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Oral Path 2 > Analytic/Systemic Strategy > Flashcards

Analytic/Systemic Strategy Flashcards

1
Q

What may you use to describe features?

A
  • Location
  • Shape and Size
  • Internal Structure
  • Effect on Surrounding Structures
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2
Q

Definition: Generalized

A

Abnormal portion affects all (most) of the osseous structures of the maxillofacial region

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3
Q

Definition: Localized

A
  • Unilateral
  • Bilateral
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4
Q

How does position of lesion in jaws aid diagnostic process?

A
  • Determining the center of the location
  • Some lesions tend to be found in specific locations
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5
Q

Where are the different origin centers of lesions and what origin are they?

A
  • Coronal to tooth: Odontogenic origin
  • Above IAC: Odontogenic origin
  • Below IAC: Not odontogenic origin
  • W/in IAC: Probably neural or vascular
  • Condylar areas: Cartilaginous lesions
  • MX sinus: Epithelial origin
    • Lined w/ pseudostratified ciliated columnar epithelium
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6
Q

How may lesion size aid in forming a differential dx?

A
  • Lesions can grow to any size
  • Odontomas: Stop growing so they don’t reach any size
  • Dentigerous cysts vs. Hyperplastic follicle
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7
Q

Different lesion shapes?

A
  • Hydraulic: Somewhat circular; appears to be fluid-filled or inflated balloon
  • Scalloped: Series of contiguous arcs or semicircles
    • Do not confuse for multilocular; multilocular lesions are often scalloped
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8
Q

Poorly defined borders

A

Difficult to draw exact delineation around most of an ill-defined periphery

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9
Q

Various types of well-defined borders

A
  • Corticated
  • Non-corticated or punched out
  • ST capsule
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10
Q

Definition: Well-defined borders

A
  • Imaginary pencil can draw the limits of the lesion
    • Don’t confuse well-defined for corticated; corticated lesions are not often well-defined, but well-defined are corticated
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11
Q

Definition: Corticated

A

Uniform RO line at the periphery of lesion

  • Displayed w/ thin RO border
  • All of the outside of the MN is corticated
  • B & L plates are corticated
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12
Q

Definition: Non-corticated

A

Sharp boundary w/ narrow transition; no bone rxn seen

  • No RO border
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13
Q

Definition: ST capsule

A

RL line at periphery; may be seen in conjunction w/ corticated periphery

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14
Q

Definition: Blending borders

A
  • Sclerotic: Wider zone of transition w/ thick RO border of reactive bone
    • RL border at the apex, but it isn’t well-defined and looks like a paint brush and not a sharpie
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15
Q

What type of lesions are totally RL?

A

Usually cysts

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16
Q

What type of lesioons are totally RO?

A

Certain bone lesions

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17
Q

What lesions are mixed RL/RO?

A

Tumor or cyst that produces calcified material

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18
Q

Increasing RO

A

Air, fat, gas < Fluid < ST < Bone marrow < Trabecular bone < Cortical bone & dentin < Enamel < Metal

19
Q

Abnormal trabecular patterns

A

Variation of number, length, width, and orientation of trabeculae

20
Q

Internal septation

A
  • Long strands of bone or walls w/in a lesion
    • Well-defined, corticated, but internally, it still has all these RO lines that look like bubbles (septations), walls of bone
21
Q

Multilocular

A

Internal structure divided into different compartments/cavities

22
Q

Unilocular

A

Singular compartment

23
Q

At what point would a mixed lesion be considered RO (radiographically)?

A
  • Mixed <1-90% - RO
  • RO >90% RO material
24
Q

What lesions are space-occupying lesions?

A

Cysts & tumors

  • Tumors: Solid mass
  • Cysts: Lining and center is often filled w/ fluid or debris

Because they are space occupying, they can have effects on surrounding structures.

Lesions can displace, resorb, expand, or destroy these structures

25
In which direction do **odontogenic lesions** displace teeth? In which direction do **bone lesions & hematopoietic lesions** displace teeth?
* **Odontogenic:** Displace tooth **apically** * **Bone lesions, hematopoietic lesions:** Displace tooth **coronally**
26
What type(s) of lesions may cause **directional resorption**?
Benign tumors/cysts
27
What types of lesions may cause **non-directional resorption**?
Malignant tumors
28
Orthodontic movement vs. Malignant lesions
* **Orthodontic movement:** Uniform widening w/ lamina dura intact * **Malignant lesions:** Irregular widening & destruction of lamina dura
29
What types of lesions cause **expansion**? What types of lesions cause **perforation**?
* **Expansion:** Slowly growing lesions; cysts & tumors * **Perforation:** Rapidly growing lesions; malignancies
30
Reactive lesions
* Life periosteium off of the cortical bone and stimulate osteoblasts to lay down new bone * Inflammatory lesions but also tumors
31
Growth characteristics of **slowly growing** lesions
* **Sharply demarcated borders** * Corticated borders (sometimes) * **Displaces** normal anatomical structures * **Expands** rather than perforates cortical plate * Overlying mucosa is normal * Pain or paresthesia is uncommon
32
Growth characteristics of **rapidly/aggressively** growing lesions
* **Poorly demarcated borders** * **Destroys normal anatomical structures** * **Perforation** of cortical plate more common * Crepitus during palpation more common * Ulceration of overlying mucosa more common * Pain or paresthesia more common
33
Odontogenic
* Lesions (cysts, tumors) derived from cells that produced teeth * **Lesions originate and are centered in teeth bearing areas** * **Lesions may extend to non-odontogenic regions** * Above IA canal * IAC displaced inferiorly * Originate where teeth normally are * The RL is from salivary glands * Ghost images from overlap
34
Non-Odontogenic
* Lesions derived from **bone, vasculature, nerve, or sinus** * **Lesions may in non-tooth bearing areas**, however often may arise in teeth bearing areas * Bone origin * Sinus origin * IA canal origin * Neural/vascular
35
Inflammatory lesion characteristics
* Focal * **Poorly defined borders** * **Pain is variable** * Often, not always, **​surrounded by sclerotic bone** * Systemic manifestation: Fever, malaise, leukocytosis, tender lymphadenopathy * Widespread * **Poorly defined borders** * **Pain is variable** * Often, not always, **surrounded by sclerotic bone** * May appear "moth-eaten" * Irregulalr patches of osteolysis surrounded by denser sclerotic bone
36
Cyst features
* Slow growth * Features * **​Usually well-defined** * **Corticated borders common** * **Hydraulic appearance on rads** * Can cause **expansion** * May arise from odontogenic or non-odontogenic **epithelium** * May resemble tumor radiographically * **All cysts are RL, except for ONE \*\*COC\*\***
37
Features of benign tumors
* Slow growth * Features * **Well-defined** * **Usually corticated** * **Displace structures** * **Can cause expansion** * ​Malignant odontogenic tumors are RARE
38
Features of malignant tumors
* **Poorly defined; destroys anatomical structures** * **Most common malignant neoplasm of jaw: metastatic carcinoma** * Lymph nodes are nontender, hard, fixed * May present as toothache * Rad * **Poorly defined** * **Widens PDL space irregularly** * **Irregular (vertical or non-directional) resorption of roots** * **May cause expanion but will perforate cortex**
39
Rationale to submit biopsy
**All biopsies should be sent for pathologic dx** * Establish a definitive dx * Confirm provisional clinical dx * Establish the adequacy of surgical margins * Obtain information to help in disease management * Acquire knowledge on clinical behavior & px * Substantiate pt records in medico-legal context
40
Enucleation
Removal of lesion only
41
Curettage
Removal of lesions and some surrounding bone w/ hand instrument
42
Peripheral ostectomy
Removal of lesion and some surrounding bone w/ rotary instrument
43
En bloc resection/segmental resection
Resection of lesion & bone w/ clear margin
44
Decompression/Marsupialization
**Used to decrease size of cysts** * Decompression: Making small opening in the cyst and keeping it open w/ a drain * Marsupialization: Converts cyst into pouch

Oral Path 2 (11 decks)

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