Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

location of apical periodontitis

A

PA region of involved tooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does periphery of apical periodontitis look like

A

well defined or ill defined; sometimes sclerotic peripheral reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
A

rarefying osteitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A

sclerosing osteitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
A

left = sclerotic bone
right = bone and root resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

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

A

apical periodontitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

vital; multiple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A

dense bone island (idiopathic osteosclerosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

vital; ; sharp; normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
A

dense bone island

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
A

healing apical scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

NO! RARE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what happens to surrounding bone in metastatic lesions? what does PDL space look like

A

cancellous bone destruction; irregular widening of PDL space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

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

A

pericornitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

imaging features of periocornitis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what other diagnses could be involved in pericornitis

A
  1. sclerotic lesions
  2. neoplasms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how to manage pericornitis

A

removal of partially erupted tooth

30
Q
A

pericornitis: note the sclerosis adjacent to the follicular space, periosteal reaction

31
Q

normal and abnormal length of folicula sac in pericornitis

A

normal: 2-3 mm
abnormal: >5mm

32
Q

what is inflammation of bone and bone marrow

A

osteomyelitish

33
Q

hallmark feature of osteomyelitis

A

sequestrum

34
Q

is osteomyelitis capable of resolving spontaneously when the cause is removed or with antibiotics

A

YES

35
Q

what happens if osteomyelitis is persisitent

A

continuous spread seen especially in:

preexisting chronic systemic disease
immunosuppressive states
Disorder of decreased vascularity

36
Q

what is hematogenous spread of infection from distant site to the jaws

A

ostemyelitis

37
Q

age, sex, site of osteomyelitis

A

age: affects people of all ages
sex: strong male predilection
site: > in mandible

38
Q

signs and symptoms of osteomyelitis

A

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
Q

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

A

osteomyelitis

40
Q

what can be used to image osteomyelitis

A

panogramic, occlusal, CBCT, MRI, nuclear imaging

41
Q

what is seen in ACUTE OM

A

Acute OM: ‘Onion skin” pattern of periosteal new bone
formation may be seen (“proliferative OM”); seen more
often in children

42
Q

what is seen in CHRONIC OM

A

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
Q
A

acute osteomyelitis with bluriring of trabeculae

44
Q

what are black and white arrows

A

both sequestra

45
Q

what are black and white arrows

A

black - sequestrum
white - periosteal reaction

46
Q
A

chronic osteomyelitis

47
Q
A

osteomyelitis - periosteal reaction “onion skin “ pattern

48
Q
A

OM-periosteal reaction onion skin pattern

49
Q

type of OM

A

CHRONIC - right side of mandible enlarged with loss of distinct cortical plates and periosteal reaction

50
Q
A

chronic OM - draning fistula

51
Q

what is a differential diagnosis for unilateral facial swelling (OM)

A

adults - malignancy
young - fibrous dysplasis

52
Q

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

A

fibrous dysplasis

53
Q

what happens when new bone laid down on bone surface by periosteal new bone formation and is superficial to bone cortex

A

OM

54
Q

what lesions contains onion skinning

A

OM, LCH, ewing sarcoma, leukemia, and lymphoma

55
Q

when is it considered MALIGNANT

A

destruction of adjacent structures or periosteum

56
Q

osteosarcoma and chondrosarcoma have capability of laying osteoid - is this osteoid iregular or dense

A

BOTH! irrecular OR dense

57
Q

difference between OM and paget disease

A

Paget disease enlarges mandible bilaterally
This is rare in OM
Sequestra are not seen in paget disease

58
Q

tx of OM

A

Removal of source of infection
Antimicrobial therapy along with surgical intervention

59
Q

is acute or chronic OM difficult to manage? why

A

chronic
Osteosclerosis reduces vascularity of bone
Surgical intervention is often necessary
More recently bisphosphonate therapy has provided some success

60
Q

what causes radiation induced changes in the jaws

A

greater than 50 grays leading to exposed bone for at least 3 months

61
Q

where do you usually get radiation induced changes in the jaw

A

posterior mandible, with or without pain

62
Q

is ORN similar to OM? how

A

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
Q
A

ORN

64
Q

can resorption mimic malignancy

A

YES

65
Q

what drugs inhibit osteoclastic function and bone resorption

A

bisphosphonates and RANKL inhibitors

66
Q

bisphos and RANKL inhibitors are important in treatment of what

A

multiple myeloma, hypercalcemia of malignancy, metastatic diseases, and osteoporosis

67
Q

most common areas of medication related osteonecrosis of jaws

A

60% posterior mandible
40% posterior maxilla

68
Q

what do you see in medicaiton related osteonecrosis of jaws imaging

A

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
Q

what does transition from A to B show

A

bisphosphanate osteonecrosis

70
Q

what does transition from A to B show

A

bisphosphonate osteonecrosis

71
Q

best way to treat medication related osteonecrosis

A

tx is unsatisfactory so best way is to just prevent it

23 Radiology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions