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Radio 2 > Ragged Radiolucencies > Flashcards

Ragged Radiolucencies Flashcards

1
Q

What are the 5 ragged RLs seen in radiography of mouth?

A 
➢Chronic Osteomyelitis
➢Osteoradionecrosis
➢Bisphosphonate Osteonecrosis
➢Primary Epidermoid Carcinoma
➢Metastatic Disease
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2
Q 
Features of \_\_\_\_\_ bony disease
Radiographic
• Irregular sclerotic trabeculation
• Cortex changes  – thinning
                               – disruption
• Sequestration
• Fracture (pathologic)
• Periosteal duplication
• Widened PDL
• Minimal displacement of teeth and bony outlines
Clinical
• Edema, purulence
• Increased mass
A

“ragged”

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3
Q

Other names for ________:

Chronic Alveolar Abscess
Chronic Dentoalveolar Abscess
a.k.a.
Chronic Osteitis

A

Chronic Osteomyelitis

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4
Q 
• Localizes inflammation and infection of 
alveolar bone, consequently it will be; 
- around teeth 
- generally milder than acute 
osteomyelitis
A

Chronic osteomyelitis

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5
Q

• inflammation of alveolar bone caused by

pathogenic organisms

A

Osteitis

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6
Q

• inflammation of alveolar and basal bone

caused by pathogenic organisms

A

Osteomyelitis

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7
Q

Pathophysiology of _______
• 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…

A

Chronic osteomyelitis

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8
Q

How many days denote the cutoff for acute or chronic osteomyelitis?

A

30 days
- <30=acute
> or equal to 30= chronic

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9
Q

Predisposing Factors of ______

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

Chronic osteomyelitis

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10
Q 
Clinical Features
• Low grade fever
• Regional lymphadenopathy
• Atrophic ,erythematous mucosa
• Denuded bone
• Suppuration

Radiographic
●radiolucency of variable size with irregular borders
●patches of reactive sclerotic bone
• Moth-eaten appearance
-Sequestration
• With increased chronicity, and a ragged moth-
eaten appearance, there can be pathologic
fracture
• sclerosing, granular trabecular pattern in low-grade
chronic conditions
Tendency for proliferative periostitis

A

Chronic osteomyelitis

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11
Q

What are the demographics of chronic osteomyelitis?

-Age, gender, site

A 
Age
40-80 years of age
Site
Body of mandible
Predominant Gender
Males
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12
Q

Management of ______
• Debride any necrotic tissue
• Antibiotic therapy
• Drain and irrigate the region

-difficult to treat

A

Chronic osteomyelitis

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13
Q

Are dentoalveolar abscesses the same thing as chronic osteomyeltitis?

A

No; chronic osteomyelitis is much worse

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14
Q

What is the classic triad of osteoradionecrosis?

A

Radiation Therapy
Trauma
Infection

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15
Q 
Predisposing factors of \_\_\_\_\_\_\_\_:
• Age
• Type and delivery of 
ionizing radiation
• Tumor site
• Diabetes
• Pagets Disease
• Hypertension
• Pre-existing Oral Status:
untreated dental 
infections (pulpal and/or 
periodontal)
• Dental Extraction 
• Poor-fitting dentures and 
other micro-traumas
A

Osteoradionecrosis

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16
Q 
Clinical
• Mild to intense pain
• Signs of inflammation (swelling, drainage)
• Tissue denudation
- Suppuration

Radiographic
-Areas of increased radiodensity interspersed with
osteolytic regions
- Hx of radiation

A

ORN

17
Q

What are the demographics of ORN?

A 
Age
40-80 years of age.
Site
Body of mandible
Predominant Gender
More common in males
18
Q

Management of _______
Hyperbaric oxygen. Surgical debridement,
resection of nonviable tissues, and antibiotics.
Other
Predisposing conditions: previous radiation,
trauma, diabetes, Pagets disease

A

ORN

19
Q 
\_\_\_\_\_ tumors
poorly defined borders
ragged irregular borders
rapid growth
follow path of least resistance
Perf quickly
A

Malignant tumors

20
Q

What is most common tumor of jaws?

A
  1. Primary carcinoma

alveolar and mucosal

21
Q

What is second most common tumor of jaw?

A

Metastatic carcinoma

22
Q

Clinical
• Normally asymptomatic
• Discovered on routine oral
examination

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

alveolar and mucosal

23
Q

Management of ________
radiation therapy
surgery
both

A

Primary carcinoma

24
Q

<1% of malignancies metastasize to the

jaws

A

Metastatic carcinoma

25
Q

growth into adjacent

tissue and soft nerves

A

LOCAL INVASION:

26
Q

: enter draining
lymphatic vessels and then to local
lymph nodes where the tumor grows

A

LYMPHATIC SPREAD:

27
Q

via veins draining the primary lesion. GI tumors to
portal veins-liver. Most common in lung, bone
marrow, brain and adrenal glands.

A

VASCULAR SPREAD:

28
Q

(Does not occur in oral tumors)
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.

A

TRANSCOELOMIC SPREAD:

29
Q

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

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

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

A

Metastatic tumors

30
Q

What are the demographics for metastatic carcinomas?

A 
Location
mandible:maxilla is 7:1
Age
40-80 years of age; mean age 56 years
Gender
Gender predilection is dependent of the tumor type
31
Q

Management of _______:
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

A

Metastatic tumors

Radio 2 (14 decks)

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