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原文題目(出處): Panoramic Radiography in the Diagnosis of Carotid Artery Atheromas and the Associated Risk Factors. The Open Dentistry Journal, 2011,5,79-83

原文作者姓名: João César Guimarães Henriques et al.

通訊作者學校: School of Dentistry, Universidade Estadual Paulista de São José dos Campos, São Paulo, Brazil

報告者姓名(組別): 黃慷慧 Intern C 組

報告日期: 2011/11/07


1. What are atheroma and atherosclerosis?

 Atheroma:calcified plaques especially composed of lipids and fibrous tissue deposited on the walls of blood vesselstrigger atherosclerosis.

 Atherosclerosis:a chronic inflammatory disease of an immunological nature, characterized by thickening and loss of elasticity of the arterial walls, associated with the presence of atheromas.

 When affect the carotids (supply the brain)strokes

 when affect the coronary (supply the heart) myocardial infarction

 result in the death of thousands of people all over the world

2. Etiopathogenesis


 metabolic, nutritional, hypertensive abnormalities, and even viral and bacterial infections

 vascular endothelium injured

 inflammatory environment developed: multiple interactions among platelets, T lymphocytes, macrophages, smooth muscle cells, adhesion molecules and genetic components

 propagate the pathological condition

accumulation of low density lipoproteins (LDL) in the intimate layer of the endothelium atheromatous plaque

superimposition of calcium deposits

3. Risk factors

 Diabetes mellitus

 complex metabolic disturbance

 complications: Coronary artery diseases, cerebrovascular diseases, peripheral vascular diseases, difficulty in wound healing and in terms of

oral manifestations, xerostomia and greater susceptibility to developing periodontal disease

 the high risk of stroke in diabetic patients is irrespective of the treatment modality used

 Obesity

 atherosclerosis presents as early as the first decade of life


 habits normally present in society nowadays have determined the increase in obesity parallel to atherosclerotic disease

 Arterial hypertension

 Smoking

 favoring a quantitative increase in bad cholesterol(LDL) and diminishing good cholesterol (HDL)

 increase blood carbon monoxide elevating the risks of lesions to the lining of the arterial wall

 Alcoholism

 play a very antagonistic role, favoring atherosclerosis

 in moderate quantity has a protective action

 Inadequate diet and eating habits

 high levels of cholesterol

 fatty acids saturated ↑total cholesterol and LDL levels

unsaturated mono-  anti-atherogenic effects poly-

 anti-atherogenic effects: ↓plasmatic LDL ,↑HDL ,

↑vasodilatation, and↓platelet aggregation

 Chronic renal disease

 Menopause

The reduced estrogen hormone levels and the other aging processes associated with menopause increase

the stroke risks in women

 Others

sedentarism, stress, hyperhomocysteinemia, radiotherapy of the head and neck, the obstructive sleep apnea syndrome, aging and being of the male gender

 more risk factors present => greater chance of atherosclerosis 4. Panoramic radiography and atheromas in carotid artery

 even partial calcifications can be observed in pano. radiographs

 One of the image exams most requested in dentistry

 findings:

 one or more irregular RO

 eventually punctuated by vertical-linear radiolucent areas,

 with single or multiple affections, of varied sizes,

 localized approximately 2.5 cm posterior and inferior to the mandibular

angle, adjacent to the space between vertebrae C3 and C4,

 uni- or bilaterally


 Why is PANO?

 low doses of radiation, low cost and has technical simplicity

normally deposited along the ascendant trajectory of the common

carotid artery that bifurcates into internal and external carotid arteries

comprised within the area of coverage

 D.D. the triticeal cartilages


 between the hyoid bone and the thyroid cartilage

 on the posterior free edge of the lateral thyro-hyoid ligaments

 The function is believed to strengthen the thyro-hyoid ligament

 of a hyaline nature and calcified as the individual aging

findigs:homogeneous RO when calcified,

regular oval shapes,

approximately 2 to 4 mm wide, 7 to 9 mm long, usually superimposed on the airspace of the pharynx close to the superior portion of vertebra C4

 the atheromas have a more lateral anatomic localization


the best way to differentiate:The antero-posterior radiograph

taken by means of the Modified Towne technique

 atheromas disposes laterally to the vertebrae, whereas the triticeal cartilages will practically not be observed

 The precision of the pano in detecting carotid artery atheromas has been continually tested

5. More specific imaging exams

 The thermograph and computerized tomography:the real extension and localization of calcifications with precision, as well as the degree of

obliteration of the carotid artery involved

 Ultrasonography with Doppler:the gold standard, noninvasive and inexpensive , with very low morbidity

6. Conclusion

When dentists are faced with a suspicion of the presence of carotid artery atheromas in panoramic radiographs, they play a important role in guiding and immediately referring their patients to doctors for adequate medical treatment, thus contributing to many lives possibly being saved.

題號 題目


在 Pano 片中,哪個解剖構造最需要跟頸動脈粥狀硬化斑塊做 D.D.?

(A) Calcified Stylohyoid Chain (B) Calcified Triticeous Cartilage

(C) Calcified Superior Cornu of the Thyroid Cartilage (D) Calcified Tonsils


答案(B) 出處:Soft Tissue Calcifications in the Neck:

Maxillofacial CBCT Presentation and Significance (From the Spring 2010 AADMRT Newsletter)

William C. Scarfe et al. University of Louisville School of Dentistry http://www.aadmrt.com/static.aspx?content=currents/scarfefarman_spring_10

題號 題目


如果發現 pano 中疑似頸動脈粥狀硬化斑塊的 RO,有 risk factors,但是難以跟

Calcified Triticeous Cartilage 分辨時,首先要考慮以哪種影像作確認?

(A) Thermograph (B) CT

(C) Ultrasonography with Doppler

(D) PA view x-ray with Modified Towne technique 答案(D) 出處:本文



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