E2: ALL RADIOGRAPHIC IMAGES Flashcards
radicular cyst
radicular cyst
Large carious lesion indicates tooth is non-vital. It has a well corticated oval lesion that is pushing on the nearby structures (the roots of the first and second molar), and the inferior alveolar canal.
radicular cyst
Non-vital tooth (Endo treated tooth), oval small cyst, touching nasopalatine canal, radiolucent, thin corticaated margin (alveolar bone in this area is thin)
radicular cyst
Non-vital tooth (tested, given), large carious lesion, circular because it has not pushed the neighboring structures, corticated, pushed onto inferior alveolar canal.
radicular cyst
Non-vital tooth, large carious lesion, a cyst forming on each apex of the molar and may have combined into one. Histologically can be different.
residual cyst
Arises from radicular cyst
residual cyst
All molars are missing, circular, well-corticated.
A Stagnes cyst would appear the same but be inferior to the inferior alveolar canal.
residual cyst
Missing #14 with a well-corticated cyst
buccal bifurcation cyst
buccal bifurcation cyst
Primary teeth still present, cyst is located distal to the furcation
buccal bifurcation cyst
Arrows point to corticated border of follicles. BBC’s border is fuzzy (infection). Lingual cusps are higher than buccal cusps. The cyst is distal to the bifurcatio of #30.
dentigerous cyst
Always in the crown
central dentigerous cyst
lateral dentigerous cyst
circumferential dentigerous cyst
dentigerous cyst
Near crown of tooth, mesioangular impaction, cyst starts at CEJ on both sides, more than 3mm, well-corticated, touching IAC
dentigerous cyst
Horizontally impacted 3rd molar, circumferential dentigerous cyst that starts at CEJ (do biopsy to confirm), well corticated, root resorption of 31 and 30, displacement of IAC and inferior border of the mandible
dentigerous cyst
Impacted #22, cyst starts from CEJ, displacement of nearby teeth
dentigerous cyst
6 and 11 have cysts surrounding the crown
dentigerous cyst
Impacted 3rd molar touching ramus, lesion goes all the way around, could potentially be an ameloblastoma (molars would be MORE displaced than a few mm as shown).
displaced hyoid bone
tonsillar calcifications
Lateral Periodontal Cyst
Lateral Periodontal Cyst
Both premolars are vital, the apical PDL space are good
Lateral Periodontal Cyst
Both premolars are vital, the apical PDL space are good
Lateral Periodontal Cyst
Between lateral incisor and canine, vital tooth. Radicular cyst formed by trauma (falling off bike) has similar appearances but on non-vital tooth.
Lateral radicular Cyst
Next to a non-vital tooth, missing teeth, appears to be coming from an
Glandular Odontogenic cyst
Glandular Odontogenic cyst
Displacement of the canine
Glandular Odontogenic cyst
Displacement of teeth, “scalloped” borders
Odontogenic Keratocyst
Odontogenic Keratocyst
3rd molar is still upright and the inferior border of the ramus is not displaced even with the large size
Odontogenic Keratocyst
Missing #17, grows along the length of the mandible, 1st and 2nd molar are not displaced
Odontogenic Keratocyst
Mild to no displacement of 1st and 2nd molars or the IAC
Odontogenic Keratocyst
Odontogenic Keratocyst
Sinus affected
Odontogenic Keratocyst
Multiple OKC
(Gorlin‐Goltz syndrome)
Multiple OKC
(Gorlin‐Goltz syndrome)
A child, multiple teeth are displaced due to the multiple cysts but no displacement of inferior border of the ramus or mandible
Nasopalatine Duct Cyst
Nasopalatine Duct Cyst
The incisors are displaced by the heart shaped cyst
Cylindrical Nasopalatine Duct
Top and bottom are the same width
Hourglass Nasopalatine Duct
Top and bottom are wide
Funnel Nasopalatine Duct
Bottom wider than top
Spindle Nasopalatine Duct
Middle wider than top and bottom
Lesion at maxillary incisors
Nasopalatine Duct cyst
simple bone cyst
simple bone cyst
Well defined cusp tips = younger person, it scallops between roots
simple bone cyst
simple bone cyst
simple bone cyst
torus palatinus
torus palatinus
torus mandibularis
torus mandibularis
torus mandibularis
What type of growth is this?
hyperostosis (exostosis)
grows outward
exostosis vs enostosis
enostosis
growth inward
enostosis
enostosis
Sclerosing Osteitis
sialolith
Ameloblastoma
It has expanded with compartments - a dentigerous cyst will not expand the borders of the mandible like ameloblastomas.
Ameloblastoma
Lesion has multiple compartments and is pushing on the borders of the mandible.
Ameloblastoma
Common in posterior
Ameloblastoma
Displacement of the teeth, expansion of the buccal and lingual plate, septa seen
Ameloblastoma
Differential diagnosis: OKC, simple bone cyst or dentigerous cyst.
Scalloping between roots, compartments, some root resorption of the molars, occlusal surface of molars are “flatter” so they’re older (rules out simple bone cyst which occurs mainly in 17 yr olds), not around crown of tooth (rules out dentigerous cyst), with some displacement of teeth (OKC is mild displacement - unlikely). Perform biopsy to confirm.
Describe in BLESSED format
ameloblastoma
BLESSED format:
B: well-defined, distinct
L: left side of mandible
E: radiolucent
S: circular/oval
S: large (from PM to 3rd molar)
E: displacement of border of mandible and IAC, root resorption
D: radiolucent
Has compartments (soap bubbles - areas of more radiolucency)
Ameloblastoma
3rd molar is displaced to the inferior border of the mandible, lesion expanded to condyle, loss of function once surgery is performed (muscles are affected), may look like dentigerous cyst - perform biopsy to be sure!
Recurrent ameloblastoma
Calcifying Epithelial Odontogenic Tumor
Areas of calcification and trabeculation - multilobular but with radiopacity.
Calcifying Epithelial Odontogenic Tumor
Multiple compartments with calcifications.
Calcifying Epithelial Odontogenic Tumor
Some calcifications (radiopacity) on the buccal with expansion.
Calcifying Epithelial Odontogenic Tumor
Some calcifications (radiopacity) on the lingual with expansion.
Adenomatoid Odontogenic Tumor
Impacted canine with lesion that expanded from root to the crown. Some small radiopacity (speckles) within the lesion in cross section. Radicular cyst would not go up to the crown of the tooth and stay more apical.
Adenomatoid Odontogenic Tumor
Some small radiopacity (speckles) within the lesion with lingual expansion.
Adenomatoid odontogenic tumor
Huge buccal expansion, radiopacity within lesion.
Odontogenic Myxoma
Lesion that has multiple compartments but has straight septas (will not appear all the time)
Odontogenic Myxoma
Lesion that has multiple compartments but has straight septas (will not appear all the time) - marings also not has well defined
Benign cementoblastoma
Almost perfect circle with areas of radiolucency surrounded by a radiolucent band followed by a corticated border. Root of molar is resorbed.
Benign cementoblastoma
Almost perfect circle with areas of radiolucency surrounded by a uniform radiolucent band followed by a corticated border.
Compound Odontoma
Impacted teeth horizontally, follicles, dilacerated roots
Compound Odontoma
Tooth-like structures, follicles –> denticles.
Complex Odontoma
Most are radiopaque surrounded by some radiolucencies, but does not look much like a tooth.
Odontoma preventing eruption
Impacted canine with a complex odontoma superior to it - does not look like a tooth.
Ameloblastic Fibroma
Occlusal lesion, looks like dentigerous cyst (but doesn’t start at CEJ. Radiolucent and prevents tooth from erupting.
Ameloblastic Fibro‐odontoma
Mixed internal content
Larger lesion has extensive calcifications.
Ameloblastic Fibro‐odontoma
Impacted tooth, has calcifications
Neurilemoma
Lesion is “diamond shape”, expansion of buccal plate.
Neurofibroma
On the inferior alveolar canal - appears like a balloon. The middle is larger than the ends = fusiform shape.
Neurofibroma
On the inferior alveolar canal - appears like a balloon. The middle is larger than the ends = fusiform shape.
Osteoma
Radiopaque lesion between canine and premolar with some expansion.
Osteoma
Radiopaque lesion similar to torus but differs in location!
Gardner’s syndrome
multiple osteomas, bone is very white compared to the teeth
Gardner’s syndrome
multiple osteomas
central hemangioma
Multiple linear trabecular patterns.
central hemangioma
Multiple linear trabecular patterns.
ossifying fibroma
Some radiolucency, some radiopacity
ossifying fibroma
Some radiolucency, some radiopacity, expansion of the buccal and lingual cortex.
ossifying fibroma
Some radiolucency and radiopacity in the sinus area with a well defined capsule.
ossifying fibroma
Some radiolucency and radiopacity in the sinus area with a well defined capsule.
ossifying fibroma
Some radiolucency and radiopacity in the sinus area with a well defined capsule.
squamous cell carcinoma
Loss of alveolar bone in the lower right 2nd molar area. No PDL or lamina dura in #30 and #31
squamous cell carcinoma
Floor of the ramus is destroyed with finger-like projections. Left side is shadow of the tongue.
squamous cell carcinoma
Radiolucent lesion. Inferior border of the IAC is lost. There is a slight growth of bone. Bottom photo is of patient after extraction and removal of the bone.
laryngeal squamous cell carcinoma
Canine has partial bone plate not picked up by scan. Patient has history of laryngeal SSC. 2nd Molar has widened PDL space, and some bone loss seen in 1st molar. You can see widened PDL space and loss of the lingual cortex on the cross-section around 18 and 19. Lower right image shows “moth-eaten” feature.
squamous cell carcinoma
Missing L coronoid process with a displaced condyle. Clinically, extremely loose lower 2nd molar that was extracted at the time this pano was taken. Red arrow on the lower left part of the mandible shows a pathological fracture. Midline has shifted because part of the jaw is missing.
squamous cell carcinoma
Image A shows no sinus floor. First pano shows no left zygomatic process. Patient presents with loose teeth multiple times that were extracted. By the end, patient has lost upper left molars and no floor of orbit.
metastatic neoplasm
Bone destruction in the first molar only. Alveolar process is normal at other tooth structures. Anytime patient tells you something happened RECENTLY (loose tooth, pain, etc).
metastatic tumor
Bone destruction, floating premolars, missing molars.
metastatic tumor
Steps are visible, irregular border. Pathological fracture.
Patient complained of loose molars (17 and 18)
metastatic tumor
Lots of bone destruction in the left ramus. Distal border of the ramus is discontinuous.
metastatic tumor
Appears like a dense bone island - but look at the age of the patient. Dense bone island usually forms in younger patients. If a patient is older with a personal or family history of cancer, look into it. This radiograph shows metastasis from prostate cancer.
metastatic tumor (from breast)
Metastasis from the breast. There are radiolucencies in the left ramus.
metastatic tumor (from prostate)
Metastasis from the prostate. Example of periosteal reaction - there is a new layer of bone growing on both the buccal and lingual as seen with the radiopacities.
osteosarcoma
Osteosarcoma in the chin area that displays lots of spicules. Sun-ray appearance is classic in late-stage patients. Early stages are much harder to diagnose.
osteosarcoma
Sun-ray appearance is classic in late-stage patients. Early stages are much harder to diagnose.
osteosarcoma (radium dial painters)
Linear spicules - Sun-ray appearance is classic in late-stage patients. Early stages are much harder to diagnose.
osteosarcoma
Widened PDL around left lower molar. The left IAC is widened. Lots of extra blood vessels.
osteosarcoma
Border of mass with radiopacity around buccal and lingual plate. Early stage, so we can’t see the classic sun-ray appearance.
osteosarcoma
Some distal root resorption. Widened PDL space. Area of radiopacity and radiolucency. Sinus infection present.
osteosarcoma
Very wide PDL space around premolar with a very radiopaque lesion.
osteosarcoma
(osteogenic sarcoma)
Widened PDL space with radiopaque sclerosis. Easy to miss because it appears like periodontal disease.
osteosarcoma
Irregular radiopacities. Widened PDL space around first molar with radiopaque sclerosis.
osteolytic lesion chrondrosarcoma
chrondrosarcoma
fibrosarcoma
multiple myeloma
“punched out” radiolucencies
multiple myeloma
“punched out” radiolucencies
multiple myeloma
“punched out” radiolucencies (difficult to see)
Before and after
R condyle is destroyed.
Asymptomatic
Complex odontoma
Radiopacities vary in sizes (no radiolucent band, not well corticated).
Dentigerous cyst
Supernumerary teeth. Radiolucency in the incisors have pushed the incisors and the canine almost to the premolar. The radiolucency surrounds the impacted tooth - (differential would be OKC and ameloblastoma).
Odontogenic keratocyst
Radiolucent, well corticated, multiple compartments, scalloped margins. OKC or amelobastoma - biopsy confirmed OKC.
Not dentigerous cyst (not around a crown of a tooth).
Not buccal bifurcation cyst (molar isn’t tipped, this patient looks older and it’s way too big).
Burkitt’s lymphoma
Burkitt’s lymphoma
Irregular bone destruction.
Leukemia
Significant periodontal bone loss in a child, especially in the bifurcation areas.
Leukemia
Significant periodontal bone loss in a child, especially in the bifurcation areas. Look at the height of alveolar bone.
Leukemia
Significant periodontal bone loss in a child, especially in the bifurcation areas. Rapid bone destruction all over the mouth.
Normal follicular space
Follicular margin is crisp. Uniformly wide (1-1.5mm) followed by a corticated margin.
Pericoronitis
Widened follicle (about 2mm). Early stage perioconitis - not sure because it’s still corticated.
Pericoronitis
Widened follicle (about 2mm). Border is not well-defined. Not wide enough or have a good corticated border to be dentigerous cyst.
osteomyelitis
Area of increased radiopacity.
Right IAC is much more well-defined and thicker than the left IAC, but is not uniform since it’s not well-defined closer to the infection site. This is because the body is trying to protect the bone in that area. With cancer, the body does not have time to defend itself because the cancer grows so fast.
Patient recently had a graft placed.
osteomyelitis
Fuzzy new bone growth at the apex of the mandible (chin area). Discontinuity of bone in this area. Many radiolucent irregularities. Most likely infection from recent bone graft.
osteomyelitis
Pathological fracture in posterior mandible. Radiopaque area is sclerotic portion. Radiolucent area is lytic portion.
sequestrum
From mandible (maxilla would not have sequestrum bc it has less vaculature). A non-vital irregular bone with a radiolucent band.
sequestrum
Circled spot at the canine is the sequestrum.
osteomyelitis
Irregular bone with radiolucent band. Not osteosarcoma because of the a new layer of bone formation.
4 mo. old baby (pain present) with meningitis.
osteomyelitis
osteomyelitis
Nuclear medicine
Radioactive material injected into baby which will bind with cells that have high bone activity. The more activity, the darker the image. Jaw and spine extremely dark.
chronic osteomyelitis
Posterior portion of IAC is not well defined. Multiple layers of bone seen on the inferior border of the mandible.
chronic osteomyelitis
Large carious lesions. Biggest radiolucency is at the root of right 1st and 2nd molars.
chronic osteomyelitis
IAC is thicker in the anterior portion. Large radiolucency. Bone is irregular. Some sclerosis. If you can’t pinpoint, it’s the nature of the disease. “Diffuse bony changes”.
chronic osteomyelitis
Lost crowns. PDL widening. Radiolucent areas in the 3rd molar region. IAC thicker. Cannot tell where it begins or ends.
advanced osteomyelitis
Infection at the area of 1st molar (missing) and has spread to the lingual of anteriors. Loss of cortical thickness.
osteoradionecrosis
radiotherapy
osteoradionecrosis
radiation therapy
Irregular bone destruction
osteoradionecrosis
Irregularities, discontinuity of jaw. Circled area is where the bone is so weak, it may fracture in the future.
Caries from radiotherapy.
osteoradionecrosis
history of radiation
Arrow points to drainage site.
MRONJ
Widespread - infects the whole jaw.
root fracture
horizontal
Radiolucent line, step deformity
single crown fracture
May appear as 2 fractures. 1 crown fracture, 1 root fracture. New fracture because you can still see the pulp canal.
root fracture
Old fracture because you can’t see pulp canal.
root fracture
Multiple fractures. Tooth has been displaced - can see outline of tooth socket (extruded)
vertical root fracture
vertical root fracture
Very difficult to identify radiographically for posterior teeth. Look for indirect features of fracture = widening PDL space - J shaped radiolucency.
vertical root fracture
J shaped radiolucency on the M aspect of the premolar
vertical root fracture
with widened PDL space
trauma
Chipped 8 and 9, PDL space intact because recent trauma.
dental trauma
Chipped 8 and 9, PDL space intact because recent trauma. Horizontal fracture of 7 with another angle - will need root canal or extraction.
mandibular fracture
2 fractures - body of mandible (goes through the mesial root of the molar) and posterior.
non-displaced condylar fracture
condyle stays in the same place
displaced condylar fracture
dislocated condylar fracture
intracapsular condylar fracture
extracapsular condylar fracture
sigmoid condylar fracture
condylar fracture
condylar fracture
Try to trace the condyle and see where you have trouble. Right side is shorter than the left side.
condylar fracture
Distal of right condyle is also fractured (not seen). Left condyle has been displaced.
mandibular fracture
mandibular fracture
fracture and infection
Areas of irregularities by the bone plate. Medical CT not recommended for patient. MRI contraindicated because of metal.
streak artifacts
Medical CT not recommended for patients with metal because it will cause artifacts in CT.
What type of imaging would you do first?
Pano or XR - not MRI!
gunshot injury
Ghost images are fuzzy of the sharp white spots.
parasymphysis fracture
parasymphysis fracture
fracture
fracture
radiation therapy
Le Fort I
Le Fort II
Le Fort III
Tripod fracture
cleft palate/alveolar process anomaly
Cleft on one side
cleft palate/alveolar process anomaly
cleft palate/alveolar process anomaly
cleft palate/alveolar process anomaly
bilateral alveolar cleft and midpalatal cleft
Crouzon syndrome
Hypoplastic maxilla, digital depressions. Head is big and large. “Beaten copper appearance”.
Crouzon syndrome
ABSENT SUTURES
hemifacial microsomia
Both borders of the inferior mandible should superimpose but it’s not in this case because 1 side is smaller than the other.
hemifacial microsomia
Left side is much smaller than right side.
hemifacial hyperplasia
Compare tooth sizes to the face.
hemifacial hyperplasia
L condyle much bigger than R condyle.
hemifacial hyperplasia
R condyle much bigger than L condyle. Distance of ramus is larger on R than L. Open bite.
Treacher Collins Syndrome
Anterior open bite. Prominent protrusion of upper and lower jaws. Condyles are hypoplastic. Patient’s face looks depressed.
Treacher Collins Syndrome
Anterior open bite. Prominent protrusion of upper and lower jaws. Condyles are hypoplastic. Patient’s face looks depressed.
Treacher Collins Syndrome
Anterior open bite. Prominent protrusion of upper and lower jaws. Condyles are hypoplastic. Patient’s face looks depressed.
Lingual salivary gland depression
No disease, below IAC
Lingual salivary gland depression
No disease, below IAC
Sublingual gland depression
Vital teeth.
Sublingual gland depression
Lingual salivary gland depression
Submandibular salivary gland depression
Submandibular salivary gland depression
Cherubism
Lots of crowding, marked radiolucencies, lots of displacement of teeth
Cherubism
Lots of crowding, marked radiolucencies, lots of displacement of teeth
Cherubism
Cherubism
Cherubism
Cherubism
tonsillar calcifications
