Objective: Applications of Cone-beam computerized tomography (CBCT) have increased dramatically in dentistry. Incidental findings (IFs) beyond the area of interest may be encountered. The maxillary sinus incidental findings in CBCT were considered the highest in the literature. This systematic review aims to analyze present literature on IFs in the maxillary sinus using CBCT Methods: Electronic databases was searched for studies on the maxillary sinus incidental findings in CBCT to assess the prevalence and significance of the incidental findings. Results: The initial search retrieved 239 abstracts, of which only 9 studies met the inclusion criteria. The sample size ranged from 34-1029 participants with a mean age of 35.4. The prevalence of incidental findings in the maxillary sinus was between 27 to 62.4%. Such findings in the maxillary sinus vary in importance and the need for intervention. The most common incidental findings were the thickening of the mucosal membrane followed by the polypoid lesion. / Oral Biology

No description available.

A radiografia panorâmica é o exame complementar de imagem mais solicitado pelos cirurgiões-dentistas e parte essencial da documentação utilizada pelos ortodontistas no planejamento do tratamento ortodôntico. Durante a transição da dentadura mista para a permanente, o processo biológico é complexo, podendo ocorrer falhas ou irregularidades odontogênicas, que resultam em anomalias dentárias. Entretanto, outras alterações podem ser vistas nas imagens radiográficas panorâmicas, que modificam densidade óssea e alteram o trabeculado ósseo no período entre o início e o término do tratamento ortodôntico. Algumas destas alterações podem interferir ou modificar o diagnóstico durante o tratamento ortodôntico. O número de imagens radiográficas obtidas durante o tratamento ortodôntico depende do protocolo estabelecido caso a caso. Neste estudo interpretamos 500 imagens panorâmicas, sendo 250 pré-tratamento ortodôntico e 250 pós-tratamento ortodôntico, de pacientes com idade de 11 a 18 anos, pertencentes ao Departamento de Ortodontia da Faculdade de Odontologia de Bauru FOB USP. A interpretação radiográfica foi realizada por um único examinador. Nosso objetivo foi avaliar imagens que foram obtidas no início e no final do tratamento ortodôntico e os resultados nos permitiram concluir que no grupo referente à transição da dentadura mista para a dentição permanente, as imagens panorâmicas possuíram o maior número de achados incidentais; a remodelação apical ortodôntica dos incisivos foi encontrada em 180 casos pós-tratamento ortodôntico; houve diferença estatisticamente significante (Teste de Wilcoxon; p<0,05) nos resultados da ossificação do complexo estilo-hióideo bilateral e realização de tratamento endodôntico pré e pós-tratamento ortodôntico; e, muitos dos achados necessitam de intervenção durante o tratamento. / Panoramic radiograph is the most requested imaging exam by dentists and it plays essential role in documentation for orthodontic treatment planning. During the transition from mixed dentition to permanent dentition, the biological process is complex and may experience odontogenic failures or irregularities that result in dental abnormalities. However, other changes can be seen in the panoramic radiography that modify bone density and trabecular bone when it is compared before and after orthodontic treatment. Some of these changes may affect and modify the diagnosis during orthodontic treatment. The number of radiographic images obtained in orthodontic treatment depends on the protocol established for each case. In this study we interpret 500 panoramic radiograph, of patients with age of 11 to 18, belonging to the Department of Orthodontics, Bauru Dental School. The radiographic interpretation was performed by a single examiner. Our objective was to evaluate images that were taken at the beginning and end of orthodontic treatment and the results allowed us to conclude that the most incidental findings were observed in panoramic images in the group concerning the transition from mixed dentition to permanent dentition; apical root resorption of the incisors was found in 180 orthodontic post-treatment cases; there was a statistically significant difference (Wilcoxon Test; p<0.05) between the results of ossification of complex bilateral stylohyoid and endodontic treatment before and after orthodontic treatment; and many of the findings require intervention during treatment.

A radiografia panorâmica é o exame complementar de imagem mais solicitado pelos cirurgiões-dentistas e parte essencial da documentação utilizada pelos ortodontistas no planejamento do tratamento ortodôntico. Durante a transição da dentadura mista para a permanente, o processo biológico é complexo, podendo ocorrer falhas ou irregularidades odontogênicas, que resultam em anomalias dentárias. Entretanto, outras alterações podem ser vistas nas imagens radiográficas panorâmicas, que modificam densidade óssea e alteram o trabeculado ósseo no período entre o início e o término do tratamento ortodôntico. Algumas destas alterações podem interferir ou modificar o diagnóstico durante o tratamento ortodôntico. O número de imagens radiográficas obtidas durante o tratamento ortodôntico depende do protocolo estabelecido caso a caso. Neste estudo interpretamos 500 imagens panorâmicas, sendo 250 pré-tratamento ortodôntico e 250 pós-tratamento ortodôntico, de pacientes com idade de 11 a 18 anos, pertencentes ao Departamento de Ortodontia da Faculdade de Odontologia de Bauru FOB USP. A interpretação radiográfica foi realizada por um único examinador. Nosso objetivo foi avaliar imagens que foram obtidas no início e no final do tratamento ortodôntico e os resultados nos permitiram concluir que no grupo referente à transição da dentadura mista para a dentição permanente, as imagens panorâmicas possuíram o maior número de achados incidentais; a remodelação apical ortodôntica dos incisivos foi encontrada em 180 casos pós-tratamento ortodôntico; houve diferença estatisticamente significante (Teste de Wilcoxon; p<0,05) nos resultados da ossificação do complexo estilo-hióideo bilateral e realização de tratamento endodôntico pré e pós-tratamento ortodôntico; e, muitos dos achados necessitam de intervenção durante o tratamento. / Panoramic radiograph is the most requested imaging exam by dentists and it plays essential role in documentation for orthodontic treatment planning. During the transition from mixed dentition to permanent dentition, the biological process is complex and may experience odontogenic failures or irregularities that result in dental abnormalities. However, other changes can be seen in the panoramic radiography that modify bone density and trabecular bone when it is compared before and after orthodontic treatment. Some of these changes may affect and modify the diagnosis during orthodontic treatment. The number of radiographic images obtained in orthodontic treatment depends on the protocol established for each case. In this study we interpret 500 panoramic radiograph, of patients with age of 11 to 18, belonging to the Department of Orthodontics, Bauru Dental School. The radiographic interpretation was performed by a single examiner. Our objective was to evaluate images that were taken at the beginning and end of orthodontic treatment and the results allowed us to conclude that the most incidental findings were observed in panoramic images in the group concerning the transition from mixed dentition to permanent dentition; apical root resorption of the incisors was found in 180 orthodontic post-treatment cases; there was a statistically significant difference (Wilcoxon Test; p<0.05) between the results of ossification of complex bilateral stylohyoid and endodontic treatment before and after orthodontic treatment; and many of the findings require intervention during treatment.

Background: Incidental findings (IFs) are reported in 20% or more of trauma CT scans. In addition to the importance of patient disclosure, there is considerable legal pressure to avoid missed diagnoses. We reported previously that 63.5% of IFs were disclosed before discharge and with 20% were nondisclosed. We initiated a multidisciplinary systemic plan to effect predischarge disclosure by synoptic CT reports with American College of Radiology recommended follow-up, electronic medical records discharge prompts, and provider education. Study Design: Prospective observational series patients from November 2019 to February 2020 were included. Statistical analysis was performed with SPSS, version 21 (IBM Corp). Results: Eight hundred and seventy-seven patients underwent 1 or more CT scans for the evaluation of trauma (507 were male and 370 were female). Mean age of the patients was 57 years (range 14 to 99 years) and 96% had blunt injury. In 315 patients, there were 523 IFs (1.7 per patient); the most common were lung (17.5%), kidney (13%), and liver (11%). Radiology report compliance rate was 84% (210 of 249 patients). There were 66 studies from outside facilities. Sixteen IFs were suspicious for malignancy. A total of 151 patients needed no follow-up and 148 patients needed future follow-up evaluation. Predischarge IF disclosure compliance rate was 90.1% (286 patients); 25 were post discharge. Four patients remained undisclosed. Compared with our previous report, clearer reporting and electronic medical records prompts increased predischarge disclosure from 63.5% to 90.1% (p < 0.01, chi-square test) and decreased days to notification from 29.5 (range 0 to 277) to 5.2 (range 0 to 59) (p < 0.01, Mann-Whitney U test). Conclusions: Timely, complete disclosure of IFs improves patient outcomes and reduces medicolegal risk. Collaboration among trauma, radiology, and information technology promotes improved disclosure in trauma populations.

No description available.

A possibilidade de obtenção de imagens em três dimensões com a Tomografia Computadorizada de Feixe Cônico (TCFC) aumentou, sobremaneira, a capacidade de diagnóstico e planejamento odontológico. Exames de TCFC cobrindo toda a região maxilofacial permitem a detecção de lesões e anomalias fora da área específica de interesse. A avaliação minuciosa do exame nos permite a constatação de achados incidentais com ou sem significado clínico. São considerados como achados incidentais, imagens descobertas não relacionadas com o propósito original do exame e incluem variações anatômicas, anomalias, lesões benignas ou malignas. Neste estudo, avaliou-se o tipo, frequência e localização de achados incidentais na região maxilofacial de exames tomográficos, e a relevância clínica dos achados foi classificada quanto à necessidade ou não de acompanhamento, tratamento ou encaminhamento para um profissional especializado. Foram avaliados 150 exames de TCFC, divididos de acordo com o tamanho do FOV (campo de visão) em três grupos: maxila 6cm, mandíbula 6cm e maxila/mandíbula 13 cm. Os achados incidentais foram categorizados em 6 zonas: vias aéreas, ATM, osso, lesões dos maxilares, dente e calcificações de tecido mole. Os resultados mostram 560 achados incidentais que foram encontrados em 92% da amostra avaliada, sendo 225 nos exames onde o FOV abrangia maxila, 99 na mandíbula e 236 na maxila/mandíbula. Os achados incidentais foram mais frequentes na zona de dente, com 27,32% dos achados, seguida pelas vias aéreas com 24,46%, calcificações de tecido mole com 20,53%, ATM com 16,42%, 7,32% osso, lesões dos maxilares 1,96% e outros achados também com 1,96%. Foi constatado ainda que: 43,46% dos achados incidentais não necessitaram de tratamento ou encaminhamento para outro profissional, 28,97% necessitaram da aquisição de novas imagens para acompanhamento e 27,57% necessitaram de tratamento ou encaminhamento. Este estudo confirmou a alta frequência de achados incidentais em exames de TCFC. Concluiu-se que é necessária a interpretação e emissão de laudo de todo o volume obtido no exame de TCFC e não somente da região do propósito do exame. / The ability to obtain images in three dimensions with Cone Beam Computed Tomography (CBCT) has greatly increased the ability for dental diagnosis and planning. CBCT exams covering all the maxillofacial areas allow the detection of abnormalities and lesions outside the specific area of interest. A thorough evaluation of the exams allows for the discovery of incidental findings with or without clinical significance. Discovered images unrelated to the original purpose of the examination are considered incidental findings and include anatomical variations, anomalies, benign and malignant lesions. In the present study, the type, frequency and location of incidental findings in the maxillofacial region of CBCT scans were evaluated, and the clinical relevance of the findings were classified as requirement or not monitoring, treatment or referral to a specialist. Evaluated were 150 CBCT exams, divided according to the size of the FOV (field of view) into three groups: 6cm maxilla, 6cm mandible and 13 cm maxilla/mandible. The incidental findings were categorized into six areas: Airway, ATM, bone, lesions of the jaws, teeth and soft tissue calcifications. The results show 560 incidental findings that were found in 92% of the sample studied, with 225 exams where the FOV covered just the maxilla, 99 in the mandible and 236 in the maxilla/mandible. The incidental findings were more frequent in the tooth zone, with 27.32% of the findings, followed by airways with 24.46%, soft tissue calcifications with 20.53%, ATM with 16.42%, 7.32% bone, 1.96% lesions of the jaw and 1.96% other findings. Also found were that 43.46% of the incidental findings did not need treatment or referral to another professional, 28.97% required the acquisition of new images for monitoring and 27.55% needed treatment or referral. The present study confirmed the high frequency of incidental findings in CBCT scans. It was concluded that it is necessary to interpret and report the total volume obtained in the CBCT examinations and not only the purpose of the examination region.

Análise de variantes alélicas no gene Armadillo Repeat Containing 5 (ARMC5) em pacientes com incidentaloma da suprarrenal identificamos 16 pacientes carreadores da mutação, a partir de dois irmãos inicialmente investigados. Aproximadamente 30% dos membros afetados desta genealogia, apresentavam somente uma suprarrenal acometida e a suprarrenal contra-lateral absolutamente normal ou discretamente espessada. Esta observação nos infere que a hiperplasia macronodular da PMAH pode ocorrer de forma assincrônica e dificultar aprincipio o seu diagnostico. A incidência de nódulos unilaterais identificados em exame de imagens na pratica clinica é muito elevada (1,4 - 2,9%, podendo chegar a 10% em pacientes com idade a cima de 70 anos) os denominados incidentalomas suprarrenais. Além disso, a grande maioria dos pacientes com nódulos suprarrenais apresentam alguma autonomia da secreção do cortisol. Considerando estes aspectos, nos propomos a investigar se os incidentalomas suprarrenais unilaterais com alguma autonomia da secreção do cortisol poderiam fazer parte do espectro de apresentação da PMAH. Nosso trabalho tem como foco analisar a frequência das variantes alélicas do ARMC5 em uma coorte multicêntrica de pacientes com nódulos suprarrenais incidentais e autonomia da secreção do cortisol. O esclarecimento da frequência da PMAH pode nos direcionar a uma melhor pratica clinica e cuidados com os pacientes / Primary macronodular adrenal hyperplasia (PMAH) was described in 1964 by Kirschner et al, and is considered a rare cause of endogenous ACTH-independent Cushing\'s syndrome (CS), usually associated with bilateral adrenal nodules. The clinical presentation of the patients is heterogeneous, ranging from subclinical to overt Cushing\'s syndrome, with all its characteristics. The cortisol secretion pattern, after the 1 mg dexamethasone overnight suppression test, identifies the intensity of cortisol secretion autonomy, ie, serum cortisol concentrations above 1.8 ug / dL and up to 5 ug / dL , characterize a possible autonomous cortisol secretion and above this value (5 ug / dL) an autonomous cortisol secretion. Patients are generally diagnosed with PMAH when undergoing ACTH-independent endogenous hypercortisolism investigation or, more frequently, during the investigation of bilateral adrenal incidentalomas and less likely in patients with metabolic syndrome associated with meningiomas of the central nervous system, since these are very prevalence in patients with PMAH. Bilateral adrenal involvement, along with the description in the literature of several PMAH-affected family relatives, has already indicated a genetic cause involved in the pathophysiology of this intriguing disease. In 2013, two studies, one Brazilian and one Franch, using distinct methodologies, identified germline mutations in ARMC5 as the major genetic cause of PMAH. The largest genealogy published so far was that of a Brazilian family, with 5 generations in which we identified 16 patients, carriers of the mutation, from two siblings initially investigated. Approximately 30% of the affected members of this genealogy had only one adrenal afected with the contralateral gland absolutely normal or discretely thickened. This observation infers us that the macronodular hyperplasia of PMAH can occur in an asynchronous way and make it difficult to diagnose it. The incidence of unilateral nodules identified in clinical imaging is very high (1.4-2.9%, and may reach 10% in patients over the age of 70), the so-called adrenal incidentalomas. In addition, the vast majority of patients with adrenal nodules have some autonomy in cortisol secretion. Considering these aspects, we propose to investigate whether unilateral adrenal incidentalomas, with some autonomy of cortisol secretion, could be part of the presentation spectrum of PMAH. Our work focuses on the frequency of allelic variants of ARMC5 in a multicentric cohort of patients with incidental adrenal nodules and autonomy of cortisol secretion. Clarifying the frequency of PMAH may lead to better clinical practice and patient care

Background: Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance. Methods: Between January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance. Results: Overall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively. Conclusion: Whole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

A possibilidade de obtenção de imagens em três dimensões com a Tomografia Computadorizada de Feixe Cônico (TCFC) aumentou, sobremaneira, a capacidade de diagnóstico e planejamento odontológico. Exames de TCFC cobrindo toda a região maxilofacial permitem a detecção de lesões e anomalias fora da área específica de interesse. A avaliação minuciosa do exame nos permite a constatação de achados incidentais com ou sem significado clínico. São considerados como achados incidentais, imagens descobertas não relacionadas com o propósito original do exame e incluem variações anatômicas, anomalias, lesões benignas ou malignas. Neste estudo, avaliou-se o tipo, frequência e localização de achados incidentais na região maxilofacial de exames tomográficos, e a relevância clínica dos achados foi classificada quanto à necessidade ou não de acompanhamento, tratamento ou encaminhamento para um profissional especializado. Foram avaliados 150 exames de TCFC, divididos de acordo com o tamanho do FOV (campo de visão) em três grupos: maxila 6cm, mandíbula 6cm e maxila/mandíbula 13 cm. Os achados incidentais foram categorizados em 6 zonas: vias aéreas, ATM, osso, lesões dos maxilares, dente e calcificações de tecido mole. Os resultados mostram 560 achados incidentais que foram encontrados em 92% da amostra avaliada, sendo 225 nos exames onde o FOV abrangia maxila, 99 na mandíbula e 236 na maxila/mandíbula. Os achados incidentais foram mais frequentes na zona de dente, com 27,32% dos achados, seguida pelas vias aéreas com 24,46%, calcificações de tecido mole com 20,53%, ATM com 16,42%, 7,32% osso, lesões dos maxilares 1,96% e outros achados também com 1,96%. Foi constatado ainda que: 43,46% dos achados incidentais não necessitaram de tratamento ou encaminhamento para outro profissional, 28,97% necessitaram da aquisição de novas imagens para acompanhamento e 27,57% necessitaram de tratamento ou encaminhamento. Este estudo confirmou a alta frequência de achados incidentais em exames de TCFC. Concluiu-se que é necessária a interpretação e emissão de laudo de todo o volume obtido no exame de TCFC e não somente da região do propósito do exame. / The ability to obtain images in three dimensions with Cone Beam Computed Tomography (CBCT) has greatly increased the ability for dental diagnosis and planning. CBCT exams covering all the maxillofacial areas allow the detection of abnormalities and lesions outside the specific area of interest. A thorough evaluation of the exams allows for the discovery of incidental findings with or without clinical significance. Discovered images unrelated to the original purpose of the examination are considered incidental findings and include anatomical variations, anomalies, benign and malignant lesions. In the present study, the type, frequency and location of incidental findings in the maxillofacial region of CBCT scans were evaluated, and the clinical relevance of the findings were classified as requirement or not monitoring, treatment or referral to a specialist. Evaluated were 150 CBCT exams, divided according to the size of the FOV (field of view) into three groups: 6cm maxilla, 6cm mandible and 13 cm maxilla/mandible. The incidental findings were categorized into six areas: Airway, ATM, bone, lesions of the jaws, teeth and soft tissue calcifications. The results show 560 incidental findings that were found in 92% of the sample studied, with 225 exams where the FOV covered just the maxilla, 99 in the mandible and 236 in the maxilla/mandible. The incidental findings were more frequent in the tooth zone, with 27.32% of the findings, followed by airways with 24.46%, soft tissue calcifications with 20.53%, ATM with 16.42%, 7.32% bone, 1.96% lesions of the jaw and 1.96% other findings. Also found were that 43.46% of the incidental findings did not need treatment or referral to another professional, 28.97% required the acquisition of new images for monitoring and 27.55% needed treatment or referral. The present study confirmed the high frequency of incidental findings in CBCT scans. It was concluded that it is necessary to interpret and report the total volume obtained in the CBCT examinations and not only the purpose of the examination region.