Madelung Deformity: Diagnosis and Treatment Options

Madelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment.The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology.When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability.We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD.

A Rare Case of a Radicular Dens Invaginatus Associated with an Inflammatory Periapical Cyst

Radicular Dens Invaginatus (RDI) represent a rare form of dens invaginatus which develops in the root of the tooth after the crown development is completed that can sometimes cause complex pathological conditions that are difficult to diagnose. This case report describes a case of a RDI associated with an inflammatory periapical cyst. A 17-year-old female complained of mobility in tooth 22. The tooth showed gyroversion and colour change and no evidence of caries or root fracture. Axial slices and tridimensional reconstruction of the cone-beam computed tomography revealed the presence of a RDI on the distal surface of the root that extended from cervical to the apical third. The diagnostic hypothesis was symptomatic infectious apical periodontitis, and conventional root canal treatment was performed. Subsequently, it was opted for a complementary surgical approach, which involved an aspiration puncture bulletin with a collection of yellow-citrus liquid, periapical curettage, apicectomy, retro-preparation and retrofilling with Mineral Trioxide Aggregate (MTA). Histopathological examination revealed was inflammatory periapical cyst. After 3-years, repair of the area was evident. Surgical management of this rare condition can be favourable for resolving endodontic infection related to this dental anomoly.

Use of Micro-Computed Tomography for Bone Evaluation in Dentistry

Micro computed tomography (µCT) follows the same principle of computed-tomography used for patients, however providing higher-resolution. Using a non-destructive approach, samples can be scanned, and each section obtained is used to build a volume using tridimensional reconstruction. For bone analysis, it is possible to obtain information about the tissue’s microarchitecture and composition. According to the characteristics of the bone sample (e.g. human or animal origin, long or irregular shape, epiphysis or diaphysis region) the pre-scanning parameters must be defined. The resolution (i.e. voxel size) should be chosen taking into account the features that will be evaluated, and the necessity to identify inner structures (e.g. bone channels and osteocyte lacunae). The region of interest should be delimited, and the threshold that defines the bone tissue set in order to proceed with binarization to separate the voxels representing bone from the other structures (channels, resorption areas, and medullary space). Cancellous bone is evaluated by means of the trabeculae characteristics and their connectivity. The cortex is evaluated in relation to the thickness and porosity. Bone mineral density can also be measured, by the amount of hydroxyapatite. Other parameters such as structure-model-index, anisotropy, and fractal dimension can be assessed. In conclusion, intrinsic and extrinsic determinants of bone quality can be assessed by µCT. In dentistry, this method can be used for evaluating bone loss, alterations in bone metabolism, or the effects of using drugs that impair bone remodeling, and also to assess the success rate of bone repair or surgical procedures.

A rare case of pedunculated bronchial hemangioma

We describe a rare case of pedunculated endobronchial hemangioma observed in a 60 years old patient complaining of chronic productive cough and accessional dyspnea which had been progressively worsening over 20 years. The lesion was first noticed at fiberoptic bronchoscopy; then computed tomography scan was performed and integrated with tridimensional reconstruction techniques. Pathology showed the picture of a vascular neoplasm, compatible with capillary hemangioma. The lesion was submitted to laser-assisted endoscopic removal in order to relieve the obstruction, leading to remission of symptoms.