Inflammatory Lesions of the Jaw Flashcards
osteoradionecrosis disease mechanism
radiation dose greater than 50 Gy
osteoradionecrosis clinical features
exposed bone for 3 months after radiation therapy, sequestrate, pathological fracture
w/ or w/out pain
osteoradionecrosis radiographic features
lifeless
- sequesrta, fracture
osteoradionecrosis DD
malignant neoplasms
antiresorptive agent induced ONJ
current or previous treatment with antiresorptive or antiangiogenic agents
exposed bone or bone that can be probed through an intra-oral or extra-oral fistula in the maxillofacial region that has peristed for more than 8WEEKS
NO PREVIOUS history of radiation therapy or obvious metastic disease to the jaw
antiresorptive agent induced ONJ disease mechanism
osteoclast inhibition and antiresorptives
pathogenesis??
antiresorptive agent induced ONJ clinical features
exposed necrotic bone +/- pain and swelling
radiographic features of antiresorptive agent induced ONJ
most often there are no specific image findings
sequestra may be present
sclerosing, widening PDL space
*similar features to osteomyletis so need to see what types of medications they are on and is it for cancer (malignant treatment or for osteoporosis?)
Comparing to osteomyletis – does it look any different?
no – so why it is so important to get medical history and why on it
Pericorinitis
Operculitis
Pericorinitis disease mechanism
inflammation of the soft tissue surrounding partially erupted tooth
Pericorinitis clinical features
pain, swelling, trismus
Pericorinitis radiographic features location? periphery? iternal structure? effects on surrounding?
location? –> mandibular 3rd molars usually
periphery? –> ill defined, sclerotic region
internal structure?–> radiolucent w/ follicle and sclerotic adjacent bone
effects on surrounding? –> rarefaction (decrease in density), slcerosing
what does it mean to be ill-defined
do not know where the lesion starts or stops
most common pathology in the jaw?
inflammatory lesion by caries or periodontal disease
general clinical features of inflammatory lesions of the jaw
redness, swelling heat and pain, vaies with degree of inflammation
can be acute or chronis
general radiographic features of inflammation
location?
periphery?
internal structure?
effects on surrounding?
location –> alveolar process
periphery –> ill-defined, sclerotic
internal structure–> radiolucent or radio-opaque
effects on surrounding –> +/- bone, widening of PDL, root resorption
- more opaque in chronis
major list of the peri-apical inflammatory lesions we see
apical periodontitis, chronic apical perio, peri-apical abscess, peri-apical ganuloma
disease mechanism / steps in order with peri-apical inflammatory lesion
starts out as? – progresses to?
first
1. caries OR trauma —> 2. necrotic pulp–>3. Apical Perio –> which will go acute or chronic
Acute –> peri-apical abscess –> osteomyelitis
chronic –> peri-apical granuloma which can become osteomyleitit or peri-apical cyst
can also go from abscess to granuloma and visa-versa
imaging features of peri-apical lesion
well -defined radio-lucency - soft tissue
changes in PDL and lamina dura
sclerotic – can affect bone surrounding - making less marow space and excess bone (trying to confine infection into the area)
resorption of root ends
if close to maxillary sinus – pushes it up
multiple variations to how it will appear depending upon intensity of the lesion (chronic – seeing more changes in the bone too)
osteomyelitis definition
inflammation of bone, may involve marrow, cortex, cancellous portion and periosteium
describe inflammatoy reaction with osteomyelitis
you get the inflammatory reaction –> into the bone –> resorption occurs –> periosteium is affeted –> exudate –> new born tries to form
osteomyelitis in young vs old patients
look at the PERIOSTEAL ATTACHMENT – not as tightly adhered to cortical outline in younger patients so may see a layer of bone formation but in adults may not be able to distinguish the new bone deposition
hallmark of osteomyelitis
sequestra formation
- dead bone radio-opaque with surrounding radio-lucency
osteomyelitis acute phase synonyms
TRUE
- like acute suppurative osteomyelitis , pyogenic osteomyelitis , sub-acute suppurative osteomyelitis , gae’s osteomyelitis . proliferative periostitis
osteomyelitis general disease mechanism
infection spreading into bone marrow
clinical features of osteomyelitis
males > females, mandible > maxilla, rapid onset, pain, swelling, fever, lymphadenopathy and leukocytosis
how do you distingish acute vs chroninc osteomyelitis
RADIOGRAPHICALLY
- not a histopathic differentiation
why mandible more than maxilla for osteomyelitis
maxilla is more porous and has a good relationship with blood supply
radiographic examination of acute osteomyelitis location? periphery? iternal structure? effects on surrounding?
location?
- posterior body of mandible
periphery?
- ill-defined
iternal structure?
- decrease in density of the bone, increase in marrow space and decrease in the trabecular bone
effects on surrounding?
- resorption and bone formation
use of two-phase nuclelar medicine study technique with gallium citrate?
inject this to see the phase of the disease and see the metabollic state of the infection and to determine location
differential diagnosis for acute phase osteomyeltitis
fibrous dysplasia, osteosarcoma, SCC (more rare)
suppurative osteomyelitits vs non suppurative
non- refers to chronic osteomyelitis
disease mechanism of chronic osteomyelittis
sequel of inadequately treated osteomyelitis, bone metabolism tipped to bone formation
clinical features of chronic osteomyelitis
symptoms are less severe and have a long history, intermittent recurrent episodes of swelling, pain, fever, lymphadenopathy
radiographic featured of chronic osteomyelitis location? periphery? iternal structure? effects on surrounding?
location?
- posterior mandible
periphery?
-gradual transition between normal and surrounding trabeculae
iternal structure?
-slecrotic, sequestra
effects on surrounding?
- changes the shape and size of the affected bone, root resorption, loss of lamina dura
differential diangosis for chronic osteomyeleits
kinda same as acute
fibrous dysplasia, and osteosarcoma but also Paget’s
sequestra are basically
dead bone floating within
-calcification within sclerotic/ lucency
radiation therapy effects after week 1?
taste loss –can last throughout entire tx period
radiation therapy effects timeline
- taste loss
- mucositis
- hyposalivation
- radiation caries
- trismus
- susceptibility to osteoradionecrosis
radiation induced changes to the jaws
disease mechanism
therapeutic radiation – malignancies – get cellular damage of bone
induced changes to the jaws
radiographic features
irregular widening - PDL space– osseous resorption
induced changes to the jaws differential
perio disease
obtain an isodose distribution for who?
pt’s that have gotten radiation therapy tx.
