LETTERS TO THE EDITOR J Oral Maxillofac Surg 72:3-5, 2014
CONE-BEAM COMPUTED TOMOGRAPHIC INCIDENTAL FINDINGS—A CAUSE FOR WORRY
volume of the CBCT scan and obtain additional training, if needed, to knowledgeably evaluate the entirety of the scan beyond the maxillofacial complex.
To the Editor:—A recently published editorial in this journal1 cited a systematic review of the literature2 detailing the aggregated incidence of incidental findings (IFs) at conebeam computed tomography (CBCT). The editorial, which denoted the most common findings (eg, vertebral degenerative changes and sinusitis) in the combined set of studies, correctly stated that none of these were life-threatening. Furthermore, the editor appropriately noted that older patients having imaging studies presumably performed for implant placement had a much higher incidence of IFs than younger patients likely being evaluated for orthodontic treatment purposes and impacted teeth. The attention of the journal readership, however, must be drawn to one of these articles written by a group of maxillofacial radiologists who described their findings in a group of 300 patients (mean age, 49.3 yr; range, 9 to 85 yr; 56.3% female patients) requiring CBCT in the main (73%) for implant placement at the University of North Carolina School of Dentistry.3 Of importance is the fact that 13 patients, likely those in the oldest cohort (n = 169; age range, 50 to 85 yr), exhibited calcified carotid artery atheromas in the cervical distribution. Price et al3 properly noted that they advised the dentists requesting these imaging studies to refer these patients to their physicians for further investigation given the gravity of this finding. This finding is substantive given that atherosclerosis is often simultaneously present in multiple arterial territories and specifically because the presence of calcified plaque in the extracranial carotid vasculature is a major cause of ischemic stroke and a risk indicator of even more advanced ischemic disease in the coronary arteries leading to myocardial infarction. At the present time, outcome studies of CBCT-detected carotid calcifications have not been executed; however, the imaging technique is not terribly dissimilar from that of noncontrast-enhanced CT, which has been used to conduct just such consequential studies. Specifically, such studies have shown that the volume of calcified carotid artery plaque is directly related to the presence of cerebral infarcts.4 Similarly, the presence and extent of carotid calcific plaque in middle-aged individuals free of extant clinical cardiovascular disease has been associated with a significantly increased hazard for incident mortality after adjustment for age, gender, and traditional cardiovascular disease factors.5 Thus, it was reassuring that the editorial recognized the need for those oral and maxillofacial surgeons who obtain and interpret their own studies to review the entire digital
ARTHUR H. FRIEDLANDER, DMD Los Angeles, CA
References 1. Hupp JR: Editorial: Cone-bean computed tomography: Incidental findings—A cause for worry. J Oral Maxillofac Surg 71:1157, 2013 2. Edwards R, Altalibi M, Flores-Mir C: The frequency and nature of incidental findings in cone-beam computed tomographic scans of the head and neck region: A systematic review. J Am Dent Assoc 144:161, 2013 3. Price JB, Thaw KL, Tyndall DA, et al: Incidental findings from cone beam computer tomography of the maxillofacial region: A descriptive retrospective study. Clin Oral Implants Res 23: 1261, 2012 4. Bos D, Ikram A, Elias-Smale SE, et al: Calcification in major vessel beds related to vascular brain disease. Arterioscler Thromb Vasc Biol 31:2331, 2011 5. Allison MA, Hsi S, Wassel CL, et al: Calcified atherosclerosis in different vascular beds and the risk of mortality. Arterioscler Thromb Vase Biol 32:140, 2012
http://dx.doi.org/10.1016/j.joms.2013.09.010
MANDIBULAR RECONSTRUCTION USING INTRAORAL MICROVASCULAR ANASTOMOSIS FOLLOWING REMOVAL OF AN AMELOBLASTOMA To the Editor:—We congratulate Dr Nkenke et al1 for the very elegant intraoral microvascular reconstruction of the mandible described in their article. It sets new standards for reconstructive surgery. However, although this is a step to decrease the magnitude of surgery, we believe an even more conservative option is available. Many of these ameloblastomas present in young adults in whom a major resection can have a significant impact on employment opportunities and marriage prospects. Not all mandibular resections are reconstructed so well. In the past 10 years, we have adopted a management approach that entails enucleation of the ameloblastoma and sterilization of the cavity with Carnoy’s solution. In a
Letters to the Editor must be in reference to a specific article or editorial that has been published by the Journal. Letters must be submitted within 6 weeks of the article’s print publication or, for an online-only article, within 8 weeks of the date it first appeared online. Letters must be submitted electronically via the Elsevier Editorial System at http://ees.elsevier.com/ joms. Letters are subject to editing and those exceeding 500 words may be shortened or not accepted due to length. One photograph may accompany the letter if it is essential to understanding the subject. Letters should not duplicate similar material or material published elsewhere. There is no guarantee that any letter will be published. Prepublication proofs will not be provided. Submitting a Letter to the Editor constitutes the author’s permission for its publication in any issue or edition of the journal, in any form or medium.
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CONE-BEAM COMPUTED TOMOGRAPHIC INCIDENTAL FINDINGS—A CAUSE FOR WORRY
volume of the CBCT scan and obtain additional training, if needed, to knowledgeably evaluate the entirety of the scan beyond the maxillofacial complex.
To the Editor:—A recently published editorial in this journal1 cited a systematic review of the literature2 detailing the aggregated incidence of incidental findings (IFs) at conebeam computed tomography (CBCT). The editorial, which denoted the most common findings (eg, vertebral degenerative changes and sinusitis) in the combined set of studies, correctly stated that none of these were life-threatening. Furthermore, the editor appropriately noted that older patients having imaging studies presumably performed for implant placement had a much higher incidence of IFs than younger patients likely being evaluated for orthodontic treatment purposes and impacted teeth. The attention of the journal readership, however, must be drawn to one of these articles written by a group of maxillofacial radiologists who described their findings in a group of 300 patients (mean age, 49.3 yr; range, 9 to 85 yr; 56.3% female patients) requiring CBCT in the main (73%) for implant placement at the University of North Carolina School of Dentistry.3 Of importance is the fact that 13 patients, likely those in the oldest cohort (n = 169; age range, 50 to 85 yr), exhibited calcified carotid artery atheromas in the cervical distribution. Price et al3 properly noted that they advised the dentists requesting these imaging studies to refer these patients to their physicians for further investigation given the gravity of this finding. This finding is substantive given that atherosclerosis is often simultaneously present in multiple arterial territories and specifically because the presence of calcified plaque in the extracranial carotid vasculature is a major cause of ischemic stroke and a risk indicator of even more advanced ischemic disease in the coronary arteries leading to myocardial infarction. At the present time, outcome studies of CBCT-detected carotid calcifications have not been executed; however, the imaging technique is not terribly dissimilar from that of noncontrast-enhanced CT, which has been used to conduct just such consequential studies. Specifically, such studies have shown that the volume of calcified carotid artery plaque is directly related to the presence of cerebral infarcts.4 Similarly, the presence and extent of carotid calcific plaque in middle-aged individuals free of extant clinical cardiovascular disease has been associated with a significantly increased hazard for incident mortality after adjustment for age, gender, and traditional cardiovascular disease factors.5 Thus, it was reassuring that the editorial recognized the need for those oral and maxillofacial surgeons who obtain and interpret their own studies to review the entire digital
ARTHUR H. FRIEDLANDER, DMD Los Angeles, CA
References 1. Hupp JR: Editorial: Cone-bean computed tomography: Incidental findings—A cause for worry. J Oral Maxillofac Surg 71:1157, 2013 2. Edwards R, Altalibi M, Flores-Mir C: The frequency and nature of incidental findings in cone-beam computed tomographic scans of the head and neck region: A systematic review. J Am Dent Assoc 144:161, 2013 3. Price JB, Thaw KL, Tyndall DA, et al: Incidental findings from cone beam computer tomography of the maxillofacial region: A descriptive retrospective study. Clin Oral Implants Res 23: 1261, 2012 4. Bos D, Ikram A, Elias-Smale SE, et al: Calcification in major vessel beds related to vascular brain disease. Arterioscler Thromb Vasc Biol 31:2331, 2011 5. Allison MA, Hsi S, Wassel CL, et al: Calcified atherosclerosis in different vascular beds and the risk of mortality. Arterioscler Thromb Vase Biol 32:140, 2012
http://dx.doi.org/10.1016/j.joms.2013.09.010
MANDIBULAR RECONSTRUCTION USING INTRAORAL MICROVASCULAR ANASTOMOSIS FOLLOWING REMOVAL OF AN AMELOBLASTOMA To the Editor:—We congratulate Dr Nkenke et al1 for the very elegant intraoral microvascular reconstruction of the mandible described in their article. It sets new standards for reconstructive surgery. However, although this is a step to decrease the magnitude of surgery, we believe an even more conservative option is available. Many of these ameloblastomas present in young adults in whom a major resection can have a significant impact on employment opportunities and marriage prospects. Not all mandibular resections are reconstructed so well. In the past 10 years, we have adopted a management approach that entails enucleation of the ameloblastoma and sterilization of the cavity with Carnoy’s solution. In a
Letters to the Editor must be in reference to a specific article or editorial that has been published by the Journal. Letters must be submitted within 6 weeks of the article’s print publication or, for an online-only article, within 8 weeks of the date it first appeared online. Letters must be submitted electronically via the Elsevier Editorial System at http://ees.elsevier.com/ joms. Letters are subject to editing and those exceeding 500 words may be shortened or not accepted due to length. One photograph may accompany the letter if it is essential to understanding the subject. Letters should not duplicate similar material or material published elsewhere. There is no guarantee that any letter will be published. Prepublication proofs will not be provided. Submitting a Letter to the Editor constitutes the author’s permission for its publication in any issue or edition of the journal, in any form or medium.
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