Maxillofacial Radiology Interpretation Flashcards Preview

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Flashcards in Maxillofacial Radiology Interpretation Deck (114):
1

Which radiographs best demonstrate caries? (1)

- Bitewings or long-cone periapical radiographs

2

When can caries be radiographically detected? What does this mean clinically? (2)

- When there has been 30-40% demineralization, so that the lesion can be differentiated from normal dentine and enamel - Because of this limitation, the carious lesion is larger (up to 25%) than that seen on radiographs

3

What can be useful when identifying early lesions? (1)

- Magnification

4

Describe earliest radiographic Proximal surface caries (3)

- Enamel caries seen as a triangular radiolucency - Just below the contact point - Apex pointing towards the amelo-dentinal junction

5

What happens when radiographic Proximal caries reaches the ADJ? (1)

- When caries reaches the ADJ, it spreads along the junction, often forming a second radiolucent triangle, with its apex pointing towards the pulp

6

When is radiographic occlusal caries difficult to diagnose?

- If the lesion is restricted to enamel

7

What is often the first indication of radiographic Occlusal caries? (2)

- A thin radiolucent line at the ADJ, with intact enamel - As the lesion progresses it becomes easier to detect

8

How is Smooth surface caries detected? (1)

- Should be visible clinically, but a radiograph can provide confirmation

9

How and where is root caries usually diagnosed? What can mimic root caries on a radiograph? (2)

- Radiographs may reveal root surface caries that is not evident clinically, usually this is interproximally - Cervical burnout can mimic root caries, except that in cervical burnout there is still an image of the root edge

10

How does recurrent caries appear radiographically? What can obscure recurrent caries? (2)

- Appears as a zone of increased radiolucency along the margins of a restoration - Radiopaque materials such as metals can obscure recurrent caries, and radiolucent lining materials can make detection difficult

11

What do radiographic signs of periapical periodontitis depend on? What is the earliest sign? (2)

- Depends on the time course of the disease process - The earliest sign is usually widening of the apical periodontal ligament, followed by loss of lamina dura

12

What is rarefying osteitis? (1)

- Bone resorption

13

What is sclerosing osteitis? (1)

- Bone formation

14

What does the body promote in an attempt to heal from chronic apical periodontitis? How does this appear radiographically? (2)

- Stimulates the formation of granulation tissue - This appears as a well-defined radiolucency surrounding the apex of a non-vital tooth

15

What is the most likely diagnosis of a well defined radiolucency surrounding the apex of a non-vital tooth with >1cm diameter? (1)

- Radicular cyst

16

What can occur intermittently with Periapical Granulomas? (1)

- Acute exacerbations of chronic lesions can occur intermittently

17

Give three possible pathological conditions resulting from Periapical Periodontitis? (3)

- Root resorption - Radicular cyst formation - Osteomyelitis

18

Why are radiographs useful in Periodontal Disease? (3)

- No radiographic signs of gingivitis - Useful to demonstrate the form of bone loss in chronic periodontal disease - As well as any local factors such as calculus or overhanging restorations

19

Where is the alveolar crest normally seen in a healthy individual? (1)

- Within 1.5mm of the amelo-cemental junction

20

Describe the three radiographic patterns of bone loss (3)

- Early: erosion of the interdental crest - Later: ‘horizontal’ loss of bone generalized and localised - ‘Complex’: osseous defects

21

Describe ‘Juvenile’ Periodontitis (1)

- Localised, aggressive

22

Describe Rapidly Progressive Periodontitis (1)

- Generalised, aggressive

23

What is Papillon-Lefevre associated with? (1)

- Genetic disorders

24

Give three ways that dental anomalies can occur (3)

- Anomalies of tooth number - Anomalies of tooth form - Anomalies of tooth structure

25

Give examples of anomalies of tooth number (2)

- Missing teeth: hypodontia, anodontia - Extra teeth: supernumerary, mesiodens, supplemental

26

What happens when there is a Germination dental anomaly? (1)

- Two teeth joined together but arising from a single tooth germ

27

What happens when there is a Fusion dental anomaly? (1)

- Two teeth joined due to the fusion of two tooth germs

28

What is Concrescence? (2)

- Condition where the cementum overlying the roots of at least two teeth join together - The cause can sometimes be attributed to trauma or crowding of teeth

29

What is Dens Invaginatus? (1)

- Infolding of the outer surface of a tooth into the interior

30

What is Dilaceration? (1)

- Sharp bend in the root direction, usually due to previous trauma

31

What is Taurodontism? (1)

- Enlarged pulp chambers, short roots (cow teeth), usually of no clinical significance

32

What is Amelogenesis Imperfecta? (2)

- Inherited condition affecting enamel formation, which is thin, pitted or grooved. - Up to 14 variants identified

33

What is Dentinogenesis Imperfecta? (2)

- Ingerited condition affecting dentine formation, which is discoloured and soft. - Can occur with Osteogenesis Imperfecta

34

What are Odontomes? (1)

- Benign odontogenic tumours (WHO) forming dental hard tissues, compound or complex

35

What size is the follicular space usually and what does a change in size suggest? (2)

- The follicular space is usually no greater than 3mm
- More than this suggests cystic change, especially if root formation is complete

36

Where are pericoronal radiolucent lesions usually seen? (2)

- Usually seen around the crown of normally erupting teeth
- The follicular space

37

What is the most common pathologic pericoronal radiolucency in the jaws? (1)

- The dentigerous (follicular/eruption) cyst

38

What other lesions may present in the same way as dentigerous (follicular/eruption) cysts? (2)

- Keratocysts
- Ameloblastomas

39

What  diagnosis does it suggest if there is calcification within a pericoronal radiolucency? (3)

- Adenomatoid Odontogenic Tumour
- Pindborg tumour
- Calcifying Odontogenic Cyst

40

Why are radilucent lesions with indistinct borders so important? What can mimic this? (2)

- Can indicate a sinister condition
- Periodontal disease can mimic more sinister conditions but usually the bone loss seen with ‘perio’ is general as opposed to the local loss seen with malignancy

41

What is crucial when differentiating various radiolucent lesions with indistinct borders? And what is the general rule? (2)

- Clinical findings
- As a general rule, bone loss with an indistinct border is a sign of serious disease

42

What is important when identifying sinister pathology? Give an example(2)

- Remember normal radiographic anatomy, bony outlines,  check these landmarks are present on viewing films
- E.g. Maxillary Sinus Carcinoma – always look for the ‘four white lines’ on OPGs, if one or more is absent then sinister pathology has to be considered

43

What possibility must be considered when looking at an opaque lesion on a radiograph? (2)

- That an opaque lesion is not actually bone, may be the adjacent soft tissues
- e.g. salivary calculus

44

What can an opcity at the end of a root be? (2)

- A sign of non-vitality – sclerosing osteitis
- Cemental lesions also need to be considered, affected teeth are usually vital

45

What is Gardener’s Syndrome? (3)

- Clinically appears as multiple jaw osteomas with or without supernumberary teeth and odontomes
- Patients with Gardener’s syndrome also develop multiple polyps in the bowel, these usually undergo malignant change by the age of 40
- Early detection can be life-saving

46

What is the most likely radiographic diagnosis from a Tubular shaped opacity extending from the styloid process? (2)

- Calcification of the stylohyoid ligament
- Very common and of little clinical significance

47

What is the most likely radiographic diagnosis from large well defined rounded opacities, sometimes multiple, in the cervical region? (2)

- Usually indicate calcification of lymph nodes.
- Very common incidental finding, not significant

48

What is a Phlebolith? (1)

A phlebolith is a small local, usually rounded, calcification within a vein

49

How do Phleboliths present on a radiograph? (2)

- Multiple small opacities made up of concentric rings
- Seen in vascular lesions

50

What is the most likely radiographic diagnosis from a rounded single opacity projected over or just below the mandibular angle? (3)

- Calculus in the submandibular gland
- Expect a history of pain/swelling with meals
- Occlusal views helpful

51

What is the most likely radiographic diagnosis from a well  defined dome-shaped opacity in the lower half of the maxillary sinuses? (3)

- Usually represent harmless polyps
- There may be a history of allergy or upper respiratory infection
- Common incidental finding on OPT

52

What is the most likely radiographic diagnosis from an opacity seen in the region of the carotid artery? (2)

- Could represent atheroma
- May serve as a warning sign for similar disease elsewhere

53

What is an Atheroma? (2)

- Atheroma is an accumulation and swelling in artery walls made up of (mostly) macrophage cells, or debris, and containing lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.
- Atheroma occurs in atherosclerosis, which is one of the three subtypes of arteriosclerosis (which are atherosclerosis, Monckeberg's arteriosclerosis and arteriolosclerosis).

54

What is Fibrous Dysplasia?

- A benign development anomaly where normal bone is replaced with fibrous bone tissue

55

How does the radiographic appearance of Fibrous Dysplasia vary?

- Radiographic appearance varies with age

56

What do early fibrous dysplasia lesions tend to look like radiographically?

- Early lesions tend to be radiolucent with well defined borders

57

What is the classic radiographic appearance of Fibrous Dysplasia?

- As lesion matures more bone is laid down leading to a mottled radiopacity so called ‘orange peel’ pattern

58

What do the borders of fibrous dysplasia lesions look like radiographically?

- The borders of the lesion then blend into the adjacent normal bone

59

What may happen to the bone in fibrous dysplasia?

- Bony expansion may occur

60

What can happen to the sinus in Fibrous Dysplasia and why? Which sinus?

- Lesions in the maxilla can occlude the sinus

61

What can Fibrous Dysplasia do to the teeth?

- Teeth may be titled or bodily displaced

62

What can Fibrous Dysplasia do to the roots and developing teeth?

- Root resorption can occur as can destruction of developing teeth

63

Which disease looks similar to Fibrous Dysplasia and how do you differentiate between the two?

- May look similar to Paget’s disease but active Fibrous Dysplasia is uncommon in middle/old age and Fibrous Dysplasia is usually unilateral unlike Paget’s

64

What is Cherubism?

-  Rare inherited fibro-osseous disease of the jaws

65


When does Cherubism develop?

- Develops in infancy

66

What does Cherubism usually present as? And then what follows?

- Usually presents as a painless bilateral enlargement of the lower face

67

In Cherubism, what develops and where? Where does this expand to?

- Enlargement of the maxilla gradually
- Cyst-like radiolucencies develop at the posterior aspect of the mandible, bilaterally

- These will expand into the rami and body

68

Describe the lesions in Cherubism

- The lesions are well defined and produce bone expansion rather than cortical perforation

69

What happens to the tooth buds in Cherubism?

- Tooth buds will be displaced or destroyed especially the 2nd and 3rd molars

70

What can happen to the erupted primary teeth in Cherubism?

- Erupted primary teeth may be shed early 

71

What is Paget’s disease characterised by?

Characterised by abnormal resorption and deposition of osseous tissue in bone(s)

72


At what age does Paget's disease usually occur?

- A disease of later middle and old age

73

What part of the body is Paget's disease common in?

- Common in the skull

74

Which jaw does Paget's Disease affect more?

- Affects the maxilla more than the mandible

75

What part of the bone is usually involved in Paget's disease?

- Usually involves all of the bone affected

76

What happens to the affected bone in Paget's Disease?

- Affected bones enlarge, teeth can be moved

77

What may also develop in Paget's Disease, other than bone enlargement?

- Osteomyelitis and sarcoma may develop

78

How does the jaw appear in the early stages of Paget's Disease? What may be seen in the skull?

- In the early stages the jaw bone has a laminated structure. Osteoporosis circumscripta may be seen in the skull

79


What can be visible ‘striking’ in Paget's Disease? Later, how can the bone look radiographically?

- Bony expansion can be striking

- Later ‘cotton wool’ areas develop

80

How can the roots of teeth be affected in Paget's Disease?

- Hypercementosis may eventually affect the roots

81

What can frank bony destruction indicate in Paget's Disease?

- Frank bony destruction may indicate the development of osteogenic sarcoma

82

Describe Osteopetrosis, including its effects on bone, teeth and cortical structure.

All bones show greatly increased density
- There may be delayed eruption and early loss of teeth
- This cortical structures such as the lamina dura and the mandibular canal walls may be totally obscured by the dense bone

83

What is Hyperparathyroidism due to?

- Due to excess circulation of PTH hormone

84

What does hyperparathyroidism usually stimulate?

- PTH stimulates osteoclasts to mobilise calcium from the skeleton

85

What percentage of body calcium is in the skeleton and what impact does this have?

99% of body calcium is in the skeleton, hence the profound impact on the bones

86

What happens to the skeleton in Hyperparathyroidism?

The skeleton becomes demineralised, so the bones look radiolucent

87

Where should you look for evidence of Hyperparathyroidism radiographically?

- Look for demineralisation of the inferior border of the mandible and sinus outlines
- Loss of lamina dura may occur

88

What kind of lesions may develop in the jaws in Hyperparathyroidism?

- Variably defined radiolucent lesions may develop in the jaws ‘brown tumours’

89

What is Hyperpituitarism due to?

- Due to excessive production of growth hormone by the anterior lobe of the pituitary

90

What does Hyperpituitarism cause in childhood?

- In childhood this causes ‘giantism’

91

What does Hyperpituitarism cause in adults and what does it affect?

- In adults it is called acromegaly and the excessive growth does not affect all bones

92

How does adult onset Acromegaly affect the jaws?

- Acromegaly leads to increased length of the ramu sand body of the mandible resulting in a class III skeletal jaw relationship

93

What can a lateral skull view reveal in Hyperpituitarism?

- A lateral skull view may, but not always reveal ‘ballooning’ of sella turcica

94

Enlargement of what -- is very common in Acromegaly?

- Enlargement of the paranasal sinuses, especially the frontal, is very common

95

What can happen to the skull in adults with Acromegaly?

- In acromegaly the outer table of the skull may be quite thickened

96

What is sickle cell anaemia and what does it cause?

-  A chronic haemolytic blood disorder
- Abnormal red blood cells rapidly destroyed

97

What happens to bone marrow in Sickle Cell Anaemia?

- This results in compensatory hyperplasia of the bone marrow

98

What are the radiographic findings in Sickle Cell Anaemia? What accounts for this?

-          Expansion of the bone marrow at the expense of spongy bone accounts for the radiographic findings

 

99

What does marrow hyperplasia lead to?

- Marrow hyperplasia leads to thinning of cancellous trabeculae and cortices

100

What appearance is seen in the skull in 5% of Sickle Cell Anaemia patients?

- May see widened diploic space in the skull and ‘hair-on-end’ appearance in 5%

101

What does bony artifaction in Sickle Cell Anaemia lead to?

- Bony infarction leads to areas of sclerosis

102

Describe the jaws in sickle cell anaemia

- Jaws look osteoporotic, thin cortices

103

What is the ‘stepladder’ pattern in Sicle Cell Anaemia?

- In between teeth, the bony trabeculae are coarse – so called ‘stepladder’ pattern

104

What is evident in this radiograph?

Q image thumb

- Missing RHS hard palate
- Missing both RHS and LHS floor of maxillary sinus
- Missing RHS posterior border of maxillary sinus

105

What is evident in this radiograph?

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- Missing RHS floor of the maxillary sinus

106

What is evident in this radiograph?

What is the differential diagnosis?

Q image thumb

- Tubular shaped opacity, extending
from the styloid process

- Calcification of the stylohyoid
ligament

107

What is evident in this radiograph?

Diagnosis?

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- Large well defined opacities

- Calcification of lymph node

108


What disease is shown by these radiographs?

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Fibrous Dysplasia

109

What disease is shown by these pictures and radiographs?

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Cherubism

110

What disease is shown by these radiographs?

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Paget's Disease

111


What disease is shown by these radiographs?

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Osteoporosis

112

What disease is shown by these radiographs?

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Hyperparathyroidism

113

What disease is shwon by these pictures and radiographs?

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Hyperpituitarism

114


What is evident in these radiograph?

Q image thumb

Sickle Cell Anaemia