2022/2023 Oral & Maxillofacial Surgery Equipment Catalog - 2

CUSTOMIZED PRACTICE SOLUTIONS
continued from page 1
In analyzing the sinuses, CBCT imaging can help
differentiate between acute and chronic rhinosinusitis.
Acute sinusitis will have a bubbly appearance, which is
indicative of active secretions. If the cortical borders are
thin and intact, this is likely acute rhinosinusitis. Typically,
this does not require an ENT referral unless the patient has
had persistent sinus symptoms for two weeks or more,
or if a sinus lift and bone graft are planned on that side.
With chronic sinusitis, there is thickening and sclerosis of
the cortical borders, and sometimes there are differences
between the right and left side, due to inflammation. Such
cases should be referred to an ENT.
Nasal area
Check the CBCT images to make sure the patient has a
straight nasal septum. Many people have a deviated nasal
septum, which can decrease the airflow on that particular
side. Also, look at the nasal turbinates and the lacrimal
ducts. Sometimes there are variations in the size of
turbinates, which is normal, but worth examining as part of
a comprehensive exam.
Sphenoid bone
When evaluating the sphenoid bone, check from side to
side to ensure the cortical border is intact, since some
pathologies show up in this particular area. Mastoid air
cells are not always symmetrical, and this isn't a concern.
Pneumatization can occur anywhere throughout the
temporal bone, and it's not uncommon to see in the
zygomatic process as well.
When evaluating a CBCT, the differences between a
styloid process and a calcified carotid atheroma should be
clear. A styloid process tends to be very high in the neck
(approximately at C1 or C2 level) while a calcified carotid
atheroma will be at C3 or C4 level. Stylohyoid ligaments
can also ossify, which is common in roughly 4% of the
population. Of the 4% of the population that have ossified
stylohyoid ligaments, only 4-10% of them actually have
eagle syndrome, which is caused by compression of the
carotid artery. If the patient is asymptomatic, that is normal.
If the patient is experiencing issues such as fainting or pain
if they turn their neck, that is more likely to be an actual
anatomical impingement.
Temporomandibular joints
Verify that there isn't thickening or sclerosis in this area,
which would be indicative of a chronic inflammatory
process. The temporomandibular joint region should have
thin cortical borders within the glenoid fossa region (the
borders are not fully ossified until an individual is 21 to 22
years old, so if you're evaluating an 18-year-old patient and
don't see cortical borders, it doesn't mean they
aren't there).
Mandibular ramus region
It's not uncommon to see beam hardening artifacts in
the ascending ramus region. However, generally these
areas should be symmetrical. Ensure that cortical borders
are smooth and intact. If not, this could be the sign of a
pathological entity.
Mandibular canal
When analyzing the mandibular canal, check the cortical
borders so you can avoid placing implants within these.
Keep in mind that in roughly 5% of the population,
osteoporotic changes make it difficult to see cortical
borders. In such cases, working with a specialist such
as an oral maxillofacial radiologist can be beneficial for
determining next steps.
Bone quality
Prior to implant procedures, examine the available bone
height and width. Look at the mandibular canal in relation
to this, and leave at least a 1- to 2-millimeter buffer in
between. That imagery will help determine the type
of fixture, its length and diameter and the access of
orientation.
CBCT imaging will also help make it clear the quality of the
bone prior to implant surgery to verify if the patient is a
good candidate for the procedure. Generalized pitting with
thin borders may indicate osteoporotic changes. This may
mean there is poor quality bone in that area.
Conclusion
All of this analysis will help ensure implant procedures
move forward seamlessly and successfully. It's equally
important to document the analysis that was done in
the patient's electronic record. This is necessary from a
medical and legal perspective. This due diligence helps
to set each patient up for success, ensure they have the
right expectations for any procedure and that you have
documentation should there be any resultant legal issues
down the road related to the procedure. This demonstrates
that you evaluated all relevant areas of the patient's
anatomy to properly plan for implants or other procedures.
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