Multiple myeloma of the jaw: A case report

Multiple myeloma is a systemic B-cell lymphoproliferative disease that causes osteolytic lesions in the vertebra, ribs, pelvic bone, skull and jaw. Rarely jaw lesions are seen as the first sign in multiple myeloma. This is a case report with follow up of a 57-year-old female patient, previously treated for osteoporosis, who presented with a swelling of the jaw. On radiographic examination, she was found to have osteolytic lesions in the mandible and skull bones. These conventional aids led to the diagnosis of multiple myeloma thereby proving that the osteoporotic lesions were a part of the spectrum of multiple myeloma. The patient underwent chemotherapy and is currently on follow-up. This case report emphasizes the importance of early diagnosis of multiple myeloma in the jaw using readily available technologies and illustrates the contribution that oral assessment can provide

Determination of Proximity of Mandibular Third Molar to Mandibular Canal Using Panoramic Radiography and Cone-beam Computed Tomography

Objectives: Position of inferior alveolar canal with respect to an impacted third molar reveals certain radiographic signs, but three-dimensional relationship to the canal can be provided with cone-beam computed tomography (CBCT). The purpose of this study was to determine which radiographic signs on panoramic radiography indicate a true relationship on CBCT. Materials and Methods: Forty samples with signs or symptoms of impacted mandibular third molar and panoramic radiograph showing signs of a close relationship with the mandibular canal as described by Félez-Gutiérrez et al. were included in the study and subjected to CBCT. Radiographic signs on panoramic radiography were compared with the relationship on CBCT. Statistical analysis was done using Chi-square test. Results: Twenty-one samples (52.5%) showed darkening of the apex, which was the most frequent type of radiographic sign of a close relationship on panoramic radiography. Twenty-three samples (57.5%) revealed a true relationship on CBCT. Darkening of the apex and narrowing of the canal were the signs most frequently associated with a true relationship. On CBCT, coronal and axial sections better predicted a true relationship. Conclusion: This study showed that the presence of any of the radiographic signs cannot definitely predict a true relationship; however, the presence of a close sign on panoramic radiography is often associated with a true relationship to the canal

Comparison of gray values of cone-beam computed tomography with hounsfield units of multislice computed tomography: An in vitro study

Purpose: Hounsfield unit (HU) provides a quantitative evaluation of bone density. The assessment of bone density is essential for successful treatment plan. Although, multislice computed tomography (MSCT) is considered as gold standard in evaluating bone density, cone-beam computed tomography (CBCT) is frequently used in dentomaxillofacial imaging due to lower radiation dose, less complex device, and images with satisfactory resolution. Aims and Objectives: The aim of this study is to determine and compare the gray value and HU value of hypodense and hyperdense structures on CBCT and MSCT, respectively. The study also evaluated and compared the gray values in different field of views within CBCT. Materials and Methods: A total of 20 dry human mandibles were obtained. The gray values and HU values of hypodense structures (extraction socket, inferior alveolar canal, and mental foramen) and hyperdense structures (enamel, cancellous, and cortical bone) were evaluated and compared between CBCT and MSCT images, respectively. The obtained data were statistically analyzed. Statistical Analysis: One-way analyses of variance, ANOVA F-test. Results: The gray value for hypodense structures in large volume CBCT scans resembled the HU value. The study showed statistically significant difference (P < 0.001) in gray values for all the hyperdense structures in CBCT when compared to HU values of MSCT scans. Conclusion: The gray value for hypodense structures in large volume CBCT scan was more reliable and analogous to HU value in MSCT. The determination of grey values in CBCT may not be as accurate as HU value in CT for hyperdense structures

A Novel Mobile Health Approach to Early Diagnosis of Oral Cancer.

AimThe incidence of oral cancer is high in India, which can be reduced by early detection. We aimed to empower frontline health care providers (FHP) for early detection and connect specialist to rural population through mHealth.Materials and methodsWe provided training to FHPs in examination of oral cavity, use of mobile phone for image capture, and risk factor analysis. The FHPs were selected from different cohorts in resource-constrained settings. The workflow involved screening of high-risk individuals in door-to-door and workplace settings, and capture of images of suspected lesions. Uploaded data were interpreted and recommendation was sent by specialist from a remote location. Their recommendation was intimated to FHPs who arranged for further action. Two more initiatives, one for multiple dental schools and another for private practitioners, were undertaken.ResultsDuring the period from 2010 to 2018, 42,754 subjects have been screened, and 5,406 subjects with potentially malignant disorders have been identified. The prevalence of potentially malignant disorders varied from 0.8 to 62% at different cohorts; 516 biopsies have been performed at remote locations.ConclusionConnecting specialists to rural population was made possible through the use of mobile health. Trained FHP were able to reach out to the population. Electronic data capture facilitated efficient follow-up. The program was very cost-effective with screening completed under $1 per person.Clinical significanceIn view of the high incidence of oral cancer in India, and the resource-constrained settings, mobile health paves the way for better access to specialist care for the rural population