Academic literature on the topic 'Maxilla - Abnormalities'

OBJECTIVES: Orthopantomogram (OPG) is a dental radiograph that captures the maxillofacial region in a single image for quick assessment of the dental arches and their surrounding structures. It can be used for treatment planning and analysis of jaw-related pathologies. Prior studies have demonstrated geographical variations in radiographic anomalies and pathologies, our purpose was to establish baseline statistics for the Pakistani population, so the Pakistani dentists are able to distinguish between anomalies and pathologies and provide appropriate care when needed. METHODOLOGY: A cross-sectional study design was used to analyze de-identified 2411 OPGs taken for routine dental care at the dental clinics of Riphah International University. These were broadly classified according to site. Data was documented on SPSS version 22 and presented as frequencies. RESULTS: From a total of 2,411 OPGs, 2326 met the inclusion criteria. The mean age of the patients was 29.06±17.99 years. Our findings included pneumatization of the maxillary sinus in 9.8%, pathological findings in the sinus in 3.9%, deflected nasal septum in 7.5%, alveolar bone loss in 32.7%, elongated styloid process in 12.1%, pathological finding associated with maxillary bone in 1.4% and mandibular bone in 2.1%. CONCLUSIONS: Our results were somewhat unique when compared with studies from other geographical locations. We established baseline statistics about the common anomalies and abnormalities noted in dental radiographs for the Pakistani population. KEY WORDS: Orthopantomogram, anomalies, mandible, maxilla

Solitary Median Maxillary Central Incisor Syndrome (SMMCI Syndrome) is a rare developmental disorder consisting of morphological defects that mainly affect structures in the midline of the body. The aetiology of this syndrome has not been fully explained, and SMMCI syndrome is observed more frequently in females. The presence of a solitary median maxillary incisor in the midline of the maxilla is a typical trait in the stomatognathic system, and this anomaly is found in both deciduous and permanent dentition. Regarding developmental abnormalities accompanying a solitary incisor with an atypical structure, the most common ones include: lack of the frenulum of the upper lip, deformations in the nasal cavity and cranial base, heart defects, cleft lip and palate, and mental disability of various severity. <b>Aim.</b> The aim of this work is to present the characteristic traits of a solitary median maxillary central incisor syndrome on the basis of a case study of a 9-yearold female patient and the analysis of available literature. <b>Material and methods.</b> The literature review was performed using the PubMed database and the following key words: incisor, maxilla, syndrome, development, SMMCI syndrome. <b>Case report.</b> When the clinical examination and medical history were performed the patient was diagnosed with signs of solitary median maxillary central incisor syndrome. The outcomes of a computed tomography scan confirmed choanal stenosis. Except for allergies to animal hair and grass, the patient did not suffer from any systemic diseases. On the basis of a clinical examination and analysis of additional tests the following diagnosis was made: I skeletal class, complete distocclusion with incisor protrusion, partial lateral bilateral cross bite and dental abnormalities. <b>Summary.</b> Patients diagnosed with SMMCI syndrome often require complex care provided by specialists from various fields of medicine and dentistry, due to the possibility of coexistence of numerous developmental abnormalities involving different body structures.

Abstract Introduction: Fibrous dysplasia is a benign bone lesion characterized by replacement of normal bone by fibrous connective tissue, and its diagnosis is based on clinical, radiological and histological findings. Objective: The aim of this study was to report a case of unilateral fibrous dysplasia in the maxilla, in the palate region, by using computed tomography. Results: On examination it was observed: a nodular lesion, with similar staining to the palatal mucosa with varicosities, regular edges, irm and painless. The radiographic indings on computed tomography showed one diffuse and heterogeneous thickening of the bony elements involving the hard palate extending to the posterior wall of the maxillary antrum. We opted for the preservation of the case, considering the age of the patient, the absence of facial asymmetry and lack of aesthetic and functional impairment. Conclusion: Thus, we emphasize that the knowledge of morphological changes is important for the diagnosis of bone pathologies, and the dentist must be familiar with the normal morphology of the structures and their possible abnormalities.

Objective To demonstrate the efficiency and applicability of two-dimensional ultrasonography in the identification of tooth germs and in the assessment of potential pathology. Design Observational, descriptive, cross-sectional study. Setting Prenatal Diagnosis Unit of Centro Hospitalar de Vila Nova de Gaia / Espinho–Empresa Pública in Portugal. Patients A total of 157 white pregnant women (median age, 32 years; range, 14 to 47 years) undergoing routine ultrasound exams. Main Outcome Measure(s) Description of the fetal tooth germs, as visualized by two-dimensional ultrasonography, including results from prior fetal biometry and detailed screening for malformations. Results In the first trimester group, ultrasonography identified 10 tooth germs in the maxilla and 10 tooth germs in the mandible in all fetuses except for one who presented eight maxillary tooth germs. This case was associated with a chromosomal abnormality (trisomy 13) with a bilateral cleft palate. In the second and third trimesters group, ultrasonography identified a larger range of tooth germs: 81.2% of fetuses showed 10 tooth germs in the maxilla and 85.0% of fetuses had 10 tooth germs in the mandible. Hypodontia was more prevalent in the maxilla than in the mandible, which led us to use qualitative two-dimensional ultrasonography to analyze the possible association between hypodontia and other variables such as fetal pathology, markers, head, nuchal, face, and spine. Conclusions We recommend using this method as the first exam to evaluate fetal morphology and also to help establish accurate diagnosis of abnormalities in pregnancy.

The abnormal growth of the craniofacial bone leads to skeletal and dental defects, which result in the presence of malocclusions. Not all causes of malocclusion have been explained. In the development of skeletal abnormalities, attention is paid to general deficiencies, including of vitamin D3 (VD3), which causes rickets. Its chronic deficiency may contribute to skeletal malocclusion. The aim of the study was to assess the impact of VD3 deficiency on the development of malocclusions. The examination consisted of a medical interview, oral examination, an alginate impression and radiological imaging, orthodontic assessment, and taking a venous blood sample for VD3 level testing. In about 42.1% of patients, the presence of a skeletal defect was found, and in 46.5% of patients, dentoalveolar malocclusion. The most common defect was transverse constriction of the maxilla with a narrow upper arch (30.7%). The concentration of vitamin 25 (OH) D in the study group was on average 23.6 ± 10.5 (ng/mL). VD3 deficiency was found in 86 subjects (75.4%). Our research showed that VD3 deficiency could be one of an important factor influencing maxillary development. Patients had a greater risk of a narrowed upper arch (OR = 4.94), crowding (OR = 4.94) and crossbite (OR = 6.16). Thus, there was a link between the deficiency of this hormone and the underdevelopment of the maxilla.

Human dental anomalies are formative defects to variety of genetic and environmental factors. Multiple anomalies are seen in patient with chromosomal abnormalities or specific syndromes. Multiple odontogenic anomalies in non syndromic patient are unusual and rare. This paper reports a rare, unique and interesting case of multiple odontogenic anomalies such as bilateral macrodontia of maxillary central incisor, hypodontia, hyperdontia in lower anterior mandible, transposition in left anterior maxilla and taurodontism with molars in a single non syndromic young Indian female patient. Patients with multiple dental anomalies require multidisplinary treatment approaches such as surgical, orthodontic, endodontic, prosthodontic rehabilitation etc. Multiple dental anomalies in non syndromic patient are rare and needs early diagnosis and require multidisplinary approach. DOI: http://dx.doi.org/10.3329/bjms.v13i1.17444 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 95-98

Bilateral Tessier no. 7 clefts are rarely reported in the literature. Here, we describe the presence of accessory maxilla with supernumerary teeth in a patient who exhibited bilateral Tessier no. 7 clefts; the diagnosis was established based on the patient’s history, clinical presentation, and computed tomography images. A review of the available literature revealed 24 patients with Tessier no. 7 clefts from 2000 to 2020, including our patient. The most common clinical manifestation in patients with Tessier no. 7 clefts comprises bilateral facial clefts. Additionally, Tessier no. 7 clefts are more frequently found in boys or men, rather than in girls or women. The presence of an accessory maxilla with supernumerary teeth in a patient with bilateral Tessier no. 7 clefts is extremely rare. Early detection of craniofacial abnormalities is important, because it may influence patient prognosis and management.

SummaryAn inflammatory periorbital cyst with secondary pressure atrophy of the maxilla was treated by surgical creation of a drainage opening to the nasal cavity in a 4-year-old Yorkshire Terrier. Following treatment, clinical signs resolved and computed tomography 5 weeks after surgery confirmed the permanence of the drainage opening. Eight months later, the dog showed no clinical abnormalities. Therefore, the procedure described in this report may offer a suitable treatment option in cases where the cyst’s size or localization prevents complete excision.

Axenfeld-Rieger syndrome is a rare autosomal dominant disorder characterized by various ocular and extraocular malformations. Dental abnormalities are considered as definitive features for the diagnosis and differentiation of Rieger syndrome from other anterior chamber of the eye malformations. A case of Rieger syndrome with distinct dental and craniofacial anomalies is described. Significant cranio-dento-facial findings that have been observed are, teeth with short and dilacerated roots, hyperplastic frenums and underdeveloped maxilla. There was an anterior crossbite, bilateral posterior openbite and moderate to severe anterior crowding.

A expansão rápida da maxila assistida cirurgicamente (ERMAC) é o procedimento de eleição para o tratamento da deficiência transversa de maxila em pacientes esqueleticamente maduros. Controvérsias em relação ao procedimento ainda persistem principalmente relacionadas aos métodos de avaliação, técnica cirúrgica utilizada, morbidade, eficácia clínica e estabilidade de resultados. A utilização da tomografia computadorizada para a avaliação da eficiência da ERMAC é uma opção atual e ainda pouco divulgada. Consequentemente, os parâmetros anatômicos para a utilização deste método ainda não foram totalmente estabelecidos. Os objetivos do presente estudo foram avaliar a confiabilidade da metodologia proposta e as alterações esqueléticas maxilares decorrentes da ERMAC com a utilização do método de avaliação por tomografia computadorizada. No período de junho de 2004 a maio de 2005, 15 pacientes, sendo 10 do sexo feminino, foram submetidos a ERMAC. A técnica cirúrgica utilizada constou de osteotomia maxilar do tipo Le Fort I, sem osteotomia da sutura ptérigo-maxilar, associada a osteotomia sagital mediana do palato. O aparelho expansor utilizado foi do tipo Hyrax. Os pacientes foram submetidos a exames de tomografia computadorizada, em tomógrafos de múltiplos detectores, no pré-operatório e após 6 meses, utilizando-se metodologia idealizada para a avaliação específica deste procedimento cirúrgico. Para a determinação do padrão das alterações transversais e ântero-posteriores, medidas lineares e angulares foram realizadas diretamente na estação de trabalho dos aparelhos de tomografia. Através de imagens obtidas nas aquisições tomográficas axiais e em reconstruções coronais, as regiões anterior, média e posterior da maxila foram avaliadas separadamente. A área de secção transversa da maxila foi também calculada. Após a avaliação dos resultados observou-se que a confiabilidade do método foi estatisticamente comprovada. Um significativo aumento da área de secção transversa da maxila foi observado (p<0.05). Entretanto, o padrão de expansão transversa não se mostrou uniforme. O aumento das dimensões transversas nas regiões anterior e média foi estatisticamente comprovado. Não foi observada expansão transversa significativa na região posterior da maxila. Ao se avaliar a relação entre a abertura do parafuso expansor e a efetiva expansão esquelética da maxila, observou-se que esta foi menor que a abertura do parafuso, em termos absolutos. O aumento transverso relativo à expansão do parafuso foi estatisticamente maior nas regiões anterior e média da maxila do que em sua região posterior. Em conclusão, a avaliação por tomografia computadorizada para a análise das alterações esqueléticas da região maxilar, em pacientes submetidos à ERMAC é metodologia confiável e reprodutível. A expansão transversa da maxila decorrente do procedimento de ERMAC utilizado no presente estudo acarretou uma expansão não uniforme da maxila, com predomínio da expansão transversa nas regiões anterior e média.
Surgically assisted rapid palatal expansion is the procedure of choice for treating transverse maxillary deficiency in mature patients. Some controversies regarding surgically assisted rapid palatal expansion remain, mainly concerning technical aspects such as type and location of osteotomy sites, as well as surgical morbidity, clinical efficiency, and stability. The evaluation of transverse expansion is still a theme of discussion. On conventional anteroposterior radiographs, anatomical structures are superimposed, resulting in a high number of image artifacts, as well as hindering the tracing and evaluation. The use of computed tomography as a method of evaluating the efficiency of this procedure has not been widely reported. Consequently, few landmarks for use in evaluating maxillary expansion have been defined. The goals of the present study were to define parameters to assess skeletal changes after surgically assisted palatal expansion, to evaluate the reliability of the proposed method and to use computed tomography to assess those parameters. From June of 2004 to May of 2005, 15 patients underwent surgically assisted rapid palatal expansion (a modified Le Fort I maxillary osteotomy without pterygomaxillary separation, together with a sagital palatal osteotomy) according to a defined protocol, using a Hyrax appliance. To determine the pattern of transversal and anteroposterior expansion, linear and angular measurements were performed on multislice computed tomography, using computed software directly on the workstation. The anterior, intermediate and posterior portions of the maxilla were evaluated separately, using a specific method, in axial acquisition and coronal reconstructed views. The cross-sectional area of the maxilla was calculated to obtain general information about maxillary expansion. The reliability of the method was statistically confirmed. Significant maxillary overall expansion was observed. However, different patterns of expansion were seen in the three regions analyzed. In the anterior and intermediate portions of the maxilla, the increase in maxillary width was significantly greater than that observed in the posterior portion. The opening of the jackscrew was greater than skeletal expansion. Comparing jackscrew opening and transverse expansion, the same pattern of asymmetric expansion was verified. No change was observed in anteroposterior dimensions. The method of computed tomography evaluation is a useful tool for evaluation of surgically assisted rapid palatal expansion changes. The accurate evaluation of the postoperative changes was heavily dependent upon images acquired through computed tomography. An overall maxillary expansion was confirmed. However, transverse expansion of the maxilla achieved through surgically assisted rapid palatal expansion without pterygoid plate separation was less than uniform.

Orientadores: Luciana Asprino, Marcio de Moraes
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A expansão rápida de maxila cirurgicamente assistida é um método eficiente no tratamento da deficiência transversa da maxila em paciente adultos. O objetivo deste estudo mecânico qualitativo foi avaliar por meio de modelos fotoelásticos de um crânio humano a simulação da expansão rápida de maxila cirurgicamente assistida, comparando três tipos de ancoragem, analisando a distribuição de forças, com e sem disjunção ptérigomaxilar. As ancoragens utilizadas foram: um expansor Hyrax com ancoragem em primeiros pré?molares e primeiros molares; um expansor chamado de Hyrax modificado, com bandas em primeiros pré?molares e primeiros molares unidos a um fio ortodôntico retangular que se estendia de caninos a segundo molar; e ancoragem óssea do distrator de Rotterdam. A análise fotoelástica qualitativa foi realizada utilizando?se polariscópio plano. Os três expansores apresentaram distribuição de tensões homogêneas pelas réplicas de crânio através dos pilares caninos, pilares zigomáticos e processos pterigóideos, se estendendo para regiões mais altas do crânio; O expansor Hyrax modificado apresentou melhor distribuição das tensões nos dentes e adjacências, com menor concentração nessa região que o expansor Hyrax. A ancoragem promovida pelo distrator de Rotterdam apresentou melhor distribuição das tensões com menor concentração nos dentes e adjacências do que os expansores Hyrax e Hyrax modificado. Após a simulação das osteotomias, ocorreu marcante diminuição de forças para as regiões superiores das réplicas de crânio. Em conclusão: A ancoragem promovida pelo expansor Hyrax modificado apresentou melhor distribuição das tensões com menor concentração das mesmas nos dentes e adjacências do que o expansor Hyrax; A ancoragem promovida pelo expansor Rotterdam apresentou melhor distribuição das tensões com menor concentração das mesmas nos dentes e adjacências do que os expansores Hyrax e Hyrax modificado; A realização da disjunção ptérigomaxilar resultou em diminuição da concentração de tensões pelo crânio independente da ancoragem avaliada
Abstract: The Surgically Assisted Rapid Maxillary Expansion (SARME) is an efficient method to treat the transverse maxillary deficiency. The aim of this mechanical and qualitative study was to evaluate the distribution of stress throughout the skull, of three different expanders used in the surgically assisted rapid maxillary expansion (SARME), using comparative photoelastic analysis simulating SARME with and without pterygoidmaxillary disjunction. The skull analogs were constructed in two halves, to allow the creation of nasal cavity and maxillary sinuses, which were subsequently bonded. It was used three different expanders in the tests. The first was a standard Hyrax-type appliance, with anchorage at first bicuspids and first molars. The second was a modified Hyrax-type appliance, with anchorage at first bicuspids and first molars that was united by means of a passively adapted rectangular orthodontic wire splinting together cuspid, bicuspid first and second molars. The third was the bone-borne Rotterdam expander. The photoelastic analysis was done immerging the skull replicas in a tank of mineral oil and using a plane polariscope. All three expanders generated similar anterior and posterior fringe patterns along the canine and zygomatic buttress and pterigoid processes. The modified hyrax showed a wider distribution of the tension through the teeth, with a decrease intensity of the fringe patterns when compared with the Hyrax expander. The Rotterdam distractor did not showed tension lines at and around the teeth, resulting in better force distribution than the two others expanders. The simulation of the osteotomies of the SARME decreased the amount of fringe patterns throughout the skull analogs. In conclusion, the three anchorage evaluated did not influence the final distribution of tension throughout the skull; there were variation in the fringe patterns generated by different anchorages; the modified Hyrax-type appliance indicates less load over teeth than the conventional Hyrx-type; the Rotterdam distractor does not load teeth, keeping the patterns of force distribution in the skull analog; the pterigomaxillary disjunction makes the SARME easier and predictable, independently of the anchorage used
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

Orientador: Márcio de Moraes
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O objetivo deste trabalho foi avaliar a precisão do posicionamento maxilar em cirurgias ortognáticas bimaxilares utilizando sequência cirúrgica convencional e sequência invertida, isto é, quando a mandíbula foi osteotomizada e fixada antes da maxila. Neste estudo retrospectivo, 80 telerradiografias obtidas em norma lateral de pacientes submeditos à cirurgia ortognática foram analisadas, sendo 40 obtidas no período pré-operatório e 40 no pós-operatório. A amostra foi dividida em 2 grupos de acordo com a sequência cirúrgica executada. No Grupo 1 constaram as radiografias de pacientes submetidos à cirurgia através da sequência convencional, enquanto no grupo 2 constaram as radiografias dos pacientes submetidos à cirurgia pela sequência invertida. Em ambos os grupos foi analisada posição final do incisivo central superior, tanto no sentido vertical quanto no ântero-posterior, sendo este resultado comparado com o que fora planejado, na busca da precisão cirúrgica. O resultado encontrado nos grupos 1 e 2 foram então confrontados na busca de diferenças entre as duas técnicas. Foi testada a hipótese nula de que não havia diferença entre os grupos analisados. Após aplicado o teste t de Welch para comparação das médias das diferenças entre o desejado e o obtido nos grupos 1 e 2, considerando significância estatística de 5% (alpha) e um teste bi-caudal, chegou-se a evidência estatística de que a hipótese não nula foi rejeitada dados os resultados obtidos das amostras (p>0,05). Sendo assim, não houve diferença no grau de precisão do posicionamento maxilar entre os grupos. Concluiu-se que tanto a sequência cirúrgica convencional quanto a sequência cirúrgica invertida mostraram ser técnicas confiáveis no posicionamento maxilar após osteotomia. tipo Le Fort I
Abstract: The objective of this study was to evaluate maxillary positioning accuracy of double jaw orthognathic surgery using conventional surgical sequence and inverted sequencing, ie, when the mandible was osteotomized and fixed prior to the jaw. In this retrospective study, 80 lateral radiographs obtained in patients that underwent orthognathic surgery were analyzed, 40 obtained in the preoperative and 40 in the postoperative period. The sample was divided into two groups according to the surgical sequence performed. Group 1 consisted of the radiographs of patients submitted to conventional surgical sequence, while group 2 consisted of the radiographs of patients that underwent surgery by the inverted sequencing. In both groups the final position of the maxillary central incisor was analyzed (in the vertical and anteroposterior planes), and this result was compared with what was planned in the pursuit of surgical precision. The results found in groups 1 and 2 were then compared in the search of differences between the two techniques. The null hypothesis, which stated that there was no difference between the groups, was tested. After applying the Welch t test for comparison of mean differences between the desired and obtained in groups 1 and 2, considering a statistical significance of 5% (alpha) and a two-tailed test, the null hypothesis was not rejected given the results of the samples (p> 0.05). Thus, there was no difference in the accuracy of maxillary positioning between the groups. It was concluded that the conventional surgical sequence as well as the inverted sequencing proved to be reliable in positioning the maxilla after Le Fort I osteotomy
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

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The use of cone beam computed tomography exam (CBCT) has increased greatly in recent years in dentistry, so there is much discussion about the role of the dentist in evaluating the anatomical structures near the maxillo-mandibular. Currently we do not know the occurrence of abnormalities in the maxillary sinuses in a large sample of CBCT examinations of dental patients with different indications. The aim of this study was 1-to investigate the occurrence of maxillary sinus abnormalities using cone beam computed tomography (CBCT) exams of asymptomatic patients, 2- identify the frequency, type and location of these findings, and 3- its association with the proximity of periapical lesions and inflammatory changes in the maxillary sinus.1113 CBCT exams were evaluated by two examiners to identify the presence or absence of abnormalities of the maxillary sinus. Cases with abnormalities were reevaluated for identification of the type of the abnormality and location within the sinus. The presence and proximity of periapical lesions in the upper posterior teeth to the lower sinus wall were recorded. Data were analyzed using descriptive statistics and chi-square test. Inter-rater agreement was calculated using Kappa statistics. Abnormalities were diagnosed in 760 (68.2%) cases (kappa coefficient 0.83). There was a significant difference between genders, showing greater occurrence in males (p<0.001). No difference in the occurrence of abnormalities was observed regarding age groups (p>0.05). Mucosal thickening was the most prevalent abnormality (66%), followed by retention cyst (10.1%) and opacification (7.8%). The most frequent location of sinusal abnormalities were in the inferior wall (46.2%), anterior (29%), medial(25.7%) and lateral wall (21.5%). No association between the proximity of periapical lesion and the presence and type of inflammatory abnormalities was observed (p=0.124). The occurrence of abnormalities in maxillary sinus of asymptomatic was considered high. These findings emphasize the importance of a comprehensive interpretation by the dentomaxillofacial radiologist of all volume of CBCT images, including the entire maxillary sinus as part of the imaging exam of routine patients.
A utilização do exame de tomografia computadorizada por feixe cônico (TCFC) tem aumentado muito nos últimos anos na Odontologia, com isso, muito se discute sobre o papel do cirurgião-dentista na avaliação de estruturas anatômicas próximas ao complexo maxilo-mandibular. Atualmente não se conhece a ocorrência de anormalidades nos seios maxilares em uma grande amostra de exames de TCFC de pacientes com diferentes indicações odontológicas. O objetivo deste estudo foi investigar: 1-ocorrência de anormalidades no seio maxilar por meio de exames de TCFC de pacientes assintomáticos, 2-identificar a frequência, tipo e localização destas anormalidades, e 3- sua associação com a proximidade de lesões periapicais e alterações inflamatórias detectadas no seio maxilar.1113 exames de TCFC foram avaliados por dois examinadores para identificar a presença ou ausência de anormalidades do seio maxilar. Os casos com anormalidades foram reavaliados para a identificação do tipo de anormalidade e localização no interior da cavidade sinusal. A presença e a proximidade das lesões periapicais em dentes superiores posteriores à parede inferior do seio foram registrados. Os dados foram analisados por estatística descritiva e teste do qui-quadrado. A concordância entre os examinadores foi calculada por meio da estatística Kappa. Anormalidades foram diagnosticadas em 760 pacientes (68,2%) (kappa 0,83 coeficiente). Houve diferença significante entre os sexos, com maior ocorrência no gênero masculino (p <0,001). Não houve diferença na ocorrência de anormalidades em relação às faixas etárias (p <0,05). Espessamento mucoso foi a alteração mais prevalente (66%), seguido de cisto de retenção (10,1%) e opacificação (7,8%). As localizações mais frequentes de anormalidades sinusais foram na parede inferior (46,2%), anterior (29%), média (25,7%) e parede lateral (21,5%). Não foi observada associação entre a proximidade da lesão periapical e presença e tipo de anormalidades inflamatórias (p = 0,124). A ocorrência de anormalidades no seio maxilar de assintomáticos foi considerada alta. Estes achados enfatizam a importância de uma interpretação abrangente pelo radiologista dentomaxillofacial de todo o volume de imagens de TCFC, incluindo todo o seio maxilar, como parte do exame de imagem dos pacientes de rotina

In Chapter 21, we described the development of the pharyngeal arches and their derivatives. Craniofacial abnormalities account for about one third of all live birth defects. These arise during the development of the pharyngeal arches described in Chapter 21 or during the events described in this chapter. The first pharyngeal arch, the mandibular arch, is one of the basic building blocks needed to form the face and associated structures. The other major building block is the frontonasal process that covers the developing forebrain. The development of the face begins after the first pharyngeal arch forms around four weeks post-fertilization. At this stage, the head consists of a large bulge over the developing forebrain, approximating to the forehead and the mandibular arch in the position of the lower jaw. A slit between the frontonasal process and mandibular arch is continuous with the foregut tube; this slit is the primitive oral cavity or stomodeum. This primitive mouth cavity has no side walls where the cheeks would be and more significantly, there is no nasal cavity. Development of the nasal and oral cavities internally and the face externally proceeds at the same time over the course of the next eight weeks of development. Essentially, the nasal cavity is formed, then divided into two and separated from the oral cavity by the palate. The sequence of events is: • Development of the nasal cavity and first part of the palate, beginning the separation the oral and nasal cavities; • Development of the maxillary arch from the mandibular arch to form the cheeks and important structures contributing to the palate; • Completion of the components required to form the palate and separate the nasal cavity into right and left cavities; • Fusion of the building blocks to complete the separation of the nasal cavity and the separation of the nasal cavity from the oral cavity. As you can see in Figure 32.1A, the stomodeum is roofed by the frontonasal process and its floor is the fused mandibular arches.

A wide variety of processes can affect the formation of teeth during development. The number, size, shape, and quality of dental hard tis­sue may be abnormal and teeth may erupt early or be prematurely shed or resorbed. When a child presents with a tooth abnormality, the clin­ical and radiographic features are often distinctive and management depends on diagnosis (Box 5.1). Broadly, developmental abnormal­ities of the teeth can be either genetically determined or acquired as a result of injurious processes affecting the developing teeth. It can be problematic to make a diagnosis, particularly when teeth initially erupt. Sometimes pathological examination of a shed or extracted tooth by ground sectioning (for enamel) or conventional sectioning of a decalci­fied tooth can provide a diagnosis. Research has provided insights into the genetic and structural basis of dental anomalies, and has resulted in a complex and extensive classification of subtypes. Minor abnormal­ities, such as failure of development of a few teeth or enamel erosion in adult life, may be dealt with in general dental practice, but it is advisable to refer younger patients with more complex or extensive dental abnor­malities to a specialist in child dental health, with links to expert diag­nostic facilities and input from orthodontic and restorative colleagues. The publically available Online Mendelian Inheritance in Man (OMIM) database provides an invaluable resource for genetic disorders, including dental abnormalities. Supernumerary teeth are common and may be rudimentary in form or of normal morphology, when they are referred to as supplemental teeth. The most common supernumerary tooth occurs in the mid- line of the maxillary alveolus and is referred to as a mesiodens, which usually has a conical shape. Eruption of adjacent normal successor teeth may be impeded by a mesiodens, which is an indication for its removal. Most supernumerary teeth occur as a sporadic event in devel­opment, but multiple extra teeth can be found in certain developmen­tal disorders. Failure of development of tooth germs results in teeth missing from the dental arch and is referred to as hypodontia. Most often the missing teeth are third molars, second premolars, and upper lateral incisors. Hypodontia is more common in the permanent dentition than in the primary teeth.