Radiopacities Outside Jaws

Question 1

◦ After repeated inflammation, the tonsillar crypts enlarge and incomplete resolution of organic
debris (dead bacteria and pus, epithelial cells, and food) can lead to dystrophic calcification.

Answer 1

Tonsilliths

Question 2

◦ Cluster of small radiopacities
◦ Large tonsilliths may be symptomatic
◦ Location:
◦ On panoramic image: single or multiple radiopaque
entities superimposed over the mid portion of the ramus
◦ On CBCT: in the tonsils or adenoids surrounding the airway

Answer 2

Tonsilliths

Question 3

What’s this?

Answer 3

Tonsilliths

Question 4

What’s this?

Answer 4

Tonsilliths

Question 5

Management of _____:
◦ Small lesions: no treatment if not symptomatic; with symptomatic patients tonsilliths may be
removed manually.
◦ Lange lesions: require tonsillectomy
◦ In elderly immunocompromised patients’ treatment may be considered because of the risk for
aspiration pneumonia

Answer 5

Tonsilliths

Question 6

oUsually present in patients who have a history of chronic
inflammation. However, can be the result of tuberculosis,
sarcoidosis, metastases of thyroid cancer or associated with a
patients who have been treated for lymphoma (radiation).
oThe presence of calcification implies either active disease or
disease that has been previously treated
◦ The lymphoid tissue becomes replaced by calcium salts.
◦ Has a cauliflower shape
◦ Generally asymptomatic

Answer 6

Calcified lymph nodes

Question 7

What’s this?

Answer 7

Calcified lymph nodes

Question 8

What’s this?

Answer 8

Calcified lymph nodes

Question 9

◦ Deposition of calcium in the medial
layer of an artery. These deposits do
not narrow down the vessel or
interfere with flow.
◦ In the extracranial head and neck
region the facial artery is affected
most often.
◦ Age-related degenerative process or
also associated with renal disease.

Answer 9

Arteriosclerosis

Question 10

◦ Calcification of the atheromatous plaques within the intima ofarteries.
◦ The lumen is narrowed → Increased risk of cerebrovascularaccident
On panoramic:
◦ Verticolinear radiopacities
◦ Mostly seen at the carotid bifurcation (C3 and C4). *Do notconfuse with thyroid or triticeous cartilage
On CBCT
◦ Radiopaque circular (on axial view) or linear (on sagittal orcoronal view) radiopacity located anywhere in the courseof any artery.

Answer 10

Atherosclerosis

Question 11

◦ Calcified thrombi developed in vessels of
hemangiomas.
◦ Presence of phleboliths often sign the presence of
a hemangioma or vascular malformation.
◦ The involved soft tissue may be swollen, throbbing,
or discolored

Answer 11

Phleboliths

Question 12

Imaging features:
Periphery and internal structure:
◦ Well-defined round or oval mixed RL/RO with a
radiolucent center.
◦ Concentric laminations, giving phleboliths a
donut shape. Radiolucent flow voids represent
the remaining patent portions of the vessel.

Answer 12

Phleboliths

Question 13

◦ Calcified mass in the sinuses, most commonly in the
maxillary sinuses.
◦ The source is usually endogenous (chronically
inflamed mucosa )
◦ Deposition of mineral salts around a central nidus
(lamination)
◦ Not attached to the sinus walls
◦ Mostly asymptomatic. However, expanding mass may
impinge on the mucosa, producing pain, congestion,
and ulceration

Answer 13

Antrolith:

Question 14

◦ Calcified mass in the nose (usually an
exogenous foreign body)
◦ Deposition of mineral salts around a
central nidus (lamination)
◦ Not attached to the nasal cavity walls
◦ Mostly asymptomatic. However,
expanding mass may impinge on the
mucosa, producing pain, congestion,
and ulceration

Answer 14

Rhinolith:

Question 15

Calcifications found within the salivary glands or their
ducts:
◦ Submandibular gland (83% to 94%)
◦ Parotid gland (4% to 10%)
◦ Sublingual gland
◦ Minor salivary glands stones are exceedingly rare,
occurring mostly in the upper lip and buccal mucosa
◦ Patients may be asymptomatic, but they may have a
history of pain and swelling at mealtimes

Answer 15

Sialolith

Question 16

Which gland is the most common area for sialoliths?

Answer 16

Submandibular

Question 17

◦ Ossified ligament may be
detected by palpation over
the tonsil as a hard, pointed
structure.
◦ Symptoms of Eagle’s syndrome
can be related to cranial
nerve impingement. Clinical
diagnosis!!

Answer 17

Ossified stylohyoid ligament

Question 18

What Sometimes has symptoms may be similar to TMD?

Answer 18

Ossified Stylohyoid ligament

Question 19

◦ Soft tissue ossification in the skin or subcutaneous
tissues (focal development of bone within the
dermis)
▪Primary: occurring in normal tissue without any
pre-existing condition
▪Secondary: developing in damaged skin (most
common) : acne
◦ Face is the most common site in the body.

Answer 19

Osteoma cutis

Question 20

◦ Most commonly in the cheek, chin and lip
◦ Single or multiple small radiopacities with well-
defined peripheries (size can range from 0.1 to 5 cm)
◦ The internal aspect may be homogeneously
radiopaque or have a radiolucent center (if large)
Management:
◦ No treatment
◦ Occasionally removed for cosmetic reasons

Answer 20

Osteoma cutis

Question 21

Differential diagnosis
◦ Sometimes symptoms may be similar to TMD
Management
◦ Asymptomatic patient: no treatment.
◦ Patients with persistent or intense symptoms:
amputation of the stylohyoid ligament .

Answer 21

Ossified stylohyoid ligament

Question 22

◦ Fibrous tissue and bone forms within the interstitial tissue
of the muscle; no actual ossification of the muscle fibers
occurs
◦ Results from acute or chronic trauma or from heavy
muscular strain caused by certain occupations and
sports.
◦ Develop at any age in either sex, but it occurs most
often in young men who engage in vigorous activity.

Answer 22

Myositis ossificans

Question 23

Imaging features:
◦ Presence of heterotopic bone along the axis of the muscle
strongly imply a diagnosis.
◦ Most commonly seen in the masseter and sternocleidomastoid
◦ Shape can be from irregular oval to linear streaks running in the
same direction as the normal muscle fibers.
◦ Appreciable radiopacity is noted within 2-6 months after injury

Answer 23

Myositis ossificans

Question 24

Management
◦ Rest and limitation of use are
recommended to diminish the extent
of the calcific deposit
◦ Surgical excision of the entire calcified
mass in cases of functional restriction
◦ Incomplete excision or excision at
an immature stage can result in
recurrence

Answer 24

Myositis ossificans

Question 25

◦ Localized inflammatory change leads to
thickening of the mucosal lining (infection,
chemical irritation, allergy, introduction of a
foreign body, or facial trauma)
◦ Incidental finding on images
◦ Well-defined non-corticated radiopaque
band of soft tissue density that follows the
contour of the bony wall of the sinus

Answer 25

Mucositis

Question 26

Does mucositis or mucous retention pseudocyst derived from an inflammatory process?

Answer 26

Mucositis

Question 27

oAccumulation of mucous within soft tissue
lining in paranasal sinus due to obstruction
of gland within the sinus lining.
oIs not a true cyst (not lined by epithelium)
oMost common in the maxillary sinus
followed by sphenoid sinus and less often in
the frontal sinuses and ethmoid air cells.
oAntral retention pseudocysts are not
related to the teeth or associated with
periapical inflammatory disease.

Answer 27

Mucous retention pseudocyst

Question 28

sinusitis affecting all the paranasal

sinuses.

Answer 28

Pansinusitis:

Question 29

◦ Generalized inflammatory condition of the sinus
mucosa caused by an allergen, bacterium, or virus.
◦ Ciliary dysfunction → retention of sinus secretions
(blockage of the ostiomeatal complex)
Clinical features:
◦ The most common sinus conditions that cause pain and tenderness to pressure over the involved sinus.
◦ Pain and sensitivity to percussion may also be referred to the premolar and molar teeth on the affected
side
◦ Could be a complication of the common cold, allergies , dental infection, virus or fungal infections, etc.

Answer 29

Sinusitis

Question 30

o_____ sinusitis may result in persistent
radiopacification of the sinus with sclerosis
and thickening of the walls .
oThe changes to the sinus wall may persist.

Answer 30

Chronic sinusitis

Question 31

oA ____ is an expanding, destructive lesion that results from a
blocked sinus ostium.
oThe blockage may result from intra-antral or intranasal inflammation,
polyp, or neoplasm, and the entire sinus becomes the pathologic
cavity
oAs mucous secretions accumulate and the sinus cavity fills, the
increase in pressure within the cavity results in thinning and
displacement of the sinus walls and, in some cases, sinus wall
destruction.
o> 90% have ophthalmic symptoms & signs

Answer 31

mucocele

Question 32

Clinical features
oSensation of fullness in the cheek, and the area may swell.
oIn the maxillary sinus→ pressure on the superior alveolar nerves
causing radiating pain.
oIf the lesion expands inferiorly, it may cause loosening of the
adjacent posterior teeth.
oIf the medial wall of the sinus is expanded, the lateral wall of the
nasal cavity deforms, and the nasal airway may become
obstructed.
oIf the lesion expands into the orbit, it may cause diplopia (double
vision) or proptosis (protrusion of the globe of the eye).

Answer 32

Mucocele