lecture 6- skull and facial bones pathology Flashcards
description, causes and symtpoms of depressed skull fracture
desc:
nearly always result of trauma
part of thr skull is pressed into the brain
causes:
trauma
symptoms:
recent trauma an dhead wounds
diagnosis, complications, treatment and siff. diagnosis for depressed skull fracture
Diagnosis
Plain film is almost never the primary imaging now
CT is the modality of choice. The fracture will be shown in detail along with any soft tissue injuries
Complications
Damage to underlying brain can cause haematomas, haemorrhages and CSF leaks
Treatment
Surgical management1
Differential diagnosis: N/A
description, causes and symptoms of osteomas
Description
Benign primary bone tumour
Causes
Can be associated with some syndromes but aetiology is unknown
Symptoms
May present as a slow growing mass
how are osteomas diagnosed
Mainly occur in the paranasal sinuses, skull vault and nasal bone
Plain film
Appear as round lesions.
CT
Appear as round hyperdense lesions.
MRI
Appearances depend on the amount of bone marrow within the osteoma but on T1 normally give low signal
complications, treatment and diff. diagnosis of osteomas
Complications
Pain and disfigurement
Treatment
They are benign and are only removed if there are causing complications
Differential diagnosis
Any other cause of bony growth including Pagets
descriotion, causes and symtpoms of skull fractures
Description
Fracture of a skull vault bone. They are a marker of the severity of the injury. They can be classified as a base of skull fracture or skull vault fracture
Causes
Trauma
Symptoms
Depends on mechanism of injury
diagnosis, complications and treatment for skull fractures
Diagnosis
Plain film is rarely used now.
CT is the first line investigation
CT is excellent at assessing the bony anatomy and allowing 3D reconstruction
Complications
Dependant on the underlying damage to the brain
Treatment
Conservative or surgical depending on severity
description, causes and symptoms of pagets disease
Description
Common metabolic bone disorder which results in extensive bone remodelling
Causes
Unknown. More common as you age
Symptoms
Localised pain
Increased bone size
Decreased range of motion
how is pagets disease diagnosed?
Bloods can show elevated levels indicative of Paget’s
Diagnosis in detail
Plain film and CT
Will see large, well defined lytic lesions in the skull. Sometimes sclerotic areas are also seen
Skull appears to fall over the facial bones
MRI
Bone has a speckled appearance with low signal intensity.
Nuclear medicine
Bone scintigraphy with Technicism is very sensitive but not specific
complications, treatment and differential diagnosis of pagets disease
complications
Pathological fractures and OA
Treatment
Medication to reduce bone growth and improve pain
painkillers
Differential diagnosis
More rare bone disorders
description, causes and symptoms of skull metastases
description: secondary cancer deposits in the bony skull
causes:
Common in patients with skeletal metastatic disease
Cancers that most frequently metastasize are
Breast, lung, prostate, renal cell, multiple myeloma
symptoms:
Can cause pressure on the brain leading to seizures
In 90% of cases there will be bony metastases elsewhere
how are skull metastases diagnosed and what complications can occur?
Diagnosis
Lytic lesions are the most common, but breast and prostate primary may result in sclerotic lesions.
Complications
May cause seizures or vision issues
what ius the treatment and diff. diagnosis fror skull metastases
Treatment
Many patients are at end of life so palliative care is given. Radiotherapy, chemotherapy and surgery can be used.
Differential diagnosis
Nonmalignant disease or Paget’s
descriotion, causes and symptoms of multiple myeloma
Description
Is a malignant bone neoplasm and the most common in adults
Causes
Unknown but more common in older age
Symptoms
Bone pain, anaemia, renal failure
how is multiple myeloma diagnosed?
Diagnosis
Radiography has a role in both diagnosis and management
It can diagnose, assess for complications and assess disease progression
Common appearances on plain film are lots of round lytic bone lesions and osteopaenia.
Plain film – a skeletal survey is often performed for diagnosis and monitoring.
However more than 40% bone destruction is needed for it to be seen so it has a high false negative rate
CT is more accurate – specificity of 90%, and sensitivity of 70%. Normally done as a low dose scan
MRI whole body is more sensitive but what are the possible issues with this?
PET-CT can help work out the disease distribution.1
what are the complications, treatment and diff. diagnosis for multiple myeloma
Complications
Pathological fractures
Treatment
Incurable
Differential diagnosis
Metastases
what is the descriotion, causes and symptoms of Le Fort fractures?
FB
Fractures of the midface – which separate the midface from the skull base.
This includes fractures of the pterygoid plates and:
Nasal fossa
Inferior orbital rim
Zygomatic arch
Causes
trauma
Symptoms
Pain and visible facial injury
description and causes of orbital blow out fractures
FB
Description
Describes a fracture of one of the walls of the orbit.
Causes
Typically, a fist or ball direct hit
what are the symtpoms of orbital blow out fractures and how are they diagnosed?
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Symptoms
Air around the eye (orbital emphysema)
Numbness in the area
The eye may be slightly displaced.
Diagnosis
Plain film is not recommended due to poor sensitivity
CT is the most used modality. Does not require contrast. CT can assess the fracture and the presence of bleeding.
what complications can occur and what is the treatment for orbital blow out fractures?
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Complications
Damage to the eye
Treatment
Generally now conservative management
Surgery if it’s a significant injury with risk of long term vision problems
description and causes of mandible fractures?
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Description
One of the most common facial fractures (60-70%).
Causes
Trauma, commonly road traffic collisions
symtpoms and diagnosis of mandible fractures
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Symptoms
Patient may be unable to close or open their mouth.
Pain
Diagnosis
Facial bones and OPG’s are common imaging methods, although CT is becoming more common as a first line imaging method
MRI is the best imaging method for assessing the soft tissue damage
what is the treatment for a mandible fracture?
fb
- conservative
- if the mandible is displaced the pt may need surgery with / without flexion
what is the description and causes of a dental abscess
dental
acute infection of the periapical tissue around the tooth root
causes:
damaged tooth enamel allowing bacteria into the tooth
what are the symptoms and diagnosis of a dental abscess?
dental
symtpoms:
pain and swelling
infection symptoms
diagnosis:
In the early stage (up to the first 10 days) there may be no imaging findings
OPG / CT may show a lucency at the tooth root
complications and treatment for dental abscess
dental
Can result in loss of the tooth
Infection can spread to the neck / brain
treatment: antibiotics
