RADIOLOGY - other pathologies Flashcards
what factors contribute to lesions appearing radiopaque on radiographs?
increased thickness of bone
osteosclerosis of bone
presence of abnormal tissues
mineralisation of normally non-mineralised tissues
what are the 3 questions you ask yourself when you see an abnormality on a radiograph?
is it anatomical?
is it artefactual?
is it pathological?
when describing radiopaque and mixed lesions, what is the main deviation when comparing to radiolucencies?
its ‘internal structure’
what are the main categories when describing the internal structure of radiopaque and mixed lesions on imaging?
entirely radiopaque vs mixed (homogenous or heterogenous)
organised vs haphazard
what is an odontoma?
a dental hamartoma - benign tumour composed of dental tissues (enamel, dentine, cementum and pulp)
what similarities are there between normal teeth and odontomas seen on imaging?
surrounded by dental follicle
mature to a certain stage (i.e., do not grow indefinitely)
what is the incidence of odontomas?
1st or 2nd most common odontogenic tumour
most common in 2nd decade (correlates with development of normal dentition)
F=M
what are the sub types of odontomas?
- compound (ordered dental structures)
- complex (disorganised mass of dental tissue)
describe compound odontomas? and where would you find them?
may present as multiple ‘mini teeth’ (denticles)
more common in anterior maxilla
describe complex odontomas? and where would you find them?
may have a ‘clump of cotton’ appearance
more common in posterior body of mandible
what are radiographic features of odontomas?
- well defined radiopacity/ radiopacities of varying radiodensity
- areas with radiodensity of enamel
- thin radiolucent margin i.e., follicle
what clinical issues do odontomas present?
- impaction of adjacent teeth
- external root resorption of adjacent teeth
- development of dentigerous cyst
what is the management of odontomas?
- excision if impeding eruption
- no risk of recurrence
what is idiopathic osteosclerosis?
localised area of increased bone density of unknown cause
- no association with inflammatory, neoplastic or dysplastic processes
what area of dentistry is idiopathic osteosclerosis relevant to?
ortho
what are names for areas of idiopathic osteosclerosis?
‘dense bone island’
‘enostosis’
what is the incidence of idiopathic osteosclerosis?
up to 6% of the population
typically presents in adolescence and stops growing by adulthood
most common in premolar-molar region of mandible
describe the radiographic presentation of idiopathic osteosclerosis?
- well-defined radiopacity
- often homogenous but can have slightly radiolucent internal areas
- no radiolucent margin
- variable shape: round, elliptical, irregular
- size usually <2cm
- not associated with teeth but can appear next to them due to circumstance: teeth not displaced and no affect on the PDL spaces of teeth
what is sclerosing osteitis?
localised area of increased bone density in response to inflammation
- inflammation often low-grade and chronic
does sclerosing osteitis have symptoms?
may have concurrent symptoms due to source of inflammation
no expansion or displacement of adjacent structures
what is another name for sclerosing osteitis?
condensing osteitis
describe the radiographic presentation of sclerosing osteitis?
well defined or poorly defined radiopacity
directly associated with source of inflammation - apex of necrotic tooth, infected cyst etc
how can you differentiate sclerosing osteitis and idiopathic osteosclerosis?
if radiographic features inconclusive then look for a source of inflammation e.g., check for signs and symptoms, sensibility test teeth
what is hypercementosis?
excessive deposition of cementum around root
does hypercementosis have symptoms?
non-neoplastic and asymptomatic
tooth vital (unless necrotic due to another reason
what causes hypercementosis?
cause unknown but more common in certain conditions i.e., pagets disease of bone and acromegaly
what is the clinical relevance of hypercementosis?
makes xla more difficult
describe the radiographic presentation of hypercementosis?
- single or multiple teeth involved - involves either entire root or just a section
- homogenous 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 a cementoblastoma?
benign odontogenic tumour of cementum
where may you find cementoblastomas?
around root of a tooth (which remains vital)
what are the symptoms associated with cementoblastoma?
often painful
can displace adjacent teeth and cortical bone
what is the incidence of cementoblastoma?
rare
wide age range but often in 2nd and 3rd decades
typically affects mandibular premolars or 1st molars
describe the radiographic presentation of cementoblastoma?
attached to a tooth root - root outline may become indistinct
thin radiolucent margin continuous with PDL space of root
* no radiolucent margin separating tumour from root surface
well-defined and radiopaque - typically homogenous and round, can be mixed radiodensity and irregularly shaped
what are tori?
bony protuberances or normal bone at characteristic sites
where may you find tori?
middle of hard palate - torus palatinus
lingual to mandibular premolars - torus mandibularis
have tori got associated symptoms?
asymptomatic
may slowly increase in size
what is the cause of tori?
potentially related to genetic factors and masticatory stresses
what is the clinical relevance of tori?
can hamper denture wear
potentially traumatised during eating
what is the incidence of tori?
varies between populations
torus palatinus - 20% of population: often arise before age 30
torus mandibularis - 8% of population: often arise in middle age
describe the radiographic presentation of tori?
solitary of multiple (torus mandibularis often bilateral)
cortical bone or a mix or cortical and trabecular bone
sessile or pedunculated
variable in size
what is an osteoma?
benign tumour of bone
they can occur anywhere in body but have a predilection for craniofacial skeleton
clinical presentation of osteoma?
hard, asymptomatic, slow-growing lump
single or multiple
osteoma incidence?
rare
wide age range
posterior mandible is most common jaw site
describe the radiographic presentation of osteoma?
entirely cortical bone or a mix of cortical and trabecullar
sessile or pedunculated
rounded, smooth margins
what is the clinical relevance of osteoma?
no malignant potential
cosmetic or function issues (excise)
multiple osteomas may indicate gardeners syndrome
what is gardener syndrome?
a rare variant of familial adenomatous polyposis
what is gardener syndrome characterised by?
colorectal polyposis
osteomas (esp of mandible)
soft tissue tumours e.g., epidermoid cyst of skin
also tend to have supernumeraries, impacted teeth and multiple areas of idiopathic osteosclerosis
why is it important for early diagnosis of gardener syndrome?
colorectal polyps inevitably become malignant
- mean age of cancer diagnosis (if not removed) if 39 years old
what is the name of a rare genetic condition with various skeletal defects?
cleidocranial dysplasia
what effect does cleidocranial dysplasia have on the teeth and jaws?
- delayed eruption
- multiple supernumerary teeth, leading to impaction of other teeth
- multiple unerupted secondary teeth, due to multiple retained primary teeth
- hypoplastic maxilla with high arched palate
- increased prevalence of cleft palate
- coarse trabecular pattern
what effect does cleidocranial dysplasia have on the sinuses and rest of the body?
- small maxillary sinuses
- absent or partially formed clavicles
- bossing (bulging) of the skull
- hypertelorism (increased distance between orbits)
what is osteomyelitis?
inflammation of bone and bone marrow due to bacterial infection
what is osteoradionecrosis?
bone death resulting from irradiation
requires high energies of radiation (radiotherapy)
what is MRONJ?
bone death associated with anti-resorptive or anti-angiogenic drugs
what are radiographic features of osteomyelitis and osteonecrosis?
osteolysis + osteosclerosis: variable mixture of radiolucent and radiopaque areas
irregularities on inner/ outer aspects of cortical bone
sequestration of bone
periosteal bone reaction (primarily in osteomyelitis)
loss of lamina dura around teeth
pathological # of bone
describe osteolysis?
breakdown of bone
describe osteosclerosis?
thickening of bone
name a reactive lesion with benign tumour-like behaviour?
central giant cell granuloma
describe central giant cell granuloma?
slow growing lesion causing expansion of bone and displacement of teeth (minority of cases more aggressive and grow rapidly)
central giant cell granuloma symptoms?
often asymptomatic but may be tender to palpation
may invade overlying soft tissue
what is the incidence of central giant cell granuloma?
wide age range but majority before age 20
F>M
most commonly affects mandible anterior to molars
what is the typical radiographic presentation of central giant cell granuloma?
site - mandible anterior to molars
size - any size
shape - unilocular or multilocular (when large) sometimes with internal thin septae
margins - well defined, poorly corticated, scalloped
internal structure - radiolucent
tooth involvement - no
effects - displacement of cortices; displacement of teeth; occasional external root resorption
number - single
name the group of rare, benign, non-inheritable conditions where normal bone is replaced by connective tissue and abnormal bone?
fibro-osseous lesions
what are the main types of fibro-osseous lesions?
cemento-osseous dysplasia (COD)
fibrous dysplasia (FD)
ossifying fibroma (OF)
what type of fibro-osseous lesions can affect any part of the skeleton but have a predilection for the jaws?
fibrous dysplasia
ossifying fibroma
what type of fibro-osseous lesions only affect the jaws?
cemento-osseous dysplasia
how are fibro-osseous lesions diagnosed?
radiology
*histopathology can be unable to distinguish between different types
why is accurate diagnosis of fibro-osseous lesions important?
prognosis and tx options vary greatly
inappropriate management increases the pt morbidity
what are radiographic features to consider when diagnosing different types of fibro osseous lesions?
anatomical location
shape
size
pattern of matrix
margin (including zone of transition)
what are the different forms of cemento-osseous dysplasia?
focal COD: single/ few localised lesions
periapical COD: lesions associated with apices of anterior mandibular teeth
florid COD: extensive lesion or many lesions
what is the incidence of cemento-osseous dysplasia?
typically pts age 30-50 years
F»M
most common in Black ethnicities
mandible> maxilla
clinical signs/ symptoms of cemento-osseous dysplasia?
often no signs/ symptoms
may be expansile (esp florid type)
rarely painful
can become infected: pain, suppuration
radiological appearance of cemento-osseous dysplasia?
mixed-radiodensity lesions located at apices of vital teeth
- well defined radiolucency with varying amounts of well defined radiopaque material
- lamina dura lost
- PDL unaffected
- tooth displacement/ ERR is rare
what does the appearance of cemento-osseous dysplasia depend on?
stage of the lesion maturation
(fully mature lesions can appear entirely radiopaque)
what is the mx of cemento-osseous dysplasia?
usually no mx needed
removal if exposed by xla, mandibular atrophy or trauma
what is the risk associated with intervening cemento-osseous dysplasia?
secondary infection
*avoid biopsy and xla of teeth involved
why may you want to consider periodic radiographic review for cemento-osseous dysplasia?
to check for development of secondary solitary bone cysts
what are the forms of fibrous dysplasia?
monostotic: single bone affected (most common)
polyostotic: multiple lesions affecting multiple bones
craniofacial: typically single lesions affecting multiple (fused) bones
what is the incidence of fibrous dysplasia?
1:30000
mean age 25 years
F=M
favours posterior maxilla
what is the clinical presentation of fibrous dysplasia in the jaw?
facial swelling due to bony expansion
may displace teeth
typically painless
what is the radiological presentation of fibrous dysplasia in the jaw?
altered bone pattern
- highly variable: granular/ orange peel/ swirling/ wispy/ amorphous
- radiodensity increases as lesions matures
bone enlarges but maintains rough anatomical shape
margins indistinct and blend into adjacent bone
- broad zone of transition
what is the mx of fibrous dysplasia?
no mx required if not causing functional/ aesthetic issues
if required; recontouring or radical resection
explain the lifespan of fibrous dysplasia lesions?
they normally stop growing but may reactivate, typically after a precipitating event like pregnancy or jaw surgery
name a fibro-osseous neoplasm occurring most often in tooth bearing areas?
ossifying fibroma
where may you find ossifying fibroma?
majority occur in the mandible
rare cases in other craniofacial bones
clinical presentation of ossifying fibroma?
slow growing bony swelling (however juvenile sub type can grow rapid)
often painless
incidence of ossifying fibroma?
occurs at any age - mean age 31 years
F>M
Radiographic presentation of ossifying fibroma?
rounded, expansile lesions - affected teeth displaced and may be resorbed
ranges from entirely radiolucent to completely radiopaque - radiodensity depends on stage of the lesion maturation
margins usually well defined
surrounding bone may be sclerotic
what is the mx of ossifying fibroma?
removal indicated due to progressive growth
surgical enucleation or resection (usually enucleates in one piece)
12% recurrence rate
name a chronic condition causing disordered remodeling of bone?
Pagets disease of bone
what does pagets disease affect?
multiple bones at the same time - resulting in enlargement of bones, malocclusion, nerve impingement, and brittle bones
majority asymptomatic
Pagets disease incidence?
up to 5% of patients >55 years
rare <40 years
M>F
more common in UK than other parts of the world
what are radiographic features of Pagets disease of bone?
general enlargement of bones
abnormal bone pattern (cotton wool appearance)
osteolytic/ osteosclerotic patches of bone
radiodensity of altered areas linked to stage of disease
dental issues: migration. hypercementosis. loss of lamina dura
what are the stages of Pagets disease of bone?
early/ osteolytic (more radiolucent)
intermediate/ mixed
late/ osteosclerotic
what is osteoporosis?
decreased bone mass
what causes osteoporosis?
age
secondary to nutritional deficiency, medications etc
what are radiographic features of osteoporosis?
thinned cortices e.g., inferior border of mandible
sparse trabecular bone pattern - general radiolucent appearance
thinned lamina dura around teeth
