient groups regarding the maximum area of salivary gland ducts before and after citric acid stimulation.The maximum area of the detectable ducts in the patient group was significantly smaller (P0.001), whereas the change in detectable duct area was significantly lower (P0.001).This study suggests that dynamic MR sialographic images and data can be useful in the diagnosis of patients with dry mouth as chief complaint.

我々は歯科放射線科・放射線部の本学附属病院に於ける役割を把握するため10年程度のスパンで外来患者数ならびに画像検査件数の推移について報告してきた．歯科疾患は硬組織に関連するものが大半を占めるが，歯科医師の知識向上と歯科医療の進歩により，軟組織病変に対するアプローチも増加した．九州歯科大学附属病院は平成11年7月に新築され，当科も当時最新鋭機種である1.5 Tesla全身用MRI装置とヘリカル撮像可能なX線CT装置を導入した．そこで，今回は附属病院の大きな変貌の中で本診療科の役割・存在意義の変化を正確に認識するため調査研究を行った．平成7年4月1日から平成19年3月31日迄の12年間に本学付属病院を受診し，当科において画像検査を受けた患者を調査対象とし，その画像検査件数を調査した．九州歯科大学附属病院が新築された平成11年度は病院全体の患者数が著しく増加すると共に本診療科の患者数も増加した．それに伴い，ほぼ全ての撮影法で件数の増加が認められた．MRI検査の撮影件数は導入以後著しく増加している．顎骨内に発症した疾患はX線CTによる検査がなされ，軟組織に発症したものはMRI検査がなされていたという結果からは，教科書等に記載されているX線CT検査とMRI検査の有効性を本学附属病院の歯科医師が理解し，適切な判断をなしているものと考える．X線CT及びMRI検査に対する他病院からの依頼数は年々増大傾向を示し，特に歯科用インプラントの術前検査は5年前より倍増している．この背景には，近年の歯科医院が歯科用インプラントの埋入に積極的になっていることが挙げられ，今後は更に増加していくことが予想される．一方で，当科のX線CT検査後のデータは市販のフリーソフト等で確認することができず，この点は大きな問題点であり早急の対応を考えているところである．

Summary Objective A gender difference in the unstimulated whole saliva flow rate (UWSFR) may be due to a difference in the sizes of the salivary glands. In this study, we investigated the relationships among the UWSFR, gland sizes and body sizes of healthy young adult males and females. Design Unstimulated whole saliva was collected for 5 min by the spitting method in 50 healthy young adults, and the flow rate of the saliva was measured. Heights and weights were measured, and body mass indices (BMI) were calculated. The sizes of the salivary glands were measured by use of a magnetic resonance imaging technique. Results Parotid and submandibular gland sizes and flow rates in females were significantly smaller than those in males, as were also the weights, heights and BMI. In both males and females, there were significant positive correlations between gland sizes and the flow rates, weights and BMI. The variations of the flow rates were reduced by standardizing them with gland sizes, weights and BMI. Conclusions These results suggest that the lower UWSFR in females as compared with males is due to the smaller gland sizes due to the smaller body sizes.

Summary Objective The aim of this study was to examine the relationships between gland sizes and the flow rate and composition of the unstimulated whole saliva in humans. Design In 28 healthy young adults, the sizes of the three major salivary glands were estimated by use of a magnetic resonance (MR) imaging technique. Unstimulated whole saliva was collected for 5 min by the spitting method, and the flow rate and the concentrations of total protein, Na + and K + and pH were measured. Results The estimated sizes of the parotid and submandibular glands showed a significant positive correlation with the flow rate and the secretion rate of total protein in the unstimulated whole saliva, but that of the sublingual glands did not. Concerning the concentrations of Na + and K + and pH, there were no correlations with the salivary gland sizes. Conclusions The results suggest that the larger the sizes of the parotid and submandibular glands, the faster the fluid flow and protein secretion rates in unstimulated whole saliva.

Objective To evaluate a proposed technique for the 3-dimensional (3D) detection of hemangiomas, including vascular malformation and their feeding arteries, in the head and neck. The new technique combines phase-contrast magnetic resonance angiography (PCMRA) without contrast medium and 3D fast asymmetric spin-echo (FASE) sequences. Methods The technique was applied to 3 patients having hemangiomas in the head and neck region. In 1 patient the image obtained with the proposed technique was compared to that obtained by standard contrast angiography. Results In all 3 patients, the 3D presence of the hemangiomas and the feeding arteries were well defined in images created by the proposed technique. Additionally, the characterization of the hemangioma's 3D structure and distribution of the feeding arteries coincided with those observed using contrast angiography in the case for which contrast angiography was also performed. Conclusions Preliminary experience shows that the proposed technique combining 3D-FASE and 3D-PCMRA is useful to visualize both the 3D structure of hemangiomas and to identify the 3D distribution of the feeding arteries without using contrast medium.

Objective To evaluate the utility of magnetic resonance (MR) cisternography using 3-dimensional (3D) fast asymmetric spin-echo (FASE) sequences with multiplanar reconstruction (MPR) for detection of the sites of neurovascular compression (NVC) in patients with trigeminal neuralgia. Study design Both MR cisternography with 3D-FASE sequences and MR angiography (MRA) were performed on 150 patients with clinical signs and symptoms that suggested trigeminal neuralgia. Results from the original MR cisternography with 3D-FASE sequences, the original MRA, and 4 reformatted images were used for interpretation. Images with inversion between black and white were used from the MR cisternography with 3D-FASE sequences to evaluate NVC. A diagnosis of NVC was made from the presence of vascular contact with the trigeminal nerve at the root entry zone (REZ) and the nature of the involved vessels. For the patients with NVC detectable on 3D-FASE or MRA images, the relationship between the clinically manifested regions and the NVC sites was also evaluated. Results Of the 150 patients evaluated, 89 were deemed to have NVC. Of these 89 patients, 3 underwent surgery that identified the artery that was involved with the trigeminal nerve. The correlation between the clinically manifested regions and the NVC sites was significantly detectable using both 3D-FASE images and MRA in 89 patients with detectable NVC. The correlation coefficient using 3D-FASE imaging was a little higher than that using MRA. Of the 61 patients deemed not to have NVC, 6 were found to have brain tumors that invaded the root entry zone of the trigeminal nerve. However, the remaining 55 patients had no identifiable cause for trigeminal neuralgia. NVC was found in the asymptomatic side in 27 (18%) of the 150 patients with trigeminal neuralgia using MR cisternography with 3D-FASE sequences. Conclusions The technique of MR cisternography using 3D-FASE sequences with MPR is more accurate and useful than MRA for detection of the site of NVC in patients with trigeminal neuralgia. Patients with trigeminal neuralgia should be further examined using MR imaging to rule out a brain tumor. Radiologists should understand that a few subjects with no symptoms could show NVC with MR cisternography.

Objective In a previous study, we named the magnetic resonance imaging (MRI) signal that is characteristic of mandibular condyles in growing children the “double contour-like structure” (DCLS). In the current study, we evaluated the alternating appearance and disappearance of the DCLS in children as they grow to elucidate the significance of the DCLS. Study design In 11 subjects who were 9-14 years old at the time of the first examination, MRI characteristics of mandibular condyles were sought from fast spin-echo intermediate-weighted images; 2 or 3 years later, repeat MRI were obtained from the same subjects. Results At the second examination, 10 of the 16 DCLSs detected at the first examination had disappeared. A significant relationship was found between the alternation of the DCLS and the bone marrow conversion from red to yellow in mandibular condyles. Alternation of the DCLS tended to coincide with eruption of the permanent maxillary second molars. The DCLS was also shown to appear as a hypersignal on T2-weighted images. Conclusions Double contour-like structure signals in mandibular condyles appeared and disappeared as children grew, and these signal alternations may be useful as a criterion for the staging of mandibular condyle development in children. Possible constituents of the DCLS may be hypervascular loose fibrous tissue and a proliferation of cartilage.

The objective of this study was to evaluate the utility of frequency-selective fat saturation (FS) T2-weighted images (T2WI) for the detection of bone marrow edema in the mandibular condyle. MR evidence of bone marrow abnormalities was examined on the set of FS T2WI and conventional T1WI or of conventional T2WI and T1WI in 200 patients with temporomandibular joint (TMJ) related pain. Other parameters studied were TMJ effusion, disk displacement categories, and cortical bone abnormalities. The detection rate and area of bone marrow edema by FS T2WI and T1WI were significantly greater than those assessed by conventional T2WI and T1WI. The correlation between bone marrow abnormalities on FS T2WI and T1WI and pain was significantly stronger than with conventional T2WI and T1WI. This study confirms that FS T2WI is useful for the detection of the "edema pattern" in the mandibular condylar associated with TMJ-related pain.

The purpose of the present study is to evaluate the background fat intensity suppression instability of each area in the head and neck region, and in the post-reconstruction with metal plate and myocutaneous flap, of patients with oral cancer using fat-saturated (FS) images. STIR and FS T2-weighted images at pre- and post-surgery in 59 patients with oral cancer were scored for uniformity of fat suppression and tissue conspicuity in each region of the head and neck. The scores of FS on uniformity of fat suppression pre-operatively were worse than those of STIR in the mandibular level, but not lesion and tissue conspicuity. However, the deterioration both of scores between pre- and post-surgery using FS was worse than that using STIR using metal plate and/or myocutaneous flap. At diagnosis, we should recognize on MR images using FS that instability of the status of fat suppression might be brought about by respective area and reconstruction with metal plate and myocutaneous flap of patients with oral cancer.

Objectives We investigated the occurrence of inflammatory paradental cysts (IPC) in the mandibular premolar, and demonstrated the points of difference with regard to diagnostic features between IPC and dentigerous cysts (DC). Material and methods We analyzed the radiographs and histology of 60 cases with a cystic lesion associated with inflammation in the mandibular premolar region based on diagnostic criteria as IPC. Results In 4 out of 60 cases, we diagnosed the 4 cysts as IPCs in the mandibular premolar region, and recognized that one form of IPC was similar to a mandibular infected buccal cyst. The other 56 non-IPC cases were diagnosed as DC. On the IPCs, the permanent tooth normally erupted in all 4 cases after treatment, but in one case, the IPC recurred. Conclusions The present investigation suggested that we might have misdiagnosed IPCs in the mandibular premolar region as DC to date. It is important to consider the differences between IPC and DC with regard to the causes of recurrence during treatment of IPC.

Objective We sought to determine the magnetic resonance imaging (MRI) characteristics of mandibular condyles in still-growing children. In addition, we also evaluated the significance of the double-contour–like structure and the conversion from red to yellow marrow characteristic of this age. Methods The MRI characteristics of mandibular condyles were determined by means of fast spin-echo intermediate-weighted images in subjects 9 to 14 years old. In 1 subject who developed temporomandibular joint–related clinical symptoms 1 year later, MRI was re-performed at that time. Results With the use of MRI, a total of 17 double-contour–like structures were detected in 42 temporomandibular joints of 9- to 14-year-olds, but neither 50 healthy joints of youths nor adults. In terms of bone marrow signal changes, the turning point was found to be 11 years old. In 1 subject, the double-contour–like structures were not visible on the MR images obtained 1 year after the first examination. Conclusion The double-contour–like structure and the periods of conversion from red to yellow marrow may be able to be used as part of the criteria for the staging of mandibular condyle development in children.

The distributions of Merkel cells and Langerhans cells within human hair follicles have been reported. However, there has been no description of the relationship between Merkel cells and Langerhans cells, which were discovered by 19th century German pathologists. Merkel cells and Langerhans cells share some similar characteristics such as the localization of human hair follicles, a close association with peripheral nerves and the expression of several neuropeptides. Merkel cells were stained with CK20 or CAM5.2, while Langerhans cells were stained with CD1a or S-100 protein. We thus immunohistochemically confirmed the preferential localization of Merkel cells and Langerhans cells in normal human hair follicles. Using a double staining technique, two- and three-dimensional observations demonstrated that a small proportion of Merkel cells were closely contacted with Langerhans cells below the sebaceous gland level, presumably indicating the bulge area. Merkel cells and Langerhans cells connected directly or approached each dendrite within the basal layer of the outer root sheath. For the first time, we demonstrated a close anatomical relationship between Merkel cells and Langerhans cells within the bulge area of human hair follicles where follicular stem cells may be present. These morphological observations suggest a functional interaction between follicular Merkel cells and Langerhans cells. We herein hypothesize that Merkel cells communicate with Langerhans cells by characteristic dendrites in which some neuropeptides or cytokines may be stored.

This study evaluates the condylar response to activator in growth and in maturing patients using radiographs and magnetic resonance images (MRI). Seven patients (four in growth and three in maturing stages) treated for mandibular distal occlusion were studied. In all seven patients, lateral roentgen cephalograms, panoramic radiograms, and MRIs were made before and following functional treatment. All patients' mandibles advanced during treatment. Downward and forward mandibular growth was observed by superimposition of lateral cephalograms. On the condylar posterosuperior regions for both groups, double contours were sometimes observed on the panoramic radiograms following therapy. These double contours coincided with an area of high intensity in the MRIs for both groups. In the mature adult group, the double contours were more clearly observed when compared with those in the growth group. There were differences in the condylar adaptation types between the growth and mature development stages. Condylar adaptation to the newly created mandibular position was nevertheless found even in adult patients.

25歳女性の手掌に生じた黒癬の1例を報告した。患者は2年程前より自覚症状を欠き,大きさに変化のない手掌の茶褐色調色素斑に気づいており,レーザー治療も考慮に入れた受診であった。茶褐色斑より得られた鱗屑を20% KOH標本として鏡検したところ茶褐色の隔壁を有する菌糸と胞子が多数みられ,培養により黒色調のコロニーが得られ黒癬と診断し,スライド培養と電顕所見とを合わせHortaea werneckiiと同定した。患者の美容意識が高まり,色素斑の治療にレーザー治療が多用されている現在,色素斑を主訴に来院する患者の存在が予想され,鑑別診断の一つに黒癬を考えておく必要があると思われた。

29歳,男性。IgA腎症に対して,ステロイドパルス療法後,プレドニゾロン40mgの内服治療中であった。右手背の採血部に出現した小丘疹が,約2ヵ月の経過で急速に増大し,乳頭状増殖が目立つ直径2cmの半球状結節を形成してきた。肉眼所見より,尋常性疣贅を考えて切除した。病理組織では,表皮は過角化と乳頭腫症を伴って著明に肥厚しており,外方性に増殖し,大小の好塩基性顆粒状細胞質内封入体が角化細胞内に多数認められた。また,in situ hybridizationにて角化細胞核内にhuman papillomavirus type-1 DNA(HPV-1 DNA)の存在を証明した。以上の所見より,好発部位である手掌,足底以外に生じ,乳頭状大型結節を形成したミルメシアと診断した。肉眼的に尋常性疣贅を考えるようなありふれた疣贅の中に,このような非典型的ミルメシアが存在することを強調したい。

Objectives:To elucidate the changes in the distributions of fluorine-18-labelled fluoro-2-deoxy-d-glucose (18F-FDG) accumulation in the tongue muscles of patients following four kinds of surgical operations for tongue cancers.Methods:The changes in the distributions of 18F-FDG accumulations in the tongue muscles on positron emission tomography (PET)-CT, in association with imaging findings on CT and MRI, were retrospectively analyzed before and after four kinds of surgical operations for 50 patients with tongue cancers.Results:18F-FDG-PET-positive areas appeared at the back of the intrinsic muscles of the tongue after invasive surgery for tongue cancers despite the absence of abnormal findings on CT and MRI. A correlation between the standardized uptake value maximum of 18F-FDG in the intrinsic muscles and the degree of invasiveness of the surgical procedures for tongue cancers (r = 0.539, p

This is the first reported case of an osteolipoma affecting the left lower lip of a 68-year-old Japanese man. It is important to be aware of lipomas, such in the present rare case, to avoid their misdiagnosis.

Purpose To elucidate the appearance and imaging characteristics of the gubernacular tract (GT) during the growth stage of children. Furthermore, this study evaluated the significance of the appearance of the GT. Study Design The visualizations of the GT were retrospectively analyzed by using panoramic radiographs and computed tomography (CT) in children. Results In patients with normal eruption who had unerupted permanent teeth, except maxillary central supernumerary teeth, the GT was clearly visualized as a well-defined low-density tract on CT but not on panoramic radiographs. In patients with obstructive eruption, including impaction, the GT was deformed and not visible on CT. Conclusions This paper describes the frequency of detection and appearance of the GT in unerupted teeth. Preliminary data suggest that any alteration to the GT may be used to predict abnormal eruption of permanent teeth.