The Teeth You Need

Hank Colgait (35) has been sent by an oromaxillofacial surgeon. Lately he has felt a painful swelling in his left mandibular angle during eating. The colleague has asked for an orthopantomograph (OPG). Orthopantomography is a dedicated and technically sophisticated tomographic technique in which tube and film cassette rotate around the head of the patient. Greg reviews the film (Fig. 13.30) and asks our students to have a good look themselves. This patient, he says, has a whole number of diagnoses. Apart from a maxillary fracture about 20 years ago and the loss of several teeth in the course of time he also has:

• A granuloma of the dental radix

• One impacted and another normal "wisdom tooth"

• One intact and one amputated dental bridge and

• The reason for Mr. Colgait's pain

Our students grab the form and assign their observations to the respective teeth. Do you want to have a go at it also?

Maxilla

18 17 16 15 14 13 12 11

21 22 23 24 25 26 27 28

Mandible

48 47 46 45 44 43 42 41

3132 33 34 35 36 37 38

Right

Left

Have you sorted it out? The correct answers are found on p. 342.

I Assign the Findings!

C"

Fig. 13.30 Orthopantomography is performed with a sophisticated and dedicated tomography unit. The cooperation and positioning of the patient are crucial. Evaluate the whole set of teeth and also the osseous components of the temporo-

mandibular joint. The cervical spine is visible laterally on both sides. Now assign the findings to the individual teeth using the scheme (see the text). Just one hint at the beginning: tooth 47 and tooth 32 are reasonably normal candidates of their kind.

In no other field of medicine can we help so much and so rapidly as in trauma medicine. If you have ever seen the metamorphosis of a beaten-up, lifeless, pale human body back into pink pulsating life—all this under the experienced hands of a crowd of swiftly working, focused, and coordinated specialists—you know why the medical profession is a worthwhile one. And if you hear the same patients tell you half a year later that they have been able to resume their private life and pick up their professional activities again, you get an impression how important the flawless functioning of emergency medicine and trauma care is for the society as a whole. Imaging plays a central role in this scenario, which is also called the "Golden Hour." It can contribute to efficient management of the acutely injured patient more than anywhere else.

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