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Radiology > Inflammatory Lesions of the Jaw > Flashcards

Inflammatory Lesions of the Jaw Flashcards

1
Q

osteoradionecrosis disease mechanism

A

radiation dose greater than 50 Gy

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2
Q

osteoradionecrosis clinical features

A

exposed bone for 3 months after radiation therapy, sequestrate, pathological fracture

w/ or w/out pain

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3
Q

osteoradionecrosis radiographic features

A

lifeless

- sequesrta, fracture

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4
Q

osteoradionecrosis DD

A

malignant neoplasms

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5
Q

antiresorptive agent induced ONJ

A

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

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6
Q

antiresorptive agent induced ONJ disease mechanism

A

osteoclast inhibition and antiresorptives

pathogenesis??

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7
Q

antiresorptive agent induced ONJ clinical features

A

exposed necrotic bone +/- pain and swelling

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8
Q

radiographic features of antiresorptive agent induced ONJ

A

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?)

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9
Q

Comparing to osteomyletis – does it look any different?

A

no – so why it is so important to get medical history and why on it

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10
Q

Pericorinitis

A

Operculitis

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11
Q

Pericorinitis disease mechanism

A

inflammation of the soft tissue surrounding partially erupted tooth

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12
Q

Pericorinitis clinical features

A

pain, swelling, trismus

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13
Q 
Pericorinitis radiographic features 
location?
periphery?
iternal structure?
effects on surrounding?
A

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

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14
Q

what does it mean to be ill-defined

A

do not know where the lesion starts or stops

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15
Q

most common pathology in the jaw?

A

inflammatory lesion by caries or periodontal disease

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16
Q

general clinical features of inflammatory lesions of the jaw

A

redness, swelling heat and pain, vaies with degree of inflammation

can be acute or chronis

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17
Q

general radiographic features of inflammation

location?
periphery?
internal structure?
effects on surrounding?

A

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

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18
Q

major list of the peri-apical inflammatory lesions we see

A

apical periodontitis, chronic apical perio, peri-apical abscess, peri-apical ganuloma

19
Q

disease mechanism / steps in order with peri-apical inflammatory lesion
starts out as? – progresses to?

A

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

20
Q

imaging features of peri-apical lesion

A

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)

21
Q

osteomyelitis definition

A

inflammation of bone, may involve marrow, cortex, cancellous portion and periosteium

22
Q

describe inflammatoy reaction with osteomyelitis

A

you get the inflammatory reaction –> into the bone –> resorption occurs –> periosteium is affeted –> exudate –> new born tries to form

23
Q

osteomyelitis in young vs old patients

A

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

24
Q

hallmark of osteomyelitis

A

sequestra formation

- dead bone radio-opaque with surrounding radio-lucency

25
Q

osteomyelitis acute phase synonyms

A

TRUE
- like acute suppurative osteomyelitis , pyogenic osteomyelitis , sub-acute suppurative osteomyelitis , gae’s osteomyelitis . proliferative periostitis

26
Q

osteomyelitis general disease mechanism

A

infection spreading into bone marrow

27
Q

clinical features of osteomyelitis

A

males > females, mandible > maxilla, rapid onset, pain, swelling, fever, lymphadenopathy and leukocytosis

28
Q

how do you distingish acute vs chroninc osteomyelitis

A

RADIOGRAPHICALLY

- not a histopathic differentiation

29
Q

why mandible more than maxilla for osteomyelitis

A

maxilla is more porous and has a good relationship with blood supply

30
Q 
radiographic examination of acute osteomyelitis 
location?
periphery?
iternal structure?
effects on surrounding?
A

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

31
Q

use of two-phase nuclelar medicine study technique with gallium citrate?

A

inject this to see the phase of the disease and see the metabollic state of the infection and to determine location

32
Q

differential diagnosis for acute phase osteomyeltitis

A

fibrous dysplasia, osteosarcoma, SCC (more rare)

33
Q

suppurative osteomyelitits vs non suppurative

A

non- refers to chronic osteomyelitis

34
Q

disease mechanism of chronic osteomyelittis

A

sequel of inadequately treated osteomyelitis, bone metabolism tipped to bone formation

35
Q

clinical features of chronic osteomyelitis

A

symptoms are less severe and have a long history, intermittent recurrent episodes of swelling, pain, fever, lymphadenopathy

36
Q 
radiographic featured of chronic osteomyelitis 
location?
periphery?
iternal structure?
effects on surrounding?
A

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

37
Q

differential diangosis for chronic osteomyeleits

A

kinda same as acute

fibrous dysplasia, and osteosarcoma but also Paget’s

38
Q

sequestra are basically

A

dead bone floating within

-calcification within sclerotic/ lucency

39
Q

radiation therapy effects after week 1?

A

taste loss –can last throughout entire tx period

40
Q

radiation therapy effects timeline

A
  1. taste loss
  2. mucositis
  3. hyposalivation
  4. radiation caries
  5. trismus
  6. susceptibility to osteoradionecrosis
41
Q

radiation induced changes to the jaws

disease mechanism

A

therapeutic radiation – malignancies – get cellular damage of bone

42
Q

induced changes to the jaws

radiographic features

A

irregular widening - PDL space– osseous resorption

43
Q

induced changes to the jaws differential

A

perio disease

44
Q

obtain an isodose distribution for who?

A

pt’s that have gotten radiation therapy tx.

Radiology (26 decks)

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