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Radiographic Interpretation > Ragged Radiolucencies > Flashcards

Ragged Radiolucencies Flashcards

1
Q

what are the ragged radiolucencies

A
  • chronic osteomyelitis
  • osteoradionecrosis
  • medication realted osteonecrosis of the jaws (MRONJ) (BRONJ)
  • primary epidermoid carcinoma
  • metastatic disease
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2
Q

what are the radiographic features of ragged bony disease

A
  • irregular sclerotic trabeculation
  • cortex changes- thinning and disruption
  • sequestration
  • fracture (pathologic)
  • periosteal duplication
  • widened PDL
  • minimal displacement of teeth and bony outlines
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3
Q

what are the clinical features of ragged bony disease

A
  • edema, purulence
  • increased mass
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4
Q

what are the other names for chronic osteomyelitis

A
  • chronic alveolar abscess
  • chronic dentoalveolar abscess
  • chronic osteitis
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5
Q

describe chronic osteomyelitis

A
  • localized inflammation and infection of alveolar bone, consequently will be:
  • around teeth
  • generally milder than acute osteomyelitis
  • sclerosing, granular trabecular pattern in blow grade chronic conditions
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6
Q

what is osteitis

A

inflammation of alveolar bone caused by pathogenic organisms

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7
Q

what is osteomyelitis

A

inflammation of alveolar and basal bone caused by pathogenic organisms

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8
Q

the pathophysiology of chronic osteomyelitis is primarily:

A

polymicrobes from odontogenic infection; also from open fractures

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9
Q

what are the microbes in chronic osteomyelitis

A
  • streptococcus, bacteroides, polystrepto
  • with increased chronicity other microbes may include actinomyces, eikenella, klebsiellla, M. tuberculosis
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10
Q

what is the difference between acute and chronic

A
  • acute is less than 30 days
  • chronic is greater than 30 days
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11
Q

what are the predisposing factors to chronic osteomyelitis

A
  • reduced vascular supply; diabetes, PCOD, FCOD, osteopetrosis, Pagets
  • immunodeficient states: AIDS, leukemia, corticosteroid treatment, malnutrition, bisphosphonates, other medications
  • odontogenic infection, trauma, surgery
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12
Q

what are the clinical features of chronic osteomyelitis

A
  • low grade fever
  • regional lymphadenopathy
  • atrophic, erythematous mucosa
  • denuded bone
  • suppuration
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13
Q

what is the radiographic apperance of chornic osteomyelitis

A
  • radiolucency of variable size with irregular borders
  • patches of reactive sclerotic bone
  • moth eaten appearance
  • sequestration
  • with increased chronicity and ragged moth eaten appearnace, there can be pathologic fracture
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14
Q

what is the cortical disruption in chronic osteomyelitis

A

irregular pattern of thinning and erosion
- sequestration

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15
Q

chronic osteomyelitis has a tendency for:

A

proliferative periostitis

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16
Q

what is the predilection for chronic osteomyelitis

A
  • age: 40-80 years of age
  • site: body of mandible
  • predominant gender: males
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17
Q

what is the management for chronic osteomyelitis

A
  • debride any necrotic tissue
  • antibiotic therapy
  • drain and irrigate the resion
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18
Q

what is the classic triad of osteoradionecrosis

A
  • radiation therapy
  • trauma
  • infection
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19
Q

what is the effect of the irradiation of bone

A

decreased vascularity and decreased cellularity

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20
Q

what are the predisposing factors for osteoradionecrosis

A
  • age
  • type and delivery of ionizing radiation
  • tumor sites
  • diabetes
  • pagets disease (osteitis deformans)
  • hypertension
  • pre-existing oral status: untreated dental infections (pulpal and/or periodontal)
  • dental extraction
  • poor fitting dentures and other micro traumas
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21
Q

what is the clinical presentation of osteoradionecrosis

A
  • mild to intense pain
  • signs of inflammation (swelling, drainage)
  • tissue denudation
  • denuded bone, swelling and drainage
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22
Q

what is seen in stage 1 osteoradionecrosis

A

red, inflamed, tissue
- symptoms presnt

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23
Q

describe stage 2 osteoradionecrosis

A

denude dbone

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24
Q

describe stage 3 osteoradionecrosis

A

extended into basal bone

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25
Q

what is the radiographic appearance of osteoradionecrosis

A

areas of increased radiodensity interspersed with osteolytic regions

26
Q

what is the predilection for osteoradionecrosis

A
  • age: 40-80 years of age
  • site: body of mandible
  • gender: males
27
Q

what is the management for osteoradionecrosis

A

hyperbaric oxygen chamber
- surgical debridement
- resection of nonviable tissues
- antibiotics

28
Q

what are the predisposing conditions for osteoradionecrosis

A
  • previous radiation
  • trauma
  • diabetes
  • pagets disease
29
Q

what diseases are treaated that cause MRONJ

A
  • osteoporosis
  • pagets disease (osteitis deformans)
  • breast cancer
  • multiple myeloma
  • prostate CA
  • colon CA
30
Q

what are the medications that cause MRONJ

A
  • bisphosphonates
  • antiangiogenic medications
31
Q

what are the bisphosphonates that cause MRONJ

A
  • non nitrogen containing bisphosphonates: etidronate (Didronel) - PO. clondronate (bonefos) -PO. tiludronate
  • nitrogen containing bisphosphonates: alendronate (fosomax)-po. pamidronate (aredia)- IV. zoledronic acid (zometa) - IV. ibandronate (boniva). risedronate (actonel)
  • denosumab
32
Q

what are the antiangiogenic medications that cause MRONJ

A

bevacizumab

33
Q

what are the dental etioligies of MRONJ

A
  • dental etiologies
  • extraction
  • implants
  • prosthesis trauma
  • spontaneous
34
Q

what are the predisposing factors for MRONJ

A
  • age
  • type and delivery of ionizing radiation
  • tumor site
  • diabetes
  • hypertension
  • pre exisiting oral status: untreated dental infections
  • dental extraction
  • poor fitting dentures
35
Q

what stages of MRONJ are asymptomatic

A

stage 0 and stage 1

36
Q

what stages of MRONJ are sympotmatic

A

stage 2 or 3

37
Q

what is the clinical presentation of BRONJ

A
  • edema , purulence
  • increased mass
38
Q

what is the radiographic presentation of BRONJ

A
  • irregular sclerotic trabeculation
  • osteolysis
  • sequestraion
  • periosteal duplication
  • minimal displacement of teeth and bony outlines
39
Q

what is the MRONJ treatment

A
  • monitoring
  • pharmacologic agents
  • minor debridement
  • major debridement
  • sequestrectomy
  • resection
40
Q

what is another name for primary epidermoid carcinoma

A

squamous cell carcinoma

41
Q

what is another name for primary intra alveolar epidermoid carcinoma

A

central sqaumous cell carcinoma
- primary epidermoid carcinoma

42
Q

what are the benign vs malignant changes

A
  • benign lesions displace teeth
  • benign lesions expans
  • malignant lesions grow around teeth
  • malignant lesions perforate
43
Q

what are the characterisitcs of malignancies

A
  • poorly defined borders
  • ragged irregular borders
  • rapid growth
  • follow path of least resistance
44
Q

what is the incidence of oral malignancy

A
  • primary carcinoma (alveolar and mucosal)
  • metastatic carcinoma
  • other: lymphoma, sarcomas, etx
45
Q

what is the clinical presentation of primary intra alveolar epidermoid carcinoma

A
  • normally asymptomatic
  • discovered on routine oral exam
46
Q

what is the radiographic appearance fo primary intra alveolar epidermoid carcinoma

A
  • rarified trabecular pattern
  • radiolucency with ill definde irregular margins
  • rapid growth
  • wide PDL ( irregular)
47
Q

what is the management of primary intra alveolar epidermoid carcinoma

A
  • radiation therapy
  • surgery
  • both
48
Q

______ of malignancies metastasize to the jaws

A

less than 1%

49
Q

what are the ways malignancies spread

A
  • local invasion
  • lympatic spread
  • vascular spread
  • transeolomic spread
50
Q

what is local invasion

A

growth into adjacent tissue and soft nerves

51
Q

what is lymphatic spread

A

enter draining lymphatic vessels and then to local lymph nodes where the tumor grows

52
Q

what is vascular spread

A

via veins draining the primary elsion, GI tumors to portal veins- liver
- most common in lung, bone marrow, brain and adrenal glands

53
Q

what is transoeclomic spread

A

primary tumor in abdominal cavity or thorax and then spread via peritoneal or pleural fluids
- start on surfaces and seed to organs in the area

54
Q

what is the pathophysiology of metastatic tumors

A

usually there is a history of a primary tumor but occasionally the metastatic lesion is the initial presentation of the disease

55
Q

what is the incidence of oral malignancy

A
  • primary carcinoma (alveolar and mucosal)
  • metastatic carcinoma
  • others: lymphoma, sarcomas
56
Q

what is the clincal presentation of metastatic tumros

A
  • may have no history of pain or previous malignancy
  • bone pain, parasthesia, tooth mobility, swelling and soft tissue masses
57
Q

what is the radiographic appearance of metastatic tumors

A
  • usually poor defined with ragged borders
  • may be expansive
  • some tend to be mixed radiolucent- radiopaque lesions such as thyroid, prostate, breast
58
Q

what is the prevalance of metastatic tumors

A
  • location: mandible more common
  • age: 40-80 age, mean age 56
  • gender: depends on tumor type
59
Q

what is the management of metastatic tumors

A
  • management by tumor board
  • treatment may include surgery, radiaiton and/or chemotherapy
  • ultimate decisions are dependent on type of primary malignacy and the decision of the multp disciplinary tumor board
60
Q
A

Radiographic Interpretation (13 decks)

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