CASE REPORT

Incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph: a case report

Surwandi Walianto , Wiwekowati Wiwekowati, Yudha Rahina

Surwandi Walianto
Biomedicine Postgraduate Program, Faculty of Medicine, Universitas Udayana, Bali, Indonesia Orthodontic Department, Faculty of Dentistry, Universitas Mahasaraswati, Bali, Indonesia. Email: surwandi3@gmail.com

Wiwekowati Wiwekowati
Orthodontic Department, Faculty of Dentistry, Universitas Mahasaraswati, Bali, Indonesia

Yudha Rahina
Dental Public Health Department, Faculty of Dentistry, Universitas Mahasaraswati, Bali, Indonesia
Online First: April 01, 2020 | Cite this Article
Walianto, S., Wiwekowati, W., Rahina, Y. 2020. Incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph: a case report. Bali Medical Journal 9(1): 339-343. DOI:10.15562/bmj.v9i1.1704


Background: The most common radiographic examinations in orthodontic are panoramic and lateral cephalometry. In panoramic and lateral cephalometric images in adult patients, sometimes can be found a fine foreign object which sometimes confuses as it scattered the radiographic image, such as needles. The needles found in the patients are known as “susuk” in Malay and Indonesian language or charm needles which believed to enhance beauty, charism, health, youth, luck, and to relieve pain. This case reports aim to elaborate the incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph.

Case Description: There was four adult woman conducted panoramic and cephalometric radiograph as a routine procedure before orthodontic treatment. The number of susuk inserted were varied, as it considered that the more needle increases the magical potency. In Case 1, the panoramic image depicts one “susuk” in the middle of the root of 44 (FDI notation) tooth. Besides, the cephalometric radiographs also show a “susuk” horizontally inserted at the root of the anterior lower teeth area. The panoramic image reveals one susuk around chin area below the apex of 42 teeth on Case 2 as well as on the soft tissue chin area in front of the apex of 41 teeth on cephalometric radiographs. In Case 3, two “susuk” were found inserted bilaterally symmetric at the upper premolar area by the panoramic image. Then, five “susuk” in the mandible and four “susuk” at the upper area of the maxilla were found in Case 4 by the panoramic image. 

Conclusion: The susuk are often exposed as incidental findings in panoramic and lateral cephalometric radiographs that are taken before performing routine orthodontic treatments. Understanding the presence of susuk is essential to avoid misdiagnosis and mismanagement and help radiologists to prevent confusion while interpreting images.

References

Zhou Y, Wang Y, Wang X, Volière G, Hu R. The impact of orthodontic treatment on the quality of life a systematic review. BMC Oral Health. 2014;14:66.

Samsonyanová L, Broukal Z. A systematic review of individual motivational factors in orthodontic treatment: facial attractiveness as the main motivational factor in orthodontic treatment. Int J Dent. 2014;2014:938274.

Smith NJ. Orthodontic radiology: a review. Int Dent J. 1987;37(1):16‐24.

Kumar R, Khambete N, Priya E. Extraoral periapical radiography: an alternative approach to intraoral periapical radiography. Imaging Sci Dent. 2011;41(4):161‐165.

Devereux L, Moles D, Cunningham SJ, McKnight M. How important are lateral cephalometric radiographs in orthodontic treatment planning?. Am J Orthod Dentofacial Orthop. 2011;139(2):e175‐e181.

Choi JW. Assessment of panoramic radiography as a national oral examination tool: review of the literature. Imaging Sci Dent. 2011;41(1):1‐6.

Shanmuhasuntharam P, Ghani SH. Susuks: charm needles in facial soft tissues. Br Dent J. 1991;170(8):309‐311.

Kanneppady SK, Kanneppady SS, Lakshman AR, Phaik KS, Shetty SR. The charming tale of charm needle! Nitte Uni J Health Sci. 2017;7(2):66-7.

Pothiawala S. Incidental radiological finding of charm needles. Hong Kong J Emerg Med. 2012;19(2):141-3.

Divakar DD, Mavinapalla S, Al Kheraif AA, Ramakrishnaiah R, Abd Rahim MF, Khan AA. Incidental radiographic finding of the concealed art of susuk. Med Sci Law. 2016;56(3):230‐232.

Loh FC, Yeo JF. Talisman in the orofacial region. Oral Surg Oral Med Oral Pathol. 1989;68(3):252‐255.

Tandjung YR, Hong CP, Nambiar P, Ibrahim N. Uncommon radiological findings: a case report. Int Dent J. 2007;57(3):173‐176.

Lim EC, Ng TH, Seet RC. A woman whose radiographs showed subcutaneous metallic objects. CMAJ. 2005;173(2):150.

Loh FC, Ling SY. Analysis of the metallic composition of orofacial talismans. Oral Surg Oral Med Oral Pathol. 1992;73(3):281‐283.

Alhamad T. Susuk. Am J Respir Crit Care Med. 2011;184(4):484.

Varghese E, Samson RS, Nagraj SK, Chandrappa PR. Susuk or charm needle: a strange object detected on orthodontic diagnostic radiographs. BMJ Case Rep. 2017;2017:bcr2017222497.

Balasundram S, Yee SCM, Shanmuhasuntharam P. Susuk: Charm needles in orofacial soft tissues. Open J Stomatol. 2013;3(2):155-62.

Bayne MR, Newlyn CP. Foreign bodies for personality cosmetics. Oral Surg Oral Med Oral Pathol. 1974;38(5):825‐826.

Nambiar P, Ibrahim N, Tandjung YRM, Shanmuhasuntharam P. Susuks (charm needles) in the craniofacial region. Oral Radiol. 2008;24(1):10-15.

Nor MM, Yushar A, Razali M, Rahman RA, Ramli R. Incidental radiological findings of susuk in the orofacial region. Dentomaxillofac Radiol. 2006;35(6):473‐474.

Chao TC. Beware of charm needles!. J Clin Forensic Med. 1997;4(1):33‐35.

Garg R, Gupta VV, Dicksit DD, Singh AK. A mystical practice revealed on the radiograph: a case report and review. J Int Oral Health. 2018;10(1):58-60.

Hussin P, Mawardi M, Lim KK. Susuk: Mysterious incidental finding. Turk J Emerg Med. 2016;16(1):45‐46.

Arishiya TF, Mohammed F. Susuk - black magic exposed "white" by dental radiographs. J Clin Diagn Res. 2014;8(7):ZD03‐ZD4.


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