Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
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Multislice computed tomography demonstrating mental nerve paresthesia caused by periapical infection: A case report

  • Yong-Min Kim (Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Ho-Keun Choi (Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Jo-Eun Kim (Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Jeong-Joon Han (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Kyung-Hoe Huh (Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University)
  • Received : 2023.12.04
  • Accepted : 2023.12.27
  • Published : 2024.03.31
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Abstract

Components derived from an infected lesion within the bone can spread through various passages in the mandible, particularly via the mental foramen. Radiologically, the spread of infection is typically nonspecific and challenging to characterize; however, multislice computed tomography (MSCT) can effectively detect pathological changes in soft tissues and the bone marrow space. This report describes the case of a 55-year-old woman who experienced mental nerve paresthesia due to a periapical infection of the right mandibular second premolar. MSCT imaging revealed increased attenuation around the periapical lesion extending into the mandibular canal and loss of the juxta-mental foraminal fat pad. Following endodontic treatment of the tooth suspected to be the source of the infection, the patient's symptoms resolved, and the previous MSCT imaging findings were no longer present. Increased bone marrow attenuation and obliteration of the fat plane in the buccal aspect of the mental foramen may serve as radiologic indicators of inflammation spreading from the bone marrow space.

Keywords

References

  1. Alves FR, Coutinho MS, Goncalves LS. Endodontic-related facial paresthesia: systematic review. J Can Dent Assoc 2014;80: e13.
  2. Giuliani M, Lajolo C, Deli G, Silveri C. Inferior alveolar nerve paresthesia caused by endodontic pathosis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92: 670-4.
  3. Ngeow WC. Is there a "safety zone" in the mandibular premolar region where damage to the mental nerve can be avoided if periapical extrusion occurs? J Can Dent Assoc 2010; 76: a61.
  4. Yeler H, Ozec I, Kilic E. Infection-related inferior alveolar and mental nerve paresthesia: case reports. Quintessence Int 2004;35: 313-6.
  5. Rowe AH. Damage to the inferior dental nerve during or following endodontic treatment. Br Dent J 1983; 155: 306-7.
  6. Yoshino P, Nishiyama CK, Modena KC, Santos CF, Sipert CR. In vitro cytotoxicity of white MTA, MTA Fillapex® and Portland cement on human periodontal ligament fibroblasts. Braz Dent J 2013; 24: 111-6.
  7. Skaper SD, Facci L, Leon A. Inflammatory mediator stimulation of astrocytes and meningeal fibroblasts induces neuronal degeneration via the nitridergic pathway. J Neurochem 1995;64: 266-76.
  8. Poveda R, Bagan JV, Fernandez JM, Sanchis JM. Mental nerve paresthesia associated with endodontic paste within the mandibular canal: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: e46-9.
  9. An CH, An SY, Choi BR, Huh KH, Heo MS, Yi WJ, et al. Hard and soft tissue changes of osteomyelitis of the jaws on CT images. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:118-26.
  10. Grimard BA, Hoidal MJ, Mills MP, Mellonig JT, Nummikoski PV, Mealey BL. Comparison of clinical, periapical radiograph, and cone-beam volume tomography measurement techniques for assessing bone level changes following regenerative periodontal therapy. J Periodontol 2009; 80: 48-55.
  11. Kim JE, Cho JB, Yi WJ, Heo MS, Lee SS, Choi SC, et al. Accidental overextension of endodontic filling material in patients with neurologic complications: a retrospective case series. Dentomaxillofac Radiol 2016; 45: 20150394.
  12. Liang X, Jacobs R, Hassan B, Li L, Pauwels R, Corpas L, et al. A comparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT(MSCT). Part I. On subjective image quality. Eur J Radiol 2010; 75: 265-9.
  13. Liang X, Lambrichts I, Sun Y, Denis K, Hassan B, Li L, et al. A comparative evaluation of cone beam computed tomography (CBCT) and multi-slice CT(MSCT). Part II: on 3D model accuracy. Eur J Radiol 2010; 75: 270-4.
  14. Hohlweg-Majert B, Pautke C, Deppe H, Metzger MC, Wagner K, Schulze D. Qualitative and quantitative evaluation of bony structures based on DICOM dataset. J Oral Maxillofac Surg 2011; 69: 2763-70.
  15. Gambarini G, Plotino G, Grande NM, Testarelli L, Prencipe M, Messineo D, et al. Differential diagnosis of endodontic-related inferior alveolar nerve paraesthesia with cone beam computed tomography: a case report. Int Endod J 2011; 44: 176-81.
  16. von Ohle C, ElAyouti A. Neurosensory impairment of the mental nerve as a sequel of periapical periodontitis: case report and review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: e84-9.
  17. Chen L, Li T, Jing W, Tang W, Tian W, Li C, et al. Risk factors of recurrence and life-threatening complications for patients hospitalized with chronic suppurative osteomyelitis of the jaw. BMC Infect Dis 2013; 13: 313.
  18. Devine M, Yilmaz Z, Hirani M, Renton T. A case series of trigeminal nerve injuries caused by periapical lesions of mandibular teeth. Br Dent J 2017; 222: 447-55.
  19. Ricucci D, Loghin S, Siqueira JF Jr. Complicated untreated apical periodontitis causing paraesthesia: a case report. Aust Endod J 2018; 44: 281-5.
  20. Scarfe WC, Levin MD, Gane D, Farman AG. Use of cone beam computed tomography in endodontics. Int J Dent 2009; 2009: 634567.
  21. Cone beam CT for dental and maxillofacial radiology: evidencebased guidelines (radiation protection no. 172). Luxembourg: European Commission; 2012.
  22. Hargreaves BA, Worters PW, Pauly KB, Pauly JM, Koch KM, Gold GE. Metal-induced artifacts in MRI. AJR Am J Roentgenol 2011; 197: 547-55.
  23. Wang X, Chen K, Wang S, Tiwari SK, Ye L, Peng L. Relationship between the mental foramen, mandibular canal, and the surgical access line of the mandibular posterior teeth: a cone-beam computed tomographic analysis. J Endod 2017; 43: 1262-6.
  24. Oliveira AC, Candeiro GT, Pacheco da Costa FF, Gazzaneo ID, Alves FR, Marques FV. Distance and bone density between the root apex and the mandibular canal: a cone-beam study of 9202 roots from a Brazilian population. J Endod 2019; 45: 538-42.e2.
  25. Tilotta-Yasukawa F, Millot S, El Haddioui A, Gaudy JF. Labiomandibular paresthesia caused by endodontic treatment: an anatomic and clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: e47-59.
  26. Trikeriotis D, Paravalou E, Diamantopoulos P, Nikolaou D. Anterior mandible canal communications: a potential portal of entry for tumour spread. Dentomaxillofac Radiol 2008; 37: 125-9.
  27. Mohammadi Z. Endodontics-related paresthesia of the mental and inferior alveolar nerves: an updated review. J Can Dent Assoc 2010; 76: a117.
  28. Sarikov R, Juodzbalys G. Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res 2014; 5: e1.
  29. Schultze-Mosgau S, Reich R. Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity. Int J Oral Maxillofac Surg 1993; 22: 214-7.
  30. Ahonen M, Tjaderhane L. Endodontic-related paresthesia: a case report and literature review. J Endod 2011; 37: 1460-4.
  31. Koseoglu BG, Tanrikulu S, Subay RK, Sencer S. Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 803-6.
  32. Ugboko VI, Ndukwe KC, Adelusola KA, Durosinmi MA. Burkitt's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report. Aust Dent J 1999; 44: 58-60.
  33. Otto S, Hafner S, Grotz KA. The role of inferior alveolar nerve involvement in bisphosphonate-related osteonecrosis of the jaw. J Oral Maxillofac Surg 2009; 67: 589-92.