Maxillofacial Radiology Interpretation Flashcards
1
Q
Which radiographs best demonstrate caries? (1)
A
- Bitewings or long-cone periapical radiographs
2
Q
When can caries be radiographically detected? What does this mean clinically? (2)
A
- When there has been 30-40% demineralization, so that the lesion can be differentiated from normal dentine and enamel - Because of this limitation, the carious lesion is larger (up to 25%) than that seen on radiographs
3
Q
What can be useful when identifying early lesions? (1)
A
- Magnification
4
Q
Describe earliest radiographic Proximal surface caries (3)
A
- Enamel caries seen as a triangular radiolucency - Just below the contact point - Apex pointing towards the amelo-dentinal junction
5
Q
What happens when radiographic Proximal caries reaches the ADJ? (1)
A
- When caries reaches the ADJ, it spreads along the junction, often forming a second radiolucent triangle, with its apex pointing towards the pulp
6
Q
When is radiographic occlusal caries difficult to diagnose?
A
- If the lesion is restricted to enamel
7
Q
What is often the first indication of radiographic Occlusal caries? (2)
A
- A thin radiolucent line at the ADJ, with intact enamel - As the lesion progresses it becomes easier to detect
8
Q
How is Smooth surface caries detected? (1)
A
- Should be visible clinically, but a radiograph can provide confirmation
9
Q
How and where is root caries usually diagnosed? What can mimic root caries on a radiograph? (2)
A
- Radiographs may reveal root surface caries that is not evident clinically, usually this is interproximally - Cervical burnout can mimic root caries, except that in cervical burnout there is still an image of the root edge
10
Q
How does recurrent caries appear radiographically? What can obscure recurrent caries? (2)
A
- Appears as a zone of increased radiolucency along the margins of a restoration - Radiopaque materials such as metals can obscure recurrent caries, and radiolucent lining materials can make detection difficult
11
Q
What do radiographic signs of periapical periodontitis depend on? What is the earliest sign? (2)
A
- Depends on the time course of the disease process - The earliest sign is usually widening of the apical periodontal ligament, followed by loss of lamina dura
12
Q
What is rarefying osteitis? (1)
A
- Bone resorption
13
Q
What is sclerosing osteitis? (1)
A
- Bone formation
14
Q
What does the body promote in an attempt to heal from chronic apical periodontitis? How does this appear radiographically? (2)
A
- Stimulates the formation of granulation tissue - This appears as a well-defined radiolucency surrounding the apex of a non-vital tooth
15
Q
What is the most likely diagnosis of a well defined radiolucency surrounding the apex of a non-vital tooth with >1cm diameter? (1)
A
- Radicular cyst
16
Q
What can occur intermittently with Periapical Granulomas? (1)
A
- Acute exacerbations of chronic lesions can occur intermittently
17
Q
Give three possible pathological conditions resulting from Periapical Periodontitis? (3)
A
- Root resorption - Radicular cyst formation - Osteomyelitis
18
Q
Why are radiographs useful in Periodontal Disease? (3)
A
- No radiographic signs of gingivitis - Useful to demonstrate the form of bone loss in chronic periodontal disease - As well as any local factors such as calculus or overhanging restorations
19
Q
Where is the alveolar crest normally seen in a healthy individual? (1)
A
- Within 1.5mm of the amelo-cemental junction
20
Q
Describe the three radiographic patterns of bone loss (3)
A
- Early: erosion of the interdental crest - Later: ‘horizontal’ loss of bone generalized and localised - ‘Complex’: osseous defects
21
Q
Describe ‘Juvenile’ Periodontitis (1)
A
- Localised, aggressive
22
Q
Describe Rapidly Progressive Periodontitis (1)
A
- Generalised, aggressive
23
Q
What is Papillon-Lefevre associated with? (1)
A
- Genetic disorders
24
Q
Give three ways that dental anomalies can occur (3)
A
- Anomalies of tooth number - Anomalies of tooth form - Anomalies of tooth structure
25
Give examples of anomalies of tooth number (2)
- Missing teeth: hypodontia, anodontia - Extra teeth: supernumerary, mesiodens, supplemental
26
What happens when there is a Germination dental anomaly? (1)
- Two teeth joined together but arising from a single tooth germ
27
What happens when there is a Fusion dental anomaly? (1)
- Two teeth joined due to the fusion of two tooth germs
28
What is Concrescence? (2)
- Condition where the cementum overlying the roots of at least two teeth join together - The cause can sometimes be attributed to trauma or crowding of teeth
29
What is Dens Invaginatus? (1)
- Infolding of the outer surface of a tooth into the interior
30
What is Dilaceration? (1)
- Sharp bend in the root direction, usually due to previous trauma
31
What is Taurodontism? (1)
- Enlarged pulp chambers, short roots (cow teeth), usually of no clinical significance
32
What is Amelogenesis Imperfecta? (2)
- Inherited condition affecting enamel formation, which is thin, pitted or grooved. - Up to 14 variants identified
33
What is Dentinogenesis Imperfecta? (2)
- Ingerited condition affecting dentine formation, which is discoloured and soft. - Can occur with Osteogenesis Imperfecta
34
What are Odontomes? (1)
- Benign odontogenic tumours (WHO) forming dental hard tissues, compound or complex
35
What size is the follicular space usually and what does a change in size suggest? (2)
- The follicular space is usually no greater than 3mm
- More than this suggests cystic change, especially if root formation is complete
36
Where are pericoronal radiolucent lesions usually seen? (2)
- Usually seen around the crown of normally erupting teeth
- The follicular space
37
What is the most common pathologic pericoronal radiolucency in the jaws? (1)
- The dentigerous (follicular/eruption) cyst
38
What other lesions may present in the same way as dentigerous (follicular/eruption) cysts? (2)
- Keratocysts
- Ameloblastomas
39
What diagnosis does it suggest if there is calcification within a pericoronal radiolucency? (3)
- Adenomatoid Odontogenic Tumour
- Pindborg tumour
- Calcifying Odontogenic Cyst
40
Why are radilucent lesions with indistinct borders so important? What can mimic this? (2)
- Can indicate a sinister condition
- Periodontal disease can mimic more sinister conditions but usually the bone loss seen with ‘perio’ is general as opposed to the local loss seen with malignancy
41
What is crucial when differentiating various radiolucent lesions with indistinct borders? And what is the general rule? (2)
- Clinical findings
- As a general rule, bone loss with an indistinct border is a sign of serious disease
42
What is important when identifying sinister pathology? Give an example(2)
- Remember normal radiographic anatomy, bony outlines, check these landmarks are present on viewing films
- E.g. Maxillary Sinus Carcinoma – always look for the ‘four white lines’ on OPGs, if one or more is absent then sinister pathology has to be considered
43
What possibility must be considered when looking at an opaque lesion on a radiograph? (2)
- That an opaque lesion is not actually bone, may be the adjacent soft tissues
- e.g. salivary calculus
44
What can an opcity at the end of a root be? (2)
- A sign of non-vitality – sclerosing osteitis
- Cemental lesions also need to be considered, affected teeth are usually vital
45
What is Gardener’s Syndrome? (3)
- Clinically appears as multiple jaw osteomas with or without supernumberary teeth and odontomes
- Patients with Gardener’s syndrome also develop multiple polyps in the bowel, these usually undergo malignant change by the age of 40
- Early detection can be life-saving
46
What is the most likely radiographic diagnosis from a Tubular shaped opacity extending from the styloid process? (2)
- Calcification of the stylohyoid ligament
- Very common and of little clinical significance
47
What is the most likely radiographic diagnosis from large well defined rounded opacities, sometimes multiple, in the cervical region? (2)
- Usually indicate calcification of lymph nodes.
- Very common incidental finding, not significant
48
What is a Phlebolith? (1)
A phlebolith is a small local, usually rounded, calcification within a vein
49
How do Phleboliths present on a radiograph? (2)
- Multiple small opacities made up of concentric rings
- Seen in vascular lesions
50
What is the most likely radiographic diagnosis from a rounded single opacity projected over or just below the mandibular angle? (3)
- Calculus in the submandibular gland
- Expect a history of pain/swelling with meals
- Occlusal views helpful
51
What is the most likely radiographic diagnosis from a well defined dome-shaped opacity in the lower half of the maxillary sinuses? (3)
- Usually represent harmless polyps
- There may be a history of allergy or upper respiratory infection
- Common incidental finding on OPT
52
What is the most likely radiographic diagnosis from an opacity seen in the region of the carotid artery? (2)
- Could represent atheroma
- May serve as a warning sign for similar disease elsewhere
53
What is an Atheroma? (2)
- _Atheroma is an accumulation and swelling in artery walls_ made up of (mostly) macrophage cells, or debris, and containing lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.
- Atheroma occurs in atherosclerosis, which is one of the three subtypes of arteriosclerosis (which are atherosclerosis, Monckeberg's arteriosclerosis and arteriolosclerosis).
54
What is Fibrous Dysplasia?
- A benign development anomaly where normal bone is replaced with fibrous bone tissue
55
How does the radiographic appearance of Fibrous Dysplasia vary?
- Radiographic appearance varies with age
56
What do early fibrous dysplasia lesions tend to look like radiographically?
- Early lesions tend to be radiolucent with well defined borders
57
What is the classic radiographic appearance of Fibrous Dysplasia?
- As lesion matures more bone is laid down leading to a mottled radiopacity so called ‘orange peel’ pattern
58
What do the borders of fibrous dysplasia lesions look like radiographically?
- The borders of the lesion then blend into the adjacent normal bone
59
What may happen to the bone in fibrous dysplasia?
- Bony expansion may occur
60
What can happen to the sinus in Fibrous Dysplasia and why? Which sinus?
- Lesions in the maxilla can occlude the sinus
61
What can Fibrous Dysplasia do to the teeth?
- Teeth may be titled or bodily displaced
62
What can Fibrous Dysplasia do to the roots and developing teeth?
- Root resorption can occur as can destruction of developing teeth
63
Which disease looks similar to Fibrous Dysplasia and how do you differentiate between the two?
- May look similar to Paget’s disease but active Fibrous Dysplasia is uncommon in middle/old age and Fibrous Dysplasia is usually unilateral unlike Paget’s
64
What is Cherubism?
- Rare inherited fibro-osseous disease of the jaws
65
When does Cherubism develop?
- Develops in infancy
66
What does Cherubism usually present as? And then what follows?
- Usually presents as a painless bilateral enlargement of the lower face
67
In Cherubism, what develops and where? Where does this expand to?
- Enlargement of the maxilla gradually
- Cyst-like radiolucencies develop at the posterior aspect of the mandible, bilaterally
- These will expand into the rami and body
68
Describe the lesions in Cherubism
- The lesions are well defined and produce bone expansion rather than cortical perforation
69
What happens to the tooth buds in Cherubism?
- Tooth buds will be displaced or destroyed especially the 2nd and 3rd molars
70
What can happen to the erupted primary teeth in Cherubism?
- Erupted primary teeth may be shed early
71
What is Paget’s disease characterised by?
Characterised by abnormal resorption and deposition of osseous tissue in bone(s)
72
At what age does Paget's disease usually occur?
- A disease of later middle and old age
73
What part of the body is Paget's disease common in?
- Common in the skull
74
Which jaw does Paget's Disease affect more?
- Affects the maxilla more than the mandible
75
What part of the bone is usually involved in Paget's disease?
- Usually involves all of the bone affected
76
What happens to the affected bone in Paget's Disease?
- Affected bones enlarge, teeth can be moved
77
What may also develop in Paget's Disease, other than bone enlargement?
- Osteomyelitis and sarcoma may develop
78
How does the jaw appear in the early stages of Paget's Disease? What may be seen in the skull?
- In the early stages the jaw bone has a laminated structure. Osteoporosis circumscripta may be seen in the skull
79
What can be visible ‘striking’ in Paget's Disease? Later, how can the bone look radiographically?
- Bony expansion can be striking
- Later ‘cotton wool’ areas develop
80
How can the roots of teeth be affected in Paget's Disease?
- Hypercementosis may eventually affect the roots
81
What can frank bony destruction indicate in Paget's Disease?
- Frank bony destruction may indicate the development of osteogenic sarcoma
82
Describe Osteopetrosis, including its effects on bone, teeth and cortical structure.
All bones show greatly increased density
- There may be delayed eruption and early loss of teeth
- This cortical structures such as the lamina dura and the mandibular canal walls may be totally obscured by the dense bone
83
What is Hyperparathyroidism due to?
- Due to excess circulation of PTH hormone
84
What does hyperparathyroidism usually stimulate?
- PTH stimulates osteoclasts to mobilise calcium from the skeleton
85
What percentage of body calcium is in the skeleton and what impact does this have?
99% of body calcium is in the skeleton, hence the profound impact on the bones
86
What happens to the skeleton in Hyperparathyroidism?
The skeleton becomes demineralised, so the bones look radiolucent
87
Where should you look for evidence of Hyperparathyroidism radiographically?
- Look for demineralisation of the inferior border of the mandible and sinus outlines
- Loss of lamina dura may occur
88
What kind of lesions may develop in the jaws in Hyperparathyroidism?
- Variably defined radiolucent lesions may develop in the jaws ‘brown tumours’
89
What is Hyperpituitarism due to?
- Due to excessive production of growth hormone by the anterior lobe of the pituitary
90
What does Hyperpituitarism cause in childhood?
- In childhood this causes ‘giantism’
91
What does Hyperpituitarism cause in adults and what does it affect?
- In adults it is called acromegaly and the excessive growth does not affect all bones
92
How does adult onset Acromegaly affect the jaws?
- Acromegaly leads to increased length of the ramu sand body of the mandible resulting in a class III skeletal jaw relationship
93
What can a lateral skull view reveal in Hyperpituitarism?
- A lateral skull view may, but not always reveal ‘ballooning’ of sella turcica
94
Enlargement of what -- is very common in Acromegaly?
- Enlargement of the paranasal sinuses, especially the frontal, is very common
95
What can happen to the skull in adults with Acromegaly?
- In acromegaly the outer table of the skull may be quite thickened
96
What is sickle cell anaemia and what does it cause?
- A chronic haemolytic blood disorder
- Abnormal red blood cells rapidly destroyed
97
What happens to bone marrow in Sickle Cell Anaemia?
- This results in compensatory hyperplasia of the bone marrow
98
What are the radiographic findings in Sickle Cell Anaemia? What accounts for this?
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- Expansion of the bone marrow at the expense of spongy bone accounts for the radiographic findings
99
What does marrow hyperplasia lead to?
- Marrow hyperplasia leads to thinning of cancellous trabeculae and cortices
100
What appearance is seen in the skull in 5% of Sickle Cell Anaemia patients?
- May see widened diploic space in the skull and ‘hair-on-end’ appearance in 5%
101
What does bony artifaction in Sickle Cell Anaemia lead to?
- Bony infarction leads to areas of sclerosis
102
Describe the jaws in sickle cell anaemia
- Jaws look osteoporotic, thin cortices
103
What is the ‘stepladder’ pattern in Sicle Cell Anaemia?
- In between teeth, the bony trabeculae are coarse – so called ‘stepladder’ pattern
104
What is evident in this radiograph?
- Missing RHS hard palate
- Missing both RHS and LHS floor of maxillary sinus
- Missing RHS posterior border of maxillary sinus
105
What is evident in this radiograph?
- Missing RHS floor of the maxillary sinus
106
What is evident in this radiograph?
What is the differential diagnosis?
- Tubular shaped opacity, extending
from the styloid process
- Calcification of the stylohyoid
ligament
107
What is evident in this radiograph?
Diagnosis?
- Large well defined opacities
- Calcification of lymph node
108
What disease is shown by these radiographs?
Fibrous Dysplasia
109
What disease is shown by these pictures and radiographs?
Cherubism
110
What disease is shown by these radiographs?
Paget's Disease
111
What disease is shown by these radiographs?
Osteoporosis
112
What disease is shown by these radiographs?
Hyperparathyroidism
113
What disease is shwon by these pictures and radiographs?
Hyperpituitarism
114
What is evident in these radiograph?
Sickle Cell Anaemia
