The extensions of the lesion in osteomyelitis of mandible were evaluated in terms of the rediographic methods employed. 26 patients suffered from the chronic osteomyelitis limited in the molar area were examined using the panoramic and occlusal radiographs in evaluating the vertical and buccolingual extensions respectively. Osteosclerotic change extended below the mandibular canal may be accompanited by the extension to the cortex of bucco-lingual side. This indicates that the extensive lesions should be complemented by the occlusal radiograph to define their bucco-lingual extension. On the other hand, osteolytic change tends to be limited above the mandibular canal and not to be extended to the cortex of bucco-lingual side. This means that the occlusal radiograph may be somewhat useless for this defined osteomyelitis.

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The presence of a malignant lesion in the maxillo-facial region can now be easily detected now using X-ray CT or MR imaging. However, patients with such lesions usually first visit a medical or dental clinic, and it is therefore still important for dental clinicians to be able to detect such a lesion on a panoramic tomograph (PT), especially in cases in which the lesion is present in the maxillary bone or its adjacent structures, regions that are not easy to observe directly. However, in the previous study, we found that the presence of such a lesion was overlooked in some of the patients and that a correct diagnosis could be established even in those patients in whom lesion had been overlooked by checking certain structures depicted on routine PTs.
In this study, the abilities of trainee dentists (graduate students of dental universities) to detect abnormal findings on PTs were investigated PT films of eight patients with malignant lesions of the maxillary sinus and adjacent tissue were given to trainee dentists who volunteered to participate in this study. The trainee dentists were requested to read the films within 2.5 minutes and to record their findings. The trainee dentists were randomly divided into three groups: one group in which films were read using the schema of PT from a textbook on oral radiology (group A), one group in which films were read using an original schema showing significant lines on a PT (group B), and one group in which films were read using the same shema as that given to group B conbined with a tabular checklist for significant structures.
After reading the films, the dentists were given a lecture on the principles and normal anatomy of PTs and on detailed findings of the films. Furthermore, 18 dentists were randomly selected from the trainee dentists who volunteered to participate in this study, and this group of trainee dentists read another film series before and after the lecture. After that, improvement in their reading ability was analyzed.
Trainee dentists in group A could detect almost no abnormal findings. Trainee dentists in group B showed higher scores than trainee dentists in group A, but could detect less than half the total number of destroyed structures. Trainee dentists in group C showed significantly greater ability to detect abnormalities than trainee dentists in the other two groups. Trainee dentists in group S misread the films and could detect almost no abnormalities before the lecture but showed significant improvement after the lecture.
From these results, we concluded that the most important factor in detecting abnormalities on PTs is checking the important lines on PT, including unfamiliar structures for dental clinicians, and comparing these lines on both sides.

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46歳女性で, 左側の後頭・頸部から上腕にかけての鈍痛を伴うシビレ感左側の口蓋扁桃の腫脹突出感および咽喉頭異常感を訴える患者において, 茎状突起長が51.30mm (左側) と長く, 茎状突起過長症と診断して, 茎状突起の切除によって訴えがすべて解消した症例を経験した。
茎状突起の観察には断層式パノラマ撮影が有用であり, 実際の茎状突起長をより反映していると思われる計測方法を考案した。
グループI (鼻副鼻腔疾患52例)の茎状突起長は32.16mm±5.93mmであった。また, グループII (咽喉頭異常感症を疑った5例) の茎状突起長は44.14±7.20mmであり, グループIに比べて長い傾向にあった。

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