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opacities outside the jaw Flashcards

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Tonsilliths

A

◦ After repeated inflammation, the tonsillar crypts enlarge and incomplete resolution of organic debris (dead bacteria and pus, epithelial cells, and food) can lead to dystrophic calcification.

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4
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Tonsilliths
◦ Cluster of?
◦ symptoms?
◦ Location: On panoramic image/ On CBCT:

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◦ Cluster of small radiopacities
◦ Large tonsilliths may be symptomatic
◦ Location:
◦ On panoramic image: single or multiple radiopaque entities superimposed over the mid portion of the ramus
◦ On CBCT: in the tonsils or adenoids surrounding the airway

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tonsilliths

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tonsilliths (lingual)

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tonsilliths (palatine)

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tonsilliths

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tonsilliths

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tonsillith (R), L ghost image

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11
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Tonsilliths Management
◦ Small lesionns:
◦ Lange lesions:
◦ In elderly immunocompromised patients’?

A

◦ Small lesions: no treatment if not symptomatic; with symptomatic patients tonsilliths may be removed manually.
◦ Lange lesions: require tonsillectomy
◦ In elderly immunocompromised patients’ treatment may be considered because of the risk for aspiration pneumonia

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12
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Calcified Lymph nodes
o Usually present in patients who have?
o The presence of calcification implies?
◦ The lymphoid tissue becomes replaced by?
◦ shape?
◦ symptoms?

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o Usually present in patients who have a history of chronic inflammation. However, can be the result of tuberculosis, sarcoidosis, metastases of thyroid cancer or associated with a patients who have been treated for lymphoma (radiation).
o The presence of calcification implies either active disease or disease that has been previously treated
◦ The lymphoid tissue becomes replaced by calcium salts.
◦ Has a cauliflower shape
◦ Generally asymptomatic

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calcified lymph nodes

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calcified lymph nodes

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calcified lymph nodes

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calcified lymph nodes

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17
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Atherosclerosis
◦ def?
◦ The lumen is? risk?
On panoramic:
On CBCT

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◦ Calcification of the atheromatous plaques within the intima of arteries.
◦ The lumen is narrowed → Increased risk of cerebrovascular accident

On panoramic:
◦ Verticolinear radiopacities
◦ Mostly seen at the carotid bifurcation (C3 and C4). *Do not confuse with thyroid or triticeous cartilage

On CBCT
◦ Radiopaque circular (on axial view) or linear (on sagittal or coronal view) radiopacity located anywhere in the course of any artery.

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carotid Aa athersclerosis

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carotid Aa atherosclerosis

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carotid atherscerlosis

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carotid athersclerosis

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Thyroid and Triticeous cartilage

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Thyroid and Triticeous cartilage

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carotid atherosclerosis

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Antrolith: ◦ def? ◦ The source is usually? ◦ Deposition of? ◦ sinus walls? ◦ symptoms?
◦ Calcified mass in the sinuses, most commonly in the maxillary sinuses. ◦ The source is usually endogenous (chronically inflamed mucosa ) ◦ Deposition of mineral salts around a central nidus (lamination) ◦ Not attached to the sinus walls ◦ Mostly asymptomatic. However, expanding mass may impinge on the mucosa, producing pain, congestion, and ulceration
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antroliths
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antrolith
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dif antroliths with varying shapes/sizes, all present with inflammation
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Rhinolith: ◦ def? ◦ Deposition of ? ◦ nasal cavity walls? ◦ symptoms
◦ Calcified mass in the nose (usually an exogenous foreign body) ◦ Deposition of mineral salts around a central nidus (lamination) ◦ Not attached to the nasal cavity walls ◦ Mostly asymptomatic. However, expanding mass may impinge on the mucosa, producing pain, congestion, and ulceration
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rhinoliths
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rhinolith
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rhinolith
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Rhinolith and Antroliths periphery/shape internal structure
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rhinolith and antrolith tx
o Referral to an otorhinolaryngologist for endonasal or sinus endoscopic surgical removal
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Sialolith def? ◦ Submandibular gland% ◦ Parotid gland % ◦ Minor salivary glands? ◦ symptoms
Calcifications found within the salivary glands or their ducts: ◦ Submandibular gland (83% to 94%) ◦ Parotid gland (4% to 10%) ◦ Sublingual gland ◦ Minor salivary glands stones are exceedingly rare, occurring mostly in the upper lip and buccal mucosa ◦ Patients may be asymptomatic, but they may have a history of pain and swelling at mealtimes
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sialolith
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sialolith
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sialolith
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Sialolith Imaging features * Periphery: * Internal structure: * Multiple sialoliths?
* Periphery: usually are cylindrical and very smooth. * Internal structure: radiopaque. * Multiple sialoliths are somewhat common.
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sialolith
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sialolith
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sialolith
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Ossified stylohyoid ligament
◦ Ossified ligament may be detected by palpation over the tonsil as a hard, pointed structure. ◦ Symptoms of Eagle’s syndrome can be related to cranial nerve impingement. Clinical diagnosis!!
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ossified stylohyoid ligament
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ossified stylohyoid ligament
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Ossified stylohyoid ligament clinical Differential diagnosis (based on symptoms)
◦ Sometimes symptoms may be similar to TMD
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Ossified stylohyoid ligament Management
◦ Asymptomatic patient: no treatment. ◦ Patients with persistent or intense symptoms: amputation of the stylohyoid ligament .
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Mucous retention pseudocyst o Accumulation of? o Is not? o Most common in? followed by? o Antral retention pseudocysts are not related to?
o Accumulation of mucous within soft tissue lining in paranasal sinus due to obstruction of gland within the sinus lining. o Is not a true cyst (not lined by epithelium) o Most common in the maxillary sinus followed by sphenoid sinus and less often in the frontal sinuses and ethmoid air cells. o Antral retention pseudocysts are not related to the teeth or associated with periapical inflammatory disease.
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mucus retention pseudocyst
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mucus retention pseudocyst
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Mucus retention pseudocyst etiology
o Most accepted hypothesis: blockage of the secretory ducts of the glands in the sinus mucosa resulting in accumulation of secretions and swelling of the tissue
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Mucous retention pseudocyst CLINICAL FEATURES o signs or symptoms? o found how? o When a pseudocyst completely fills the maxillary sinus cavity, it may? o The retention pseudocyst may also rupture as a result of?
o Rarely causes any signs or symptoms. o It is incidental finding. o When a pseudocyst completely fills the maxillary sinus cavity, it may prolapse (extrude) through the ostium and cause nasal obstruction. o The retention pseudocyst may also rupture as a result of abrupt pressure changes caused by sneezing or blowing of the nose, producing postnasal discharg
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mucus retention pseudocyst
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Mucous retention pseudocyst imaging features ◦ sizes? ◦ Single or multiple? ◦ appearence? ◦ effects on the surrounding structures?
◦ Range widely in size—from the size of a fingertip to a size large enough to fill the sinus completely. ◦ Single or multiple ◦ Well-defined, non-corticated, smooth, dome- shaped, and homogeneous radiopaque masses. ◦ There are no effects on the surrounding structures
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Mucositis ◦ etiology? ◦ found how? ◦ app?
◦ Localized inflammatory change leads to thickening of the mucosal lining (infection, chemical irritation, allergy, introduction of a foreign body, or facial trauma) ◦ Incidental finding on images ◦ Well-defined non-corticated radiopaque band of soft tissue density that follows the contour of the bony wall of the sinus
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mucositis
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mucositis
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what pathology can be seen here
mucositis
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Sinusitis ◦ defined/etiology? ◦ what is dysfunctional? ◦ Pansinusitis?
◦ Generalized inflammatory condition of the sinus mucosa caused by an allergen, bacterium, or virus. ◦ Ciliary dysfunction → retention of sinus secretions (blockage of the ostiomeatal complex) ◦ Pansinusitis: sinusitis affecting all the paranasal sinuses.
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forms of sinusitis based on duration
◦ Acute sinusitis: has been present for 4 weeks or less ◦ Chronic sinusitis: has been present for more than 12 consecutive weeks ◦ Subacute sinusitis: lasting from more than 4 weeks up to 12 weeks
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sinusitis clinical features; ◦ The most common sinus conditions that cause? ◦ Pain and sensitivity to percussion? ◦ Could be a complication of?
◦ The most common sinus conditions that cause pain and tenderness to pressure over the involved sinus. ◦ Pain and sensitivity to percussion may also be referred to the premolar and molar teeth on the affected side ◦ Could be a complication of the common cold, allergies , dental infection, virus or fungal infections, etc.
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Sinusitis Image features: ◦ Generalized? ◦ May cause? ◦ Acute: ◦ Chronic:
◦ Generalized thickening of the mucosal lining around most or all sinus cavity walls (radiopacification of the sinus) ◦ May cause blockage of the sinus ostium. ◦ Acute: Air entrapment (bubbles) ◦ Chronic: Thickening and sclerosis of the walls
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sinusitis
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sinusitis
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sinusitis
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sinusitits
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likley dx/cause?
odontogenic sinusitis
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sinusitis
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Chronic Sinusitis difference on imaging
o Chronic sinusitis may result in persistent radiopacification of the sinus with sclerosis and thickening of the walls . o The changes to the sinus wall may persist.
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chronic sinusitis
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chronic sinusitis
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chronic sinusitis
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chronic sinustitis
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chronic sinusitis
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Management of sinusitis overall? acute? chronic?
The goal is to control the infection, promote drainage, and relieve pain Acute sinusitis: ◦ Treated pharmacologically (decongestants) to reduce mucosal swelling ◦ Antibiotics (in case of bacterial sinusitis). Chronic sinusitis: ◦ The goal is ventilation and drainage. ◦ Endoscopic surgery is used to enlarge obstructed ostia or alternative path of drainage maybe established
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Mucocele o def? o results from? and the entire sinus becomes? o progression? o > 90% have what signs/symptoms?
o A mucocele is an expanding, destructive lesion that results from a blocked sinus ostium. o The blockage may result from intra-antral or intranasal inflammation, polyp, or neoplasm, and the entire sinus becomes the pathologic cavity o As mucous secretions accumulate and the sinus cavity fills, the increase in pressure within the cavity results in thinning and displacement of the sinus walls and, in some cases, sinus wall destruction. o > 90% have ophthalmic symptoms & signs
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mucocele
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mucocele
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opthalamic s/s of mucocele
Periorbital swelling, pain, exophthalmos, and visual disturbance
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Mucocele Clinical features o Sensation of? o In the maxillary sinus→ pressure on? o If the lesion expands inferiorly, it may cause? o If the medial wall of the sinus is expanded, the lateral wall of the nasal cavity? o If the lesion expands into the orbit, it may cause?
o Sensation of fullness in the cheek, and the area may swell. o In the maxillary sinus→ pressure on the superior alveolar nerves causing radiating pain. o If the lesion expands inferiorly, it may cause loosening of the adjacent posterior teeth. o If the medial wall of the sinus is expanded, the lateral wall of the nasal cavity deforms, and the nasal airway may become obstructed. o If the lesion expands into the orbit, it may cause diplopia (double vision) or proptosis (protrusion of the globe of the eye
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mucocele
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Mucocele o About 90% of mucoceles occur in? o Internal radio app? o When the mucocele is associated with the maxillary antrum how are teeth affected?
o About 90% of mucoceles occur in the ethmoid air cells and frontal sinuses o Internally, the sinus cavity is uniformly radiopaque. o When the mucocele is associated with the maxillary antrum, teeth may be displaced, or roots resorbed.
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mucocele management
excision

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