Ragged Radiolucencies Flashcards
What are the 5 ragged RLs seen in radiography of mouth?
➢Chronic Osteomyelitis ➢Osteoradionecrosis ➢Bisphosphonate Osteonecrosis ➢Primary Epidermoid Carcinoma ➢Metastatic Disease
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“ragged”
Other names for ________:
Chronic Alveolar Abscess
Chronic Dentoalveolar Abscess
a.k.a.
Chronic Osteitis
Chronic Osteomyelitis
• Localizes inflammation and infection of alveolar bone, consequently it will be; - around teeth - generally milder than acute osteomyelitis
Chronic osteomyelitis
• inflammation of alveolar bone caused by
pathogenic organisms
Osteitis
• inflammation of alveolar and basal bone
caused by pathogenic organisms
Osteomyelitis
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…
Chronic osteomyelitis
How many days denote the cutoff for acute or chronic osteomyelitis?
30 days
- <30=acute
> or equal to 30= chronic
Predisposing Factors of ______
- Reduced vascular supply; diabetes, PCOD, FCOD, osteopetrosis, Pagets, etc…
- Immunodeficient states: AIDS, leukemia, corticosteroid treatment, malnutrition, bisphosphonates, other medications
- Odontogenic infection, trauma, surgery
Chronic osteomyelitis
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
Chronic osteomyelitis
What are the demographics of chronic osteomyelitis?
-Age, gender, site
Age 40-80 years of age Site Body of mandible Predominant Gender Males
Management of ______
• Debride any necrotic tissue
• Antibiotic therapy
• Drain and irrigate the region
-difficult to treat
Chronic osteomyelitis
Are dentoalveolar abscesses the same thing as chronic osteomyeltitis?
No; chronic osteomyelitis is much worse
What is the classic triad of osteoradionecrosis?
Radiation Therapy
Trauma
Infection
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
Osteoradionecrosis
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
ORN
What are the demographics of ORN?
Age 40-80 years of age. Site Body of mandible Predominant Gender More common in males
Management of _______
Hyperbaric oxygen. Surgical debridement,
resection of nonviable tissues, and antibiotics.
Other
Predisposing conditions: previous radiation,
trauma, diabetes, Pagets disease
ORN
\_\_\_\_\_ tumors poorly defined borders ragged irregular borders rapid growth follow path of least resistance Perf quickly
Malignant tumors
What is most common tumor of jaws?
- Primary carcinoma
alveolar and mucosal
What is second most common tumor of jaw?
Metastatic carcinoma
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)
- Primary carcinoma
alveolar and mucosal
Management of ________
radiation therapy
surgery
both
Primary carcinoma
<1% of malignancies metastasize to the
jaws
Metastatic carcinoma
growth into adjacent
tissue and soft nerves
LOCAL INVASION:
: enter draining
lymphatic vessels and then to local
lymph nodes where the tumor grows
LYMPHATIC SPREAD:
via veins draining the primary lesion. GI tumors to
portal veins-liver. Most common in lung, bone
marrow, brain and adrenal glands.
VASCULAR SPREAD:
(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.
TRANSCOELOMIC SPREAD:
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
Metastatic tumors
What are the demographics for metastatic carcinomas?
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
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
Metastatic tumors
