solitary opacities Flashcards
exostoses
Are hamartomous masses of mostly cortical bone, arising from the bone surface. They may incorporate a small amount of internal cancellous bone.
Exostosis locations?
a. Most commonly on?
b. Less commonly on?
a. Most commonly on the buccal surfaces of the maxillary alveolar processes, usually in the canine or molar area.
b. Less commonly on the palatal surface of the alveolar bone
exotosis
1. size, number?
2. shapes?
3. Always covered with? palpation?
4. gender? age?
- May attain a large size, may be solitary or multiple.
- May be flat, nodular or pedunculated.
- Always covered with mucosa and are bony hard on palpation.
- Male predominance and increase frequency with age
EXOSTOSES Imaging Features
1. Location. .
2. Periphery.
- Location:
* The maxillary alveolar process is the most common location. In PAs they are superimposed over the roots of the adjacent teeth. - Periphery:
* Well defined with a curved border.
exotosis
exotosis
EXOSTOSES imaging features
3. Internal structure.
4. Effects on adjacent structures.
5. Effects on adjacent teeth.
6. Management
- Internal structure.
* Usually is homogeneous and radiopaque.
* Although when large it can have an internal cancellous bone, they most often consist only of cortical bone. - Effects on adjacent structures.
* Continuous with the bone surface. - Effects on adjacent teeth.
* No effects. - Management
* No treatment required
exotosis with cancellous interior
exotoses at alveolar crest
exotoses
subpontic hyperostosis
Torus
Is an exostosis that may occur in the midline of the hard palate (torus palatinus) or the lingual surface of the mandible (torus mandibularis).
possible etiologies for tori
*It has been hypothesized that genetic and environmental factors may be involved in the development of torus mandibularis, with masticatory forces being reported as an essential factor underlying formation
Torus Clinical Features
* The torus palatinus: % population
* Mandibular tori: % population
* gender
* Age and developement
- The torus palatinus: ~20% of the population
- Mandibular tori: ~8% of the population.
- Twice as often in women as in men.
- Although tori may be discovered at any age, it is rare in children. They usually develop in young adults before 30 years of age, and they may continue to enlarge slowly during a lifetime
Torus
Clinical Features
* The number, size, and shape of tori?
*Palatal tori?
*These lesions have been described as being?
- The number, size, and shape of tori can vary
broadly.
*Palatal tori: The base is in the palate and the
bulk extends downward into the oral cavity.
*These lesions have been described as being
flat, lobulated or nodula
tori
tori and exotosis
Torus
Clinical Features
*In the mandible, single or multiple? unilateral or bilateral? most common location?
*Mandibular tori can also vary in?
* what covers the bony mass? may appear? Consequently?
*Patients unaware of having tori? may believe?
*In the mandible, single or multiple tori can develop, and they can be unilateral or bilateral, most often developing in the premolar region
*Mandibular tori can also vary in size, ranging from an outgrowth that is barely palpable to one that contacts a torus on the opposite side.
*Normal mucosa covers the bony mass, and the mucosa may be thin and appear pale. Consequently, if traumatized, the mucosa may easily ulcerate.
*Patients often are unaware of having tori, and sometimes, patients who do discover them may insist that they have arisen suddenly and have grown rapidly.
Torus Imaging Features
Location:
* On maxillary periapical or panoramic images?
*On mandibular periapical images?
- On maxillary periapical or panoramic images, a torus palatinus appears as a well-defined, oval, dense radiopaque structure superimposed over the crowns and/or roots of the maxillary premolar and molar dentition
*On mandibular periapical images, a torus mandibularis appears as a well-defined, oval, radiopaque entity, usually superimposed on the roots of premolars and molars and occasionally over a canine or incisor
torus palatinus
torus mandibularis
torus palatinus
torus mandibularis
film bent, not a torus
torus palatinus
Torus
Effects on adjacent structures?
* Effects on adjacent teeth?
* Management?
Effects on adjacent structures:
Tori are continuous with the bone surface from which they are arising.
* Effects on adjacent teeth:
Tori have no effects on the teeth.
* Management:
Tori do not usually require treatment, although removal may be necessary to accommodate a removable denture.
Idiopathic osteosclerosis
Disease Mechanism
Clinical Features
Disease Mechanism
* A.K.A: Dense bone islands (DBI) or enostosis
*Are the “internal counterparts” of exostoses
* Represent localized growths of cortical bone into the
cancellous bone.
Clinical Features: Asymptomatic.
idiopathic osteosclerosis
Idiopathic osteosclerosis Imaging Features
Location:
*More common in?
*Most often where?
* Their presence does not correlate with?
*More common in the mandible than in the maxilla
*Most often in the premolar and molar areas
* Their presence does not correlate with the presence or absence of teeth.
idiopathic ostesclerosis
Idiopathic osteosclerosis
Periphery:
Internal structure:
Effects on adjacent structures:
.
Periphery:
* DBIs directly abut adjacent normal bone with a well defined the periphery that blends with the trabeculae of the surrounding bone.
Internal structure:
* The internal pattern of DBIs can vary from a ground glass-like pattern to one that is uniformly radiopaque
Effects on adjacent structures:
* There are no effects on adjacent structures.
idiopathic osteosclerosis
Idiopathic osteosclerosis or dense bone island
Effects on adjacent teeth:
Effects on adjacent teeth:
A DBI located periapical to a tooth root can (but rare) induce external root resorption
In all circumstances, the tooth pulp is vital, and the root resorption appears to be self-limiting. A visible periodontal ligament space may be visible between the resorbed tooth root and the DBI
idiopathic osteosclerosis dif dx
- When a DBI is located at a root apex, it may resemble periapical sclerosing osteitis.
- Dense bone islands may also have similarities to periapical cemento-osseous dysplasia, or hypercementosis or cementoblastoma.
Idiopathic osteosclerosis or dense bone island Management
DBI does not require treatment. If multiple DBIs are present, the patient’s family history should be reviewed for the presence of colonic polyps
this pt’s hx should be reviewed for?
colon polyps
Osteoma
Disease Mechanism
* It is unclear whether osteomas are?
*Radiologic appearances similar to?
* Osteomas develop from? may occur where?
- It is unclear whether osteomas are hamartomas or neoplasms.
*Radiologic appearances similar to dense bone
islands, exostosis, and tori. - Osteomas develop from the periosteum and may occur either externally on a bone surface or within the paranasal sinuses (most commonly frontal sinuses or ethmoidal air cells)
frontal sinus osteoma
osteoma
Osteoma Clinical Features
* ages?
* solitary or multiple? occurr on a single bone or on numerous bones?
* The osteomas are attached to the cortex of the jaw by?
* When osteomas develop on a bone surface, a patient may perceive? swelling pain?
* Structurally divisions?
- Can occur at any age but are most commonly >40 years.
- Can be solitary or multiples, occurring on a single bone or on numerous bones.
- The osteomas are attached to the cortex of the jaw by a pedicle or along a wide base.
- When osteomas develop on a bone surface, a patient may perceive a hard swelling. The swelling is painless until its size or position interferes with function.
- Structurally, osteomas can be divided into three types: lesions composed of cortical bone (also called ivory osteomas); lesions composed of cancellous bone;
and lesions composed of a combination of both.
Osteoma Imaging Features
1. Location (more common arch? where?)
- Location.
* The mandible is more commonly involved than the maxilla.
* Most frequently on the medial surface of the ramus or on the inferior border of the mandible.
most likely?
osteoma
Osteoma
2. Periphery.
3. Internal structure.
4. Effects on surrounding structures.
- Periphery.
* Have a well-defined borders. - Internal structure.
* Osteomas composed solely of cortical bone are
uniformly radiopaque
* Osteomas containing cancellous bone show
internal trabecular structure. - Effects on surrounding structures.
* Large lesions can displace adjacent soft tissues,
such as the muscles of mastication, and cause jaw
dysfunction.
osteoma
Osteoma
Differential Interpretation
*A small osteoma may be similar in
appearance to large hyperostosis or
torus
osteoma management
Unless the osteoma interferes with normal function or presents a cosmetic problem, this lesion may not require treatment. In such cases, the osteoma should be kept under observation.
Resection of osteomas is possible but may be difficult if the osteoma is of the cortical (ivory) type
ivory osteomas
completely cortical bone
mixed osteoma
Gardner syndrome Disease Mechanism
- Multiple of what lesions may be present
- Characterized by the development of?
- Increased frequency of?
- Multiple osteomas (usually appearance in the second decade of life) are a feature of Gardner syndrome, as are multiple dense bone islands, epidermoid cysts, and subcutaneous desmoid tumors.
- Characterized by the development of multiple colonic polyps (higher risk for developing colon cancer)
- Increased frequency of supernumerary and impacted teeth, and odontomas may also occur in Gardner syndrome
management of gardner syndrome
- Early diagnosis.
- Multiple osteomas + family history of colorectal cancer = Physician referral for examination of intestinal polyposis and management
likely dx?
gardner syndrome
ODONTOMA Disease Mechanism
* Is a? characterized by?
* Complex odontoma?
* Compound odontoma?
* Dilated odontoma?
- Is a hamartoma that is characterized by the production of mature enamel, dentin, cementum, and pulp tissue.
- Complex odontoma: A nondescript and heterogeneous mass of the dental hard tissues.
- Compound odontoma: Multiple well-formed teeth
(denticles) referred to as a compound odontoma. - Dilated odontoma: may also be a severe expression of a dens in dente
compound odontoma
odontoma
- commonlaity? effect on eruption?
- Most form while the dentition is developing when?
- increase in size?
- Compound vs complex occurence
- Compound odontoma gender?
- Complex gender?
- eruptions?
- Very common and often they interfere with the eruption of permanent teeth
- Most form while the dentition is developing in the 2nd decade of life.
- Left unidentified or untreated, odontomas will not increase in size.
- Compound odontomas are about twice as common as the complex type.
- Compound odontoma: equal in men and women
- Complex: 60% in women
- In very rare circumstances, a compound odontoma may erupt into the mouth
complex odontoma
ODONTOMA Imaging Features
Location:
- The majority of compound odontomas occur in? %?
- % of complex odontomas are found in the?
Periphery:
Internal structure.
- Compound odontoma:
- Complex odontomas :
- A dilated odontoma?
Location:
- The majority of compound odontomas (62%) occur in the anterior maxilla
- 70% of complex odontomas are found in the mandibular first and second molar area
Periphery:
- The borders of odontomas are well defined, with an irregular periphery, surrounded by a radiolucent rim and have a cortical border.
Internal structure.
- Compound odontoma: Radiopaque (toothlike structures or denticles ).
- Complex odontomas contain an irregular, but somewhat more homogeneous mass of calcified tissue. The density of the mineralized matrix within these lesions may vary, reflecting differences in the amount and type of hard tissue that has been formed.
- A dilated odontoma has a single calcified structure with a more radiolucent central portion that has an
overall form similar to a doughnut
compound odontoma
complex odontoma
dialted odontoma
compound odontoma
dialated odontoma
ODONTOMA
Effects on surrounding structures?
Effects on adjacent teeth?
Management?
Effects on surrounding structures:
- Large odontomas may cause expansion of bone, but with maintenance of the cortical boundary.
Effects on adjacent teeth:
- Odontomas can interfere with the normal eruption of teeth, and most (70%) are associated with impacted.
Management:
- Odontomas are removed by simple excision. They do not recur and are not locally invasive.
Fibrous dysplasia (monostotic) dx mech
- Is a bone dysplasia
Disease Mechanism:
- Altered bone metabolism
- Cancellous bone is replaced by fibrous connective tissue containing varying amounts of immature, abnormal bone.
- Compared with normal bone, there are more trabeculae per unit volume
monostotic FD typical pattern
unilateral (single bone)
mst common sites mono FD
ribs, femur, tibia, maxilla, and mandible
typical demo of mono FD
when does lesion growth cease?
Discover in young individuals (approximately from 12 years of age)
- The lesions usually become static when skeletal growth ceases
mono FD lesions may become active during:
pregnancy or with the use of oral contraceptives
gender predilection of mono FD
none
symptoms of mono FD
- Most of the times is mild and asymptomatic. However, patients with jaw involvement may first complain of unilateral facial swelling or an enlarging deformity of the alveolar process.
- If craniofacial lesions involve the skull base, the bone changes may impinge on neural foramina
Fibrous dysplasia (monostotic) Imaging Features
Location:
- Maxilla:Mandible (2:1) and frequently seen in the more posterior regions
mono FD radio image periphery
Commonly poorly defined, with a gradual and broad transition between the dysplastic and normal bone.
- Occasionally the boundary between the dysplastic and normal bone can appear better defined and even corticated, especially in young lesions
mono FD effect on cortex
can expand/ thin it
fibrous dysplasia likely
Fibrous dysplasia (monostotic)
Internal structure (radiogrpah)
- The internal density may be radiolucent, radiopaque, or a mixture of both compared with normal bone.
*Granular appearance (ground-glass), a pattern resembling the surface of an orange, a wispy arrangement (cotton wool), an amorphous pattern or pattern similar to a fingerprint
what could present both these ways?
FD
what is pathgnomic for FD in furcations?
“fingerprint” pattern
what are the lucencies when FD app as “cotton wool”
simple bone cysts
where is the pathology? what could it be?
L man and max in the posterior: ground glass app, failed PM eruption in maxilla, thinning man cortex, likely FD
mono FD
most likely lesion?
mono FD, cotton wool app
Fibrous dysplasia (monostotic)
Effects on surrounding structures:
* small lesions?
*cortex?
* sinus?
* dentition?
* lamina dura/PDL?
* IAN?
- If the lesion is small, it may have no effect on surrounding structures.
- Expansion and intact thinned-outer cortex, affecting the bone more evenly along its length.
- May expand into the sinus by displacing its cortical boundary
- Usually do not affect the dentition. However, it can displace teeth or interfere with normal eruption.
- The lamina dura disappears because this bone also is changed into the abnormal bone pattern. A very narrow PDL space is seen.
- Fibrous dysplasia appears to be unique in its ability to displace the inferior alveolar nerve canal in a superior direction
likely lesion?
mono FD
sinus shape with mono FD
shape is kept but will decrease in size
Fibrous dysplasia (monostotic)
Management:
* lesion during surgical intervention?
*CT imaging can be used for?
*Occasional monitoring?
*Orthodontic treatment and cosmetic surgery?
*Sarcomatous changes?
*In female hormonal changes?
*Growth from stimulation of a lesion during surgical intervention in young patients have been reported.
*CT imaging can be used baseline study for future comparisons.
*Occasional monitoring of the lesion or ask the patient to report any changes (with most lesions, growth is complete at skeletal maturation).
*Orthodontic treatment and cosmetic surgery may be limited or delayed.
*Sarcomatous changes are unusual but have been reported, especially if therapeutic radiation has been administered (malignancies)
*In female hormonal changes (pregnancy or oral contraceptives) may stimulate growth
FD, unilateral affected
excision sometime required
compound odontoma
usually destroys cortical bundries (FD does not0
