Oral and maxillofacial radiology: The challenge of change
نویسنده
چکیده
Oral and maxillofacial radiologists may teach, practice, and/or conduct research with regard to any aspect of ra diology. They are also responsible for establishing guide lines for radiographic selection criteria, radiation safety, and quality assurance. Some oral and maxillofacial radio logists have joint appointments in medical radiology. This provides a collaborative working environment with med ical radiologists, who generally are not conversant with the diagnostic imaging of the jaws. Many oral surgeons argue that they do not need to ob tain radiology reports, as they could biopsy the lesion and send samples for histologic examination. This assumption is not necessarily true for many reasons, not the least of which is that the role of the radiologist in a multidiscipli nary team goes beyond diagnosis. A radiologist should also identify the precise extent of a lesion and its relation ship to adjacent vital structures, report cortical perforation and soft tissue involvement, recommend additional imag ing modalities, and report incidental findings. Neverthe less, many oral pathologists insist that diagnosis can be made through biopsy alone. This idea has been overstated to the point of losing its originality. To overcome this turf war, our multidisciplinary teams should take note of the many diagnoses that depend mostly on radiological rather than clinical or histological evidence. For instance, ossi fying fibroma and fibrous dysplasia of the jaw often show similar histological features, making distinguishing be tween the two entities on the basis of histology difficult, if not impossible. 1 Here is where the radiologist provides useful diagnostic data, enabling the appropriate distinction of the former, which is a metabolic disease usually requir ing no treatment, from the latter, which is a true neoplasm that requires resection. 1 Additionally, secondary infection of developmental lesions can mask their characteristic microscopic features, which makes the diagnosis even more difficult, as oral pathologists tend to diagnose these cases as infected cystic wall. Therefore, expert imaging interpretation should help guide pathologists in appropri ately analyzing histopathological findings. 2 Another note worthy example is the small dentigerous cyst. Histologic features are insufficient to distinguish between a small dentigerous cyst and a large dental follicle. It may seem that identifying a cystic cavity at the time of surgery may be the only reliable way to arrive at a definitive diagnosis; however, a radiographic sign of expansion will confirm the diagnosis of dentigerous cyst. 3 What is more, the his tological features of …
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