Association between Adenoid-Nasopharyngeal Ratio and Tympanogram Width in Adenoid Hypertrophy Patients

Introduction Adenoid hypertrophy is a change in adenoid size that can lead to obstruction the Eustachian tube and become a risk factor for otitis media effusion (OME) in children. Standard objective examination of adenoid hypertrophy uses adenoid-nasopharyngeal ratio (A-N ratio) based on correct lateral skull radiography. Adenoid hypertrophy is one of the factors causing OME in children. There is still much debate about the association between A-N ratio and tympanogram width (Tw). Determining the association of A-N ratio and Tw in adenoid hypertrophy patients. Methods Participants performed a true lateral radiographic examination using Fujioka method to determine A-N ratio, and Tw to determine middle-ear pressure. The distance between examination of A-N ratio and tympanogram examination was at maximum of ~1 week. The association between A-N ratio and Tw in patients with adenoid hypertrophy used the Pearson correlation test. This research employed significance level p < 0.05. Results Most participants were aged between 6 and 10 years (38.10%), male patients (57.14%), and the symptom most participants complained of was snoring during sleep (38.10%). Most participants had A-N ratio of 0.53 to 0.70 (61.90%) with an average of 0.60 ± 0.05. The average value of Tw measurement was 102.83 ± 50.03 daPa (r = 0.605; p < 0.001). Conclusion There is a significant association between A-N ratio base on true lateral radiographic examination and Tw in adenoid hypertrophy patients.

An unusual case of lead migration in occipital nerve stimulation: A case report and literature review

Background: Lead migration is a complication associated with occipital nerve stimulation (ONS). We present a rare case in which fibrosis in the stress relief loop caused lead migration in the treatment of occipital neuralgia. Case Description: A 30-year-old woman with a 5-year history of refractory occipital neuralgia, who had been under ONS therapy for 2 months, presented with a sudden onset of typical occipital neuralgia pain associated with cervical muscles spasms and myoclonus. A skull radiography showed lead migration. The patient underwent surgery for lead repositioning. During surgery, we identified extensive fibrosis throughout the stress relief loop that produced several constriction points. The fibrosis in the stress relief loop increased tension on the lead during head-and-neck movement, causing progressive migration of the lead. Conclusion: Although lead migration is a common complication of ONS, its association with fibrosis in the stress relief loop has not, to the best of our knowledge, been reported before. Lead migration can directly affect treatment outcome and it is, therefore, important to fully understand the possible mechanisms that can cause it and how to promptly manage them.

Diagnosis and surgical management of acanthomatous ameloblastoma in a 5-month-old female Boerboel puppy

A five-month-old female Boerboel puppy presented with a rapidly expanding fibrous growth around the canine tooth of the right maxilla was diagnosed as having acanthomatous ameloblastoma based on findings from skull radiography, cytology of fine needle aspiration, biopsy and histopathology of resected growth. Lateral radiograph of the skull revealed moderate osteolysis of the maxilla with presence ofun-erupted maxillary canine teeth. Cytology of fine needle aspirate from the growth showed clusters of epithelial cells that were hyperchromatic and showing palisade arrangement. The mass was surgically resected using diathermy instrument following general anaesthesia using combination of intramuscular injection of xylazine (0.5mg/kg), and intravenous injection of propofol (4mg/kg). Post-operative management included Ibuprofen suspension (100mg) administered for 3-days, intravenous vincristine (0.5mg/m2 ) once weekly and oral cyclophosphamide (50mg) was administered twice weekly for six weeks. Histopathology of the growth showed odontogenic epithelium embedded in pulp ectomesenchyme. Features of odontogenic epithelium include palisading epithelium with anti-basilar nuclei and centrally located cells having features of stellate reticulum. This is probably the first reported case of acanthomatous ameloblastoma in a Boerboel puppy that was successfully managed. Keywords: Acanthomatous, Ameloblastoma, Boerboel-puppy, Chemotherapy, Odontoid

Transferable Architecture for Segmenting Maxillary Sinuses on Texture-Enhanced Occipitomental View Radiographs

Maxillary sinuses are the most prevalent locations for paranasal infections on both children and adults. Common diagnostic material for this particular disease is through the screening of occipitomental-view skull radiography (SXR). With the growing cases on paranasal infections, expediting the diagnosis has become an important innovation aspect that could be addressed through the development of a computer-aided diagnosis system. As the preliminary stage of the development, an automatic segmentation over the maxillary sinuses is required to be developed. This study presents a computer-aided detection (CAD) module that segments maxillary sinuses from a plain SXR that has been preprocessed through the novel texture-based morphological analysis (ToMA). Later, the network model from the Transferable Fully Convolutional Network (T-FCN) performs pixel-wise segmentation of the maxillary sinuses. T-FCN is designed to be trained with multiple learning stages, which enables re-utilization of network weights to be adjusted based on newer dataset. According to the experiments, the proposed system achieved segmentation accuracy at 85.70%, with 50% faster learning time.

Evaluation of Patient Radiation Doses in Skull Radiography

Purpose: Exposures to medical ionizing radiations elevate the risk of stochastic effects such as cancer in exposed individuals. It is of utmost importance to monitor the radiation doses delivered to patients and their optimization to reduce the associated radiation risks without limiting the diagnostic information. Methods: Entrance surface air kerma (ESAK) in a total of 64 adult patients in diagnostic digital Xray examinations were calculated and effective doses were estimated as per International Atomic Energy Agency (IAEA). Results: Median ESAK (mGy) and associated effective doses obtained were skull PA (0.45mGy, 0.005mSv) and skull Lat (0.25mGy, 0.003mSv). Results were compared with UK diagnostic reference levels and studies in India.Conclusion: The comparison revealed that the calculated ESAK and effective dose values wereless than the published literature. ESAK values reported in this study could further contribute toestablishing LDRLs.