Radiopacities Outside the Jaws Flashcards
what are tonsilliths from
repeated inflammation, the tonsillar crysts enlarge and incomplete resolution of organic debris (dead bacteria and pus, epithelial cells, and food) can lead to dystrophic calcification
how do tonsilliths appear on radiographs
- cluster of small radiopacities
- on pano: single or multiple radiopaque entities superimposed over the mid portion of the ramus
- on CBCT: in the tonsils or adenoids surrounding the airway
what are the types of tonsils
- pharyngeal tonsils
- tubal
- palatine tonsils
- lingual tonsils
what is the management for tonsilliths
- small lesions: no treatment if not symptomatic. with symptomatic patients tonsilliths may be removed manually
- large lesions: require tonsillectomy
- in elderly immunocompromised patients treatment may be considered because of the risk for aspiration pneumonia
what are calcified lymph nodes caused by
- pts who have history of chronic inflammation
- can be the result of tuberculosis, sarcoidosis, metastases of thyroid cancer or associated with a patients who have been treated for lymphoma - radiation
the presence of calcification in lymph nodes implies:
either active disease or disease that has been previously treated
in calcified lymph nodes, the lymphoid tissue becomes replaced by:
calcium salts
calcified lymph nodes have a ____ shape
cauliflower
are calcified lymph nodes symptomatic
generally no
what is atherosclerosis
- calcification of the atheromatous plaque within the intima of arteries
- the lumen is narrowed -> increased risk of cerebrovascular accident
how does atherosclerosis appear on pano
- verticolinear radiopacities
- mostly seen at the carotid bifurcation (C3 and C4)
how does atherosclerosis appear on CBCT
- radiopaque circular on axial view or linear on sagittal or coronal view radiopacity located anywhere in the course of any artery
what can atherosclerosis be confused with on pano
thyroid or triticeous cartilage
where is thyroid and triticeous cartilage found
at the level of the hyoid bone or below
what is the distinguishing feature of thyroid cartilage
the border is more RO
where are rhinoliths found
within the nasal cavity
where are antroliths found
within the paranasal sinuses
what is the antrolith, its source, and describe it
- 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 can impinge on the mucosa producing pain, congestion and ulceration
what is the DDX for the antrolith
osteoma
describe the rhinolith
- 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
what is the periphery and shape of rhinoliths and antroliths
various shapes and sizes depending on the nature of the nidus but all have well defined periphery
describe the internal structure of the rhinolith and antrolith
homogenous or heterogenous radiopacities depending on the nidus, and sometimes may have laminations
what is the treatment for rhinolith and antrolith
referral to an otolaryngologist for endonasal or sinus endoscopic surgical removal
what is the incidence of sialoliths
- submandibular gland (83-94%)
- parotid gland (4-10%)
- sublingual gland
- minor salivary glands stones are exceedingly rare occuring mostly in the upper lip and buccal mucosa
patients may be asymptomatic with sialolith but they may have a history of:
pain and swelling at mealtimes
what are the imaging features of the sialolith
- periphery: usually are cylindrical and very smooth
- internal structure: radiopaque
- multiple sialoliths are somewhat common
how do ossified stylohyoid ligaments feels
by palpation over the tonsils as a hard, pointed structure
what is eagles syndrome
pain from calcified stylohyoid ligament
symptoms of eagles syndrome can be related to_____. this is a _____ diagnosis
- cranial nerve impingement
clinical
what is the DDX for ossified stylohyoid ligament
sometimes symptoms may be similar to TMD
what is the management of ossified stylohyoid ligament
- asymptomatic patient: no tx
- patients with persistent or intense symptoms: amputation of the stylohyoid ligament
what is another name for the mucous retention pseudocyst
antral retention pseudocyst
what is a mucous retention pseudocyst
accumulation of mucous within soft tissue lining in paranasal sinus due to obstruction of gland within the sinus lining
describe the features of the mucous retention pseudocyst
- not a true cyst - not lined by epithelium
- always attached to a wall
- dome shaped radiopaque mainly found in maxillary sinus followed by sphenoid sinus and less often in the frontal sinuses and ethmoid air cells
antral retention pseudocysts are not related to:
the teeth or associated with periapical inflammatory disease
what is the etiology for the mucous retention pseudocyst
blockage of the secretory ducts of the glands in the sinus mucosa resulting in accumulation of secretions and swelling of the tissue
what are the clinical features of the mucous retention pseudocyst
- rarely causes any signs or sympotms
- it is an incidental finding
- when a pseudocyst completely fills the maxillary sinus cavity, it may prolapse through the ostium and cause nasal obstruction
- the retention pseudocyst may also rupture as a result of abrupt pressure changes caused by sneezing or blowing of the nose producing postnasal discharge
what are the imaging features of the mucous retention pseudocyst
- 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 homogenous radiopaque masses
- there are no effects on the surrounding structures
what is the management for the mucous retention pseudocyst
- no treatment (resolve spontaneously without any residual effect on the antral mucosa)
- check patency of ostiomeatal complex if large
what is mucositis
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
what is sinusitis
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)
what is pansinusitis
sinusitis affecting all the paranasal sinuses
what are the 3 types of sinusitis based on time-
- acute sinusitis: has been present for 4 weeks or less
- chronic sinusitis: has been present for more than 12 consecutive weeks
- subacute sinusitis: lasting for more than 4 weeks up to 12 weeks
what are the clinical features of sinusitus
- 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
what are the imaging features of sinusitis
- generalized thickening of the mucosal lining around most or all sinus cavity walls
- may cause blockage of the sinus ostium
- acute: air entrapment (bubbles)
- chronic: thickening and sclerosis of the walls
chronic sinusitis may result in:
persistent radiopacification of the sinus with sclerosis and thickening of the walls
what is the management of sinusitis
the goal is to control the infection, promote drainage and relieve pain
what is the tx for acute sinusitis
- treated pharmacologically to reduce mucosal swelling
- antibiotics
what is the tx for chronic sinusitis
- goal is ventilation and drainage
- endoscopic surgery is used to enlarge obstructed ostia or alternative path of drainage maybe established
what is a mucocele
an expanding, destructive lesion that results from a blocked sinus ostium
mucocele blockage may result from:
intra-antral or intranasal inflammation, polyp or neoplasm and the entire sinus becomes the pathologic cavity
as mucous secretions accumulate and the sinus cavity fills, the increase in pressure within the cavity with a mucocele results in:
thinning and displacement of the sinus walls and in some cases wall destruction
more than _____ of patients with mucocele have opthalmic symptoms and signs
greater than 90%
what are the opthalmic signs and symptoms in mucocele
periorbital swelling, pain, exopthalmos, and visual disturbances
what are the clinical features of the. mucocele
- sensation of fullness in the cheek, and the area may swell
- in the maxillary sinus -> pressure on the superior alveolar nerves causing radiating pain
- if the lesion expands inferiorly, it may cause loosening of the adjacent posterior teeth
- if the medial wall of the sinus is expanded the lateral wall of the nasal cavity deforms and the nasal airway may become obstructed
- if the lesion expands into the orbit it may cause diplopia or proptosis
about 90% of mucoceles occur in:
the ethmoid air cells and frontal sinuses
when the mucocele is associated with the maxillary antrum:
teeth may be dispalced or roots resorbed
what is the tx for mucocele
surgical excision
