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23 Radiology > 12 - Inflammatory Conditions of the Jaw > Flashcards

12 - Inflammatory Conditions of the Jaw Flashcards

1
Q

cardinal signs of inflammation

A

Rubor - Redness
Tumor - Swelling
Calor - Heat
Dolor - Pain
Functio laesa - Loss of function

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2
Q

radiographic features of inflammation

A
  1. location: (localized- PA, diffuse - osteomyelitis)
  2. periphery: well or ill defined
  3. internal structures: radiolucent or radiopaque
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3
Q

how does inflamamation affect surrounding bone

A
  • Widening of PDL space
  • Cortical plate perforation/lost
  • Root resorption may be present
  • Periosteum may be elevated and form new bone (Periosteal reaction)
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4
Q

timing, cell changes, and tissue changes in acute inflammation

A

timing: recent pain, swelling or fever
cell changes: macrophages, neutrophils
tissue changes: PA abscess

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5
Q

timing, cell changes and tissue changes in chronic inflammation

A

timing: longer period; variable signs and symptoms
cell changes: fibroblasts, osteoclasts, osteoblasts,capillaries
tissue changes: PA granuloma and PA cyst

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6
Q

mehanism of PA inflammatory disease

A
  • Pulpal necrosis
  • Metabolites derived from necrotic pulp exit the tooth root apex
  • Cause inflammatory response in periapical PDL space and surrounding bone
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7
Q

clinical features of apical periodontitis

A

Range from asymptomatic or occasional tooth ache to severe pain
With or without facial swelling, fever, and lymphadenopathy

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8
Q

what images are used for apical periodontitis?

A
  1. PA images: Initial imaging
  2. Panoramic images: useful to characterize extent of lesion
  3. Occlusal images: To detect periosteal bone reaction, if any
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9
Q

location of apical periodontitis

A

PA region of involved tooth

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10
Q

what does periphery of apical periodontitis look like

A

well defined or ill defined; sometimes sclerotic peripheral reaction

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11
Q

what happens in early and later stages of the internal structure of apical periodontitis

A
  • Early stage - normal/subtle changes
  • Later - focal widening of PDL space with apical loss of lamina dura; periapical radiolucency, may be surrounded by zone of sclerosis; Possible root resorption
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12
Q

what does apical periodontitis do to surrounding structures

A

Bone deposition may be seen around focus of R/L
Occasionally, lesion may be entirely made up
of sclerotic
bone, with some evidence of widening of PLS -
Sclerosing osteitis
Localized or diffuse

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13
Q
A

rarefying osteitis

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14
Q
A

sclerosing osteitis

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15
Q
A

left = sclerotic bone
right = bone and root resorption

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16
Q

what are differential diagnoses for inflammatory jaw conditions

A
  1. PA cemento-osseous dysplasia (PCOD)
  2. dense bone island
  3. fibrous scar
  4. metastatic lesions
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17
Q

in early stages of PCOD, bone loss can appear similar to what?

A

apical periodontitis

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18
Q

is teeth vital or necrotic in PCOD? mutiple of single apices involved?

A

vital; multiple

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19
Q

Periodontal ligament spaces normal; Teeth vital; Sharp transition between normal/abnormal bone; may cause root resorption.

A

dense bone island (idiopathic osteosclerosis)

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20
Q

is teeth vital or nectroic in dense bone island? sharp or blunt transition? PDL space wide or normal?

A

vital; ; sharp; normal

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21
Q
A

dense bone island

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22
Q

what is this:

Even after successful orthograde endodontic treatment or retrograde treatment the radiolucency may persist at root apex.
Area consists of dense connective tissue.
Patient’s clinical history should be considered.
Comparison of previous radiographs, if available, is essential.

A

fibrous scar

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23
Q
A

healing apical scar

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24
Q

is it common for metastatic lesions and blood borne malignancies to develop within the PA regions

A

NO! RARE

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25
what happens to surrounding bone in metastatic lesions? what does PDL space look like
cancellous bone destruction; irregular widening of PDL space
26
what is: Inflammation of soft tissues surrounding crown a of a partially erupted tooth Most often seen in association with mandibular 3rd molar; young adults Gingiva gets inflamed and swollen (due to entrapment of microbial debris and secondary trauma) Pain, swelling and trismus are common presentations
pericornitis
27
imaging features of periocornitis
vary : No if change if inflammation confined to soft tissues There may be radiolucency around the tooth and root There may be osteosclerosis around tooth and roots If inflammatory response becomes exuberant, changes can extend to bone surface, producing periosteal new bone formation Periphery of lesion is poorly defined
28
what other diagnses could be involved in pericornitis
1. sclerotic lesions 2. neoplasms
29
how to manage pericornitis
removal of partially erupted tooth
30
pericornitis: note the sclerosis adjacent to the follicular space, periosteal reaction
31
normal and abnormal length of folicula sac in pericornitis
normal: 2-3 mm abnormal: >5mm
32
what is inflammation of bone and bone marrow
osteomyelitish
33
hallmark feature of osteomyelitis
sequestrum
34
is osteomyelitis capable of resolving spontaneously when the cause is removed or with antibiotics
YES
35
what happens if osteomyelitis is persisitent
continuous spread seen especially in: preexisting chronic systemic disease immunosuppressive states Disorder of decreased vascularity
36
what is hematogenous spread of infection from distant site to the jaws
ostemyelitis
37
age, sex, site of osteomyelitis
age: affects people of all ages sex: strong male predilection site: > in mandible
38
signs and symptoms of osteomyelitis
Rapid onset, PAIN, SWELLING OF ADJACENT TISSUES, FEVER, LYMPHADENOPATHY, AND LEUKOCYTOSIS Involved teeth mobile and sensitive to percussion Purulent discharge possible Paresthesia of lower lip has been reported
39
Intermittent, recurrent episodes of swelling, pain, fever, and lymphadenopathy Paresthesia and drainage with fistula may also occur Patient may have little or no pain Culture results are usually negative If left untreated, it can spread throughout the jaws In mandible, it can spread to TMJ and cause septic arthritis
osteomyelitis
40
what can be used to image osteomyelitis
panogramic, occlusal, CBCT, MRI, nuclear imaging
41
what is seen in ACUTE OM
Acute OM: 'Onion skin" pattern of periosteal new bone formation may be seen ("proliferative OM"); seen more often in children
42
what is seen in CHRONIC OM
Chronic OM: the R/L lines that separate layers of periosteal new bone from one another may begin to fill up with sclerotic bone pattern; may be visible clinically as facial asymmetry; may also develop a fistula
43
acute osteomyelitis with bluriring of trabeculae
44
what are black and white arrows
both sequestra
45
what are black and white arrows
black - sequestrum white - periosteal reaction
46
chronic osteomyelitis
47
osteomyelitis - periosteal reaction "onion skin " pattern
48
OM-periosteal reaction onion skin pattern
49
type of OM
CHRONIC - right side of mandible enlarged with loss of distinct cortical plates and periosteal reaction
50
chronic OM - draning fistula
51
what is a differential diagnosis for unilateral facial swelling (OM)
adults - malignancy young - fibrous dysplasis
52
what is the bone manufactured from within and the outer cortex may be thinned by the changes; the location of surface cortex does not change
fibrous dysplasis
53
what happens when new bone laid down on bone surface by periosteal new bone formation and is superficial to bone cortex
OM
54
what lesions contains onion skinning
OM, LCH, ewing sarcoma, leukemia, and lymphoma
55
when is it considered MALIGNANT
destruction of adjacent structures or periosteum
56
osteosarcoma and chondrosarcoma have capability of laying osteoid - is this osteoid iregular or dense
BOTH! irrecular OR dense
57
difference between OM and paget disease
Paget disease enlarges mandible bilaterally This is rare in OM Sequestra are not seen in paget disease
58
tx of OM
Removal of source of infection Antimicrobial therapy along with surgical intervention
59
is acute or chronic OM difficult to manage? why
chronic Osteosclerosis reduces vascularity of bone Surgical intervention is often necessary More recently bisphosphonate therapy has provided some success
60
what causes radiation induced changes in the jaws
greater than 50 grays leading to exposed bone for at least 3 months
61
where do you usually get radiation induced changes in the jaw
posterior mandible, with or without pain
62
is ORN similar to OM? how
YES IlI defined margins Bony cortex may be eroded Opaque or radiolucent or mixed density bone Possible sequestra (areas of necrotic bone separated from main bone)
63
ORN
64
can resorption mimic malignancy
YES
65
what drugs inhibit osteoclastic function and bone resorption
bisphosphonates and RANKL inhibitors
66
bisphos and RANKL inhibitors are important in treatment of what
multiple myeloma, hypercalcemia of malignancy, metastatic diseases, and osteoporosis
67
most common areas of medication related osteonecrosis of jaws
60% posterior mandible 40% posterior maxilla
68
what do you see in medicaiton related osteonecrosis of jaws imaging
Radiographic findings vary. Apart from clinical exposed bone, there may be no radiographic findings. Thickening of lamina dura, widening of PDL space, bone sclerosis, or extensive bone loss, and sequestra.
69
what does transition from A to B show
bisphosphanate osteonecrosis
70
what does transition from A to B show
bisphosphonate osteonecrosis
71
best way to treat medication related osteonecrosis
tx is unsatisfactory so best way is to just prevent it

23 Radiology (15 decks)

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