Radiological interpretation of radiopacities and mixed lesions of the jaws Flashcards Preview

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Flashcards in Radiological interpretation of radiopacities and mixed lesions of the jaws Deck (25)
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1

What can a radipacity be?

1. Normal anatomical structure

2. Artefactual

3. Pathological maybe because of:

-a dental anomaly

-a bony lesion

-a soft tissue calcification

-a foreign body

2

What is this showing? 

Hypercementosis. 

3

What is hypercementosis? 

-Disease of the elderly

-Usually effects the entire bone

-Enlarged head and thickening of the affected long bones -Cotton wool appearance of the bone

-Hypercementosis

4

What is this? 

Developmental bony ex

5

What is this?

Slerosing osteitis. (inflammatory) 

6

What are the radiographic features of acute osteomyletis? 

Ragged, patchy or moth eaten areas of radiolucency.

Evidence of radiopaque sequestra of dead bone within the radiolucency.

New subperiostal bone formation, particularly along the lower border of the mandible.

7

What are the radiographic features of chronic osteomyletis? 

Localised patchy or moth eaten areas of bone destruction.

Sclerosis of the surrounding bone.

Radiopaque sequestra.

Involucrum surrounding the area of destruction following subperiosteal bone formation.

8

What are the types of tumours that can affect bone? 

1. Odontogenic:

-Calcifying epithelial odontogenic tumour

-Ameloblastic fibro-odontoma (covered in last lecture)

-Adenomatoid odontogenic tumour

-Calcifying cystic odontogenic tumour

-Benign cementoblastoma

 

2. Non-odontogenic

-Osteoma

-Chondroma

-Osteogenic secondary

-Metastases

9

What is a calcifying epithelial odontogenic tumour (CEOT / Pindborg tumour)? 

Age: 20 – 60 years

Frequency: Rare

Site: Molar / premolar region mandible – occasionally maxilla.

Size: Variable

Shape: Unilocular / multilocular, round often associated with an un-erupted tooth.

Outline: Variable definition and cortication, can be scalloped.

Radiodensity: Early stages radiolucent than numerous scattered opacities “driven snow” mainly around the crown

Effects: Teeth resorbed / displaced. Expansion.

10

What is an adenomatoid Odontogenic Tumour (AOT)? 

Age: 90% before age of 30

Frequency: 2-7 % odontogenic tumours

Site: Anterior maxilla (canine region)

Size: Variable

Shape: Unilocular, often surrounds an entire un- erupted tooth

Outline: Well defined and corticated

Radiodensity: Mixed density – small opacities (snowflakes) commonly centrally

Effects: Teeth displaced, rarely resorbed Buccal and palatal expansion – may extend into antral space

11

What is a Calcifying Cystic Odontogenic Tumour CCOT - Gorlins Cyst? 

Age: Variable

Frequency: Rare

Site: Maxilla / mandible – anterior or premolar regions

Size: Up to ~ 4cm

Shape: Unilocular, round / oval

Outline: Well defined and corticated

Radiodensity: Initially radiolucent in time variable amount of calcified material internally of tooth like density

Effects: Displacement, causing divergence of roots, possible resorption. Expansion

12

What is a benign Cementoblastoma?

Age: Mean age 20 years

Frequency: Rare

Site: Apex of mandibular first molars, occasionally premolars

Size: Variable – 2-3cm

Shape: Attached to tooth root, round “golf ball”

Outline: Well defined

Radiodensity: Radiopaque in late stages with peripheral radiolucency

Effects: Attached to roots which are obscured – if large can cause expansion

13

What is an osteosarcoma?

• Primary malignant tumour of bone

• Radiologically 3 types:

– Osteolytic: Moth eaten, spiking resorption of teeth

– Osteosclerotic 

– Mixed lytic and sclerotic

Poorly defined, variable radiopacity, sun ray (sunburst appearance)

14

What is this?

A breast metastasis.

15

What different types of osseus dysplasias are there? 

• Periapical Osseous Dysplasia

• Focal Osseous Dysplasia

• Florid Osseous Dysplasia

• Familial Gigantiform Osseous Dysplasia

16

What's a periapical osseus dysplasia?

Age: Middle age (black women)

Frequency: Rare

Site: Apices of several lower anterior teeth

Size: Small – 5-6mm but can coalesce

Shape: Round, unilocular

Outline: Variable –non corticated

Radiodensity: Radiopaque in late stages with peripheral radiolucency

Effects: No expansion, displacement or resorption – teeth vital

17

What is a Focal Osseous Dysplasia?

Age: Middle age (white women)

Frequency: Uncommon

Site: Solitary, mainly posterior mandible may be at extraction sites

Size: Small –

Shape: Round, unilocular

Outline: Variable –non corticated

Radiodensity: Radiopaque in late stages with peripheral radiolucency

Effects: No expansion, displacement or resorption – teeth vital

18

What is a Florid Osseous Dysplasia?

Age: Middle age (black women)

Frequency: Rare

Site: Multiple quadrants

Size: Larger up to 2-3cm

Shape: Round, unilocular

Outline: Variable – occasionally corticated

Radiodensity: Radiopaque in late stages with peripheral radiolucency

Effects: No displacement or resorption – teeth vital. Can expand bone

19

What is Familial Gigantifom Dysplasia?

• Rare, autosomal dominant

• 10-20 year old white females

• Rapid growth with marked facial deformity

20

What is Fibrous Dysplasia?

A bone related lesion. 

Age: 10-20 year olds

Site: Maxilla > Mandible

Size: Variable and difficult to define

Shape: Round

Outline: Poorly defined with edges merging imperceptibly with normal bone

Radiodensity: Initially radiolucent ; Later “ground glass / orange peel / finger print” appearances

Effects: Displacement, rarely resorbed. Loss of lamina dura Expansion, possible encroachment on the antrum, skull base etc..

21

What is McCune Albright Syndrome?

Polystotic Fibrous dysplasia

Café au Lait pigmentation

Precocious puberty

22

What is Ossifying Fibroma?

Age: 2nd – 4th decade (mainly women)

Site: Mandible > Maxilla

Size: Variable can cause deformity

Shape: Round, unilocular

Outline: Smooth and well defined - encapsulated

Radiodensity: Mixed density with late stages radiopaque +/- a radiolucent periphery

Effects: Teeth displaced, occasionally resorbed – often downward bowing of the mandible

23

What is Osteopetrosis (Albers – Schonberg disease)?

•    Hereditary condition – sclerosis of the skeleton (marble bone)

•    Fragile bones and anaemia

•    Bone formation is normal but resorption is reduced

24

What do radiopaque salivary calculi look like?

25

What is an antrolith?

An antrolith is a calcified mass within the maxillary sinus.