Ragged Radiolucencies Flashcards
(60 cards)
1
Q
what are the ragged radiolucencies
A
- chronic osteomyelitis
- osteoradionecrosis
- medication realted osteonecrosis of the jaws (MRONJ) (BRONJ)
- primary epidermoid carcinoma
- metastatic disease
2
Q
what are the radiographic features of ragged bony disease
A
- irregular sclerotic trabeculation
- cortex changes- thinning and disruption
- sequestration
- fracture (pathologic)
- periosteal duplication
- widened PDL
- minimal displacement of teeth and bony outlines
3
Q
what are the clinical features of ragged bony disease
A
- edema, purulence
- increased mass
4
Q
what are the other names for chronic osteomyelitis
A
- chronic alveolar abscess
- chronic dentoalveolar abscess
- chronic osteitis
5
Q
describe chronic osteomyelitis
A
- localized inflammation and infection of alveolar bone, consequently will be:
- around teeth
- generally milder than acute osteomyelitis
- sclerosing, granular trabecular pattern in blow grade chronic conditions
6
Q
what is osteitis
A
inflammation of alveolar bone caused by pathogenic organisms
7
Q
what is osteomyelitis
A
inflammation of alveolar and basal bone caused by pathogenic organisms
8
Q
the pathophysiology of chronic osteomyelitis is primarily:
A
polymicrobes from odontogenic infection; also from open fractures
9
Q
what are the microbes in chronic osteomyelitis
A
- streptococcus, bacteroides, polystrepto
- with increased chronicity other microbes may include actinomyces, eikenella, klebsiellla, M. tuberculosis
10
Q
what is the difference between acute and chronic
A
- acute is less than 30 days
- chronic is greater than 30 days
11
Q
what are the predisposing factors to chronic osteomyelitis
A
- reduced vascular supply; diabetes, PCOD, FCOD, osteopetrosis, Pagets
- immunodeficient states: AIDS, leukemia, corticosteroid treatment, malnutrition, bisphosphonates, other medications
- odontogenic infection, trauma, surgery
12
Q
what are the clinical features of chronic osteomyelitis
A
- low grade fever
- regional lymphadenopathy
- atrophic, erythematous mucosa
- denuded bone
- suppuration
13
Q
what is the radiographic apperance of chornic osteomyelitis
A
- radiolucency of variable size with irregular borders
- patches of reactive sclerotic bone
- moth eaten appearance
- sequestration
- with increased chronicity and ragged moth eaten appearnace, there can be pathologic fracture
14
Q
what is the cortical disruption in chronic osteomyelitis
A
irregular pattern of thinning and erosion
- sequestration
15
Q
chronic osteomyelitis has a tendency for:
A
proliferative periostitis
16
Q
what is the predilection for chronic osteomyelitis
A
- age: 40-80 years of age
- site: body of mandible
- predominant gender: males
17
Q
what is the management for chronic osteomyelitis
A
- debride any necrotic tissue
- antibiotic therapy
- drain and irrigate the resion
18
Q
what is the classic triad of osteoradionecrosis
A
- radiation therapy
- trauma
- infection
19
Q
what is the effect of the irradiation of bone
A
decreased vascularity and decreased cellularity
20
Q
what are the predisposing factors for osteoradionecrosis
A
- age
- type and delivery of ionizing radiation
- tumor sites
- diabetes
- pagets disease (osteitis deformans)
- hypertension
- pre-existing oral status: untreated dental infections (pulpal and/or periodontal)
- dental extraction
- poor fitting dentures and other micro traumas
21
Q
what is the clinical presentation of osteoradionecrosis
A
- mild to intense pain
- signs of inflammation (swelling, drainage)
- tissue denudation
- denuded bone, swelling and drainage
22
Q
what is seen in stage 1 osteoradionecrosis
A
red, inflamed, tissue
- symptoms presnt
23
Q
describe stage 2 osteoradionecrosis
A
denude dbone
24
Q
describe stage 3 osteoradionecrosis
A
extended into basal bone
25
what is the radiographic appearance of osteoradionecrosis
areas of increased radiodensity interspersed with osteolytic regions
26
what is the predilection for osteoradionecrosis
- age: 40-80 years of age
- site: body of mandible
- gender: males
27
what is the management for osteoradionecrosis
hyperbaric oxygen chamber
- surgical debridement
- resection of nonviable tissues
- antibiotics
28
what are the predisposing conditions for osteoradionecrosis
- previous radiation
- trauma
- diabetes
- pagets disease
29
what diseases are treaated that cause MRONJ
- osteoporosis
- pagets disease (osteitis deformans)
- breast cancer
- multiple myeloma
- prostate CA
- colon CA
30
what are the medications that cause MRONJ
- bisphosphonates
- antiangiogenic medications
31
what are the bisphosphonates that cause MRONJ
- non nitrogen containing bisphosphonates: etidronate (Didronel) - PO. clondronate (bonefos) -PO. tiludronate
- nitrogen containing bisphosphonates: alendronate (fosomax)-po. pamidronate (aredia)- IV. zoledronic acid (zometa) - IV. ibandronate (boniva). risedronate (actonel)
- denosumab
32
what are the antiangiogenic medications that cause MRONJ
bevacizumab
33
what are the dental etioligies of MRONJ
- dental etiologies
- extraction
- implants
- prosthesis trauma
- spontaneous
34
what are the predisposing factors for MRONJ
- age
- type and delivery of ionizing radiation
- tumor site
- diabetes
- hypertension
- pre exisiting oral status: untreated dental infections
- dental extraction
- poor fitting dentures
35
what stages of MRONJ are asymptomatic
stage 0 and stage 1
36
what stages of MRONJ are sympotmatic
stage 2 or 3
37
what is the clinical presentation of BRONJ
- edema , purulence
- increased mass
38
what is the radiographic presentation of BRONJ
- irregular sclerotic trabeculation
- osteolysis
- sequestraion
- periosteal duplication
- minimal displacement of teeth and bony outlines
39
what is the MRONJ treatment
- monitoring
- pharmacologic agents
- minor debridement
- major debridement
- sequestrectomy
- resection
40
what is another name for primary epidermoid carcinoma
squamous cell carcinoma
41
what is another name for primary intra alveolar epidermoid carcinoma
central sqaumous cell carcinoma
- primary epidermoid carcinoma
42
what are the benign vs malignant changes
- benign lesions displace teeth
- benign lesions expans
- malignant lesions grow around teeth
- malignant lesions perforate
43
what are the characterisitcs of malignancies
- poorly defined borders
- ragged irregular borders
- rapid growth
- follow path of least resistance
44
what is the incidence of oral malignancy
- primary carcinoma (alveolar and mucosal)
- metastatic carcinoma
- other: lymphoma, sarcomas, etx
45
what is the clinical presentation of primary intra alveolar epidermoid carcinoma
- normally asymptomatic
- discovered on routine oral exam
46
what is the radiographic appearance fo primary intra alveolar epidermoid carcinoma
- rarified trabecular pattern
- radiolucency with ill definde irregular margins
- rapid growth
- wide PDL ( irregular)
47
what is the management of primary intra alveolar epidermoid carcinoma
- radiation therapy
- surgery
- both
48
______ of malignancies metastasize to the jaws
less than 1%
49
what are the ways malignancies spread
- local invasion
- lympatic spread
- vascular spread
- transeolomic spread
50
what is local invasion
growth into adjacent tissue and soft nerves
51
what is lymphatic spread
enter draining lymphatic vessels and then to local lymph nodes where the tumor grows
52
what is vascular spread
via veins draining the primary elsion, GI tumors to portal veins- liver
- most common in lung, bone marrow, brain and adrenal glands
53
what is transoeclomic spread
primary tumor in abdominal cavity or thorax and then spread via peritoneal or pleural fluids
- start on surfaces and seed to organs in the area
54
what is the pathophysiology of metastatic tumors
usually there is a history of a primary tumor but occasionally the metastatic lesion is the initial presentation of the disease
55
what is the incidence of oral malignancy
- primary carcinoma (alveolar and mucosal)
- metastatic carcinoma
- others: lymphoma, sarcomas
56
what is the clincal presentation of metastatic tumros
- may have no history of pain or previous malignancy
- bone pain, parasthesia, tooth mobility, swelling and soft tissue masses
57
what is the radiographic appearance of metastatic tumors
- usually poor defined with ragged borders
- may be expansive
- some tend to be mixed radiolucent- radiopaque lesions such as thyroid, prostate, breast
58
what is the prevalance of metastatic tumors
- location: mandible more common
- age: 40-80 age, mean age 56
- gender: depends on tumor type
59
what is the management of metastatic tumors
- management by tumor board
- treatment may include surgery, radiaiton and/or chemotherapy
- ultimate decisions are dependent on type of primary malignacy and the decision of the multp disciplinary tumor board
60
