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RADIO INTERPRETATION > ragged lucencies > Flashcards

ragged lucencies Flashcards

1
Q

potential ragged lucencies

A

➢Chronic Osteomyelitis
➢Osteoradionecrosis
➢Medication Related Osteonecrosis of the Jaws (MRONJ), (BRONJ)
➢Primary Epidermoid Carcinoma
➢Metastatic Disease

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2
Q

radiographic features of ragged lucencies
* trabeculation?
* Cortex changes?
* Sequestration?
* pathologic result?
* Periosteum?
* PDL
* teeth and bony outlines?

A
  • Irregular sclerotic trabeculation
  • Cortex changes – thinning or disruption
  • Sequestration
  • Fracture (pathologic)
  • Periosteal duplication
  • Widened PDL
  • Minimal displacement of teeth and bony outlines
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3
Q

clinical features of ragged lucencies

A
  • Edema, purulence
  • Increased mass
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4
Q

Chronic Osteomyelitis can only occur when infection goes beyond?

A

beyond alveolar bone

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5
Q

why is chronic osteomyelitis less common in jaw?

A

good blood supply of alveolar bone, basal with lesser supply

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6
Q

Chronic Alveolar Abscess/ Chronic Dentoalveolar Abscess a.k.a. Chronic Osteitis
compared to acute osteomyelitis?

A
  • Localizes inflammation and infection of alveolar bone, consequently it will be; around teeth and generally milder than acute osteomyelitis
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7
Q

osteitis vs osteomyelitis

A
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8
Q

Chronic Osteomyelitis
Pathophysiology

A
  • Primarily polymicrobes from odontogenic infection; also from open fractures
  • streptococcus, Bacteroides, Polystrepto
  • With increased chronicity other microbes may include Actinomyces, Eikenella, Klebsiella, M. tuberculosis, etc.
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9
Q

osteomyelitis acute vs chronic time frame

A
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10
Q

Chronic Osteomyelitis
Predisposing Factors

A

1.Reduced vascular supply; diabetes, any COD, osteopetrosis, Pagets, etc…
2.Immunodeficient states: AIDS, leukemia, corticosteroid treatment, malnutrition, bisphosphonates, other medications
3.Odontogenic infection, trauma, surgery

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11
Q

Chronic Osteomyelitis Clinical Features:
* temp?
* LN?
* mucosa?
* bone?
* drainage?

A
  • Low grade fever
  • Regional lymphadenopathy
  • Atrophic ,erythematous mucosa
  • Denuded bone
  • Suppuration
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12
Q

Chronic Osteomyelitis
Radiographic app

A

● radiolucency of variable size with irregular borders
● patches of reactive sclerotic bone
* Moth-eaten appearance
 Sequestration (necrotic bone)

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13
Q

what can be seen here?

A

sequestration, may be seen with chronic osteomyelitis

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14
Q

what is marked by the arrow

A

pathologic fracture

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15
Q
  • With increased chronicity, and a ragged moth-
    eaten appearance, there can be what complication as a result?

in osteomyelitis

A

pathologic fracture

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16
Q

Chronic Osteomyelitis radio app in low grade chronic conditions

A
  • sclerosing, granular trabecular pattern in low-grade chronic conditions
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17
Q

low grade chronic osteomyelitis has a tendency for what tissue rxn?

A

proliferative periostitis

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18
Q

what is seen? what may this indicate?

A

proliferative periostitis, low grade chronic osteomyelitis

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19
Q

Chronic Osteomyelitis
Age?
Site?
Predominant Gender?

A

40-80 years of age

Body of mandible

Males

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20
Q

Chronic Osteomyelitis Management

A
  • Debride any necrotic tissue
  • Antibiotic therapy
  • Drain and irrigate the region
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21
Q

classic triad of ORN

A

Radiation Therapy
Trauma
Infection

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22
Q

Pathophysiology ORN

A

ORN was primarily a non- healing wound secondary of endarteritis
* Effect of irradiation of bone: decreased vascularity and decreased cellularity

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23
Q

Predisposing Factors of ORN

A
  • Age
  • Type and delivery of ionizing radiation
  • Tumor site
  • Diabetes
  • Pagets Disease
  • Hypertension
  • Pre-existing Oral Status: untreated dental infections
  • Dental Extraction
  • Poor-fitting dentures and other micro-traumas
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24
Q

ORN clinical

A
  • Mild to intense pain
  • Signs of inflammation (swelling, drainage)
  • Tissue denudation
  • Denuded bone, swelling and drainage
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25
Q

what stages of ORN is denuded bone present?

A

stages 1, 2, 3

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26
Q

radio app of ORN

A

Areas of increased radiodensity interspersed with osteolytic regions

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27
Q

Osteoradionecrosis
Age
Site
Predominant Gender

A

40-80 years of age.
Body of mandible
More common in males

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28
Q

Osteoradionecrosis Management

A

Hyperbaric oxygen. Surgical debridement,
resection of nonviable tissues, and antibiotics.

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29
Q

ORN predispoing conditions

A

previous radiation, trauma, diabetes, Pagets disease

30
Q

Medication Related Osteonecrosis of the Jaws (MRONJ) vs. Bisphosphonate Related Osteonecrosis of the Jaws
(BRONJ)

A
  • Terminology has been difficult in relation to the multiple medications that can cause these bony changes
31
Q

Medications that cause MRONJ

A

antiresorptive medications:
non-nitrogen-containing bisphosphonates
● etidronate
● clodronate
nitrogen-containing bisphosphonates
● alendronate (Fosomax) - PO

32
Q

dx tx with antiresorpative meds

A
  • Osteoporosis
  • Breast cancer
  • Multiple myeloma
  • Prostate CA
  • Colon CA
33
Q

MRONJ – Dental Etiologies

A

Extraction
Implants
Prosthesis trauma
spontaneous

34
Q

MRNOJ stages

A

at risk
stage 0-3

35
Q

which MRNOJ stages are symptomatic

A

2 and 3

36
Q

at risk for MRNOJ findings

A

No apparent necrotic bone in patients who have been
treated with either oral or IV bisphosphonates

37
Q

stage 0 mrnoj clinical findings

A

No clinical evidence of necrotic bone, but non-specific
clinical findings, radiographic changes, and symptoms

38
Q

stage 1 mnroj clinical findings

A

Exposed and necrotic bone, or fistulae that probes to the bone in patients who are asymptomatic and have no evidence of infection

39
Q

stage 2 mnroj clinical findings

A

Exposed and necrotic bone, or fistulae that probes to the bone, associated with infection as evidenced by pain and erythema in the region of the exposed bone, with or without purulent drainage

40
Q

stage 3 mnroj clinical findings

A

Exposed and necrotic bone or a fistula that probes to bone in patients with pain, infection, and one or more of the following: exposed and necrotic bone extending beyond the region of alveolar bone (i.e., inferior border and ramus in the mandible, maxillary sinus, and zygoma in the maxilla) resulting in pathologic fracture, extra-oral fistula, oral-antral/oral-nasal communication or osteolysis extending to the inferior border of the mandible of sinus floor

41
Q

mrnoj stage? pt has no symptoms/denuded bone

A

0

42
Q

mrnoj stage? (PT without symptoms)

A

1

43
Q

BRONJ – maxilla and zygoma clinical findings

A
  • Edema, purulence
  • Increased mass
44
Q

BRONJ – maxilla and zygoma radio findings

A
  • Irregular sclerotic trabeculation
  • Osteolysis
  • Sequestration
  • Periosteal duplication
  • Minimal displacement of teeth and bony outlines
45
Q

MRONJ - TREATMENT

A
  • monitoring
  • pharmacologic agents
  • minor debridement or major debridement
  • sequestrectomy
  • resection
46
Q

primary epidermoid carcinoma known as?

A

SCCa

47
Q

benign vs malignant changes and tooth displacement?

A

bening will displace teeth, malignant may not

48
Q

benign vs malignant changes and the periosteum/cortex?

A

bening causes a onion skin reaction (proliferation of periosteum), malignant causes a blow out of cortex

49
Q

malignancies radio app

A
50
Q

Commonality of Oral Malignancies

A
  1. Primary carcinoma (alveolar and mucosal), most common
  2. Metastatic carcinoma
  3. Others; lymphomas, sarcomas, etc.
51
Q

Primary Intra-Alveolar Epidermoid Carcinoma Clinical
* Normally?
* Discovered how?

A
  • Normally asymptomatic
  • Discovered on routine oral examination
52
Q

Primary Intra-Alveolar Epidermoid
Carcinoma Radiographic findings
1. trabecular pattern?
2. margins?
3. growth rate?
4. PDL ?

A
  1. Rarified trabecular pattern
  2. Radiolucency with ill-defined, irregular
    margins
  3. Rapid growth
  4. Wide PDL (irregular)
53
Q

rarefied pattern

A
54
Q

desrcribe the trabeculae

A

rarefied

55
Q

are these central or perihperal lesions

A

peripheral

56
Q

what can be seen here? what should be suspected?

A

widened PDL, SCCa (Primary Intra Alveolar Epidermoid Carcinoma)

57
Q

Primary Intra-Alveolar Epidermoid Carcinoma
Management

A

radiation therapy, surgery, both

58
Q

METASTATIC CARCINOMA at jaws commonality?

A

<1% of malignancies metastasize to the
jaws

59
Q

ROUTES OF SPREAD for metastasis

A
  • LOCAL INVASION: growth into adjacent tissue and soft nerves
  • LYMPHATIC SPREAD: enter draining lymphatic vessels and then to local lymph nodes where the tumor grows
  • VASCULAR SPREAD: via veins draining the primary lesion. GI tumors to portal veins-liver. Most common in lung, bone marrow, brain and adrenal glands.
  • TRANSCOELOMIC SPREAD: primary tumor in abdominal cavity or thorax and then spreads via peritoneal or pleural fluids. Start on surfaces and seed to organs in the area
60
Q

Metastatic Tumors
Pathophysiology

A
  • Usually there is a history of a primary tumor but occasionally the metastatic lesion is the initial presentation of the disease
61
Q

metastatic carcinomas commonality in the oral cavity

A

2nd most common oral malignancy

62
Q

Metastatic Tumors
Clinical

A
  • May have no history of pain or previous malignancy
  • Bone pain, paresthesia, tooth mobility, swelling and soft tissue masses
63
Q

Metastatic Tumors Radiographic app
1. Usual app?
2. expansion?
3. Some tend to appear as? which ones?

A
  1. Usually poorly defined with ragged borders
  2. May be expansive
  3. Some tend to be mixed radiolucent- radiopaque lesions; thyroid, prostate, breast
64
Q

teeth and metastasis

A

can be dsiplaced by the mass (supererupted, drift, etc.)

65
Q

metastasis growth rates

A

rapid growth occurs like other malignancies

66
Q

prevalence metastatic tumors of the jaw

A

~ 1.8 x 106 - 10 malignant osseous tumors in skull & jaws
less than 1% of malignancies metastasize to the jaw

67
Q

metastasis in jaw arch ratio

A

mandible:maxilla is 7:1

68
Q

age for metastasis to the jaw

A

40-80 years of age; mean age 56 years

69
Q

gender predilection for metastasis to jaw

A

based on tumor type

70
Q

Metastatic Tumors
Management

A

Management by tumor board
Treatment may include surgery, radiation, and/or
chemotherapy
Ultimate decisions are dependent on the type of
primary malignancy and the decision of the multi-
disciplinary tumor board

RADIO INTERPRETATION (18 decks)

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