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ABSTRACT The Sphenoid Sinus is considered the paranasal sinus with more variation to the degree of pneumatization. Thus, this work aimed report to the first case on the interference of this anatomical variation for orthognathic surgery. A 18- year-old woman, with isolated cleft palate repaired, was submitted to orthognathic surgery to correct the maxillomandibular skeletal discrepancy. The cone beam computed tomography (CBCT) exam performed for preoperative planning showed a great extension for the adjacent structures, with proximity to the posterior wall of the maxillary sinus and pterygomaxillary fissure bilaterally. The postoperative CBCT image evidenced the compromise of the sinus floor due to the factors related to the transoperative period. This case, along with literature review, highlighted the importance of identifying sphenoid sinus variation in CBCT exams prior to orthognathic surgery, in order to avoid serious complications for the patient, such as sinus infections; hemorrhages; mucocele formation or intracranial involvement.

RESUMO O Seio Esfenoidal é considerado o seio paranasal com maior variação quanto ao grau de pneumatização. Assim, este trabalho objetivou relatar o primeiro caso sobre a interferência dessa variação anatômica para a cirurgia ortognática. Mulher,18 anos, com fissura de palato isolada reparada, foi submetida à cirurgia ortognática para correção da discrepância esquelética maxilomandibular. O exame de tomografia computadorizada de feixe cônico (TCFC), realizado para planejamento pré-operatório, mostrou grande extensão para as estruturas adjacentes, e com proximidade da parede posterior do seio maxilar e fissura pterigomaxilar bilateralmente. A imagem de TCFC pós-operatória evidenciou o comprometimento do assoalho do seio devido aos fatores relacionados ao transoperatório. Este caso, juntamente com a revisão da literatura, destacou a importância de identificar a variação do seio esfenoidal nos exames de TCFC prévios à cirurgia ortognática, a fim de evitar complicações graves para o paciente, tais como sinusite, hemorragias, formação de mucoceles ou, até mesmo, envolvimento intracraniano.

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OBJECTIVE: The aim of this study was to evaluate the posterior superior alveolar canal (PSAC) in patients with cleft lip and palate (CLP) as compared to patients with no cleft lip and palate (NC) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: This was a retrospective multicenter study based on two steps: (1) evaluating intra- and inter-calibration and (2) detecting the presence or absence of PSAC and its location, diameter, and anastomosis with anterior superior alveolar canal. RESULTS: A total of 300 patients were selected for the study, out of which 150 were categorized as CLP (75 men, 75 women; mean age: 29.8 years) and 150 were categorized as NC (75 men, 75 women; mean age: 40.3 years). PSAC in patients with CLP and NC was visible in 100% of the cases, in men and women, bilaterally. PSAC location in CLP was middle and upper third of the maxillary sinus as compared to NC (lower third) (chi-squared < 0.001). PSAC mean diameter in CLP was 1.12 mm. It was larger compared to 0.6 mm in NC (t-test < 0.0001). CONCLUSION: PSAC location in patients with CLP was predominantly in the middle and upper third of the maxillary sinus, compared with NC. PSAC mean diameter in CLP was 1.12 mm. It was larger compared to that of 0.6 mm in NC. CLINICAL RELEVANCE: These anatomical variations in CLP are important and should be acknowledged by surgeons for the following reasons: (1) to perform pre-surgical planning, (2) to avoid bleeding, and (3) to avoid neurosensory alterations.

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OBJECTIVE: To evaluate the canalis sinuosus (CS) in individuals with cleft lip and palate (CLP) and compare the findings with individual's NON-CLP using cone beam computed tomography (CBCT). MATERIALS AND METHODS: The sample consisted of 100 CBCT exams of NON-CLP individuals (G1 group) and 200 of CLP individuals (G2 group). Recorded parameters included presence of CS, accessory canal to the CS, diameter greater than 1 mm, gender, age, localization in relation to teeth, and adjacent structures. Statistical tests were used to compare the findings between groups. A p value of < 0.05 was considered as significant. RESULTS: A higher prevalence of accessory canal was found in the G2 (p < 0.001). The anteroposterior diameter of the right side CS in G2 was higher than G1 (p < 0.05), with average of 1.4 mm ± 0.4 mm. The accessory canal had a larger diameter in G2 than G1 (p < 0.05) with average of 1.3 mm ± 0.3 mm. Between UCLP, the CS presented the largest diameter for the side NON-CLP (p < 0.001). The accessory canal was more distant from the cortical buccal in G2 (P < 0.05). The dental region incidence of the accessory canal was molars and premolars for G2 and canines and incisors in G1. CONCLUSION: Individuals with CLP show higher prevalence of accessory canal to the CS with larger diameters than NON-CLP. It is necessary that the professional make adequate planning prior to surgeries, using the CBCT, in order to avoid neurovascular lesions, since these individuals undergo several surgeries in the CS region.

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A fissura labiopalatina é uma malformação craniofacial que, como o próprio nome induz, envolve lábio, rebordo alveolar e palato. Pode ser acompanhada por algumas anomalias dentárias como o dens in dente, que necessita de avaliação radiográfica para auxílio em seu diagnóstico. Objetivo: Identificar nas radiografias periapicais o dens in dente em indivíduos com fissura labiopalatina, especificamente na região próxima à fissura. Metodologia: Foram avaliados 10 exames de radiografias periapicais de indivíduos com fissura labiopalatina, do arquivo de imagens digitais da Seção de Diagnóstico Bucal do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC-USP, Bauru-SP, Brasil). Em uma primeira etapa, foram identificados os dens in dentes de cada indivíduo e posteriormente classificados de acordo com Oehlers (1957). Após essas etapas, todos os prontuários dos indivíduos foram avaliados quanto ao histórico de tratamento desses dentes. Conclusão: Na amostra radiográfica de indivíduos com fissura labiopalatina, encontrou-se a maior frequência do dens in dente no dente 12. De acordo com a classificação de Oehlers, 70% dos casos foram grau II, 30% grau I e o grau III não foi encontrado. Entre os lados das fissuras avaliadas com a presença de dens in den-te, 40 % estavam do lado direito, 40% bilateralmente e 20% do lado esquerdo. A radiografia periapical é fundamental para complementar o diagnóstico clínico. O tratamento pode variar de acordo com os níveis de comprometimento dessa anomalia dentária e depende da correta avaliação por parte do dentista.

The cleft lip and palate is a craniofacial malformation that, as its name induces, involves the lip, alveolar ridge, and palate. It may be accompanied by some dental anomalies such as dens in dente, which needs radiographic evaluation to aid in its diagnosis. Objective: To identify in periapical radiographs the dens in dente in individuals with cleft lip and palate, specifically in the region close to the cleft. Methods: Ten periapical radiographs of individuals with cleft lip and palate from the digital image file of the Oral Diagnosis Section at Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (Bauru, São Paulo, Brazil) were evaluated. In a first step, the dens in dente of individuals were identified. In a second step, they were classified according to the Oehlers (1957). After these phases, all the records of the individuals were evaluated regarding the treatment history of these teeth. Conclusion: In the radiographic sample of individuals with cleft lip and palate, the highest frequency of dens in dente was found in tooth 12. According to the Oehlers classification, 70% of the cases were type 2, 30% type 1, and type 3 was not found. Between the sides of the cleft evaluated for the presence of dens in dente, 40% were on the right side, 40% bilaterally, and 20% on the left side. Periapical radiography is essential to complement the clinical diagnosis. Treatment can vary according to the levels of impairment of this dental anomaly and depends on the correct evaluation by the dentist.

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O uso crescente da Tomografia Computadorizada de Feixe Cônico (TCFC) na área odontológica tem permitido o aumento dos achados incidentais em exames que são realizados por outros fins. Dentre essas uma, das mais comuns e com impacto na vida dos pacientes é o ateroma calcificado das artérias carótidas (ACAC), e no seu diagnóstico diferencial existem as ossificações das cartilagens da laringe. Para correta identificação dessas calcificações são necessários conhecimentos acerca da localização anatômica, distribuição e sua morfologia, sendo que a TCFC fornece uma localização tridimensional (3D) acurada. Entretanto existem diferentes softwares de pós-processamento de imagens disponíveis no mercado, e não há na literatura estudos sobre a capacidade desses softwares para a visualização dessas estruturas. Esse estudo tem o objetivo de identificar essas calcificações supracitadas, nos softwares de visualização de TCFC, i-Cat Vision® e Invivo5®, nas reconstruções multiplanares e 3D em dois grupos diferentes, sendo um grupo de exames de indivíduos com fissuras labiopalatinas (HRAC) (50 exames de TCFC) e outro sem fissuras labiopalatinas (FOB) (100 exames de TCFC). Foram avaliados 150 exames (112 do gênero feminino e 38 do gênero masculino) de TCFC por dois observadores devidamente treinados e calibrados. Para o grupo sem fissuras labiopalatinas foi encontrada diferença estatística significante entre a idade e a quantidade de calcificações encontradas. Considerando todas as calcificações, foram encontrados 104 indivíduos com alguma calcificação, representando 69,33% da amostra, sendo que o grupo HRAC apresentou 88% e o grupo FOB 59%. Foi possível demonstrar diferença estatística significante ao se comparar a quantidade de calcificações entre os grupos avaliados. Foi assumido nesse trabalho que as reconstruções separadamente do programa Invivo5® seria a padrão- ouro, nesse momento o programa i-Cat Vision® foi considerado mais específico do que sensível...

The widespread use of CBCT in Dentistry leads to an increasing of incidental findings regarding exams for different purposes. The most common incidental finding that impacts the patients quality of life is the carotid artery calcifications as well as the ossification of laryngeal cartilage which is the most common differential diagnosis for aterosclerosis. To identify this calcifications/ossification correctly it is necessary to know about its anatomic localization, distribution and morphology once that CBCT images may evidence an accurate 3D location. Therefore many different manipulations imaging software for CBCT technology is available and there is no research in the literature about the capacity of this software to visualize these calcification/ossification structures. This study aimed to identify these calcifications/ossification, in two different visualization softwares: i-Cat Vision® and Invivo5®, both in Multiplanar Reconstruction (MPR) and 3D reconstruction, in two different groups, where one was constituted of cleft lip and palate (50 CBCT exams) patients and the other by patients without cleft lip and palate (100 CBCT exams). Two calibrated and trained observers evaluated 150 CBCT exams (112 were female and 38 male). There was significantly statistical difference when comparing age and calcifications quantity for no cleft lip and palate group. When considering all calcifications in both groups, 104 patients in 150 (total number) showed some calcification/ossification, representing 69,33%. The percentage of calcification/ossification in the cleft lip and palate group were 88% whereas the other one evidenced 59%. And due to this difference, there was significantly statistical difference between these groups. Besides, the Invivo5® software was considered the gold-standard (multiplanar reconstruction and 3D reconstruction) to identify the structures previously mentioned; then i-Cat Vision® software showed more specificity than...

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