Maxillofacial radiological - interpretation 2

Question 1

How to describe a lesion?

Answer 1

Radiolucent, radiopaque, mixed density
Where is it - e.g. ramus of mandible
Is it single or multiple
Always describe the border - is the lesion well defined and corticated (white edge) = slow growing (usually benign), just well defined or is it ill defined
Is there any associated root displacement or resorption of the root? - resorption is mostly seen in benign lesions
Is there any displacement or destruction of structures like the ID canal or the maxillary sinus wall?
- Can push the floor of the sinus up or down, sideways, direction of it tells you where the lesion originated
Is there any bony expansion?

Question 2

What does it mean if a lesion is well defined and corticated (white edge)?

Answer 2

Usually benign as slow growing

Question 3

What are the most common bony abnormalities seen radiographically?

Answer 3

Well defined radiolucent lesions

Question 4

How do malignant tumours impact roots?

Answer 4

Leaves the tooth, no root resorption, resorbs the surrounding bone

Question 5

What can well defined radiolucent lesions be?

Answer 5

Most will be cysts - 8/10
However benign neoplasms, giant cell lesions and haemangioma need to be considered
Some lesions are typically unilocular or multiocular = how a child draws a cloud

Question 6

Pericoronal radiolucent lesions?

Answer 6

Usually seen around the crown of the erupting tooth in the follicular space
Follicular space is no greater than 3mm, more than this suggests cystic change, esp if root formation is complete

Question 7

Radiolucent lesions with

indistinct borders

Answer 7

Periodontal disease may mimic more sinister conditions but usually the bone loss seen with perio is general as opposed to the local loss seen with malignancy
Clinical findings are crucial in helping to differentiate the various lesions
Bone loss with an indistinct border is a sign of serious disease

Question 8

What is a sign of serious disease

Answer 8

Bone loss with an indistinct border is a sign of serious disease

Question 9

What are ill defined lesions typically?

Answer 9

Infec or tumour

Question 10

Radiolucent lesions with

indistinct borders

Answer 10

Sinister pathology usually removes normal bony outlines … this is why you need to know your normal anatomy … and why you need to check that these landmarks are present when viewing films
This is best illustrated with Maxillary Sinus Carcinoma … always look for the ‘4 white lines’ on OPGs … if one or more are absent then sinister pathology has to be considered

Question 11

What do tumours do?

Answer 11

Remove things that you would usually expect to see

Question 12

Radiopaque lesions

Answer 12

Always consider the possibility that an opaque lesion is not actually in the bone … it may be in the adjacent soft tissues eg salivary calculus
In the jaws, retained roots are very common … a central radiolucent root canal is a helpful sign
Buried teeth are common … they can migrate into unusual places!!

Question 13

Radiopaque lesions

Answer 13

An opacity at the end of a root can be a sign of non-vitality … sclerosing osteitis. Cemental lesions also need to be considered … affected teeth are usually vital

Question 14

Radiopaque lesions

Answer 14

Dense areas of bone are commonly detected on OPGs … these are usually clinically silent and idiopathic

Question 15

Gardner’s syndrome?

Answer 15

The presence of multiple jaw osteomas with or without supernumerary teeth and odontomes is highly suggestive
Patients with Gardner’s syndrome develop multiple polyps in the bowel … these usually undergo malignant change by the age of 40
Early detection can be life-saving
Present in 20s

Question 16

Soft tissue opacities

Answer 16

Position, shape and clinical history crucial
Tubular shaped opacity extending from the styloid process is calcification of the stylohyoid ligament … very common and of little significance clinically
Large well defined rounded opacities, sometimes multiple, in the cervical region usually indicate calcification of lymph node.
Very common incidental finding … not significant

Question 17

Soft tissue opacities - multiple small opacities?

Answer 17

Multiple small opacities made up of concentric rings are suggestive of phleboliths … seen in vascular lesions

Question 18

Soft tissue opacities - rounded single opacities?

Answer 18

Rounded single opacity projected over or just below the mandibular angle is often a calculus in the submandibular gland … expect a history of pain/swelling with meals. Occlusal views helpful

Question 19

Soft tissue opacities

Answer 19

Well defined dome-shaped opacities in the lower half of the maxillary sinuses usually represent harmless polyps … there may be a history of allergy or upper respiratory infection. Common incidental finding on OPG

Question 20

Soft tissue opacities

Answer 20

Opacity seen in the region of the carotid artery could represent atheroma and may serve as a warning sign for similar disease elsewhere