Search

The aim of this study was to analyze the morphologic features of alveolus in relatively healthy maxillary and mandibular incisors using cone-beam-computed tomography (CBCT). CBCT images of 318 patients were retrospectively acquired. Alveolar bone in incisive area was divided into: type 1 (thick), type 2 (relatively thick with mono-plate concavity), type 3 (thin with double-plate concavities), and type 4 (vulnerably thin). Alveolus prevalence and widths were analyzed statistically relative to age, gender, and molar relationship. Prevalence of type 1 alveolus was 78.9% in maxillary central incisors, 15.1% in maxillary lateral incisors, 24.1% in mandibular central incisors, and 5.0% in mandibular lateral incisors. Type 2 alveolus was commonly observed in the maxillary lateral incisors (82.2%), mandibular central incisors (66.2%), and mandibular lateral incisors (87.9%). Prevalence of type 3 and 4 alveoli ranged from 0.0 to 9.4%. As for maxillary central incisors, type 1 was the widest both at the alveolar crest (7.77 ± 0.58 mm) and apical area (9.05 ± 1.86 mm), while type 3 had the lowest width at the apical region (4.08 ± 0.51 mm). Among maxillary central incisors, prevalence of type 1 tended to decrease with age. At all maxillary and mandibular incisor sites, alveolus widths were significantly thicker in males than in females. At maxillary lateral incisor and mandibular incisor sites, prevalence of alveolus type was significantly different among three molar relationships. A 4-type classification system was suggested for alveolus morphology in incisive region. Identification of alveolus type might aid in the corresponding treatment.

OBJECTIVES/HYPOTHESIS To explore the clinically feasible diagnosis criteria and treatment outcomes of allergy-related sialodochitis (ARS). STUDY DESIGN Prospective Cohort Study. METHODS Ninety-six consecutive patients were enrolled by the following criteria: 1) recurrent swelling of ≥2 large salivary glands that lasted for ≥3 months; 2) with mucus plug exudations; 3) with atopic diseases; 4) ductal stenosis and/or ectasia. Sixty-four patients with elevation of peripheral blood eosinophil (PBE) and/or serum IgE level comprised group A (highly-suspected ARS group), while the remaining 32 comprised group B (patients without confirmed evidence of ARS). These patients were treated with interventional endoscopy. A chronic obstructive sialadenitis symptom (COSS) questionnaire was used to quantify the treatment outcomes. RESULTS In group A, Serum IgE was elevated in 84.4% of patients and PBE was elevated in 34.4% of patients. Percentage of submandibular gland involvement was higher in group A than group B (48.4% vs. 18.8%). On sialograms, the snowflake changes of branch ducts were seen in higher percentage of group A compared with group B (59% vs. 35% for parotid glands, 27% vs. 8% for submandibular glands, respectively). Mucus plug smears showed abundant eosinophils in 14 group A patients. Biopsy of five group A patients revealed significant eosinophil infiltration around the main and interlobular ducts. During follow-up, the COSS scores were significantly decreased in both groups, and group B was improved better than group A. CONCLUSION PBE and serum IgE are important diagnostic indexes of ARS. Mucus plug smear or histopathology verifies the diagnosis. Interventional endoscopy is helpful for ARS cases. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2030-2035, 2021.

OBJECTIVES To investigate the clinical, laboratory, radiological, histopathological, and immunohistochemical features, and the expression of allergy-related cytokines in eosinophilic sialodochitis (ES). METHODS Thirty-eight patients diagnosed with chronic obstructive sialadenitis (COS) who had undergone glandular excision or incisional biopsy were enrolled. Seventeen patients with comorbid atopic disease and increased ductal tissue eosinophils comprised the ES group, while 21 patients comprised the COS group. The clinicopathological features and allergy-related cytokine expression were compared between groups. RESULTS The ES group frequently involved multiple, bilateral major salivary glands, and the number of glands was significantly greater than the COS group (2.8 ± 1.1 vs. 1.2 ± 0.4, P

Objectives The aim of this study was to evaluate and quantify variations of bifid mandibular canals (BMCs) in a population of Northern China by using cone beam computed tomography (CBCT). Study Design CBCT images of 1000 consecutive patients were analyzed by using the NewTom proprietary software. BMCs were identified and classified on the basis of the Naitoh classification. Linear and angular measurements of BMCs were performed. Statistical analyses were conducted by using χ2 and Wilcoxon tests. Results BMCs were observed in 13.2% of 1000 patients and 8.4% of 2000 sides. The prevalence of BMCs was significantly lower in patients in the first 2 decades and in cases with a class II molar relationship. The retromolar canal (68.4%) was the most common type of BMC observed. No buccolingual canals were identified; however, 2 special canals were detected. A classification system of 3 subtypes of retromolar canals was suggested. On average, the beginning site of the branches from the opening of the main canal was at a distance of 8.1 mm. The mean diameter and length of BMCs were 2.1 mm and 12.6 mm, respectively. Conclusions This study underlined the prevalence and characteristics of BMCs in a population of Northern China. Preoperative identification of BMCs with CBCT may help prevent postoperative complications.

To explore whether a computed tomography (CT) examination of the head and neck region induces biological damage and whether the damage was correlated with the radiation dose. Peripheral blood was taken from 33 individuals who received head and neck CT examinations. Blood samples were divided into three groups: the control group and the in vivo and in vitro irradiation groups. The number of DNA double-strand breaks was estimated by comparing the changes in the rates of γ-H2AX foci formation in the peripheral blood before and after CT examination. The absorbed dose and effective dose were calculated with the software VirtualDose based on the Monte Carlo method, and the absorbed doses in blood were estimated accordingly. The γ-H2AX foci rates were increased in the in vivo (p < 0.001) and in vitro irradiation groups (p < 0.001) after CT examination when compared with those in the control group. The rate of γ-H2AX foci formation showed linear dose–responses for the CT dose index volume (CTDIvol), dose–length product (DLP), and blood dose after CT examination. A CT examination of the head and neck region provides a high enough radiation dose to induce DNA double-strand breaks in cells in the peripheral blood. There was a linear correlation between the formation of DNA double-strand breaks and radiation doses after CT examination. In addition to ensuring image quality, in a real clinical situation, the scanning area should be strictly administered, and repeated operations should be avoided to minimise the patient’s radiation dose.

Objectives: To characterize the radiographic features of maxillary ameloblastoma (AM), odontogenic keratocyst (OKC) and dentigerous cyst (DC) comparatively by using spiral CT and cone beam CT (CBCT). Methods: Clinical records, histopathological reports, and nonenhanced spiral CT or CBCT images of 191 consecutive patients with primary maxillary AMs, OKCs, or DCs were retrospectively acquired, and radiographic features were analyzed. Results: The study included 118 males and 73 females (age: 5–84 years). 72.0% of AMs and 84.3% of OKCs originated from the posterior maxilla, while 69.6% of DCs occurred in the anterior maxilla. Among 25 AMs, 44.0% were of desmoplastic type, with honey-combed appearance. 84.0% of AMs were circular or oval in shape, 84.0% expanded buccally, and 36.0% invade the nasal floor. Among 89 OKCs of 88 patients, 61.8% were circular or oval, 58.4% expanded buccally, 49.4% were dentigerous, 41.6% nearly filled the maxillary sinus, and 13.5% invaded the nasal floor. 93.7% (74/79) of DCs enveloped a single tooth, and the tooth–cyst relationship was centripetal in 35, eccentric in 30, and circumferential in 9. Moreover, 98.2% (55/56) of the cysts enveloping a supernumerary tooth were DCs, while 80.9% (38/47) of the cysts enveloping the third molar were OKCs. Conclusions: Maxillary AMs tend to grow with buccal expansion and invade the nasal floor, and DAs with honey-combed lobularity are common. Maxillary OKCs have variant shapes and tend to invaginate the maxillary sinus. The tooth–cyst relationship of dentigerous OKCs and DCs can be centripetal, eccentric, or circumferential.

To analyse the anterior extension of the maxillary sinus, distribution of the sinus septa and vertical relationship between the maxillary sinus and molar roots using cone beam computed tomography (CBCT).Imaging data of 970 consecutive patients who underwent CBCT scans were retrospectively collected. The anterior border, septa distribution of the maxillary sinus and relationship between the maxillary sinus and molar roots were analysed. The root-sinus relationship was divided into three types; the roots protruding into the sinus or touching the floor without a bony barrier was defined as Type I root-sinus relationship.Overall, 15.5% of the maxillary sinuses extended beyond the incisor region and 68.9% extended beyond the canine region. A bony septum of ≥ 2 mm was detected in 16.9% (328/1940) of the maxillary sinuses from 26.0% (252/970) of the patients. Among the 355 septa in the 328 sinuses with septa, 108 (30.4%) were located at the first and second premolar region, 180 (50.7%) at the first and second molar region and 67 (18.9%) posterior to the second molar. Among the first molars, a Type I root-sinus relationship was detected in 61.0% of palatine roots, 55.4% of distobuccal (DB) roots, and 52.7% of mesiobuccal (MB) roots. Moreover, among three-rooted second molars, a Type I relationship was detected in 62.0%, 58.2% and 45.8% of MB, DB and palatine roots, respectively.The maxillary sinus can extend beyond the incisor region; approximately 1/6 of sinuses have bony septa; and 1/2 of molar roots protrude into the maxillary sinus or touch the sinus floor without a bony barrier.

Purpose To quantify gland function before and after endoscopy-assisted lithectomy for patients with parotid stones and to analyze correlations among different evaluation modalities. Materials and Methods This study investigated 58 patients (27 men and 31 women) with a stone larger than 5 mm or multiple parotid stones who underwent successful endoscopy-assisted surgery at the authors' center from August 2007 through September 2017. Meticulous postoperative manipulations were administered routinely for 3 to 6 months to promote functional recovery of the affected gland. Gland function was evaluated preoperatively and 6 to 36 months (mean, 12 months) postoperatively by sialography, scintigraphy, and sialometry. Statistical analyses were conducted to quantify gland function recovery and to distinguish correlations among the 3 objective tests. Results Preoperative sialograms exhibited ductal ectasia at the stone site with ductal stenosis anterior to the stone (n = 53) or duct interruption at the stone site (n = 5). Postoperative sialograms of 45 patients without stones were categorized as approximately normal (type I; n = 17); showing ectasia or stenosis of the main duct without persistent contrast on the functional film (type II; n = 16); showing ectasia or stenosis of the main duct with mild contrast retention (type III; n = 6); or showing poor ductal shape with evident contrast retention (type IV; n = 6). Scintigraphy of 23 preoperative and 12 postoperative patients and sialometry of 24 preoperative and 12 postoperative patients indicated severe preoperative impairment and postoperative improvement of gland function. Postoperatively, although no relevant differences in saliva flow rate were found between the 2 sides, scintigraphy showed lower function of the affected gland compared with the control side. Statistical data showed positive correlations among the 3 methods. Sialography intuitively reflected the ductal shape, whereas sialometry and scintigraphy were more sensitive for evaluating gland function. Conclusion For patients with parotid stones, minimally invasive endoscopic surgery and meticulous postoperative manipulations help preserve the glands and facilitate recovery of gland function. The 3 evaluating modalities have certain positive correlations.

Autologous transplantation of submandibular gland (SMG) is effective for severe keratoconjunctivitis sicca (KCS). Sialography is a method for morphological evaluation of the transplanted gland.We recruited 15 patients (15 eyes) with severe KCS who had successfully undergone SMG transplantation. Thirteen patients had normal transplanted SMGs, while two patients were suspected to have obstructive sialadenitis of the transplanted SMG. Sialography was performed in each patient with meglumine diatrizoate. Projections were applied immediately and 5, 7, and 10 min after contrast injection. The median dose of the contrast medium was 0.9 ml (range, 0.7–1.1 ml) for the full-size transplanted SMGs and 0.5 ml for the glands after reduction surgery. The acini and the ducts were clearly visible on sialograms. The contrast medium was completely excreted in 10 min in normal transplanted SMGs. The main duct had a regular shape in normal transplanted SMGs, while irregular dilation and stricture of the duct with delayed excretion of the contrast medium were found in the glands with obstructive sialadenitis. In conclusion, sialography is clinically feasible and valuable for the morphological evaluation of the transplanted SMG.

Aim The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in assessing maxillary molar furcation involvement (FI). Materials and Methods Fifteen patients with generalized chronic periodontitis after initial therapy were recruited. CBCT was performed in maxillary molars with probing pocket depths of ≥6 mm and advanced FI, and CBCT images were analysed. Furcation surgery was performed in 20 maxillary molars. Lastly, intra-surgical FI assessments were compared with CBCT-based data. Results Intra-surgical findings confirmed 82.4% of the CBCT data, with a weighted kappa of 0.917. The agreement between both assessments was the highest in buccal furcation entrances, followed by distopalatal and mesiopalatal furcation entrances. Of the four parameters tested of detailed root anatomy and furcation morphology, the mean length of the root trunk and the width of the furcation entrance revealed by CBCT were consistent with their respective intra-surgical values (p > 0.05). Horizontal bone loss and vertical bone loss were underestimated by CBCT relative to their respective intra-surgical classifications (p ≤ 0.05). Conclusions Cone-beam computed tomography images demonstrate a high accuracy in assessing the loss of periodontal tissue of the FI and root morphologies in maxillary molars.

Purpose To evaluate the diagnostic accuracy of computed tomography (CT) of the parotid gland for Sjogren's syndrome in comparison with conventional X-ray sialography. Methods CT scans and X-ray sialography were performed in 34 patients with confirmed Sjogren's syndrome and 22 symptomatic controls without the disease. CT data from 57 asymptomatic controls were included for quantitative analysis. The CT findings of heterogeneity, abnormal diffuse fat tissue deposition, diffuse punctate calcification, swelling or atrophy, nodularity or cystic changes of the parotid gland were analyzed by two independent blinded readers. The correlation between CT and X-ray sialography findings was evaluated. Diagnostic performance and receiver operating characteristics curves were calculated. Results On CT, heterogeneity of the parotid gland was seen in 30/31 (reader 1/reader 2) Sjogren's syndrome patients by the two readers (sensitivity 88.2%/91.2%; specificity 100%/90.9%). Abnormal diffuse fat tissue deposition was seen in 28/28 SS patients by the readers (sensitivity 82.3%/82.3%; specificity 100%/90.9%). Diffuse punctate calcification was seen in 10/12 Sjogren's syndrome patients (sensitivity 29.4%/35.2%; specificity 100%/100%). Stagings of CT findings correlate positively with sialography. The areas under the receiver operating characteristics curves were 0.887 (P = 0.000) and 0.908 (P = 0.000) for the maximum and standard deviation (SD) of the CT value. Conclusions Parotid CT is accurate and reliable in the diagnosis of Sjogren's syndrome. Heterogeneity, abnormal diffuse fat tissue deposition, and diffuse punctate calcification are specific for Sjogren's syndrome. CT attenuation analysis is helpful in diagnosis.

Purpose To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw. Materials and Methods Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraossous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression. Results Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications. Conclusions Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.

Objective The aim was to evaluate a semirigid endoscopic technique for diagnosis and management of sialolithiasis. Study design Diagnostic and interventional sialendoscopic procedures were performed in 90 patients with sialoliths (78 submandibular glands and 12 parotid glands). Results Owing to its extreme flexibility and rigidity, the endoscope can be introduced easily into the ductal system. Sialoliths with a round or irregular shape were detected by endoscopy in all cases, including 84 radiopaque and 6 radiolucent stone cases. Of the 78 cases with sialoliths in the submandibular (Wharton's) duct, 14 were present in the hilum of the main duct, 34 in the premolar region of the duct, 24 in the molar region of the duct, and 6 in both the premolar and the molar regions of the duct. Among these cases, we could remove the stones intraductally in 44 cases by endoscopy alone. Additionally, 6 cases were treated with basket retrieval and endoscopic-assisted surgery, and the remaining 27 were treated with endoscopic-assisted surgery. Of the 12 cases of sialoliths in the parotid (Stensen's) duct, 9 were treated with basket retrieval and 1 with basket-capturing and open surgery via a buccal incision. In total, 87 of 90 cases were successfully treated, with (n = 34) or without (n = 53) endoscopic-assisted surgery. These patients were stone free at their last follow-up (3 to 30 months). Conclusions The semirigid endoscope permits a better visualization of sialoliths and coexisting obstructive pathologies. With minimally invasive procedures, most stones in the main duct of the salivary gland can be removed using either an intraductal or an extraductal approach.

Purpose The purpose of this study was to evaluate the outcomes of sclerotherapy of maxillofacial venous malformations by use of absolute ethanol and pingyangmycin (bleomycin A 5 hydrochloride). Patients and Methods We treated 23 consecutive patients with maxillofacial venous malformations by sclerotherapy with a combination of absolute ethanol and pingyangmycin under local anesthesia. The size of the lesions ranged from 2 cm × 2 cm to 12 cm × 10 cm. Venography showed the presence of large venous lakes. Venograms were obtained during the first procedure before and after injection of absolute ethanol (0.5-2.5 mL) to confirm the site of the nidus and assess the effect of sclerosis of the nidus and draining veins. Subsequently, 8 to 16 mg of pingyangmycin dissolved in 40 mL of saline solution was infused into the nidus by a dynamic infusion pump at a rate of 1 mL/min. If necessary, this procedure was repeated once in 2 or 4 weeks. The clinical outcomes and complications were evaluated. Results The duration of follow-up ranged from 6 to 37 months, with a mean of 20.3 months. Only 1 procedure was required in 3 patients, and the procedure was required to be repeated twice in 9 patients, 3 times in 7, and 4 times in 4. All the patients were satisfied with the treatment results, and excellent clinical results were obtained in 9 patients. There was no skin necrosis or nerve damage. Conclusions Percutaneous sclerotherapy with the combined use of absolute ethanol and pingyangmycin is a safe and effective treatment for maxillofacial venous malformations.

Objective The aim of this study was to investigate with cone-beam computed tomography (CBCT) the locations of impacted maxillary canines and resorption of neighboring incisors. Study design Two hundred ten impacted maxillary canines were analyzed using CBCT images. The locations of the impacted canines were assessed and angular and linear measurements were taken using NewTom proprietary software. In addition, root resorption of neighboring incisors was investigated. Results Among these impactions, 45.2% were impacted buccal-labially, 40.5% were impacted palatally, and 14.3% in the midalveolus. The locations varied: mesial-labial impaction (n = 67), mesial-palatal impaction (n = 74), in situ impaction (n = 31), distal impaction (n = 12), horizontal impaction (n = 18), and inverted impaction (n = 8). Quantitive measurements further depicted these variations. Root resorption was present in 27.2% of lateral and 23.4% of central incisors, and 94.3% of these resorptions occurred where the impacted canines were in close contact with the incisors. Conclusion The location of impacted maxillary canines varies greatly in 3 planes, and the resorption of neighboring permanent incisors is common.

Objective To evaluate the incidence of two-rooted mandibular premolar morphology using full-mouth periapical film series in a Chinese population, with particular emphasis on bilateral incidence, so as to provide a clinical anatomical basis for root canal treatment in mandibular premolars. Methods A total of 2015 patients who underwent dental treatment and had full mouth periapical radiographs at the Peking University School of Stomatology from April 2011 to April 2012 were enrolled in this study. Three experienced dentists reviewed the patients' periapical films and classified the root morphology of mandibular premolars bilaterally. The incidence of unilateral and bilateral double roots were recorded and calculated, including confirmed and suspected bucco-lingual root types. Results In terms of the morphology of two-rooted mandibular first premolars, of the 2015 cases with complete root formation, two-rooted first premolars were detected in 120 cases, with a total number of 159 teeth. According to the number of teeth, the overall incidence of double roots was 4.03% (159/3972). In terms of the morphology of two-rooted mandibular second premolars, of the 2015 cases with complete root formation, two-rooted second premolars were detected in 24 cases, with a total number of 33 teeth. According to the number of teeth, the overall incidence of double roots was 0.85% (33/3880). Conclusions The roots of mandibular premolars display specific morphological patterns. Based on a large sample, we observed and calculated not only the occurrence rate of bucco-lingual and mesio-distal double roots in first and second mandibular premolars, but also the incidence of unilateral or bilateral double roots within the same mandible. These findings could provide useful information on the anatomical structure of mandibular premolars for endodontic, prosthodontic and surgical procedures, and could improve the quality of treatment and reduce complications.

Objective To elaborate on the classification of central arteriovenous malformations (AVMs) in the jaw based on angioarchitecture and to evaluate the correlation of this classification with treatment options. Study design X-ray films and digital subtraction angiograms (DSA) of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of bone resorption, feeding arteries, nidus of the malformations, and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation of this classification system with treatment options. Results The angiographic pictures of 25 cases with central AVMs could be divided into 5 types: Type I (n = 5) had diffused microarteriovenous fistulas (AVFs); type II (n = 8) had 1 large venous pouch with all the feeding arteries draining into it; type III (n = 7) had a large venous pouch as well as diffused microAVFs (I + II); type IV (n = 2) had multiple venous pouches; and type V (n = 3) had multiple venous pouches and diffused microAVFs (I + IV). The angioarchitecture corresponded well to the x-ray appearance in all cases except 1 (96%) . With respect to the treatment outcomes, type II, III, and IV AVMs gained clinical cure in 100% of the cases, whereas type I and type V AVMs obtained clinical cure only in 60% and 33.3% of the cases, respectively. Conclusions Central AVMs in the jaw contained variant patterns of angioarchitecture and could be divided into 5 types. This angiographic classification was helpful for decision making about appropriate therapy.

To evaluate the effect of regenerative therapy for the treatment of furcation involvements of mandibular molars with cone-beam computed tomography (CBCT).In the study, 38 furcation involvements of mandibular molars were included and randomly divided into two groups. The experimental group accepted guided tissue regeneration and bone graft therapy, and the control group only flap surgery. The clinical examination and CBCT examination were performed at baseline and 1 year post-surgery.The clinical and CBCT data of both groups were not statistically different at baseline (P0.05). At the end of 1 year post-surgery, except gingival recession, the clinical parameters of both groups were significantly improved (P0.001). The vertical and horizontal attachment gains of the experimental group were (3.20 ± 1.82) mm and (2.05 ± 1.27) mm, respectively, and significantly higher than the changes of the control group (P0.001). And at the end of 1 year post-surgery, the experimental group showed significantly higher bone gain at the vertical and horizontal directions compared with those of the control group: (2.82 ± 0.97) mm and (2.24 ± 0.92) mm, respectively (P0.001).With the limitation of this study, the effect of guided tissue regeneration surgery and bone graft therapy for the treatment of furcation involvements of mandibular molars is significantly better than that of the flap surgery. CBCT can reflect the horizontal and vertical bone changes of furcation area, which is more comprehensive than traditional periapicals.

Objectives To develop a novel technique to visualize dentogingival profiles by using cone beam computed tomography (CBCT) and to evaluate the accuracy of mucogingival tissue thickness measurements with CBCT, as compared with direct measurements in vitro . Methods A silicone matrix loaded with radiopaque impression material was prepared before performing CBCT on a patient. Two dry cadaver mandibles with simulated mucogingival tissue and six segmental cadaver jaws were used to assess the accuracy of mucogingival tissue thickness measurements directly and radiographically with CBCT images. Paired t tests were used to evaluate the intra- and interexaminer reliability and to compare the data between direct and CBCT imaging measurements at α = 0.05. Results No statistically significant differences were observed between direct and CBCT imaging measurements of simulated mucogingival tissue thickness in mandibular models and in cadaver jaws ( P > .05). Results of direct measurements with simulated mucogingival tissue thickness indicated good intra- and interexaminer reliability. Conclusions A novel technique was developed to obtain mucogingival tissue thickness data on the use of radiopaque impression materials and CBCT imaging. This new method provides a reliable visual dentogingival profile and a means to objective measurements.

Aims To determine the pathological basis and clinical features of obstructive sialadenitis in transplanted submandibular glands (SMGs). Methods A total of 161 patients (174 eyes) with keratoconjunctivitis sicca underwent microvascular SMG transplantation. Patients were followed up at approximately 1 and 4 months and annually thereafter. Clinical data, including dry eye discomfort, symptoms of ductal obstruction, and Schirmer test, were recorded. Sialography was performed in six patients. In addition, SMG autotransplantation was performed in 22 rabbits. Salivary flow was recorded and the morphology of glands was examined at 6 months postoperatively by light microscopy. Results Among the patients, 16 out of 172 glands during the latent period (0–3 months) and 2 out of 154 glands with long-term follow-up (>1 year) showed obstructive sialadenitis. Typical manifestations were continuous small volumes of viscous secretions, recurrent gland swelling, decreased Schirmer test values, and irregular dilation of the main duct on sialography. The transplanted SMGs eventually showed no secretion in five cases. Of the 22 rabbit SMGs, 4 had obstructive sialadenitis. Morphological examination showed chronic inflammatory infiltration with salivary deposits. Conclusions Obstructive sialadenitis of transplanted SMGs is a chronic inflammation secondary to ductal obstruction, which leads to insufficient ocular lubrication and potential treatment failure.

To explore the clinical application of endoscope-assisted operative retrieval of large parotid stones as a minimally invasive alternative.From January 2010 to April 2013, 6 patients (male: 5, female: 1, age from 30-62 years, and median age: 49.5 years)suffering from recurred swelling of parotid gland due to sialoliths were treated by endoscope-assisted parotid surgery in Peking University School and Hospital of Stomatology. All of the patients underwent clinical, ultrasonographic and cone-beam CT (CBCT) examinations to get the detailed information of the number, location and size of stones, which was recorded in the medical records. endoscope-assisted parotid surgery was performed under general anesthesia in all the 6 cases after the failure of basket or forcep retrieval firstly. During the operation, sialoendoscope was used to locate the stone exactly and then the calculus was exposed through a pre-auricular approach and released by incising the duct. The postoperative complications were recorded and observed during the follow-up periods.Preoperative radiological examinations showed that all of the sialoliths were near the hilum of parotid gland ducts in the 6 cases, which were 5-9 mm in diameter. All of the stones were removed successfully by endoscope-assisted operative retrieval. The incisions healed smoothly in all the 6 cases. There were no cases of facial nerve weakness, infection or salivary fistula. After a mean follow-up of 19 months (ranging from 6-36 months), 5 patients remained asymptomatic and 1 patient had mild obstructed or infective symptoms. The final results were satisfied.It is suggested that endoscope-assisted operative retrieval is a viable minimally invasive alternative to remove the large or recalcitrant parotid stones with a high successful rate and low complications.

To classify the relationship of the sagittal root positions of the maxillary anterior teeth to their respective osseous housings, and to measure the thickness of facial and palatal alveolar bone by cone-beam computed tomography (CBCT).Twenty-three subjects [9 male, 14 female, mean age: (24.5 ± 1.6) years] who fulfilled the inclusion criteria were involved in this study. The CBCT images were evaluated and the relationship of the sagittal root position of the maxillary anterior teeth to its associated osseous housing was recorded as Kan's Class 1, 2, 3, 4. The facial and palatal alveolar bone thickness at three locations:2 mm apical to crest level, mid-root level and apical level, was measured respectively.Ninety seven point one percent(134/138)of the anterior maxillary teeth were classified as Class 1. Only 2.9% (4/138) were Class 4.Occurrences of2 mm thickness of maxillary facial alveolar bone were found 2.2% (6/276 sites) at 2 mm apical to crest level and mid-root level in the sample of maxillary anterior teeth.The majority of the anterior maxillary teeth roots were positioned close to the labial cortical plate. Most tooth sites in the anterior maxilla had a thin facial bone wall.

To investigate the features of the fill of interdental spaces by gingival papillae and the associated factors.Fifteen volunteers with healthy gingiva were involved in this study. The height and thickness on the alveolar crest level of 62 maxillary anterior papilla were measured radiographically with cone-beam computed tomography (CBCT) scans. A standardized periodontal probe with Williams markings was used for measurements of the papilla width on the alveolar crest level.When the papilla was complete fill interdentally, the mean height of papillary tissue on the alveolar crest level (equal to contact point-bone crest) was (3.67 ± 0.51) mm. The mean thickness of papilla on the alveolar crest level was (8.38 ± 0.75) mm. The papilla height had a positive correlation with papilla thickness (r = 0.433, P0.001).The cone-beam computed tomography can be used for clear visualization of the papilla profile and the measurements of papilla height and thickness. Thicker and wider tissue was associated with an increased likelihood of having a complete papilla fill.

To develop a novel method for obtaining the clear visualization of the gingival profile by cone-beam computed tomography (CBCT) that consistently allows the measurements of gingival thickness and use it to explore the relationship between the gingival thickness and gingival biotype, and the gingival thickness and underlying alveolar bone thickness in the maxillary anterior region.In this study, 15 volunteers with healthy gingiva in the maxillary anterior teeth were involved, and a special preparation was done before CBCT scans including making impression with the contrast agent. The tissue biotypes were assessed clinically with the probe, The thickness of both gingiva and bone and the gingival thickness of the cemento-enamel junction (CEJ) were measured radiographically with cone-beam computed tomography scans. All data analyses were performed using SPSS 16.0.The CBCT image showed clear visualization of the gingival profile. The average gingival thickness of the CEJ was (1.22±0.32) mm. A correlation was observed between the tissue biotypes and the gingival thickness (r=0.449,P0.05). The labial gingival thickness was negative associated with the underlying bone thickness measured with CBCT in the maxillary anterior region (r=-0.31, P=0.021).A method was established for measuring gingival thickness based on cone-beam computed tomography. The gingival biotypes had a positive correlation with gingival thickness of the CEJ.

To investigate the clinical effects of sialoendoscopically-assisted sialolithectomy for the sialolithiasis in the hilum of the submandibular glands.Between December 2005 and March 2011, treated 80 cases of radiography-verified sialiolithiasis in the hilum of the submandibular glands, The patients included 42 males and 38 females aged from 13 to 68 years. All these patients underwent sialoendoscopic observation and sialoendoscopically-assisted sialolithectomy and were followed up periodically for 3 - 6 months after operation. The success rate of stone removal, postoperative complications and clinical effects were analysed.The stones were completely removed in 71 cases, and almost completely removed in 5 cases, with a successful rate of 95% (76/80). Among 76 successful cases, 8 were treated by basket entrapment, 59 by intraoral open surgery and 9 by both of these two techniques. Within 3 - 6 months' follow-up, 1 case suffered temporary lingual nerve parenthesis and two suffered ranula formation.Sialoendoscopically-assisted sialolithectomy is a safe and effective gland-preservation technique for the patients with the hilum of the submandibular glands.

To establish a convenient, objective and applicable method to assess gingival biotype using periodontal probing.A total of 66 maxillary anterior teeth from 14 volunteers (6 males, 8 females) with healthy gingiva, aged from 20 to 30 years, were recruited in this study. The gingival biotypes were evaluated by whether or not the outline of the periodontal probe was clear inside the gingiva. Gingival thickness of the cemento-enamel junction (CEJ) in upper anterior teeth was measured by cone-beam CT (CBCT).The method of periodontal probing-assessed gingival biotype had good consistency and repeatability. The result of probing-assessed gingival biotype was consistent with that obtained by CBCT. The mean thickness of gingiva in thin, compromised and thick gingival biotype was (1.02 ± 0.20), (1.28 ± 0.25) and (1.46 ± 0.25) mm. These differences were significant for all three comparisons (P = 0.001, respectively).Periodontal probing-assessed gingival biotype is a simple, relatively objective and suitable method for clinical examination.

ObjectiveTo measure the tooth lengths of fully developed permanent upper incisors and to qualitatively evaluate the root shapes of the incisors in patients with cleft lip and palate (CLP).DesignCross-sectional, noninterventional, case-control imaging study.SettingHospital and Stomatology Unit of Peking University, Beijing, China (institutional tertiary care).ParticipantsSixty consecutive nonsyndromic CLP patients (including 40 unilateral [UCLP] and 20 bilateral [BCLP]), and 53 age- and sex-matched controls were selected for this study.Main Outcome MeasureCrown heights and root lengths of permanent upper incisors were measured from cone beam computed tomography scans, and the root shapes of upper incisors were evaluated.ResultsCompared with controls, the crown heights of upper incisors in CLP patients were reduced by 9.7% to 22.5% ( p < .05), and the root lengths were reduced by 15.8% to 31.7% ( p < .05). BCLP patients had greater reductions than the UCLP cases ( p < .05). There were no significant differences between incisors and their antimeres in controls and BCLP patients. However, measurements on the cleft side in UCLP patients were lower than those of the noncleft side ( p < .05). The prevalence of atypical root shape was higher in CLP than in the control group ( p = .002); of these, 83.3% (30/36) occurred in central incisors near the cleft.ConclusionThe permanent upper incisors in nonsyndromic CLP patients are underdeveloped. Incisor developmental deficiency was greater in teeth adjacent to the cleft.

Purpose To assess the clinical effects of endoscopy-assisted sialolithectomy for submandibular hilar calculi. Materials and Methods The present study was undertaken in 70 patients with symptomatic stones in the hilum of submandibular glands who underwent endoscopy-assisted sialolithectomy from December 2005 through March 2011 in the Peking University School and Hospital of Stomatology. The operative data were analyzed retrospectively. All patients were followed periodically postoperatively. Submandibular gland function was investigated by postoperative symptoms, clinical examinations, sialography, and scintigraphy. Results Submandibular stones were successfully removed in 65 patients, with a success rate of 92.9%. Temporary lingual nerve injury occurred in 1 patient. Two patients developed ranulae and underwent an uneventful sublingual gland excision. During a mean follow-up of 23 months (range, 6 to 55 mo), 52 of 65 patients were symptom free, whereas 11 patients complained of occasional swelling of the affected gland at mealtimes and 2 patients developed a recurrent stone. Thirty patients underwent postoperative sialography. The sialographic appearances included 4 types: 1) approximately normal; 2) the main duct was significantly dilated at the hilum, but no persistent contrast was seen on the functional film; 3) the main duct was significantly dilated in the hilar region, and persistent contrast was seen at the dilated hilum of the functional film; 4) the main duct was dilated or strictured, and persistent contrast was seen on the functional film. Three of the 4 patients who underwent scintigraphy exhibited good function. Conclusions Sialoendoscopy-assisted sialolithectomy is a safe and effective gland-preservation technique for patients with hilar stones of the Wharton's duct.

To evaluate the application of cone-beam computed tomography (CBCT) in the detection of dental root fractures and to analyse the demographic profile of these fractures.The study group comprised 398 teeth that were examined by CBCT for determining whether they had a root fracture. Patient characteristics were recorded, and the location, fractured roots, fracture types and three-dimensional images of the related skeletal structures were analysed. Two experienced oral radiologists independently analysed each case and reached a consensus, and the diagnosis was graded in one of the following three categories: fracture definitely present (FDP), fracture probably present (FPP) and no visible fracture (NVF).Among these teeth, 155 (39.0%) were diagnosed as FDP, 14 (3.5%) as FPP and 229 (57.5%) as NVF in the consensus reading. During follow-up, all teeth diagnosed as FDP and 4 of the 14 teeth diagnosed as FPP were intra-operatively demonstrated to be fractured. In FDP cases, 60.0% of the patients were aged from 50 to 69 years. In total, 107 FDP teeth were non-endodontically treated, and the remaining were endodontically treated with (n = 16) or without (n = 32) crown placement. The maxillary and mandibular molars were most frequently affected (81.9%). The fractured roots were mostly palatal (65.7%) in maxillary molars and mesial (84.2%) in mandibular molars. The fractures were characterised as vertical (n = 84), horizontal (n = 34), oblique (n = 5) and complicated (n = 32) fractures.The application of CBCT is valuable for the diagnosis of root fracture.

To compare the temporomandibular joint space and condylar position on transcranial projections between the patients with anterior disc displacement (ADD) and the healthy controls. To investigate the diagnostic value of the condylar position for the ADD patients.120 joints of 120 ADD patients and 30 joints of healthy adults, who were taken transcranial projections, were included in this study. The transcranial projections were scanned with precise scanning apparatus and saved as joint photographic group image. The joint spaces were measured with the software of Auto CAD. Two different quantitative methods of joint space measurement, ZHANG Zhen-kang's method and Kamelchuk's method, were used based on the transcranial projections. The ln(P/A) values were calculated (P:width of the posterior joint space; A: width of the anterior joint space). Concentric position of the condyle was defined if ln(P/A) value was between -0.25 and +0.25. If ln(P/A) was larger than +0.25, the condylar position was defined as anteriorly eccentric. Posteriorly eccentric position was indicated when ln(P/A) value was lower than -0.25. The results were compared and software SPSS 12.0 was used for statistical analysis.The results of the two linear measurement methods demonstrated that the superior and posterior joint spaces of the ADD patients were narrower than those of the healthy controls significantly (P0.05), while the anterior joint spaces of the ADD patients had no significant differences with those of the controls (P0.05). In addition, there were significant differences in ln(P/A) values of joint spaces between the patients with ADD patients and the controls (P0.05).Posterior position of the condyle could be a sign of existence of ADD, but ADD could not be diagnosed only by the posterior condyle position showed on the transcranial projections because of the variation of the condylar position.

To evaluate the accuracy of measurement of II degree furcation involvements in molars of dry mandibles by cone-beam computed tomography (CBCT).Twenty molars with II degree furcation involvements in dry mandibles were examined directly and measured by CBCT. Eight parameters were selected to describe the exact appearance of each II degree furcation involvements, including vertical defect dimensions, horizontal defect dimensions and furcation entrance dimensions. The results were compared with the corresponding data obtained by probing and periapical radiograph.All furcation involvements could be correctly classified by CBCT. For 5 of 8 parameters, no significant difference was found between the data obtained by CBCT and probing measurements (P0.05). The distances from furcation entrance to alveolar crest, to bottom of bone pocket, and to the deepest site of horizontal bone defect measured by CBCT were less than those probed directly (P0.05), but the differences were less than 0.5 mm (0.21, 0.24, 0.35 mm, respectively). The localization of furcation entrance may cause the differences. Two out of 20 furcation involvements could not be detected on periapical radiographs, and only 2 of 8 parameters could be measured on periapical radiographs.CBCT could provide precise and detailed 3D images of II degree furcation involvements in vitro.

To investigate the actual relationship between the impacted mandibular third molars (IMTM) and the mandibular canals on panoramic radiographs and cone beam computed tomography (CBCT).A cross-sectional study design was used and panoramic radiographs of 390 patients (645 sides developed IMTM) were included in the present study. The relationship between the IMTM and the mandibular canal on panoramic radiographs was defined in three types: 'untouched', 'touching in point', and 'superimposition or line touching'. The IMTM superimposing and line touching with mandibular canals on panoramic radiographs were examined by CBCT.The relationship types on panoramic radiographs were as follows: 'untouched' type 441 IMTM (68.4%), the type of 'touching in point' 149 IMTM (23.1%) and the type of 'superimposition and line touching' 55 IMTM (8.5%). CBCT showed that 25 (50%) of 50 IMTM of superimposition and line touching type impinged on the mandibular canals.More than 90% of IMTM which do not have intimate relationship with the mandibular canals can be screened out by panoramic radiographs. The IMTM which belong to the line touching and superposition type on panoramic radiographs should be examined by CBCT.

To investigate the value of endoscopy in the diagnosis and treatment of sialolithiasis.Diagnostic and interventional sialoendoscopic procedures were performed in 52 patients with sialolithiasis (43 submandibular glands and 9 parotid glands).Of the 34 sialoliths in the anterior and/or posterior part of the Wharton's duct, 24 were removed with basket retrieval; 2 removed with open surgery and basket retrieval, and 8 removed with open surgery under the guidance of endoscopy. Eight sialoliths in the hilum of the Wharton's duct were treated with open surgery. Of the 9 stone cases in the Stensen's duct, 3 was removed with basket retrieval, 3 was removed after opening-up of the ostium, 1 was treated with basket capturing and open surgery. The obstructive symptoms were improved in these cases during 1-24 months' follow-up.Sialoendoscopy is a minimal invasive and efficacious technique for the diagnosis and treatment of sialolithiasis.

To evaluate the clinical use of cone beam dental CT in the diagnosis of temporomandibular joint osteoarthrosis.Forty-eight cases diagnosed as temporomandibular joint osteoarthrosis (OA) and disk displacement with or without reduction accompanied by OA changes were included, and a total of 96 joints received both trans-pharyngeal radiography and cone beam CT (CBCT) examination. The detectable rate for OA radiographic changes was compared between the two examinations.The radiographic appearances of osteoarthrotic condyle included six types: loss of the lamina dura density of condyle surface (type I), destructive and erosive bone changes (type II), flattening of the articular surface (type III), sclerosis (type IV), osteophytes (type V), and false cyst change (type VI). The detectable ratio of CBCT for all types of osteoarthrosis was 65.63%, 37.50%, 27.08%, 31.25%, 28.13%, 1.04%, respectively, and the detectable ratio of trans-pharyngeal radiographs was 52.08%, 19.79%, 32.29%, 23.96%, 12.50%, 2.08% respectively. Intraobserver and interobserver reproducibility for type I and type II was in good agreement with both the trans-pharyngeal radiographs and CBCT, Kappa0.60.CBCT had higher detectable rates for pathological changes of osteoarthrosis, and could show the exact location, size, and the types of pathological changes. CBCT may be used as a measure in evaluating disease severity and progression, and in clinical trials of disease treatment.

To investigate the condyle position in the fossa and obtain the reference ranges of Temporomandibular joint (TMJ) space of 50 healthy adults (100 joints) by using cone beam computed tomography (CBCT).Fifty healthy adults (100 joints) were selected and undergone CBCT examination in the intercuspal position. Five different methods of joint space measurement were used based on the joint sagittal middle layer of CBCT images and the results were analysed statistically.The reference ranges of TMJ space of CBCT images by using five measurement methods were obtained. The results of the linear measurement methods demonstrated that there were no significant differences between anterior and posterior spaces (Zor=0.99, P0.05),no significant differences between the two side joint spaces including anterior, posterior and superior spaces (tor=1.40, P0.05 ),and also no significant differences in ln (P/A) values between two side joints (tor=0.74, P0.05).All the results of the five measurement methods showed that the condyle was located in the center of the fossa with a variation in the healthy adults in intercuspal position.The CBCT image of the sagittal middle layer of the joint could show the joint space accurately and has an important value in the research related to the changes of TMJ space.

To evaluate the feasibility of cone beam computed tomography (CBCT) for the evaluation of trabecular bone structure in mandibular condyle and to investigate the distribution of the trabecular bone structure within mandibular condyle.Eighty condyles from 40 healthy young volunteers (aged 20-32) were scanned by CBCT. A coronoid image was acquired of each condyle and divided into 8 regions where regions of interest were specified. After CBCT images were binarized, four morphological parameters including bone volume fraction, trabecular thickness, trabecular number and trabecular separation were computed.All parameters were significantly different between the superior zone and middle/inferior zone of the condyle (P0.05). Superior zone showed the largest bone volume fraction (52.2%), the highest trabecular number (1.33 mm(-1)), the thinnest trabecular thickness (393.48 microm), and the smallest trabecular separation (361.59 microm). Inferior zone showed the smallest bone volume fraction (49.64%). These results were not significantly different between bilateral sides of the condyles (P0.05).Trabecular bone structure was inhomogeneous within the condyle, but symmetrical between bilateral sides of the condyles. CBCT combined with image processing is a feasible tool in evaluating trabecular bone structure of human mandibular condyle.

Osteoarthritic lesions of Temporomandibular joint(TMJ) were assessed by dental cone beam computed tomography(CBCT), and compared with conventional radiographic technology.The study was conducted retrospectively on 511 joints of 350 patients, who had undergone dental CBCT, panoramic radiography, transcranial projection and transpharygeal projection of TMJ. The results were compared and the accuracy with CBCT was assessed. The types of osseous condylar abnormalities were observed.(1) The occurrence of osteoarthritis in male and female were 59.04% and 69.66%, respectively, with no significant difference. (2) Compared with CBCT, panoramic radiography, transpharygeal projection examination showed no significant difference, with the accuracy being 90.64% and 94.10%, respectively; However, transcranial projection indicated a significant difference in comparison with CBCT and the accuracy was 86.97%. (3) A higher occurrence of osteoarthritic lesions of the condyle was sclerosis (39.86%). Bony proliferation or osteophyte (28.18%) and ill-defined cortical bone (18.90%) were followed.Cone beam CT, which reproduces multiple images including axial, coronal and sagittal planes of the joint, provides a complete radiographic investigation of the bony components of the TMJ. It is one of the best choices of imaging diagnosis of TMJ osteoarthritis. Panoramic radiography and transpharygeal projection examination are also good choices for showing osseous condylar abnormalities in the clinic, but transcranial projection examination is inferior.

Purpose The purpose of this article is to introduce the use of cone-beam computed tomography (CBCT) for evaluation of supernumerary teeth. Methods The study group comprised 487 patients with a total of 626 supernumerary teeth who were examined by CBCT. Patient characteristics were recorded, and the number, location, shape, and 3-dimensional position of the supernumeraries were analyzed. The ability of CBCT to visualize dental and skeletal structures relative to supernumerary teeth was also evaluated. Results Males were affected more than females in a ratio of 2.64:1. Seventy-two percent of the patients had 1 supernumerary tooth, 27.3% had 2, and 0.6% had 3 supernumeraries. Supernumerary teeth were most frequently located in the anterior maxilla (92%), and their sagittal location relative to the neighboring teeth could be used for classification purposes. Supernumeraries were most commonly conical in shape (83.5%). CBCT yielded accurate 3-dimensional pictures of the dental and bony structures. The sagittal positions of the 578 supernumerary teeth in the anterior maxilla were divided into 6 types, of which types I and III were most commonly associated with local malocclusions. Moreover, 43.4% of the premaxillary supernumeraries were inverted and 21.1% were transversely oriented. Conclusions CBCT imaging yields accurate 3-dimensional pictures of local dental and bony structures, which is helpful for pretreatment evaluation of supernumerary teeth.

To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options.X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options.The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively.Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.

Objective The purpose of this study was to investigate the angiographic features of hypervascular head and neck neoplasms and to evaluate the effects of embolization on these lesions. Methods Angiograms and operation records of 25 patients with hypervascular neoplasms (23 neck paragangliomas, 1 hemangiopericytoma, and 1 hemangioendothelioma) were retrospectively analyzed, and the effects of 8 embolization procedures were estimated. Results Angiograms demonstrated that 23 neck paragangliomas (NPs) were manifested as richly vascularized lesions, and were divided into 3 types. Type I NPs (n = 2) were located cranial-laterally to the carotid bifurcation, and were removed with an intact carotid artery and injured vagus nerve. Type II (n = 17) lesions widened the bifurcations in 16 of 17 cases. During the operation, the continuity of the internal carotid arteries was preserved in 15 of 17 cases. Type III (n = 4) lesions enveloped the carotid bifurcations, and were removed together with the bifurcations in 3 of 4 cases. In 6 type II paraganglioma cases intra-arterial embolization was employed and the paragangliomas were removed with less blood loss (238 mL) than the nonembolized group (600 mL). Additionally, the infratemporal hemangiopericytoma and the parotid hemangioendothelioma were embolized and removed uneventfully. Conclusions Angiographic studies are highly valuable for the diagnosis and preoperative analysis of hypervascular head and neck neoplasms. Also, embolization therapy may minimize intraoperative blood loss. Both methods should be employed in a team approach to lesion treatment.