radiology 2 Flashcards
are interventional measure often done in scotland for salivary obstruction
no
what are 3 interventional measures for salivary obstruction
- surgical removal of the stone
- removal of the gland
- dilate structures of the gland
why might surgical dilation of salivary ducts not be possible
extent of scar tissue from chronic infection
what must the salivary stone be to remove it
- mobile
- located in lumen/ main duct
- duct must be patent and wide to allow passage of the stone
where must the salivary stone be in the submandibular gland in order to remove it
within lumen or main duct distal to the posterior border of the mylohyoid
where does a salivary stone by in the parotid duct in order to remove it
distal to the hilum or anterior border of the gland
what must the duct be for balloon dilation
patent anterior to the stricture to allow passage of the equipment
what % of balloon dilation results in complete resolution
56
what 4 tests would be used to test for sjogrens
- blood test
- schirmer test
- sialometry
- labial gland biopsy
what 5 things are we looking for on an ultrasound for sjogrens
- atrophy of the gland
- heterogenous parenchymal pattern
- hypoechoic
- fatty infiltration
- changes suggesting MALT lymphoma
what do sjogrens syndrome pts have a higher risk of
developing lymphoma
what is the number 1 imaging modality for sjogrens
ultrasound
what is stage 1 on the diagnostic criteria for sjogrens
punctate
what is stage 2 on the diagnostic criteria for sjogrens
globular
what is stage 3 on the diagnostic criteria for sjogrens
cavitation
what is stage 4 on the diagnostic criteria for sjogrens
destructive
what other changes in the salivary glands mimic sjogrens
- radiotherapy
- SLE and sarcoidosis
what does radiotherapy do to salivary glands
causes atrophy
what is scintigraphy
injection of radioactive technetium 99 pertechnetate
what is the half life of the contrast used in scintography
6 hrs
what can you used in scintography to gain images
gamma camera
what does scintography of the salivary glands show us
how well the glands are working
what will there be in scintography of salivary glands if the gland is working well
uptake into the gland
what will there be on scintography of salivary glands if there is a tumour
reduced uptake
which tumour will not be seen on a scintography of salivary glands
warthins tumour
what is the first line imaging modality to rule out obstruction or neoplasia of salivary glands
ultrasound
when is a biopsy required of salivary gland
if neoplasia
what biopsy would be taken for neoplasia of salivary gland
FNA
core biopsy
give two examples og benign salivary tumours
- pleomorphic adenoma
- warthins tumour
what will a benign tumour of salivary gland be like on imaging
- well defined
- encapsulated
- peripheral vascularity
- no lymphadenopathy
name 3 malignant tumours of salivary gland
- mucoepidermoid carcinoma
- acinic cell carcinoma
- adenoid cystic carcinoma
what will a malignant salivary gland tumour look like on images
- irregular margins
- poorly defined
- increased/ tortuous internal vascularity
- lymphadenopathy
what may low grade malignancy imitate on images
benign
what is MRI useful for in salivary glands
surgical assessment of lesions that may not be seen on radiograph
which part of which salivary gland may not be seen on radiograph and need MRI
deep lobe of parotid
why should you do MRI before biopsy for salivary gland (parotid)
inflammatory appearances may appear on scan complicating diagnosis
when would you image minor salivary glands
when pathological or enlarged
what image would you take for a minor salivary gland if the indication is superficial
ultrasound
what image would you take for a minor salivary gland if the indication is deep
MRI
apart from a deep lesion, when else might a MRI be taken for a minor salivary gland
if bony involvement
what do minor salivary glands have a higher risk of than major glands
malignancy
where might you get bony involvement for minor salivary gland pathology
- retromolar pad
- hard palate
what are “B” symptoms of malignancy
- weight loss
- night sweats
what type of cancer do night sweats particularly relate to
lymphoma
why might malignancy cause issues in moving the tongue
if involvement of the hypoglossal nerve
what is the name for changes to a pts voice
dysphonia
when might a malignancy pt get loss of hearing
advanced disease - involvement of facial and vestibulocochlear nerves
what might malignant bone look like on radiograph
moth eaten
name the different things you have to describe about pathology on a radiograph
- site
- size
- shape
- margins
- internal structure
- effects
- tooth involvemnt
- no. of
name some radiographic signs of malignancy
- moth eaten bone
- floating teeth
- non-healing sockets
- unusual periodontal bone loss
- spiculated periosteal reaction
- ununsual uniform widening of PDL
- loss of lamina dura
- loss of bony outlines
- thinning of cortical margin
- spiking root resorption
what does a rapidly growing radiography lesion suggest
aggressive or malignant
which benign lesions grow at a rapid pace
- ameloblastoma
- central giant cell granuloma
- odontogenic maxomas
what type of margins would indicate a benign lesion radiographically
corticated defined margins
what might lack of cortication indicate
healing lesion
superimposed infection
fast growing lesion
what is a bad prognostic sign radiographically of a leison
moth eaten bone with no margins
why do benign lesions have corticated margins
because they are slow growing so the bone has time to react and expand with the lesion
what will benign lesions do to other anatomical structures
displace them due to slow growth
what will malignant lesions do to other anatomical structures
destroy them
will a malignant lesion cause displacement of the IAN
no
will a benign lesion cause displacement of the IAN
yes
what does generalised widening of the PDL indicate
malignancy
what does generalised loss of lamina dura indicate
malignancy
who is osteosarcoma commonly in
young adults - 30s
name 6 risk factors for osteosarcoma
- fibrous dysplasia
- retinoblastoma
- previous exposure to radiation
- previous primary bone cancer
- pagets disease
- chronic osteomyelitis
what % of osteosarcoma occur in the head and neck
10
what are the 4 most common symptoms of osteosarcoma
- persistent pain
- oedema
- paraesthesia
- B symptoms
what will be seen radiographically for late stage osteosarcoma
spiking periosteal reaction
what will osteosarcoma look like in its early stages, radiographically
- slightly moth eaten
- widened PDL
what is multiple myeloma
proliferation of plasma cells in bone marrow leading to overproduction of immunoglobulins
what is a solitary lesion of multiple myeloma called
plasmocytoma
what are multiple lesions of multiple myeloma called
multiple myeloma
who is most often affected by multiple myeloma
middle aged adults
what shape will multiple myeloma be radiographically
round and unilocular
what will the internal structure of multiple myeloma be
radiolucent
what will the margins of multiple myeloma be radiographically
well defined and not corticated
what can large lesions of multiple myeloma lead to
path fracture
if multiple myeloma is multi focal what can it affect
all of skeleton
which type of lymphoma is most often seen in the head and neck
B cell lymphoma
how can lymphoma initially persist
soft tissue lump
what is langerhans histocytosis
proliferation of langerhans cells and eosinophilic leucocytes
what are the 3 manifestations of langerhans histocytosis
- eosinophilic granulomas
- hand schuller christian disease
- letterer siwe disease
what is eosinophilic granulomas
solitary lesion, typically affects adolescents
what is hand schuller christian disease
multifocal eosinophilic granulomas
- chronic and widespread, begins in childhood and develops into adulthood
what is letterer siwe disease
widespread disease affecting children under 3 years old
what shape will langerhans histocytosis be
unilocular
what internal structure will langerhans histocytosis have
radiolucent
what margins will langerhans histocytosis have
smooth outline
what effects does langerhans histocytosis have
floating teeth
what 5 tissues cause bone metastasis
- lung
- prostate
- breast
- kidney
- thyroid
what will metastasis look like radiographically
- moth eaten
- radiolucent
what can breast and prostate metastasis be radiographically
sclerotic/ osteogenic
can we decipher between primary and secondary tumours radiographically
no - take good MH and clinical assessment
what can low grade malignancy mimic
benign lesion
name 3 differential diagnosis’ of malignancy on radiographs
- osteomyelitis
- osteoradionecrosis
- MRONJ
what is radiopaqueness in pathology due to
- increased thickness of bone
- osteosclerosis of bone
- abnormal tissues
- mineralisation of non-mineralised tissues
what is the main deviation between cysts and other pathologies
internal structure
what is another name for odontoma
dental hamartoma
what is an odontoma
benign tumour of dental tissues
what are odontomas made up of
enamel, dentine, cementum and pulp
what similarities to normal teeth do odontomas have
- detal follicle
- mature to a certain stage
do odontomas grow indefinitely
no, will mature
when are odontomas most common
2nd decade
what do odontomas correlate with
development of normal dentition
which gender is more likely to get odontomas
=
what are the two types of odontoma
compound
complex
what are compound odontomas
ordered dental structures
which type of odontoma are known as ‘mini teeth’
compound
where are compound odontomas most common
anterior maxilla
what are complex odontomas
disorganised mass of dental tissue
what appearance will complex odontomas have radiographically
clump of cotton appearance
where are complex odontomas more commonly found
posterior mandible
what internal structure do odontomas have
mixed radiopacities
what are the areas of radiodensities in odontomas
areas of enamel
what is the thin radiolucent margin around odontomas
follicle
what shape will odontomas have
well-defined
what clinical issues may odontomas have
- impaction of adjacent teeth
- root resorption
- dentigerous cyst
what is the management of odontomas
excision
what is the recurrence of odontomas
nil
what is idiopathic osteosclerosis
localised area of increased bone density
does idiopathic osteosclerosis have any association with inflammatory, neoplastic and dysplastic processes?
no
how are idiopathic osteosclerosis’s often diagnosed
incidental
what do idiopathic osteosclerosis’s have relevance to
ortho Tx
what is the incidence of idiopathic osteosclerosis
6%
when does idiopathic osteosclerosis present
adolescents
when do idiopathic osteosclerosis’s stop growing
adulthood
where do idiopathic osteosclerosis commonly occur
pre-molar/ molar region of mandible
what shape do idiopathic osteosclerosis have raidographically
round, ellipltical, irregular
what size are idiopathic osteosclerosis
<2cm
what margins do idiopathic osteosclerosis have
well defined
what internal structure do idiopathic osteosclerosis have
general homogenous opacity but sometimes slight radiolucent areas
what effect do idiopathic osteosclerosis have
nil
what is sclerosing osteitis
localised area of increased boen density due to inflammation
what causes sclerosing osteitis
chronic low grade inflammation
is sclerosing osteitis symptomatic
concurrent symptoms due to source of inflammation
does sclerosing osteitis have expansion or displacement of adjacent structures
no
what is another name for sclerosing osteitis
condensing osteitis
what margins does sclerosing osteitis have
can be well or poorly defined
what are sclerosing osteitis’s often associated with
apex of necrotic teeth
infected cyst
what should you do for sclerosing osteitis if radiographic signs are inconclusive
look for clinical source of inflammation
what is hypercementosis
excessive deposition of cementum around root
is hypercementosis symptomatic
no
is hypercementosis tooth vital
yes
what is the cause of hypercementosis
unknown
what conditions is hypercementosis common in
pagets disease, acromegaly
what is the clinical relevance of hypercementosis
makes XLA more difficult
what can be affected by hypercementosis
single or multiple teeth
entirety of root or just a section
what radiographic presentation will hypercementosis have
homogenous radiopacity continuous with root surface
is the radiodensity of hypercementosis the same as dentine
similar but slightly different
what extends around the periphery of hypercementosis
PDL
what are the margins of hypercementosis like
often smooth but can be irregular
what is cementoblastoma
benign odontogenic tumour of cementum
where does cementoblastoma occur
around the root of a tooth
is the tooth involved with cementoblastoma vital
yes
is cementoblastoma painful
yes
what effects can cementoblastoma have
displace adjacent teeth and cortical bone
what age does cementoblastoma commonly occur
2nd-3rd decade
where does cementoblastoma commonly occur
mandibular molar/premolar region
what margin does cementoblastoma have
thin, radiolucent margin continuous with the PDL
in cementoblastoma is there a margin that separates the tumour from the root surface
no
what radiographic properties does cementoblastoma have
homogenous and round, irregular shape and mixed radiodensity
what are tori
bony protuberances of the bone are characteristic sites
where do tori occur
- middle of the hard palate
- lingual mandibular premolars
what are tori of the palate called
tori palatinus
what are mandibular tori called
tori mandibularis
do tori grow
yes, slowly
what causes tori
unknown - potentially genetics, and masticatory stresses
what is the clinical relevance of tori
- hamper denture wear
- potentially traumatised during eating
what is the incidence of tori palatinus
20%
what age do tori palatinus arise
before 30
what is the incidence of tori mandibularis
8%
when does tori mandibularis occur
middle age
what do tori consist of
- cortical bone
- or mix of cortical and trabecular bone
what two phenotypes can tori have
sessile or pedunculated
what is an osteoma
benign tumour of bone
where does osteoma often occur
can occur anywhere but most often craniofacial skeleton
what does osteoma clinically present as
- hard
- asymptomatic
- slow-growing lump
how many osteomas will occur at once
can be just one or multiple
where do osteomas most commonly occur
posterior mandible
what type of bone makes up osteoma
cortical or mix of cortical and trabecular
what two phenotypes can osteoma hvae
sessile or pedunculated
what type of margins do osteomas have
smooth rounded
do osteoma have malignant potential
no
what issues might osteomas cause
- aesthetics issues
- functional issues
what is the Tx if an osteoma is causing issues
excision
what may multiple osteomas indicate
gardners syndrome
what is gardners syndrome
variant of familial adenomatous polyposis
what is gardners syndrome characterised by
- colorectal polyposis
- osteomas
- soft tissue tumours
what dental defects do pts with gardners syndrome have
supernumeraries, impacted teeht and idiopathic osteoclerosis
what dental defects do pts with gardners syndrome have
supernumeraries, impacted teeht and idiopathic osteoclerosis
why is gardners syndrome significant
colorectal polyps will become cancerous
what is the mean age of cancer diagnosis for gardners syndrome if not treated
39
what inheritance does gardners syndrome have
autosomal dominant
how else can gardners syndrome happen if not genetically predisposed
sporadically
what would you do if a pt have multiple osteomas and some impacted teeth
refer for genetic testing and investigation for gardners syndrome
what is cleidocranial dysplasia
rare genetic condition with various skeletal defects
what bone pattern is seen in in cleidocranial dysplasia
corse trabecular pattern
which two bone conditions have overlapping radiographic features
osteomyelitis and osteonecrosis
what is osteomyelitis
inflammation of bone and bone marrow due to bacterial infection
what is osteoradionecrosis
bone death resulting from irradiation
what can help differentiate between osteoradionecrosis adn osetomyelitis
history and clinical history
what do osteoradionecrosis adn osetomyelitis result in radiographically
variable mixture of radiolucent and radiopaque areas
what is periosteal bone reaction seen in
osteomyelitis
what affect on teeth might osteoradionecrosis and osetomyelitis cause
loss of lamina dura
if osteoradionecrosis and osetomyelitis is extreme, what might happen
path fracture
what is osteolysis
breakdown of bone
what does osteolysis cause on the radiograph
radiolucency
what is osteosclerosis
thickening of bone
what does osteosclerosis cause on the radiograph
radiopacity
what is periosteal bone reaction
inflammation results in periosteum laying down new layers of bone around the area
what is a giant cell granuloma
reactive lesion with benign tumour like behaviour
how fast does giant cell granuloma grow
slowly
what effects does giant cell granuloma have
displacement of bone and teeth
what affects do a small minority of giant cell granuloma have
fast growing, aggressive form
what symptoms do giant cell granuloma have
tender to palpation - nothing else
what may you see clinically for giant cell granuloma
invasion into soft tissues
what age range do giant cell granulomas occur
before 20
what gender is more likely to get giant cell granuloma
female
where does giant cell granuloma most commonly affect
mandible anterior to molars
what shape will giant cell granuloma be
unilocular
what shape will giant cell granuloma if large
multilocular
what margins do giant cell granuloma have
well defined, poorly corticated, scalloped
what internal structure do giant cell granuloma have
radiolucent or thin septae if present
does giant cell granuloma have tooth involvement
no
what effects do giant cell granuloma have
displacement of cortices, teeth and occasional root resorption
how many giant cell granuloma occur at once
1
when is root resorption from giant cell granuloma more likely
when rapidly growing aggressive form
what are fibro-osseous lesions
benign condition where bone is replaced with connective tissue or abnormal bone
are fibro-osseous genetic
no
what are the 3 main types of fibro-osseous
- cemento osseous dysplasia
- fibrous dysplasia
- ossifying fibroma
which type of fibro-osseous only affects the jaws
cemento osseous dysplasia
can histology differentiate between different types of fibro-osseous
no
what plays the biggest part in diagnosing different types of fibro-osseous
radiology
why is accurate diagnosis of fibro-osseous lesions important
Tx options vary
what does inappropriate management of fibro-osseous lesions do
increase pt morbidity
what are the 3 types of cemento osseous dysplasia
- focal cemento osseous dysplasia
- periapical cemento osseous dysplasia
- florid cemento osseous dysplasia
what is focal cemento osseous dysplasia
single or a few localised lesions
what is periapical cemento osseous dysplasia
lesions associated with apices of mandibular teeth
what is florid cemento osseous dysplasia
extensive lesions or many lesions
what age groups does cemento osseous dysplasia affect
30-50
what gender is more prone to cemento osseous dysplasia
female
what ethnicity is more likely to get cemento osseous dysplasia
black ethnicities
what site is more likely to have cemento osseous dysplasia
mandible
what is often seen clinically for cemento osseous dysplasia
nothing
which type of cemento osseous dysplasia is more likely to be expansile
florid
are cemento osseous dysplasias painful
rarely
are cemento osseous dysplasias assoicated with vital or non-vital teeth
vital
is the PDL affected by cemento osseous dysplasia
no
what shape will cemento osseous dysplasia be
well defined
what does the radiopacity of cemento osseous dysplasia depend on
stage of the lesion
how might fully mature cemento osseous dysplasia lesions appear
entirely radiopaque
what is ofetn lost with cemento osseous dysplasia
lamina dura
does cemento osseous dysplasia cause tooth displacement or resorption
rarely
what is the management of cemento osseous dysplasia
usually none
when is removal of cemento osseous dysplasia recommended
exposure by:
- XLA
- mandibular atrophy
- trauma etc
what is there a risk of following intervention of cemento osseous dysplasia
secondary infection
why is biopsy avoided with cemento osseous dysplasia
to avoid secondary infection
when would biopsy of cemento osseous dysplasia be done
atypical presentation - rapid expansion
why are XLA of involved teeth of cemento osseous dysplasia avoided
to avoid secondary infection
what should you consider doing for cemento osseous dysplasia
periodic radiographic review
why is cemento osseous dysplasia revied radiographically
to check for formation of solitary bone cysts
what are the 3 types of fibrous dysplasia
- monostotic
- polystotic
- craniofacial
what is the most common type of fibrous dysplasia
monostotic
what is monostotic fibrous dysplasia
single bone affected
what is polystotic fibrous dysplasia
multiple lesions affecting multiple bones
what is cranciofacial fibrous dysplasia
single lesion affecting multiple bones
what is the incidence of fibrous dysplasia
1:30000
what is the mean presentation of fibrous dysplasia
25 years
what gender is more prone to fibrous dysplasia
=
where is fibrous dysplasia most commonly found
posterior maxilla
how does fibrous dysplasia present clincally
facial swelling
displaced teeth
painless
how will fibrous dysplasia loook radiographically
altered bone pattern
what internal structure will have fibrous dysplasia
orange peel, granular, swirling, wispy
radiographically, what increases as a fibrous dysplasia lesion matures
radiodensity
as the bone in fibrous dysplasia enlarges, what deos it maintain
anatomical shape
what margins will fibrous dysplasia have
indistinct, blending into adjacent bone
what is the management of fibrous dysplasia if not causing any issues
nil
what is the management of fibrous dysplasia if causing issues
- recontouring
- radical resection
many fibrous dysplasia lesions stop growing, but what may happen after an event
start growing again
give 2 examples of an event that would cause a mature fibrous dysplasia lesion to start growing again
- pregnancy
- jaw surgery
what is an ossifying fibroma
fibro-osseous neoplasm in tooth bearing area
where do the majority of ossifying fibromas occur
mandible
what is the clinical presentation of ossifying fibroma
slow growing bony swelling
painless
how does the juvenile subtype of ossifying fibroma differ from the normal type
subtype grows rapidly
what age group is affected by ossifying fibroma
any age
what is the mean age of presentation for ossifying fibroma
31
what gender is more prone to ossifying fibroma
female
what shape will ossifying fibroma be
rounded, expansile lesion
what affects will ossifying fibroma have
displace teeth, resorb teeth
what is the internal structure of ossifying fibroma
ranges from entirely radiolucent to entirely radiopaque
what does the radiodensity of ossifying fibroma lesion depend on
maturation of lesion
what margins will ossifying fibroma have
well defined
what might the surrounding bone of ossifying fibroma be
sclerotic
what is the management of ossifying fibroma
removal due to progressive growth
how is a ossifying fibroma removed
enucleation or resection
what is the rescurrence rate of ossifying fibroma
12%
what is pagets disease
chronic condition causing disordered remodelling of the bone
how many bones does pagets disease affect
multiple at one time
what affects does pagets disease have
- maloccluion
- nerve impingement
- brittle bones
what are the symptoms of pagets disease
majority asymptomatic
what is the incidence of pagets disease
up to 5% of pts >55
what age range is pagets disease rare in
<40
what age range is pagets disease more common in
> 55
what gender is more prone to pagets
male
where is pagets disease most commonly found in the world
UK
what appearance will pagets disease have on a radiograph
cotton weel - abnormal bone pattern
what is the radiodensity of pagets disease linked to
stage of the disease
what patches of bone can be seen in pagets disease
osteosclerotic and osteolytic
what is seen generally in pagets disease
enlargement of bones
what will be seen radiographically in early stages of pagets disease
ostelytic
what will be seen radiographically in late stages of pagets disease
osteosclerotic
what is the cotton wool appearance of bone in pagets linked to
later stage of disease
what is osteoporosis
decreased bone mass
how does osteoporosis happen
- age related
- secondary to nutritional deficiencies or medications
what affect will be seen around teeth for osteoporosis radiographically
thinned lamina dura
what affects on bone will be seen in osteoporosis radiographically
- thinned cortices
- sparse trabecular bone pattern
what causes the radiolucent affect in osteoporosis
sparse trabecular bone
what is there an increased risk of with osteoporosis
path fractures
