The xeroradiographic appearanceof simple bone cyst of the mandible C. J. Nortjk,” A. G. Farman,** Republic of South Africa
and 1. J. de V. Joubert,***
Cape Province,
X eroradiography (derived from the Greek word xeros, meaning “dry”),
is an electrostatic systemof image recording which was developedby Chester Carlson in 1938 and is the basis of many commercial document copying machines. The first dental application of xeroradiography was reported by Hills and associates,3in 1955, and during the past 3 or 4 years a number of articles have appeared in the dental literature on the use of this technique, especially in the disciplines of orthodontics and oral surgery.2-’ Thesereports indicated that xeroradiography can produce images of the head and neck region with an excellent contrast not possible with standardx-ray techniques. Thus, it would seemthat xeroradiography will be used more and more frequently in the future, especially in the field of cephalometrics. A review of the literature, however, reveals a shortageof information concerning the xeroradiographic features of pathologic conditions of the jaws. For this reason, we present the comparative results of conventional roentgenographic
and xeroradiographic techniques in the detection and diagnosis of a classic case of simple bone cyst of the mandible. CASE REPORT
A Cape Colored male patient, 18 years of age, was first seen on Aug. 28, 1976, when he attendedthe Oral Surgery Clinic of the University of the Western Cape. He complained of pain in the region of the socket from which the right mandibular second premolar had been extracted (elsewhere) 3 days earlier. On clinical examination, the extraction socket showed all of the usual features of a “dry socket.” Lateral jaw roentgenogramswere taken by conventional meansand with xemradiography. In general, the xeroradiograph showed much finer detail than did the conventional roentgenogram. There was a large radiolucency in the right premolar and molar area of the mandible (Fig. 1). The *Facultyof Dentistry,Universityof Stellenhosch. **Facultyof Dentistry,Universityof Stellenbosch, Oral EpidemiologyResearch Group,SouthAfrica Medical ResearchCouncil. ***Faculty of Dentistry,Universityof the WesternCape. 0030-4220/78/0345-0485.$00.30/O
0
1978 The C. V. Mosby Co.
485
486
Nortjk,
Farman,
and Joubert
Oral Surg. March. I978
Fig. 1. Xeroradiograph and conventional lateral oblique radiograph of a typical simple bone cyst of the mandible. The conventional radiograph(above) showsmuch less fine detail than the xeroradiograph(below), but the apparent outline of the lesion is the samein both cases. lesion showed an irregular but definite edge with slight cortication. It extended between the roots of the adjacent teeth, however, the lamina dura surrounding the roots was clearly identifiable. Slight expansion of the base of the mandible was discernible. The roentgenologic diagnosis was that of a simple bone cyst. There was no significant medical history, and no prior symptoms could be detected in the dental history. In view of the possibility of a spread of infection to the bony defect, the patient was placed on clindamycin hydrochloride hydrate (150 mg. capsules, q.i.d., for 4 days). After failing to keep two appointments, the patient returned 3 weeks later. At this visit, with the patient under local anesthesia and 15 mg. intravenous diazepam sedation, the bony defect was exposed. The bone cavity was filled only with gas. The lateral walls of the cavity and the tooth extraction socket were thoroughly curetted. The floor and roof of the defect were not curetted in order to prevent damage to the inferior dental neumvascular bundle and to protect the vitality of the overlying teeth. The lining of the cavity was found to consist of a thin layer of soft tissue which was firmly adherent to the surrounding bone. The curettings were fixed in fotmol-saline solution and submitted for histopathologic analysis.
Volume 45 Number 3
Xeroradiographic
appearance of simple bone cyst
487
Microscopic examination revealedthat the lining consistedentirely of maturefibrous connective tissue with a slight chronic inflammatory cell infiltrate and occasional multinucleated giant cells of the foreign body type. This confirmed the roentgenologic opinion of simple bone cyst. The patient was seenone week postoperatively for removal of sutures. At that time he was free from pain and discomfort. He has failed to report for further follow-up examinations. DISCUSSION
The edge-enhancement properties and soft-tissue details produced by xeroradiography mean that it is hound to he used especially in the fields of orthodontics and orthognathic surgery and in the detection of hone fractures. Its particular value for orthodontics in clarifying such cephalometric landmarks as point A and point B, in the fine detail of soft-tissue profile, and in the improved definition of dental structures, are well established.5-g It has heen noted by WolfelO that xeroradiography has a greater x-ray contrast acceptancecapability than the routine roentgenographicfilm, when considering sharp and abrupt differences in object density (for example, fractures), but that routine radiographic film has greater contrast gradients when broad areas of subtle or gradually changing differences in density are concerned. It may be that xeroradiography can show “fine details of bone almost as sharply defined as in a histologic section,“* but this samefine bony detail may actually decreasethe clarity of small, poorly demarcated,central radiolucent lesions. Well-demarcated large radiolucent lesions, such as the simple bone cyst described, would, however, appear to be clearly demonstratedby both routine radiographic and xeroradiographic techniques. As xeroradiography will be used more frequently in the future, there is an obvious needfor a full documentationof the xeroradiographic appearanceof all jaw lesions so that they are not inadvertently missed when this technique is employed. REFERENCES 1.
Binnie,W. H., Stacey, A. J., Davis, R., and Lawson, R. A.: Applications of Xeroradiogmphy in Dentistry, J. Dent. 3: 105-109,1975.
2. Editorial, J. Dent. 3: 97-98, 1975. 3. Hills, T. H., Stanford, R. W., and Moore, R. D.: Xeroradiography: Present Medical Application, Br. J. Radiol. 28: 545551, 1955. 4. Johnson, N. A.: Xeroradiography for Cephalometric Analysis, Am. J. Otthod. 69: 524-526, 1976. 5. Lapinskas, V. S., and Lapinskene, A. V.: Xeroradiography and the Prospects of Its Use in Dentistry, Stomatologiia (Mosk.) 47: 35-38, 1968. 6. Lopez, J.: Xeroradiography in Dentistry, J. Am. Dent., Assoc. 92: 106-l 10, 1976. 7. Nortje, C. J.: In Cleaton-Jones, P., and Slack, B. (editors): Proceedings of the Tenth Scientific Congress of the South African Division of the International Association for Dental Research, Durban, Johannesburg, 1976, The Printing Department, University of the Witwatersrand. 8. Rawls, H. R., and Owen, W. D.: The Dental Prognosis for Xeroradiography, ORAL SURG. 33: 476-480, 1972. 9. Shutz, J., and Wannenmacher, M. C.: Xeroradiography in the Maxillofacial Area, Proc. Int. Assoc. Dento-Maxillo-Fat. Radiol. 3: 479-482, 1974. 10. Wolfe, J. N.: Xeroradiography: Image Content and Comparison With Film Roentgenograms, Am. J. Roentgenol. 117: 690-695, 1973.
Reprint requeststo: Dr. C. J. Nortje Department of Oral Roentgenology University of Stellenbosch Private Bag X 1 7505 Tygerberg Cape Province Republic of South Africa.
and 1. J. de V. Joubert,***
Cape Province,
X eroradiography (derived from the Greek word xeros, meaning “dry”),
is an electrostatic systemof image recording which was developedby Chester Carlson in 1938 and is the basis of many commercial document copying machines. The first dental application of xeroradiography was reported by Hills and associates,3in 1955, and during the past 3 or 4 years a number of articles have appeared in the dental literature on the use of this technique, especially in the disciplines of orthodontics and oral surgery.2-’ Thesereports indicated that xeroradiography can produce images of the head and neck region with an excellent contrast not possible with standardx-ray techniques. Thus, it would seemthat xeroradiography will be used more and more frequently in the future, especially in the field of cephalometrics. A review of the literature, however, reveals a shortageof information concerning the xeroradiographic features of pathologic conditions of the jaws. For this reason, we present the comparative results of conventional roentgenographic
and xeroradiographic techniques in the detection and diagnosis of a classic case of simple bone cyst of the mandible. CASE REPORT
A Cape Colored male patient, 18 years of age, was first seen on Aug. 28, 1976, when he attendedthe Oral Surgery Clinic of the University of the Western Cape. He complained of pain in the region of the socket from which the right mandibular second premolar had been extracted (elsewhere) 3 days earlier. On clinical examination, the extraction socket showed all of the usual features of a “dry socket.” Lateral jaw roentgenogramswere taken by conventional meansand with xemradiography. In general, the xeroradiograph showed much finer detail than did the conventional roentgenogram. There was a large radiolucency in the right premolar and molar area of the mandible (Fig. 1). The *Facultyof Dentistry,Universityof Stellenhosch. **Facultyof Dentistry,Universityof Stellenbosch, Oral EpidemiologyResearch Group,SouthAfrica Medical ResearchCouncil. ***Faculty of Dentistry,Universityof the WesternCape. 0030-4220/78/0345-0485.$00.30/O
0
1978 The C. V. Mosby Co.
485
486
Nortjk,
Farman,
and Joubert
Oral Surg. March. I978
Fig. 1. Xeroradiograph and conventional lateral oblique radiograph of a typical simple bone cyst of the mandible. The conventional radiograph(above) showsmuch less fine detail than the xeroradiograph(below), but the apparent outline of the lesion is the samein both cases. lesion showed an irregular but definite edge with slight cortication. It extended between the roots of the adjacent teeth, however, the lamina dura surrounding the roots was clearly identifiable. Slight expansion of the base of the mandible was discernible. The roentgenologic diagnosis was that of a simple bone cyst. There was no significant medical history, and no prior symptoms could be detected in the dental history. In view of the possibility of a spread of infection to the bony defect, the patient was placed on clindamycin hydrochloride hydrate (150 mg. capsules, q.i.d., for 4 days). After failing to keep two appointments, the patient returned 3 weeks later. At this visit, with the patient under local anesthesia and 15 mg. intravenous diazepam sedation, the bony defect was exposed. The bone cavity was filled only with gas. The lateral walls of the cavity and the tooth extraction socket were thoroughly curetted. The floor and roof of the defect were not curetted in order to prevent damage to the inferior dental neumvascular bundle and to protect the vitality of the overlying teeth. The lining of the cavity was found to consist of a thin layer of soft tissue which was firmly adherent to the surrounding bone. The curettings were fixed in fotmol-saline solution and submitted for histopathologic analysis.
Volume 45 Number 3
Xeroradiographic
appearance of simple bone cyst
487
Microscopic examination revealedthat the lining consistedentirely of maturefibrous connective tissue with a slight chronic inflammatory cell infiltrate and occasional multinucleated giant cells of the foreign body type. This confirmed the roentgenologic opinion of simple bone cyst. The patient was seenone week postoperatively for removal of sutures. At that time he was free from pain and discomfort. He has failed to report for further follow-up examinations. DISCUSSION
The edge-enhancement properties and soft-tissue details produced by xeroradiography mean that it is hound to he used especially in the fields of orthodontics and orthognathic surgery and in the detection of hone fractures. Its particular value for orthodontics in clarifying such cephalometric landmarks as point A and point B, in the fine detail of soft-tissue profile, and in the improved definition of dental structures, are well established.5-g It has heen noted by WolfelO that xeroradiography has a greater x-ray contrast acceptancecapability than the routine roentgenographicfilm, when considering sharp and abrupt differences in object density (for example, fractures), but that routine radiographic film has greater contrast gradients when broad areas of subtle or gradually changing differences in density are concerned. It may be that xeroradiography can show “fine details of bone almost as sharply defined as in a histologic section,“* but this samefine bony detail may actually decreasethe clarity of small, poorly demarcated,central radiolucent lesions. Well-demarcated large radiolucent lesions, such as the simple bone cyst described, would, however, appear to be clearly demonstratedby both routine radiographic and xeroradiographic techniques. As xeroradiography will be used more frequently in the future, there is an obvious needfor a full documentationof the xeroradiographic appearanceof all jaw lesions so that they are not inadvertently missed when this technique is employed. REFERENCES 1.
Binnie,W. H., Stacey, A. J., Davis, R., and Lawson, R. A.: Applications of Xeroradiogmphy in Dentistry, J. Dent. 3: 105-109,1975.
2. Editorial, J. Dent. 3: 97-98, 1975. 3. Hills, T. H., Stanford, R. W., and Moore, R. D.: Xeroradiography: Present Medical Application, Br. J. Radiol. 28: 545551, 1955. 4. Johnson, N. A.: Xeroradiography for Cephalometric Analysis, Am. J. Otthod. 69: 524-526, 1976. 5. Lapinskas, V. S., and Lapinskene, A. V.: Xeroradiography and the Prospects of Its Use in Dentistry, Stomatologiia (Mosk.) 47: 35-38, 1968. 6. Lopez, J.: Xeroradiography in Dentistry, J. Am. Dent., Assoc. 92: 106-l 10, 1976. 7. Nortje, C. J.: In Cleaton-Jones, P., and Slack, B. (editors): Proceedings of the Tenth Scientific Congress of the South African Division of the International Association for Dental Research, Durban, Johannesburg, 1976, The Printing Department, University of the Witwatersrand. 8. Rawls, H. R., and Owen, W. D.: The Dental Prognosis for Xeroradiography, ORAL SURG. 33: 476-480, 1972. 9. Shutz, J., and Wannenmacher, M. C.: Xeroradiography in the Maxillofacial Area, Proc. Int. Assoc. Dento-Maxillo-Fat. Radiol. 3: 479-482, 1974. 10. Wolfe, J. N.: Xeroradiography: Image Content and Comparison With Film Roentgenograms, Am. J. Roentgenol. 117: 690-695, 1973.
Reprint requeststo: Dr. C. J. Nortje Department of Oral Roentgenology University of Stellenbosch Private Bag X 1 7505 Tygerberg Cape Province Republic of South Africa.
