Solitary Radiopacities Flashcards
what are exostoses
hamartomous masses of mostly cortical bone, arising from the bone surface
- may incorporate a small amount of internal cancellous bone
what are the clinical features of exostoses
- most commonly on buccal surfaces of the maxillary alveolar processes, usually in the canine or molar area
- less commonly on the palatal surface of the alveolar bone
- 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 in frequency with age
where are exostoses found
the maxillary alveolar process is the most common location
- in PAs they are superimposed over the roots of adjacent teeth
describe the periphery of exostoses
well defined with a curved border
describe the internal structure of exostoses
usually is homogenous and radiopaque
- although when large it can have an internal cancellous bone, they most often consist only of cortical bone
what are the effects of exostoses on adjacent structure
continuous with bone surface
what are the effects of exostoses on adjacent teeth
no effects
what is the management of exostoses
no tx required
what is a torus
an exostosis that may occur in the midline of the hard palate (torus palatinus) or the lingual surface of the mandible (torus mandibularis)
what is involved in torus developemnt
genetic and environmental factors
- masticatory forces are also an essential factor underlying formation
what are the clinical features of tori
- torus palatinus ~20% of population
- mandibular tori ~8% of population
- twice as often in women as in men
- although tori may be discovered at any age, it is rare in children
- usually develop in young adults before 30 years of age and may continue to enlarge slowly during a lifetime
describe palatal tori
- the base is in the palate and the bulk extends downward into the oral cavity
- these lesions can be flat, lobulated or nodular
where do mandibular tori ususally develop and appear as
- most often in premolar region
- can be single or mulitiple or unilateral or bilateral
describe the mucosa that covers tori
normal mucosa covers bony mass, and the mucosa may be thin and appear plae
- if traumatized the mucosa may easily ulcerate
how does a torus palatinus appear on maxillary periapical or panoramic image
a well-defined, oval, dense radiopaque structure superimposed over the crowns and/or roots of the maxillary premolar and molar dentition
how does a torus mandibularis appear on mandibular periapical inages
well-defined, oval , radiopaque entity, usually superimposed on the roots of premolars and molars and occasionally over a canine or incisor
what are the effects on adjacent structure with tori
tori are continuous with the bone surface from which they are ariseing
describe the effects tori have on adjacent teeth
no effects
what is the management for tori
they do not usually require tx although removal may be necessary to accommodate a removable denture
what is the disease mechanism of idiopathic osteosclerosis
- the “internal counterparts” of exostoses
- represent localized growths of cortical bone into the cancellous bone
what is another name for idiopathic osteosclerosis
dense bone islands (DBI) or enostosis
what are the clinical features of idiopathic osteosclerosis
asymptomatic
what is the location of idiopathic osteosclerosis
- 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
describe the periphery of idiopathic osteosclerosis
- DBIs directly abut adjacent normal bone with a well defined the periphery that blends with the trabeculae of the surrounding bone
describe the internal structure of idiopathic osteosclerosis
the internal pattern of DBIs can vary from a ground glass like pattern to one that is uniformly radiopaque
what are the effects of idiopathic osteosclerosis in adjacent structures
no effects
what are the effects of idiopathic osteosclerosis on adjacent teeth
- A DBI located periapical to a tooth can induce external root resorption
- in all circumstances the tooth pulp is vital and the root resorption appears to be self limiting. a visible periodontal space may be visible between the resorbed tooth root and the DBI
what is the differential interpretation with idiopathic osteosclerosis
- when a DBI is located at a root apex, it may resemble PA sclerosing osteitis
- dense bone islands may also have similarities to PA cemento- osseous dysplasia or hypercementosis or cementoblastoma
what is the management of idiopathic osteosclerosis
- DBI does not require tx
- if multiple DBIs are present the patients family hx should be reviewed for the presence of colonic polyps
what is the disease mechanism for osteoma
- 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 within either externally on a bone surfface or within the paranasal sinuses ( most commonly frontal sinuses or ethmoidal air cells)
what are the clinical features of osteomas
- can occur at any age but are most comonly over 40 years
- can be solitary or multiples occuring 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 the osteomas develop on a bone surface a pt 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
what are the 3 types of osteomas
- lesions composed of cortical bone (also called ivory osteomas)
- lesions composed of cancellous bone
- lesions composed of a combination of bone
what is the location of osteomas
- 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
describe the periphery of osteomas
well defined borders
describe the interal structure of osteomas
- osteomas composed solely of cortical bone are uniformly radiopaque
- osteomas containing cancellous bone show internal trabecular structure
what are the effects of osteomas on surrounding structures
- large lesions can displace adjacent soft tissues, such as the muscles of mastication and cause jaw dysfunction
what is the differential interpretation of osteomas
a small osteoma may be similar in appearance to large hyperostosis or torus
what is the management of osteomas
unless the osteoma interferes with a normal function or presents a cosmetic problem this lesion may not require tx
- in such cases, osteomas should be kept under observation
- resection of osteomas is possible but may be difficult if the osteoma is of the cortical type
what is the disease mechanism of gardner syndrome
- multiple osteomas usually in the second decade of life, mulitple dense bone islands, epidermoid cysts and subcutaneous desmoid tumors
- characterized by the development of multiple colonic polys- higher risk for developing colon cancer
- increased frequency of supernumerary and impacted teeth and odontomas may also occurw
what is the management of gardner syndrome
- early dx
- multiple osteomas and fam hx of colorectal cancer = physicial referral for exam of intestinal polyps and management
what is the disease mechanism of odontomas
- a hamartoma that is characterized by the production of mature enamel, dentin, cementum and pulp tissue
- complex odontomas: a nondescript or heterogenous mass of the dental hard tissues
- compound odontomas: multiple well formed teeth referred to as a compound odontoma
- dilated odontoma: may also be a severe expression of a dens in dente
what are the clinical features of odontoma
- very common and often interfere with the eruption of permanent teeth - may be found during investigations of retained or delayed eruption
- 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 twice as common as the complex type
- compound odontoma: equal in men and women
- complex: 60% in women
- in very rare circumstances, a compound odontomas may erupt into the mouth
what is the location of odontomas
- the majority of compound odontomas (62%) are in the anterior maxilla
- 70% of complex odontomas are found in the mandibular first and second molar area
describe the periphery of odontomas
the borders of odontomas are well defined, an irregular periphery surrounded by a radiolucent rim and have a cortical border
describe the internal structure of odontomas
- compound odontomas: RO
- complex odontomas: contain an irregular but somewhat more homogenous mass of calcified tissue. the density of the minrelzied matrix within these lesions may vary greatly, reflecting differences in the amount and type of hard tissue that has been formed
- a dilated odontoma has a single calfifed structure with a more radiolucent central portion that has an overall form similar to a doughnut
what are the effects of odontomas onsurrounding structures
large odontomas may cause expansion of bone but with maintenance of the cortical boundary
what are the effects of odontomas on adjacent eeth
odontomas can interfere with the normal eruption of teeth and most (70%) are associated with impacted teeth
what is the management of odontomas
odontomas are removed by simple excision
- they do not recur and are not locally invasive
what is fibrous dysplasia (monostotic)
a bone dysplasia
what is the disease mechanism of fibrous dysplasia
- altered bone metabolism
- cancellous bone is replaced by fibrous CT containing varying amounts of immature, abnormal bone
- compared with normal bone there are more trabeculae per unit volume
what are the clinical features of fibrous dysplasia
- most commonly affects skeleton unilaterally
- the most common sites include the ribs, femur, maxilla, and mandible
- discover in youn individuals about 12 years old
- the lesions usually become static when skeletal growth ceases
- lesions may become active during pregnancy or with the use of oral contraceptives
- does not have sex predilection
- most of the times is mild and asymptomatic. pt 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
what is the location of fibrous dysplasia
maxilla: mandible (2:1) and frequently seen in the more posterior regions
describe the periphery of fibrous dysplasia
- commonly poorly deefined 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
describe the internal structure of fibrous dysplasia
- the internal density may be radiolucent , radiopaque or a mixture of both compared to 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 effects on surrounding structures does fibrous dysplasia have
- 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 patter. 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
what is the management of fibrous dysplasia
- 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
- in female hormonal changes (pregnancy or oral contraceptives) may stimulate growth
