Radiopacities outside the jaws

Question 1

Tonsilliths

Answer 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.

Question 2

Tonsilliths
◦ Cluster of small —
◦ Large tonsilliths may be —

Answer 2

radiopacities
symptomatic

Question 3

Tonsilliths
Location:
◦ On panoramic image:
◦ On CBCT:

Answer 3

single or multiple
radiopaque entities superimposed over the mid
portion of the ramus

in the tonsils or adenoids surrounding
the airway

Question 4

Tonsilliths
Management
◦ Small lesions:
◦ Lange lesions:
◦ In elderly immunocompromised patients’ treatment may be considered because of the risk for —

Answer 4

no treatment if not symptomatic; with symptomatic patients tonsilliths may be
removed manually.

require tonsillectomy

aspiration pneumonia

Question 5

Calcified Lymph nodes
o Usually present in patients who have a history of chronic
inflammation. However, can be the result of (4)

Answer 5

tuberculosis,
sarcoidosis, metastases of thyroid cancer or associated with a
patients who have been treated for lymphoma (radiation)

Question 6

2. Calcified Lymph nodes
   o The presence of calcification implies either (2)
   ◦ The lymphoid tissue becomes replaced by —.
   ◦ Has a — shape
   ◦ Generally —

Answer 6

active disease or disease that has been previously treated
calcium salts
cauliflower
asymptomatic

Question 7

3. Atherosclerosis

Answer 7

◦ Calcification of the atheromatous plaques within the intima of
arteries.

Question 8

3. Atherosclerosis
   ◦ The lumen is narrowed →

Answer 8

Increased risk of cerebrovascular
accident

Question 9

3. Atherosclerosis
   On panoramic:
   (2)

Answer 9

◦ Verticolinear radiopacities
◦ Mostly seen at the carotid bifurcation (C3 and C4). *Do not
confuse with thyroid or triticeous cartilage

Question 10

3. Atherosclerosis
   On CBCT
   (1)

Answer 10

◦ Radiopaque circular (on axial view) or linear (on sagittal or
coronal view) radiopacity located anywhere in the course
of any artery

Question 11

Antrolith:
◦ Calcified mass in the sinuses, most commonly in the
—
◦ The source is usually —
◦ Deposition of mineral salts around a —
◦ Not attached to the —
◦ Mostly asymptomatic. However, expanding mass may

Answer 11

maxillary sinuses.
endogenous (chronically inflamed mucosa )
central nidus (lamination)
sinus walls

impinge on the mucosa, producing pain, congestion,
and ulceration

Question 12

Rhinolith:
◦ Calcified mass in the —
◦ Deposition of mineral salts around a —
◦ Attached to the nasal cavity walls?
◦ Mostly asymptomatic. However,
expanding mass may impinge on the

Answer 12

nose (usually an exogenous foreign body)
central nidus (lamination)
No
mucosa, producing pain, congestion,
and ulceration

Question 13

Rhinolith and Antroliths
Periphery and Shape

Answer 13

various shapes and sizes. depending on the nature of the nidus but all have well defined periphery

Question 14

Rhinolith and Antroliths
Internal structure

Answer 14

homogenous or heterogenous RO, depending on the nidus, and sometimes may have laminations

Question 15

Rhinolith and Antroliths
Treatment:

Answer 15

o Referral to an otorhinolaryngologist for endonasal or sinus
endoscopic surgical removal

Question 16

Sialolith

Answer 16

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

Question 17

Sialolith
Patients may be asymptomatic, but they may have a
history of

Answer 17

pain and swelling at mealtimes

Question 18

Sialolith
maging features
* Periphery:
* Internal structure:
* — sialoliths are somewhat
common.

Answer 18

usually are cylindrical and very smooth.
radiopaque
Multiple

Question 19

Ossified stylohyoid ligament
◦ Ossified ligament may be
detected by
◦ Symptoms of

Answer 19

palpation over
the tonsil as a hard, pointed
structure.
Eagle’s syndrome
can be related to cranial
nerve impingement. Clinical
diagnosis!!

Question 20

Ossified stylohyoid ligament
Differential diagnosis

Answer 20

◦ Sometimes symptoms may be similar to TMD

Question 21

Ossified stylohyoid ligament
Management
◦ Asymptomatic patient:
◦ Patients with persistent or intense symptoms:

Answer 21

no treatment.
amputation of the stylohyoid ligament .

Question 22

Mucous retention pseudocyst

Answer 22

o Accumulation of mucous within soft tissue
lining in paranasal sinus due to obstruction
of gland within the sinus lining.

Question 23

Mucous retention pseudocyst
o Is not a
o Most common in the —
followed by — and less often in
the (2)

Answer 23

true cyst (not lined by epithelium)
maxillary sinus. sphenoid sinus, frontal sinuses and ethmoid air cells.

Question 24

Mucous retention pseudocyst
o Antral retention pseudocysts are not
related to the teeth or associated with

Answer 24

periapical inflammatory disease.

Question 25

Mucus retention pseudocyst
Etiology
o Most accepted hypothesis:

Answer 25

blockage of the
secretory ducts of the glands in the sinus mucosa
resulting in accumulation of secretions and swelling
of the tissue.

Question 26

Mucous retention pseudocyst
CLINICAL FEATURES
o Symptoms?
o It is — finding.
o When a pseudocyst completely fills the
maxillary sinus cavity, it may …
o The retention pseudocyst may also rupture as
a result of …

Answer 26

Rarely causes any signs or symptoms.
incidental
prolapse (extrude) through the ostium and cause nasal obstruction.

abrupt pressure changes caused by sneezing or blowing of the nose,
producing postnasal discharge

Question 27

Mucous retention pseudocyst
Imaging features
Size
Number
Appearance
Effects on surrounding structures

Answer 27

◦ Range widely in size—from the size of a fingertip
to a size large enough to fill the sinus completely.
◦ Single or multiple
◦ Well-defined, non-corticated, smooth, dome-shaped, and homogeneous radiopaque masses.
◦ There are no effects on the surrounding structures.

Question 28

Mucous retention pseudocyst
Management:
(2)

Answer 28

◦ No treatment (resolve spontaneously without any
residual effect on the antral mucosa)
◦ Check patency of ostiomeatal complex if large.

Question 29

Mucositis

Answer 29

Localized inflammatory change leads to
thickening of the mucosal lining (infection,
chemical irritation, allergy, introduction of a
foreign body, or facial trauma)

Question 30

Mucositis
◦ — finding on images
◦ What does it look like

Answer 30

Incidental

Well-defined non-corticated radiopaque
band of soft tissue density that follows the
contour of the bony wall of the sinus

Question 31

Sinusitis

Answer 31

◦ Generalized inflammatory condition of the sinus
mucosa caused by an allergen, bacterium, or virus.

Question 32

Sinusitis
◦ Ciliary dysfunction →
◦ Pansinusitis:

Answer 32

retention of sinus secretions
(blockage of the ostiomeatal complex)

sinusitis affecting all the paranasal
sinuses.

Question 33

Sinusitis
Based on the length of time the disease has been present:
◦ Acute sinusitis:
◦ Chronic sinusitis:
◦ Subacute sinusitis:

Answer 33

has been present for 4 weeks or less
has been present for more than 12 consecutive weeks
lasting from more than 4 weeks up to 12 weeks

Question 34

Sinusitis
Clinical features:
◦ The most common sinus conditions that cause …
◦ Pain and sensitivity to percussion may also be referred to the …
◦ Could be a complication of the (5)

Answer 34

pain and tenderness to pressure over the involved sinus.
premolar and molar teeth on the affected
side

common cold, allergies , dental infection, virus or fungal infections, etc

Question 35

Sinusitis
Image features:
◦
◦ May cause blockage of the —.
◦ Acute:
◦ Chronic:

Answer 35

Generalized thickening of the mucosal lining around most or all sinus cavity walls (radiopacification of the sinus)
sinus ostium
Air entrapment (bubbles)
Thickening and sclerosis of the walls

Question 36

Chronic Sinusitis
o Chronic sinusitis may result in
o The changes to the sinus wall may persist

Answer 36

persistent
radiopacification of the sinus with sclerosis
and thickening of the walls .

Question 37

Sinusitis
Management

Answer 37

The goal is to control the infection, promote drainage,
and relieve pain

Question 38

Management
Acute sinusitis:
(2)

Answer 38

◦ Treated pharmacologically (decongestants) to
reduce mucosal swelling
◦ Antibiotics (in case of bacterial sinusitis).

Question 39

Management
Chronic sinusitis:
◦ The goal is
◦ Endoscopic surgery is used to

Answer 39

ventilation and drainage.
enlarge obstructed
ostia or alternative path of drainage maybe
established.

Question 40

Mucocele
o A mucocele is an expanding, — lesion that results from a
blocked sinus ostium.
o The blockage may result from
o As mucous secretions accumulate and the sinus cavity fills, the
increase in pressure within the cavity results in
o >—% have ophthalmic symptoms & signs

Answer 40

destructive

intra-antral or intranasal inflammation,
polyp, or neoplasm, and the entire sinus becomes the pathologic
cavity

thinning and displacement of the sinus walls and, in some cases, sinus wall destruction.

90

Question 41

Mucocele
Clinical features
o Sensation of
o In the maxillary sinus→
o If the lesion expands inferiorly, it may cause
o If the medial wall of the sinus is expanded, the — wall of the
nasal cavity deforms, and the — may become
obstructed.
o If the lesion expands into the orbit, it may cause

Answer 41

fullness in the cheek, and the area may swell.
pressure on the superior alveolar nerves causing radiating pain.
loosening of the adjacent posterior teeth.
lateral, nasal airway
diplopia (double vision) or proptosis (protrusion of the globe of the eye)

Question 42

Mucocele
o About –% of mucoceles occur in the ethmoid
air cells and frontal sinuses
o Internally, the sinus cavity is uniformly —.
o When the mucocele is associated with the —, teeth may be displaced, or
roots resorbed.

Answer 42

90
radiopaque
maxillary antrum

Question 43

Mucocele
Management:

Answer 43

• Surgical excision