Radiological interpretation of radiopacities and mixed lesions of the jaws Flashcards
What can a radipacity be?
- Normal anatomical structure
- Artefactual
- Pathological maybe because of:
- a dental anomaly
- a bony lesion
- a soft tissue calcification
- a foreign body
What is this showing?
Hypercementosis.
What is hypercementosis?
- Disease of the elderly
- Usually effects the entire bone
- Enlarged head and thickening of the affected long bones -Cotton wool appearance of the bone
- Hypercementosis
What is this?
Developmental bony ex
What is this?
Slerosing osteitis. (inflammatory)
What are the radiographic features of acute osteomyletis?
Ragged, patchy or moth eaten areas of radiolucency.
Evidence of radiopaque sequestra of dead bone within the radiolucency.
New subperiostal bone formation, particularly along the lower border of the mandible.
What are the radiographic features of chronic osteomyletis?
Localised patchy or moth eaten areas of bone destruction.
Sclerosis of the surrounding bone.
Radiopaque sequestra.
Involucrum surrounding the area of destruction following subperiosteal bone formation.
What are the types of tumours that can affect bone?
- Odontogenic:
- Calcifying epithelial odontogenic tumour
- Ameloblastic fibro-odontoma (covered in last lecture)
- Adenomatoid odontogenic tumour
- Calcifying cystic odontogenic tumour
- Benign cementoblastoma - Non-odontogenic
- Osteoma
- Chondroma
- Osteogenic secondary
- Metastases
What is a calcifying epithelial odontogenic tumour (CEOT / Pindborg tumour)?
Age: 20 – 60 years
Frequency: Rare
Site: Molar / premolar region mandible – occasionally maxilla.
Size: Variable
Shape: Unilocular / multilocular, round often associated with an un-erupted tooth.
Outline: Variable definition and cortication, can be scalloped.
Radiodensity: Early stages radiolucent than numerous scattered opacities “driven snow” mainly around the crown
Effects: Teeth resorbed / displaced. Expansion.
What is an adenomatoid Odontogenic Tumour (AOT)?
Age: 90% before age of 30
Frequency: 2-7 % odontogenic tumours
Site: Anterior maxilla (canine region)
Size: Variable
Shape: Unilocular, often surrounds an entire un- erupted tooth
Outline: Well defined and corticated
Radiodensity: Mixed density – small opacities (snowflakes) commonly centrally
Effects: Teeth displaced, rarely resorbed Buccal and palatal expansion – may extend into antral space
What is a Calcifying Cystic Odontogenic Tumour CCOT - Gorlins Cyst?
Age: Variable
Frequency: Rare
Site: Maxilla / mandible – anterior or premolar regions
Size: Up to ~ 4cm
Shape: Unilocular, round / oval
Outline: Well defined and corticated
Radiodensity: Initially radiolucent in time variable amount of calcified material internally of tooth like density
Effects: Displacement, causing divergence of roots, possible resorption. Expansion
What is a benign Cementoblastoma?
Age: Mean age 20 years
Frequency: Rare
Site: Apex of mandibular first molars, occasionally premolars
Size: Variable – 2-3cm
Shape: Attached to tooth root, round “golf ball”
Outline: Well defined
Radiodensity: Radiopaque in late stages with peripheral radiolucency
Effects: Attached to roots which are obscured – if large can cause expansion
What is an osteosarcoma?
- Primary malignant tumour of bone
- Radiologically 3 types:
– Osteolytic: Moth eaten, spiking resorption of teeth
– Osteosclerotic
– Mixed lytic and sclerotic
Poorly defined, variable radiopacity, sun ray (sunburst appearance)
What is this?
A breast metastasis.
What different types of osseus dysplasias are there?
- Periapical Osseous Dysplasia
- Focal Osseous Dysplasia
- Florid Osseous Dysplasia
- Familial Gigantiform Osseous Dysplasia
What’s a periapical osseus dysplasia?
Age: Middle age (black women)
Frequency: Rare
Site: Apices of several lower anterior teeth
Size: Small – 5-6mm but can coalesce
Shape: Round, unilocular
Outline: Variable –non corticated
Radiodensity: Radiopaque in late stages with peripheral radiolucency
Effects: No expansion, displacement or resorption – teeth vital
What is a Focal Osseous Dysplasia?
Age: Middle age (white women)
Frequency: Uncommon
Site: Solitary, mainly posterior mandible may be at extraction sites
Size: Small –
Shape: Round, unilocular
Outline: Variable –non corticated
Radiodensity: Radiopaque in late stages with peripheral radiolucency
Effects: No expansion, displacement or resorption – teeth vital
What is a Florid Osseous Dysplasia?
Age: Middle age (black women)
Frequency: Rare
Site: Multiple quadrants
Size: Larger up to 2-3cm
Shape: Round, unilocular
Outline: Variable – occasionally corticated
Radiodensity: Radiopaque in late stages with peripheral radiolucency
Effects: No displacement or resorption – teeth vital. Can expand bone
What is Familial Gigantifom Dysplasia?
- Rare, autosomal dominant
- 10-20 year old white females
- Rapid growth with marked facial deformity
What is Fibrous Dysplasia?
A bone related lesion.
Age: 10-20 year olds
Site: Maxilla > Mandible
Size: Variable and difficult to define
Shape: Round
Outline: Poorly defined with edges merging imperceptibly with normal bone
Radiodensity: Initially radiolucent ; Later “ground glass / orange peel / finger print” appearances
Effects: Displacement, rarely resorbed. Loss of lamina dura Expansion, possible encroachment on the antrum, skull base etc..
What is McCune Albright Syndrome?
Polystotic Fibrous dysplasia
Café au Lait pigmentation
Precocious puberty
What is Ossifying Fibroma?
Age: 2nd – 4th decade (mainly women)
Site: Mandible > Maxilla
Size: Variable can cause deformity
Shape: Round, unilocular
Outline: Smooth and well defined - encapsulated
Radiodensity: Mixed density with late stages radiopaque +/- a radiolucent periphery
Effects: Teeth displaced, occasionally resorbed – often downward bowing of the mandible
What is Osteopetrosis (Albers – Schonberg disease)?
- Hereditary condition – sclerosis of the skeleton (marble bone)
- Fragile bones and anaemia
- Bone formation is normal but resorption is reduced
What do radiopaque salivary calculi look like?
What is an antrolith?
An antrolith is a calcified mass within the maxillary sinus.
