Radiology Flashcards
Jaw lesions exhibit a spectrum of different radiographic appearances
such as
Radiolucent - dark areas
Radiopaque - white areas
majority of pathologies of the jaw appear as radiolucent or radiopaque
radiolucent
Majority of pathologies are radiolucent
* Includes almost all of the most common pathologies
why is this
- Due to reduced radiodensity compared to surrounding bone
- Result of either:
- Resorption of bone
- ↓ mineralisation of bone
- ↓ thickness of bone
what is the most common presentation of pathologies of the jaw
cyst like presentation
What is a cyst?
A pathological cavity having fluid, semi-fluid
or gaseous contents & which is not created
by the accumulation of pus
what does indolent mean
in reference to a cyst - it means that the cyst is just present there and not really affecting anything, remains the same size and not affecting the structures around it
there are diverse group of lesions what are they in their presentation?
Diverse group of lesions
- Asymptomatic ↔ symptomatic
- Slow growing ↔ fast growing
- Indolent ↔ destructive
- Almost all benign
jaw cysts can be split in to two groups what are they
90% of jaw cysts are odontogenic (releated to jaw and teeth)
Non-odontogenic
odontogenic cyst is then split in to what types of cysts
developmental
inflammatory
radicular cyst
inflammatory collateral cysts
paradental cyst
buccal bifurcation cyst
the above cyst belong to which group
inflammatory cysts of the odontogenic cysts
dentigerous cyst
odontogenic keratocyst
lateral periodontal dental cyst
the above cyst belong to which group of cyst
developmental cyst of odontogenic cyst
what three things should you assess when you first see a radiolucency to help with diagnosis
is it either
- anatomical - no problem
- artefactual - part of the imaging/equipment
- pathological
what is unilocular
having, consisting of, or characterized by only one loculus or cavity; single-chambered.
when you have identified a radiolucency, you need to describe it.
what 7 things do you describe
1.Site
2. Size
3. Shape
4. Margins
5. Internal structure
6. Effect on adjacent anatomy
7. Number
when describing a radiolucency point 6 - effect on adjacent anatomy
what are we looking for?
to see if there has been any displacement
which bone holds the part of the teeth
alveolar bone or basal bone
alveolar bone
so if a radiolucency is present within the area of the tooth and its bone, we would describe the location as in the alveolar bone
what is the basal bone
Basal bone is the osseous tissue of the mandible and maxilla. It forms the dental skeletal structure. Basal bone is found below the alveolar process. In contrast, basal bone is a part of the alveolar process. It is the thin bone that lines the alveolus
this bone lies below the alveolar bone
what is the maxillary tuberosity
The maxillary tuberosity is the most hind-most (distal) aspect of the upper jaw (maxilla), housing the sockets of the upper wisdom teeth, with its back (posterior) border curving upward and distally. The upper wisdom tooth lies just in front and within the maxillary tuberosity
lesions below alveolar canal - highly unlikely to be
odontogenic
maxillary sinus floor – lesions entirely above are highly unlikely to be
odontogenic
Describe the boundaries
*
“Extends between teeth 44 & 48, & from the
alveolar crest to the inferior cortical margin of the
mandible”
what is pseudolocular
one locule, which is begining to seperate, but theres no definite walls separating the areas of differnet compartments
looks like a shit
what is multilocular
multiple locules bunched togther
when describing the shape of a radiolucency what would we include
“Locularity”
- Unilocular
- Pseudolocular
- Multilocular
General
* Rounded
* Scalloped - can see scalloped margins
* Irregular - resembles no shape
irregular shaped cysts tend to be more sinister and associated with malginancies
when describing a margin of a lesion there are two groups what are they
well-defined &
poorly defined &
when describing the margin of a cyst it can be described as* Well-defined &…
a. Corticated
b. Non
-corticated
what does this mean
well defined means that you can see where the radiolucency starts and stops
corticated means - there is a dense layer of bone surrounding that cyst
poorly defined margins are described as
c. Blending into the adjacent normal anatomy
d. “Ragged” or “moth
-eaten” - edges of radiolucency in surronding areas
defined & corticated but can become
poorly defined if
infected
– typically
associated with clinical signs/symptoms
when defining the internal structure of cyst
it can be the following
- Entirely radiolucent – most common
- Radiolucent with some internal
radiopacity - (Radiopaque)
when describing the internal radiopacities, how would we describe them?
Description of internal radiopacities
* Amount
Scant, multiple, dispersed, etc.
- Bony septae
Thin/coarse, prominent/faint,
straight/curved - Particular structure
Enamel & dentine radiodensity
if a radiolucency has an involvement of tooth, this can help aid in diagnosis
where can expect the position of the radiolucency near a tooth?
- Around apex/apices - radicular cyst
- At side of root - lateral periodontal cyst
- Around crown - dentigerious cyst
- Around entire tooth
what is a dentigerous cyst
Dentigerous cyst – this type of cyst is usually seen nearby or on the crown of an un-erupted wisdom tooth, upper canines or lower wisdom teeth. Periapical cyst (aka odontogenic or radicular cyst) – caused by trauma or tooth decay, which, in turn, causes death or necrosis of the tooth pulp.
cyst involvement of tooth typically means what
Typically means lesion is related to tooth
* Important note: proximity may be
incidental if lesion simply occurred near
tooth (so do not assume they must be
related)
what effects can a cyst have on a neighboring tooth
Displacement/impaction
* Resorption
* Loss of lamina dura
* Widening of PDL space
* Hypercementosis
what effects can a cyst have on a neighboring bone
Bone
* Displacement of cortices
* Perforation of cortices
* Sclerosis of trabecular
bone
what effects can a cyst have on Inferior alveolar canal /
maxillary sinus / nasal cavity
Displacement
* Erosion
* Compression
the number of lesions present can help diagnosis,
a few particular lesions occur?
bilaterally - this helps narrow the diagnosis
majority of lesions occur in what numbers?
alone
how many lesions need to be present to suspect a syndrome
if multiple >2
what is a paradental cyst
The paradental cyst is an odontogenic cyst of inflammatory origin, which occurs on either the buccal, distal, or (rarely) mesial aspects of partially erupted mandibular third molars. In most cases there is an associated history of recurrent pericoronitis.
why are paradental cysts associated with lower 8s
lower 8s - unerupted/partialy erupted can cause complications such as infection, these infections give rise to inflammatory cysts
Most common pathological radiolucency in jaw bones
radicular cyst
Radicular cyst is an Inflammatory odontogenic cyst initiated by
- Initiated by chronic inflammation at apex of tooth
due to pulp necrosis - Always associated with a non-vital tooth
pulpal necrosis
↓
periapical periodontitis
↓
periapical granuloma
↓
radicular cyst
if you are looking at a radiolucency around the apex of a tooth and it is vital - what type of cyst is it not
radicular cyst
radciular cyst is most common in 4th and 5th decade why?
most common time for caries to develop to cause pulpal necrosis
what is the presentation of a radicular cyst?
Presentation
* Often asymptomatic
* May become infected → pain
* Typically slow-growing with limited expansion
what are the difference between a radicular cyst vs periapical granuloma
- Difficult to differentiate radiographically
- Radicular cysts typically larger
- If radiolucency diameter >15mm → 2/3’s of cases will be radicular cysts
what is a residual cyst
Residual cyst
* When radicular cyst persists after loss of tooth
(or after tooth is successfully root canal treated)
* Knowledge of clinical/treatment history important
to avoid misdiagnosis
what is a lateral radicular cyst
Radicular cyst associated with an accessory
canal
* Located at side of tooth instead of apex
what changes of the unerupted tooth to form a dentigerous cyst?
Developmental odontogenic cyst
* Cystic change of dental follicle
* Associated with crown of unerupted/impacted tooth
* e.g. mandibular third molars, maxillary canines
the shape of a dentigerous cyst is always
: unilocular & rounded but can be scalloped if large
a dentigerous cyst arises from a follicular space, if follicular space is greater than how many mm, does it qualify as a dentigerous cyst?
Consider cyst if follicular space ≥5mm
* Measure from surface of crown to edge of follicle
* Normal follicular space typically 2-3mm
* Assume cyst if >10mm
Consider cyst if radiolucency is asymmetrical
Inflammatory collateral cysts
Inflammatory odontogenic cysts
- Associated with a vital tooth
- 2-7% of odontogenic cysts
- Most common in 1st-2
nd decades - Asymptomatic but can cause swelling
Collective term for:
* Buccal bifurcation cyst
- Typically occurs at buccal aspect of mandibular first molar
- Paradental cyst
-Typically occurs at distal aspect of partially-erupted mandibular third molar
Odontogenic keratocyst
Developmental odontogenic cyst
* No specific relationship to teeth
* Can grow large before clinically evident
* High recurrence rates
trabecular bone is easier to displace as it isnt as compact as cortical bone.
cortical bone is greatest bucco-lingually
so an a 2d image the cyst may appear very big but may not have had much displacement
Basal cell naevus syndrome
- Multiple basal cell carcinomas
- Palmar & plantar pitting
- Calcification of intracranial dura mater
- etc.
Ameloblastoma
Benign epithelial odontogenic tumour
* Locally destructive but slow-growing
* Typically painless
* High recurrence rates
Nasopalatine duct cyst
Developmental non-odontogenic cyst
* Arises from nasopalatine duct epithelial remnants
* Occurs in anterior maxilla
* Often asymptomatic but patient may notice “salty” discharge
why do infected cysts lose their well-defined and corticated margins
the inflammatory response eats away in to the bone, losing it that well defined margin
infected cysts Can mimic radiographic features of malignancy what clinical features should you check for to eliminate such diagnosis
Check for clinical features of secondary infection
* Pain
* Soft tissue swelling/redness/hotness
* Purulent exudate
what are the clinical signs and symptoms for malignancy in oral cavity?
- leukoplakia
- erythoplakia
- erythroleukoplakia
- non healing socket
- non healing ulcer
- unusually mobile tooth - no hx of periodontal disease
- swelling/exophytic mass
- lymphadenopathy
signs and symptoms for malignancy in oral cavity, known as B symptoms
- weight loss
- night sweats
- problem moving tongue
- dysphagia - prob swallowing
- dysphonia - chnage in voice
- loss of hearing (more advanced)
- pathological fracture - no hx of trauma
what is meant by exophytic
Exophytic is a descriptive term used by radiologists/pathologists to describe solid organ lesions arising from the outer surface of the organ of origin
what are the radiographic signs of malignancy
- moth eaten bone
- non-healing sockets
- floating teeth
- unusual periodontal bone loss
- unusual widening of the periodontal ligament space
- generalised loss off lamina dura
- loss of bony outlines for anatomical features - walls of antrum, corticated margins of IDC
if the size of the lesion is rapidly increasing it more likely to be referred to as?
aggressive/malignant
benign vs malignant margin - what would we like to see?
well defined lesions
corticated margin
cortication demonstrates that the bone has had time to remodel at the periphery of the radiolucency = slow growing = benign
lack of cortication may represent
healing lesion
superimposed infection
what does a moth eaten radiolucent bone with no margin demonstrate
bad prognostic sign
aggressive and more likely to be malignant pathologies
malignancy grows at a rate that does not allow cortical bone to react and will be eroded and perforated by the lesion and may form a more aggressive periosteal reaction
benign vs malignant - effect on other structures
- benign lesions will displace anatomical structures due to slow growth
- malignant lesions destroy anatomical structures
- know what is normal, particularly for the maxillary sinus
benign lesion between two teeths will see them displaced which way
laterally
the following will be noticed with malignancy
- spiking root resorption
- generalised widening of the PDL space
- generalised loss of lamina dura
what are the radiographic features of multiple myeloma
- round/unilocular
- radiolucent
- punched out
- well defined, not corticated
- large lesions can lead to pathological fracture
- if multifocal, can affect all skeleton (do a skeletal survey)
lymphoma
- lymphoproliferative group of diseases
- typically B cell lymphoma
- can present initialy as soft tissue lump
we can get bone metastasis from?
- lungs
- prostrate
- breast
- kidney
- thyroid
what are the imaging modalities that we can use for the TMJ
- plain films
- Cone beam CT
- Computed Tomography
- MRI
- Nuclear medicine
Plain films of the TMJ will include which modalities
- Panoramic (DPT/OPT)
- PA mandible
- Reverse Townes
- Lateral Obliques
what are the indications for doing an OPT for TMJ assessment?
indicated if
- recent trauma
- change in occlusion
- mandibular shift
- sensory/motor alterations
- change in range of movement
why do we image the salivary glands
obstruction
Mucous plugs
Salivary stones (sialoliths)
Neoplasia
Dry mouth
Swelling
What imaging modalities can we use for salivary glands?
Plain radiographic techniques
Ultrasound
Injection of iodinated contrast (sialography)
CT (Computed Tomography)
MRI (Magnetic Resonance Imaging)
Nuclear Medicin
Plain film radiography for the salivary glands include which ones
Lower true occlusal (potential for submandibular salivary stones)
OPT (assesing sialoiths in the submandibular gland)
Lateral Oblique
Other calcifications that could bemistaken for sialoliths
Tonsilloliths (tonsil stones)
Phleboliths
Calcified plaques (atheromas) in carotid artery
Normal anatomy (hyoid bone)
Elongated/calcified stylohyoid ligament
Calcified lymph nodes
Ultrasound
Ultrasound–what is it?
No ionising radiation
High frequency sound waves
Frequency that cannot be heard audibly
Sound waves have short wave length which are not transmittablethrough air
Require coupling agent to help sound waves get into tissue
Ultrasound–how does it work?
Transducer emits and detects sound waves/echoes
Transducer creates sound waves when electric current is given to crystals on transducer surface
Sound waves enter body and reflect back to transducer when boundaries between different tissues are met e.g. boundary between muscles and salivary gland.
Using speed of sound and time to return the echo, the tissue depths are calculated and the ultrasound unit creates a 2D image
what do the following mean
HYPOECHOIC
HYPERECHOIC
HOMOGENEOUS
HETEROGENEOUS
Why is ultrasound good for salivary glands?
why is
Glands are superficially positioned
Apart from the deep lobe of the parotid (hidden deep to the ramus)
can you give whilst using ultrasonic to aid saliva flow
can give sialogogue (ie citric acid) to aid saliva flow
Obstructive salivary gland disease symptoms include
“Meal time symptoms”
Prandial swelling and pain
“rush of saliva into the mouth”
Bad taste
Thick saliva
Dry mouth
what is a sialolith
salivary stome
Sialography–what is it?
Injection of iodinated radiographic contrast into salivary duct tolook for obstruction.
Done either with Panoramic (DPT), skull views (rotated PA mandible+ Lateral Oblique) or Fluoroscopic approach.
No local anaesthetic
Very small volume of contrast injected (typically 0.8-1.5ml)
what are the indications for sialography
Looking for obstruction or stricture(narrowing) of salivary duct which could be leading meal time symptoms
Planning for access for interventional procedures (basket retrieval of stones or balloon dilatation of ductal strictures)
what are the Risks of procedure sialography
Discomfort
Swelling
Infection
Any stone could move
Allergy to contrast (very rare)
- MRI is alternative as no contrastused
what is the benefit of fluoroscopic sialography
can watch the contrast entering ductal system in “real time”
Fluoroscopic Sialography Useful to using minimally invasive salivary gland interventions such as
basket retrieval of stones
Can see the exact location of the basket/balloon in relation to the duct.
what are the 3 phases of sialography
pre-contrast
contrast/filling phase
emptying phase
contrast is injected via
canula
what is the makeup of the contrast
- iodine based
- aqueous rather than oil based
- iso-osmolar
extravasation means what
perforation of the ductal wall
normal findings of the parotid gland through sialography will show the parotid gland having an appearance of what
a tree in winter appearance
thick trunk = main duct
narrowing of the other ductile structures
normal findings of the submandibular gland through sialography will show the submandibular gland having an appearance of what
bush in winter appearance
acinar changes
affects the image
what is the aciniar
The acinus is the basic functional unit of the exocrine pancreas. It is composed of acinar cells, centroacinar cells, and duct cells
what is blushing
over filling the acinar with too much contrast
What if the patient has an iodineallergy?
MRI Sialography
Heavy T2W scan
Gets rid of all tissues apart from fluid
what is the Selection Criteria for stone removal
- Stone must be mobile
- Stone should be located within lumen on main duct distal to posterior border of mylohyoid (SMG)
- Stone should be distal to hilum orat anterior border of the gland(parotid)
- Duct should be patent and wide to allow passage of the stone
what would the parotid gland look like under a ultrasound with a patient with sjogrens
a hetrogenous appearance
gland not as well defined
sjogrens will affect pair of glands
compared to obstructive - with just one gland
this helps with diagnosis
what is Scintigraphy
Intra-venous Injection of radioactive Technetium 99mpertechnetate
- half life 6 hours
- use gamma camera to gain images
this assesses how well the glands are working
uptake into glands if they are working well
most tumors will have reduced uptake, apart from warthins tumour (adenolymphoma)
is warthins tumor benign or malignant
benign - pleomorphic adenoma
low grade malignancy will mimic benign pathology
that is why we bioposy a submandibular gland that is neoplastic in origin
minor salivary glands have a higher chance of malignancy compared to a large salivary gland with a lesion
pathologies appearing radiopaque on radiographs will do so due to
↑ thickness of bone
Osteosclerosis of bone
Presence of abnormal tissues
Mineralisation of normally non-mineralised tissues
when describing radiopaque and radiolucent lesions , they both share the same categories. how do each of these differ when it comes to describing
Main deviation is “internal structure”
Entirely radiopaque vs. mixed
i.e. homogeneous vs. heterogeneous
Organised vs. haphazard
what is a dental odontoma
Benign tumour composed of dental tissues
Enamel, dentine, cementum & pulp
Similarities to normal teeth
- Surrounded by a dental follicle
- Mature to a certain stage(i.e. do not grow indefinitely)
what is the incidence of odontoma
1stor 2ndmost common odontogenic tumour (vs. ameloblastoma)
Most common in 2nd decade
Correlates with development of normal dentition
F = M
odontomas present as two sub types what are they
“Compound” (ordered dental structures)
May present as multiple “mini teeth” (i.e. denticles)
More common in anterior maxilla
“Complex” (disorganised mass of dental tissue)
May have a “clump of cotton” appearance
More common in posterior body of mandible
Radiographic features to look for: Odontoma
Well-defined radiopacity/radiopacities of varying radiodensity
Areas with radiodensity of enamel
Thin radiolucent margin (i.e. follicle)
what are the potential clinical issues an odontoma can cause as an unerupted tooth
Impaction of adjacent teeth
External root resorption of adjacent teeth
Development of dentigerous cyst
what is the management of of odontomas
excision - no risk of recurrence
what is enucleation of a cyst
Enucleation has been most effective and reliable method to treat cysts. It completely removes the cystic capsule, thus reducing the possibility of recurrence.
what is idiopathic osteosclerosis
Localised area of ↑ bone density of unknown cause
No association with inflammatory, neoplastic or dysplastic processes
Asymptomaticincidental finding on radiographs
Potential relevance to orthodontics
a.k.a. “dense bone island” or “enostosis”
idiopathic osteosclerosis is asymptomatic, so it can be an incidental finding when you’re looking at radiographs
what relevance does idiopathic osteosclerosis have on dental treatment
may have some impact on orthodontic treatment. the orthodontist may have trouble moving tooth in areas where there is an increase density of bone.
where is the most common location for a idiopathic osteosclerosis
premolar, molar region of the mandible
what is the radiographic presentation of idiopathic osteosclerosis
Well-defined radiopacity
Often homogeneous
- But can have slightly radiolucent internal areas
No radiolucent margin
Variable shape
Round, elliptical, irregular, etc.
Size usually < 2cm
Not associated with teeth but will often appear next to them simply due to circumstance
Teeth not displaced
No affect on PDL spaces of teeth
what is sclerosing osteitis
Localised area of ↑ bone densityin response to inflammation
- Inflammation often low-grade & chronic
- May have concurrent symptoms due to source of inflammation
- No expansion or displacement of adjacent structures
a.k.a“condensing osteitis”
Radiographic presentation
- Well-defined or poorly-defined radiopacity
- Directly associated with source of inflammation
Apex of necrotic tooth, infected cyst, etc
Sclerosing osteitis vs. idiopathic osteosclerosis
If radiographic features inconclusive then look for a source of inflammation
e.g. check for signs/symptoms; sensibility test teeth
what is hypercementosis
Excessive deposition of cementum around root
- Non-neoplastic & asymptomatic
- Tooth vital (unless necrotic due to another reason)
Cause unknown but more common in certain conditions
e.g. Paget’s disease of bone, acromegaly
Clinical relevance: makes extractions more difficult
what is the radiographic presentation of hypercementosis
Single or multiple teeth involved
- Involves either entirety of root or just a section
Homogeneous radiopacity continuous with root surface
- Radiodensity subtly different to dentine of root
PDL space of tooth extends around periphery
Margins often smooth but can be irregular
what is cementoblastoma
Benign odontogenic tumour of cementum
- Occurs around root of a tooth (which remains vital)
- Often painful
- Can displace adjacent teeth & cortical bone
Incidence
- Rare
- Wide age range but often in 2nd-3rddecades
- Typically affects mandibular premolars or 1stmolars
what is the radiographic presentation of cementoblastoma
Attached to a tooth root
- Root outline may become indistinct
Thin radiolucent margin continuous with PDLspace of root
Note:no radiolucent margin separatingtumour from root surface
Well-defined & radiopaque
Typically homogeneous & round
Can be mixed radiodensity & irregularly-shaped
what is the name of this bony protuberance
torus palatanus
what is the name of this bony protuberance
torus mandibularis
what is the clinical relevance of tori
can hamper denture wear
potentially traumatised during eating
what is an osteoma
Benign tumour of bone
- Can occur anywhere but has predilection for craniofacial skeleton
- Clinically presents as a hard, asymptomatic, slow-growing lump
- Single or multiple
Incidence
Rare
Wide age range
Posterior mandible ismost common jaw site
Osteoma
Radiographic presentation
Radiographic presentation
- Entirely cortical bone or a mix of cortical & trabecular
- Sessile or pedunculated
- Rounded, smooth margins
Clinical relevance
- No malignant potential
- Cosmetic or functional issuesexcision
- Multiple osteomas may indicate Gardner syndrome
what is Cleidocranial dysplasia
Rare genetic condition with various skeletal defects (including teeth & jaws)
Teeth & jaws
Generally delayed eruption
Multiple supernumerary teethimpaction of other teeth
Multiple unerupted secondary teethmultiple retained
primary teeth
Hypoplastic maxilla with high arched palate
Increased prevalence of cleft palate
Coarse trabecular pattern
name this condition
cleidocranial dysplasia
what is Osteomyelitis & osteonecrosis
Osteomyelitis
Inflammation of bone & bone marrow due to bacterial infection
Osteoradionecrosis
Bone death resulting from irradiation
Requires high energies of radiation (e.g. radiotherapy)
Medication-related
osteonecrosis of the jaw (MRONJ)
Bone death associated with anti-resorptive or anti-angiogenic drugs
why is it important to have a good medical history when dealing with a patient with one of the following
Osteomyelitis & osteonecrosis
these conditions both have similar radiographic features
what are the radiographic features of Osteomyelitis & osteonecrosis
Osteolysis & osteosclerosis of affected region
Results in a variable mixture of radiolucent & radiopaque areas
Irregularities on inner/outer aspects of cortical bone
Sequestration of bone
if there is significant amount of osteomyelitis what can it result in
pathological fracture of bone
what is giant cell granuloma
Reactive lesion with benign tumour-like behaviour
Slow-growing lesion causing expansion of bone & displacement of teeth
- Minority of cases more aggressive & grow rapidly
Often asymptomatic but may be tender to palpation
May invade into the overlying soft tissues
Incidence
Wide age range but majority before age 20
F > M
Most commonly affects mandible anterior to molar
Central giant cell granuloma:Typical radiographic presentation
Site:mandible anterior to molars
Size:any size
Shape:unilocular or multilocular (when large)
Margins:well-defined;
poorly corticated;scalloped
Internal structure:radiolucent
Tooth involvement:no
Effects:displacement of cortices; displacementof teeth; occasional external root resorption
Number: single
Focal COD: single or few localised lesions
Periapical COD: lesions associated with apices of anterior mandibular teeth
Florid COD: extensive lesion or many lesions
what dysplasia is being shown
cemento-osseous dysplasia
which race is cemento-osseous dysplasia most common with
black people
what is focal COD
Focal cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion of bone characterized by the replacement of normal bone by fibrous tissue and subsequently followed by its calcification with osseous and cementum-like material. It is mostly asymptomatic in nature and requires no treatment
what is florid cemento-osseous dysplasia
Florid cemento-osseous dysplasia (FCOD) is a condition that occurs in the jaw bone, especially close to where the teeth are formed.
what is pagets disease
Chronic condition causing disordered remodelling of bone
Affects multiple bones at same time
Results in enlargement of bones, malocclusion, nerve impingement (e.g. cranial nervedeficits), brittle bones
Majority asymptomatic
what are the radiographic features of pagets disease
General enlargement of bones
Abnormal bone pattern (e.g. “cotton wool” appearance)
Osteolytic or osteosclerotic patches of bone
Radiodensity of altered areas linked to stage of disease
Early/osteolyticintermediate/mixedlate/osteosclerotic
Dental issues
Migration,hypercementosis, loss of lamina dura
