Shika Hoshasen

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Objectives: To clarify the usefulness of the cortical shape of the mandible on panoramic radiographs for identifying osteoporosis patients aged ≥40 years in general practice at our radiology clinic （at Matsumoto Dental University Hospital）.
Methods: Of the patients in whom panoramic radiography was used to diagnose dental diseases at our radiology clinic between 2012 and 2015, 4,459 Japanese patients （2,112 males and 2,347 females） aged ≥40 years had their panoramic radiographs examined in this study. Eight certified oral and maxillofacial radiologists who had between 6 and 37 years of experience independently classified the cortical shape of the mandible into three categories （normal, mildly to moderately eroded cortices, and severely eroded cortices） based on panoramic radiographs obtained during daily general practice at our radiology clinic. Logistic regression analysis （forward selection; adjusted for gender, age, the number of teeth present, hypertension ［present or absent］, and diabetes mellitus ［present or absent］） was used to evaluate the association between the cortical shape of the mandible and a diagnosis of osteoporosis.
Results: Of the 4,459 subjects, 244 （5.5％） had been diagnosed with osteoporosis by a physician. Progressive cortical erosion of the mandible was significantly associated with gender （women） and advancing age （P<0.001）. The individuals with mildly to moderately and severely eroded cortices exhibited odds ratios for a diagnosis of osteoporosis of 2.50 （95％ confidence interval ［CI］, 1.65-3.78） and 3.83 （95％ CI, 2.37-6.17）, respectively.
Conclusions: Our study suggested that the shape of the mandibular cortex on panoramic radiographs is useful for identifying osteoporosis patients aged ≥40 years in general practice at radiology clinics.

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A 44-year-old female patient complained of spontaneous articular pain in her left temporomandibular joint. Her mandible had shifted toward the right, and she exhibited a crossbite. A large radiopaque body was seen in the posterior of the condylar head on radiography. Computed tomography revealed that the posterior of the left condyle was occupied by a radiopaque lesion measuring 15×20 mm. The left external auditory canal had been narrowed by the lesion. Several small radiopaque bodies were observed around the left condyle. Both the large mass and small radiopaque bodies were found to be located in a region of joint effusion in the upper joint space on magnetic resonance imaging （MRI）. The mandibular fossa exhibited a rough surface on both CT and MRI. Surgical enucleation of the lesion was performed. The histopathological diagnosis was synovial osteochondromatosis.

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