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1 - BDS4 finals - big topics > Radiology > Flashcards

Radiology Flashcards

(72 cards)

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1
Q

What is a cyst?

A

a pathological cavity having fluid, semi-fluid or gaseous contents and which is not created by the accumulation of pus

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2
Q

Cysts - initial radiographs that can be taken to investigate

A

periapical
occlusal
panoramic

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3
Q

supplemental radiographs that can be taken to investigate cysts

A

CBCT
facial radiographs

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4
Q

Radiographic features of cysts

A

shape
- often spherical or egg-shaped
- most grow by hydrostatic pressure

margins
- often well defined
- often corticated

locularity
- ofren unilocular

multiplicity
- can be single, bilateral or multiple
- multiple cysts may indicate a syndrome

inclusion of unerupted teeth

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5
Q

Cysts - effect on surrounding anatomy

A

displacement of cortical plates, adjacent teeth, maxillary sinus, inferior alveolar canal
- variable degree and pattern of growth
- root resorption may occur with chronic cysts

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6
Q

cysts - radiographic signs of secondary infection

A

may lose definition and cortication
typically associated with clinical signs and symptoms

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7
Q

Classification of cysts

A

structure
- epithelium lined vs no epithelial lining

origin
- odontogenic vs non odontogenic

pathogenesis
- developmental vs inflammatory

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8
Q

give examples of developmental odontogenic cysts

A

dentigerous cyst and eruption cysts
odontogenic keratocyst
lateral periodontal cyst

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9
Q

give examples of odontogenic inflammatory cysts

A

radicular cyst and residual cyst
inflammatory collateral cysts
- paradental cyst
- buccal bifurcation cysts

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10
Q

features of odontogenic cysts

A

occur in tooth bearing areas
most common cause of bony swelling in the jaws
- >90% of all cysts in oral and maxillofacial region
all lined with epithelium

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11
Q

most common odontogenic cysts

A

radicular cyst (and residual cyst)
- 60% of odontogenic cysts
dentigerous cyst (and eruption cyst)
- 18%
odontogenic keratocyst
- 12%

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12
Q

radicular cysts features

A

inflammatory odontogenic cyst
- always associated with a non-vital tooth
- initiated by chronic inflammation at apex of tooth due to pulp necrosis
sometimes called dental cysts or periapical cysts

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13
Q

radicular cysts vs periapical granulomas

A

difficult to differentiate radiographically
radicular cysts typically larger
if radiolucency diameter >15mm = 2/3 cases will be radicular cysts

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14
Q

radicular cysts radiographic features

A

well defined, round/oval radiolucency
corticated margin continuous with lamina dura of non-vital tooth
larger lesions may cause displace adjacent structures
long-standing lesions may cause external root resorption and/or contain dystrophic calcification

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15
Q

radicular cyst histology

A

epithelial lining - often incomplete
connective tissue capsule
inflammation in capsule

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16
Q

how do radicular cysts grow?

A

osmotic effect with semi-permeable wall
cytokine mediated growth

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17
Q

name 2 variants of radicular cysts

A

residual cysts
lateral radicular cysts

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18
Q

what is a residual cyst?

A

when a radicular cyst persists after loss of tooth
- or after tooth is successfully root canal treated

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19
Q

what is a lateral radicular cyst?

A

a radicular cyst associated with an accessory canal
- located at side of tooth instead of apex

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20
Q

dentigerous cyst features

A

developmental odontogenic cyst
associated with crown of unerupted (and usually impacted) tooth
- e.g. mandibular 3rd molars, maxillary canines
cystic change of dental follicle

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21
Q

Dentigerous cyst radiological features

A

corticated margins attached to cemento-enamel junction of tooth
- larger cysts may begin to envelop root of tooth
may displace involved tooth
tend to be symmetrical initially
- larger cysts may begin to unilaterally expand
- variable displacement of cortical bone/bony expansion

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22
Q

dentigerous cyst - histology

A

thin non-keratinised stratified squamous epithelium
- may resemble radicular cyst if inflamed

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23
Q

how to tell the difference between a dentigerous cyst and an enlarged follicle

A

consider cyst if follicular space 5mm or more
- measure from surface of crown to edge of follicle
- normal follicular space typically 2-3mm
- assume cyst if >10mm
consider cyst if radiolucency is asymmetrical

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24
Q

eruption cyst features

A

variant of dentigerous cyst
- continued within soft tissue rather than bone
associated with an erupting tooth
- more commonly incisors
- almost exclusively affects children

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25
odontogenic keratocyst radiographic features
often have scalloped margins 25% are multilocular often cause displacement of adjacent teeth - root resorption uncommon characteristic expansion - can have significant mesio-distal expansion without bucco-lingual expansion
26
nasopalatine duct cyst presentation
often asymptomatic patients may note 'salty' discharge larger cysts may displace teeth or cause swelling in palate always involves midline but not always symmetrical
27
nasopalatine duct cyst; radiographic features
periapical or/and standard maxillary occlusal - corticated radiolucency between/over roots of central incisors - often unilocular - may appear 'heart shaped' due to superimposition of anterior nasal spine CBCT may be indicated if better visualisation of cyst required for surgical planning
28
Nasopalatine Cyst vs incisive fossa
incisive fossa - may or may not be visible radiographically - midline, oval shaped radiolucency - typically not visibly corticated transverse diameter can be considered in absence of clinical issues: <6mm assume incisive fossa 6-10mm consider monitoring >10mm = suspect cyst
29
Cysts - how to obtain material for histology
aspiration biopsy - drainage of contents incisional biopsy - partial removal excisional biopsy - complete removal
30
incisional biopsy method for cysts
usually under LA select region where lesion appears superficial raise mucoperiosteal flap remove bone as required - using round bur incise and remove section of lining may be combined with marsupialisation
31
Cysts - outline surgical options
enucleation - removal of all cystic lesion marsupialisation - creation of a surgical window in the wall of the cyst, removing the contents and suturing the cyst wall to the surrounding epithelium - encourages the cyst to decrease in size and may be followed up by enucleation at a later date
32
enucleation is the treatment of choice for most cysts, what are the advantages?
whole lining can be examined pathologically primary closure little aftercare needed
33
enucleation disadvantages
risk of mandible fracture with very large cysts for dentigerous cyst - may wish to preserve tooth old age/ill health clot filled cavity may become infected incomplete removal of lining may lead to recurrence damage to adjacent structures
34
marsupialisation indications
if enucleation would damage surrounding structures - e.g. ID nerve difficult access to area may allow eruption of teeth affected by dentigerous cyst elderly or medically compromised patient very large cysts would risk jaw fracture if enucleation was performed
35
marsupialisation advantages
simple to perform may spare vital structures can combine with enucleation at later procedure
36
marsupialisation disadvantages
opening may close and cyst may reform complete lining not available for histology difficult to keep clean lots of aftercare needed long time to fill in
37
What is osteogenesis imperfecta?
aka - brittle bone disease type 1 collagen defect 4 main types
38
clinical features of osteogenesis imperfecta
weak bones multiple fracture sometimes associated with type 1 dentinogenesis imperfecta
39
rarefying osteitis
localised loss of bone in response to inflammation - occurs secondary to another from of pathology
40
condensing osteitis
localised increase in bone density in response to low-grade inflammation - most common around apex of tooth with necrotic pulp
41
bone necrosis aetiology
osteomyelitis - acute or chronic avascular necrosis - age related iscahemia - anti-resorptive medication irradiation - ORN
42
Osteoclast inhibitors are commonly used to treat...
bone metastases Paget's disease osteoporosis
43
Give examples of developmental bone abnormalities
Torus - palatine - mandibular osteogenesis imperfecta achondroplasia - autosmal dominant oseteopetrosis - lack of osteoclast activity fibrous dysplasia - fibrous replacement of bone - active under 20 years - slow growing, asymptomatic bony swelling
44
Give 3 examples of metabolic bone diseases
osteoporosis rickets and osteomalacia hyperparathyroidism
45
What is osteoporosis
a quantitative deficiency of bone bone atrophy as bone resorption exceeds formation
46
Osteoporosis aetiology
sex hormone status calcium physical activity age secondary - hyperparathyroidism - Cushing's syndrome - diabetes mellitus
47
Osteomalacia aetiology
vitamin D deficiency - diet - lack of sunlight - renal causes - malabsorption osetiod forms but fails to calcify
48
what is hyperparathyroidism?
where calcium is mobilised from bones
49
Peripheral giant cell epulis - differential diagnosis
Brown's tumour aneurysmal bone cysts giant cell tumours - very rare Central giant cell granuloma
50
What is Cherubism?
a rare austominal dominant condition multilocular lesions in multiple quadrants
51
Cherubism - histology
vascular giant cell lesions
52
Paget's disease clinical signs
bone swelling pain nerve compression
53
Paget's disease is linked to..
raised alkaline phosphatase
54
Paeget's disease dental changes
Loss of lamina dura hypercementosis migration - due to bone enlargement
55
Paget's disease histology
active: increased bone turnover - osteoblast and osteoclast activity will burn out
56
Paget's complications
infection tumour
57
What is an osetoma? describe the features
a bone tumour - solitary - mostly cortical bone - slow growing
58
multiple osetomas can be indicative of...
Gardner syndrome
59
osetoblastoma - features
bone tumour rare often very active growth
60
Name 2 cementum lesions
cemetoblastoma memento-osseous dysplasia
61
cementoblastoma features
neoplasm attached to root histology same as osteoblastoma
62
osteosarcoma features
rare age 30s - likely Paget's related if elderly mandible?maxilla local destruction and bony expansion risk of recurrence and metastases
63
Oodntogenic tumours classification
epithelial mesenchymal mixed
64
odotontogenic sources of epithelium
Rests of Malassez - remnants of Hertwig's epithelial root sheath Rests of Serres - remnants of dental lamina reduced enamel epithelium - remnants of the enamel organ
65
give examples of epithelial odontogenic tumours
ameloblastom a adematoid odontogenic tumour clarifying epithelial odontogenic tumour
66
name a mesenchymal odontogenic tumour
odontogenic myxoma
67
name a mixed odontogenic tumour
odontoma
68
>50% of odontogenic tumours are..
ameloblastoma or odontoma
69
Ameloblastoma features
benign epitelial tumour locally destructive but slow-growing typically painless 80% in posterior mandible
70
odontoma features
benign mixed "tumour" malformation of dental tissue
71
odontoma similarities to teeth
mature to a certain stage can be associated with other odontogenic lesions - e.g. dentigerous cysts surrounded by dental follicle lie above inferior alveolar canal
72
types of odontoma
compound - ordered dental structures - may appear as denticles - multiple mini teeth - more common in anterior maxilla complex - disorganised mass of dental tissues - more common in posterior body of mandible

1 - BDS4 finals - big topics (17 decks)

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