pathology and radio overlap Flashcards
based off the radio chart and path sg
condensing osteitis
RP
teeth are non-vital need to do vitalility testing to differentiate between this and osteosclerosis
most likely MD M and PM
no RL rim
widening PDL because this is a chronic inflammatory response
osteosclerosis
idiopathic osteosclerosis
RP
teeth are vital need this to diff between this and condensing osteitis
most likely MD M and PM
asymptomatic
well defined - a bit more well defined RP than condensing osteitis
NO RL BORDER.
variant: socket sclerosis when TE and excess sclerotic bone deposited
periapical cemento-osseous dysplasia
periapical RP (initial-RL, intermediate- mixed, mature- RP)
teeth are VITAL
RL RIM condensing osteitis and osteosclerosis DO NOT have this
single or multiple
most common in ant md
no tx teeth vital
**COMMON IN MID AGED AFRICAN AMERICAN AND ASIAN WOMAN
Focal cemento-osseous dysplasia
periapical RP (initial- RL, intermediate- mixed, mature- RP)
sclerotic border around lesion, THIN RL rim
most likely in post md
no tx
traumatic bone cysts may be associated with some COD –> florid
florid cemento osseous dysplasia
a generalized RP of the JAW
assymptomatic, possible dull/low grade pain
multifocal often bilateral and symmetrical, needs to be in 2 or more quadrants to be considered florid
periapical and focal can become florid.
associated with traumatic bone cyst and these can be extensive
VITAL TEETH
no tx
cementoblastoma
periapical RP, common around the md 1M but also PM
solitary lesion and expansile
tooth VITAL
often PAINFUL
will destroy ROOT will see the RP on the apex of the tooth osteoscleorosis doesnt seem to damage the rooth.
highest seen in young adults.
histo: benign cemento-like tissue. RP bc lots of cementum.
Tx: remove neoplasm, cementum and tooth will all be fused together
hypercementosis
periapical RP
teeth VITAL
PDL, lamina dura are all in tact.
Gives the apex of root a bulbous-shape
**seen in Paget’s ds (pagets ds has an increased risk for developing osteosarcoma*)
tori palatinus
solitary RP
an outgrowth of normal bone
seen superimposed with mx sinus
exostoses
solitary RP
looks simi in histo to tori
no tx
subpontic hyperostosis
solitary RP
outgrowth of bone could lead to soft tissue inflammation
seen underneath pontic of FPD
tx: removal of hyperostosis
osteoma
solidarity RP
outgrowth of normal bone
jaw involvement - mostly mand
seen in Garderners Syndrome.
in males: compact osteoma
in females: cancellous osteoma
tx: remove if interefering with function
odontoma
solitary RP
THE MOST COMMON ODONTOGENIC TUMOR basically a malformed tooth
can be compound (@ant) or complex (@post)
- Compound has a RL rim, more distinguishable while Complex looks like a large RP mass*
tx: enucleation.
root fragment
~radio only~
solitary RP
will be in the shape of a root
main diff dx for retained root tip = osteosclerosis
tx: removal if available, if it is in the bone with no path, leave and montior.
fibrous dysplasia - monocystic
solitary RP
has ground glass appearnance, “fingerprint” pattern
ASYMMETRICAL
ill-defined borders
may have tooth displacement
tx: no radiation therapy, wait for the pt to stop growin bc that is when the lesion will stop too.
fibrous dysplasia - polystotic
generalized RP
has ground glass appearnance, “fingerprint” pattern
ASYMMETRICAL
ill-defined borders, in more than one bone. can extend into mx sinus and may expand into ptyergoid process
may have tooth displacement
**skin has cafe au lait skin pigmentation, shepard cane bones and facial assymetry.
**Craniofacial FD, Jaffe-Lichtenstein Syndrome has FD, McCune-Albright Syndrome has FD
tx: no radiation therapy, wait for the pt to stop growin bc that is when the lesion will stop too.
Pagets ds
generalized RP
lucent, mixed or RP
ground glass/loss of lamina dura
has abnormal resporption/appositon of bone. looks simi to florid FD, but Pagets has the entire mx and expansion is more uniform
**at high risk for developing osteosarcoma
- has generalized hypercementosis
tx: control pain and try to decrease bone turnover inolved in lesion. Sx if in the way of funt. Calcitonin, bisphos.
osteopetrosis two types
autosomal recessive: malignant. Seen in utero or infantile
autosomal dom: benign. Not present until adulthood.
involves reduces osteoclast bone resportion so bone density is increased, results in symmetric skeletal sclerosis. Bones are dense but abnormally brittle and fracture easily.
diffuse involvement
tx: bone marrow transplant, systemic steroids, ab and hyperbaric oxygent for osteomyelitis.
jawbones can delay tooth eruption and osteomyelitis
chronic osteomyelitis
radio only
RL of variable size with irregular border
**moth-eaten appearance
**sequestra = pockets of necrotic bone
island of dead bone with RL surrouding it
inflammation of bone marrow (most commonly froma dental infection)
symptoms less severe than acute. More than 30 days (4weeks) for chronci
pt will have intermittent swelling, pain, low grade fever, lymphadenopathy, atrophic erythematous mucousa, denuded bone
tx: drain and irrigate region, ab therapy, debridement
diffuse scleorosing osteomyelitis
*more heavy in radio*
RP will look like sclerotic bone chronic or acute osteomyelitis looked more like RL.
a chronic form of osteomylitis with a pronounched sclerotic response
tx: antibiotics wn work, need to get O2 in this area.
tonsilloliths
RP outside the jaw
chronic inflammation with large calcifications
found in mid ramus area (lingual to ramus -> Palatine tonsil calcificaiton, bucall to ramus -> parotid sialoliths)
antral pseudocyts
RP outside of the Jaw, in mx sinus
dome shaped, well defined RP near floor of mx sinus
You can see it pushing down the floor of max sinus. It looks a bit deformed. MAKE SURE TO COMPARE IT TO THE OTHER SIDE TOO.
pseduocyt -> no epithelial lining
usually asymptomatic. Can make a dx based off of XR.
tx: resolves spontaneously, no tx.
ossifying fibroma
mixed RL/RP lesions
well demarcated, circumferential with expansion and thinning of corticies
asymptomatic, slow growing, expansive lesion
histo: hyperplastic fibrous CT and areas of mineralizations
tx: enucleaiton
calcifying epithelial odontogenic tumor vs calcifying odontogenic cyst
aka Pindborg tumor
most seen at md M-R region.
~50% of these lesions are pericoronal RL but then ~50% are central bone lesions and not associated with an impacted tooth
osteosarcoma
(osteogenic sarcoma)
early- RL, ragged margins
teeth are VITAL
moderate- mixeed “ragged margins and moth-eaten” RL , irregular and perforated corticees (see moth eaten patterin in chronic osteomyelitis)
advanced- “sun-ray” appearance
XR clue: “spiking of resportion” looking to see if there is a sharp root edge.
chondrosarcoma
mixed RL and RP
diffuse, ragged, RL with ill-defined borders, isolated widening of the PDL too
malignant neoplasm of chondroblasts or chondrocytes
cartilage ONLY is produced by lesion
most commonly seen in MX(path) there is NO PREVALENT JAW SITE (radio)
osteomyelitis with proliferative periostitis
onion skin pattern
facial assymetry and swelling is bony hard
triad of osteoradionecrosis
radiation therapy
trauma (necrotic pulp, mucosal ulceration, fracture)
infection
osteoradionecrosis (ORN)
radio only
decreased vascularity and cellularity due to radiation
its diffuse, ragged
areas of increased RD intersoersed with osteolytic regions
primary intra-alveolar epidermoid carcinoma
central squamous cell carcinoma/primary epidermoid carcinoma.
in cancellous bone bc took path of least resistance
looks like floating teeth. like on the pic.
WILL PERFORATE THROUGH JAW INSTEAD OF EXPANDIN IN CORTEX.
metastatic carcinoma
the most common maligant neoplasm located in bone, but secondary malignancy in bone.
ill-defined with ragged borders, may be expansive
nevoid basal cell carcnioma cell syndrome
NBCCS (path only)
mutation to PTCH tumor suppresor gene
manifestations: bifid ribs, multiple OKCS, skin tumors, neoplasms, palmar pitting.
