Maxillofacial Imaging

doi:10.3174/ajnr.A0721

T.A. Larheim and P.-L. Westesson, eds. Heidelberg, Germany: Springer; 2006, 440 pages, 1450 illustrations, $259.00.

The authors, who are well-recognized leaders in dental medicine and maxillofacial radiology, have undertaken the task of writing a concise and comprehensive book that covers the evolving role of advances in imaging technology in the diagnosis of various dental and maxillofacial conditions.

This book is intended to be an “atlas” to target not only radiologists but also head and neck and maxillofacial surgeons, otolaryngologists, and other physicians who may encounter these clinical conditions in their daily practice. There are 14 chapters. The style of each chapter generally has the same outline format, begins with a concise introduction of the topic, and discusses salient clinical features of a wide variety of cases and their imaging features.

The illustrations are a major component of the book and are almost uniformly excellent. They are clearly labeled with gross pathologic specimens complementing many case studies. The text is well referenced and current.

The introductory chapter is devoted to maxillofacial anatomy. The high-quality and well-labeled 3D and high-resolution cross-sectional CT and MR images will be extremely useful to radiologists and nonradiologists who may not be so familiar with this anatomy. At the end of the chapter, the images demonstrating correlative MR and gross anatomy of the temporomandibular joint are particularly well illustrated.

The next 4 chapters discuss the various pathologic conditions of the mandible and maxilla; these include congenital, infectious, and neoplastic lesions. Plain radiographic and CT and MR features of several different conditions in each category of diseases are discussed to familiarize their imaging characteristics to both dental and other medical specialists. Although I appreciate that this work is not intended to be a textbook, it would have been helpful to include the clinical management of the various disease conditions as well as the cancer staging nomenclature of the different head and neck neoplasms and their treatment options.

The chapter related to the temporomandibular joint gives valuable practical information about the potential usefulness of state-of-the-art MR compared with previous conventional imaging modalities in practically all categories of diseases. In selected cases, illustrations from surgical and autopsy specimens that supplement the MR images are also very informative. The next 4 chapters elucidate the gamut of pathologic conditions that pertain to regions closely related to the jaw. These conditions include dental implants, maxillofacial trauma, craniofacial deformities, and disorders of the paranasal sinuses. The chapter on dental pathology, including implants, is a very useful overview for the medical profession because this area is well known to dentists. The potential of CT, including advanced conebeam techniques along with high-quality reconstructed images, is provided.

A comprehensive overview of the various types of maxillofacial fractures and imaging modalities, including advanced CT reconstruction modalities available in the different subtypes of fractures, is discussed at length in the chapter on facial trauma. In the chapter on disturbances of facial growth, a thorough review and illustrations of craniofacial anomalies, with emphasis on the complementary role of both 2D and 3D CT imaging, are discussed.

The next 2 chapters focus on the evolving role and advantages of advanced imaging techniques, namely CT and MR, compared with traditional dental/conventional plain radiographs (that dentists are more familiar with) in the diagnosis of diseases of the paranasal sinuses and the adjacent maxillofacial soft tissues, which include lesions of the oropharynx or oral cavity and deep neck spaces.

At the end of the book, a particularly useful chapter deals with lesions of the surrounding tissues that the radiologist will commonly encounter during the work-up of a patient with a maxillofacial lesion. Clinical and imaging characteristics of a potpourri of congenital, degenerative, inflammatory, infectious, and neoplastic conditions are discussed.

Finally, the last chapter includes various interventional procedures for the treatment of assorted pathologic conditions of the orbitofacial region that the maxillofacial radiologist may be asked to perform. Indications and techniques of procedures such as arthroscopy of the temporomandibular joint, a sialogram, biopsy of the deep neck space, and embolization of a hemangioma are briefly covered.

In summary, the authors have achieved their goal of providing an introduction to the role of advanced imaging modalities, primarily CT and MR, in maxillofacial imaging. Overall, this book is well organized and has a unique format that meets its intended purpose. It is a concise “atlas” that is simple to use and to the point, with a plethora of high-quality, clearly labeled illustrations. However, for particular topics in which specific details are needed, the audience should be warned that it may need to research other material as well. The authors are encouraged to use this book as a foundation for future editions of a more formal textbook on maxillofacial imaging. I recommend this book to anyone who is interested in maxillofacial radiology.