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Oral Path 2 > Analytic/Systemic Strategy > Flashcards

Analytic/Systemic Strategy Flashcards

1
Q

What may you use to describe features?

A
  • Location
  • Shape and Size
  • Internal Structure
  • Effect on Surrounding Structures
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2
Q

Definition: Generalized

A

Abnormal portion affects all (most) of the osseous structures of the maxillofacial region

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3
Q

Definition: Localized

A
  • Unilateral
  • Bilateral
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4
Q

How does position of lesion in jaws aid diagnostic process?

A
  • Determining the center of the location
  • Some lesions tend to be found in specific locations
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5
Q

Where are the different origin centers of lesions and what origin are they?

A
  • Coronal to tooth: Odontogenic origin
  • Above IAC: Odontogenic origin
  • Below IAC: Not odontogenic origin
  • W/in IAC: Probably neural or vascular
  • Condylar areas: Cartilaginous lesions
  • MX sinus: Epithelial origin
    • Lined w/ pseudostratified ciliated columnar epithelium
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6
Q

How may lesion size aid in forming a differential dx?

A
  • Lesions can grow to any size
  • Odontomas: Stop growing so they don’t reach any size
  • Dentigerous cysts vs. Hyperplastic follicle
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7
Q

Different lesion shapes?

A
  • Hydraulic: Somewhat circular; appears to be fluid-filled or inflated balloon
  • Scalloped: Series of contiguous arcs or semicircles
    • Do not confuse for multilocular; multilocular lesions are often scalloped
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8
Q

Poorly defined borders

A

Difficult to draw exact delineation around most of an ill-defined periphery

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9
Q

Various types of well-defined borders

A
  • Corticated
  • Non-corticated or punched out
  • ST capsule
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10
Q

Definition: Well-defined borders

A
  • Imaginary pencil can draw the limits of the lesion
    • Don’t confuse well-defined for corticated; corticated lesions are not often well-defined, but well-defined are corticated
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11
Q

Definition: Corticated

A

Uniform RO line at the periphery of lesion

  • Displayed w/ thin RO border
  • All of the outside of the MN is corticated
  • B & L plates are corticated
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12
Q

Definition: Non-corticated

A

Sharp boundary w/ narrow transition; no bone rxn seen

  • No RO border
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13
Q

Definition: ST capsule

A

RL line at periphery; may be seen in conjunction w/ corticated periphery

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14
Q

Definition: Blending borders

A
  • Sclerotic: Wider zone of transition w/ thick RO border of reactive bone
    • RL border at the apex, but it isn’t well-defined and looks like a paint brush and not a sharpie
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15
Q

What type of lesions are totally RL?

A

Usually cysts

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16
Q

What type of lesioons are totally RO?

A

Certain bone lesions

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17
Q

What lesions are mixed RL/RO?

A

Tumor or cyst that produces calcified material

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18
Q

Increasing RO

A

Air, fat, gas < Fluid < ST < Bone marrow < Trabecular bone < Cortical bone & dentin < Enamel < Metal

19
Q

Abnormal trabecular patterns

A

Variation of number, length, width, and orientation of trabeculae

20
Q

Internal septation

A
  • Long strands of bone or walls w/in a lesion
    • Well-defined, corticated, but internally, it still has all these RO lines that look like bubbles (septations), walls of bone
21
Q

Multilocular

A

Internal structure divided into different compartments/cavities

22
Q

Unilocular

A

Singular compartment

23
Q

At what point would a mixed lesion be considered RO (radiographically)?

A
  • Mixed <1-90% - RO
  • RO >90% RO material
24
Q

What lesions are space-occupying lesions?

A

Cysts & tumors

  • Tumors: Solid mass
  • Cysts: Lining and center is often filled w/ fluid or debris

Because they are space occupying, they can have effects on surrounding structures.

Lesions can displace, resorb, expand, or destroy these structures

25
Q

In which direction do odontogenic lesions displace teeth? In which direction do bone lesions & hematopoietic lesions displace teeth?

A
  • Odontogenic: Displace tooth apically
  • Bone lesions, hematopoietic lesions: Displace tooth coronally
26
Q

What type(s) of lesions may cause directional resorption?

A

Benign tumors/cysts

27
Q

What types of lesions may cause non-directional resorption?

A

Malignant tumors

28
Q

Orthodontic movement vs. Malignant lesions

A
  • Orthodontic movement: Uniform widening w/ lamina dura intact
  • Malignant lesions: Irregular widening & destruction of lamina dura
29
Q

What types of lesions cause expansion? What types of lesions cause perforation?

A
  • Expansion: Slowly growing lesions; cysts & tumors
  • Perforation: Rapidly growing lesions; malignancies
30
Q

Reactive lesions

A
  • Life periosteium off of the cortical bone and stimulate osteoblasts to lay down new bone
  • Inflammatory lesions but also tumors
31
Q

Growth characteristics of slowly growing lesions

A
  • Sharply demarcated borders
  • Corticated borders (sometimes)
  • Displaces normal anatomical structures
  • Expands rather than perforates cortical plate
  • Overlying mucosa is normal
  • Pain or paresthesia is uncommon
32
Q

Growth characteristics of rapidly/aggressively growing lesions

A
  • Poorly demarcated borders
  • Destroys normal anatomical structures
  • Perforation of cortical plate more common
  • Crepitus during palpation more common
  • Ulceration of overlying mucosa more common
  • Pain or paresthesia more common
33
Q

Odontogenic

A
  • Lesions (cysts, tumors) derived from cells that produced teeth
  • Lesions originate and are centered in teeth bearing areas
  • Lesions may extend to non-odontogenic regions
  • Above IA canal
    • IAC displaced inferiorly
  • Originate where teeth normally are
  • The RL is from salivary glands
  • Ghost images from overlap
34
Q

Non-Odontogenic

A
  • Lesions derived from bone, vasculature, nerve, or sinus
  • Lesions may in non-tooth bearing areas, however often may arise in teeth bearing areas
  • Bone origin
  • Sinus origin
  • IA canal origin
    • Neural/vascular
35
Q

Inflammatory lesion characteristics

A
  • Focal
    • Poorly defined borders
    • Pain is variable
    • Often, not always, ​surrounded by sclerotic bone
    • Systemic manifestation: Fever, malaise, leukocytosis, tender lymphadenopathy
  • Widespread
    • Poorly defined borders
    • Pain is variable
    • Often, not always, surrounded by sclerotic bone
    • May appear “moth-eaten”
      • Irregulalr patches of osteolysis surrounded by denser sclerotic bone
36
Q

Cyst features

A
  • Slow growth
  • Features
    • ​Usually well-defined
    • Corticated borders common
    • Hydraulic appearance on rads
    • Can cause expansion
  • May arise from odontogenic or non-odontogenic epithelium
  • May resemble tumor radiographically
  • All cysts are RL, except for ONE **COC**
37
Q

Features of benign tumors

A
  • Slow growth
  • Features
    • Well-defined
    • Usually corticated
    • Displace structures
    • Can cause expansion
  • ​Malignant odontogenic tumors are RARE
38
Q

Features of malignant tumors

A
  • Poorly defined; destroys anatomical structures
  • Most common malignant neoplasm of jaw: metastatic carcinoma
  • Lymph nodes are nontender, hard, fixed
  • May present as toothache
  • Rad
    • Poorly defined
    • Widens PDL space irregularly
    • Irregular (vertical or non-directional) resorption of roots
    • May cause expanion but will perforate cortex
39
Q

Rationale to submit biopsy

A

All biopsies should be sent for pathologic dx

  • Establish a definitive dx
  • Confirm provisional clinical dx
  • Establish the adequacy of surgical margins
  • Obtain information to help in disease management
  • Acquire knowledge on clinical behavior & px
  • Substantiate pt records in medico-legal context
40
Q

Enucleation

A

Removal of lesion only

41
Q

Curettage

A

Removal of lesions and some surrounding bone w/ hand instrument

42
Q

Peripheral ostectomy

A

Removal of lesion and some surrounding bone w/ rotary instrument

43
Q

En bloc resection/segmental resection

A

Resection of lesion & bone w/ clear margin

44
Q

Decompression/Marsupialization

A

Used to decrease size of cysts

  • Decompression: Making small opening in the cyst and keeping it open w/ a drain
  • Marsupialization: Converts cyst into pouch

Oral Path 2 (11 decks)

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