W6 - Soft Tissue Calcification Part II - Amar Flashcards
general note**
Always add negative findings when describing pathology
Ex. “no evidence of calcification”
What is a phlebolith?
Calcified thrombi found in vasculature of cavernous hemangiomas
- in the head and neck regions, phleboliths always indicate the presence of hemangioma
- Most frequently seen in cheek
multiple phleboliths in cavernous hemangioma
- radiograph of pts cheek
multiple phleboliths on RHS
Describe the periphery and shape of phleboliths
Round/oval shape
Up to 6mm in diameter
Smooth periphery
Describe the internal structure of phleboliths
- Can appear as homogeneously radiopaque
- More frequently - laminations - bulls eye look
- May have radiolucent centre - remaining patent portion of vessel
Why is diagnosing phleboliths important for dentists?
Identifying phleboliths will identify possible vascular lesion (haemangioma)
- Critical if surgical procedures are in tx plan
Where is the triticeous cartilage?
between greater cornu of hyoid and superior horn of thyroid cartilage
What causes triticeous cartilage calcifications?
Age
Periphery and shape of triticious cartilage calcification
7-9 mm in length
2-4 mm in width
Periphery is well-defined and smooth
Where does triticious cartilage calcification appear radiographically? (OPG)
Within pharyngeal air space
Inferior to greater cornu of hyoid
Adjacent to superior border of C4
Triticeous cartilage
Differential diagnosis of calcified triticeous cartilage
Managment of calcified triticeous cartilage
No tx required
What are the arrows pointing towards?
Black - epiglottis
White - Thyroid cartilage
Rhinolith vs Antrolith
Rhinolith
- in nose
- deposition of mineral salts around nidus
- nidus is exogenous foreign body (ex. bead)
Antrolith
- in antrum
- deposition of mineral salts around nidus
- nidus is endogenous (root tip, bone fragment)
Symptoms of rhinolith/antrolith
- Initially asymptomatic
- As it grows → pain, congestion, ulceration
- Unilateral purulent rhinorrhea
- Sinusitis
- Headace
- Epistaxis
- Nasal obstruction
rhinolith
Periphery and shape of rhinolith
Variety of shapes and sizes
Well-defined smooth or irregular borders
antrolith
antrolith
rhinolith
Differential diagnosis of rhinolith and antrolith
Osteoma
Root fragments
Managment of rhinolith / antrolith
Referral to GP / ENT
What are the 3 conditions associated with ossification of the styloid ligament
If it measures more than 30 mm → pathology
Styloid chain ossification
Eagle’s syndrome
Styloid syndrome
Pt is >40 yo
Hard pointed structure discovered via palpation over tonsil
Symptomless
Dx?
Styloid chain ossification
Giveaway is the asymptomatic
Pt has vague nagging to intense pain in pharynx when swallowing, turning head and opening mouth (yawn)
Pt had tonsillectomy recently
Dx?
Eagle’s Syndrome
- Elongated styloid process pressing on scar tissue from neck trauma causes symptoms by pressing on glossopharyngeal nerve
Pt has vague nagging to intense pain in pharynx when swallowing, turning head and opening mouth (yawn)
No history of trauma
Pt has attacks of otalgia, tinnitus, temporal headaches and vertigo
Dx?
Stylohyoid (carotid artery) syndrome
What causes the pain and symptoms in stylohyoid syndrome
Mechanical irritation of sympathetic nerve tissue in arterial wall
- causes regional carotidynia (unilateral tenderness of carotid artery)
Could be:
- Styloid chain ossification
- Eagle’s syndrome
- Stylohyoid syndrome
Depending on pt history
Significance of size of these calcifications
Doesn’t matter
May or may not induce symptoms
Depends on whether its impinging on glossopharyngeal nerve
Could be:
- Styloid chain ossification
- Eagle’s syndrome
- Stylohyoid syndrome
Depending on pt history
Describe the internal structure of styloid ligament ossification conditions
Homogenously radiopaque
Differential diagnosis of styloid process conditions
TMJ - pain on opening
However, ther will be no radiographic evidence for TMJ
Managment of styloid conditions
Referral to ENT for amputation of stylohyoid process
Nothing wrong
Normal variation of mx sinus
Nothing wrong
Normal variation of maxillary sinus
Features of mucositis (symptoms, tx, radiographic appearance)
- Asymptomatic
- No tx required
- R/F - non corticated band paralleling the bony wall of the sinus
Mucositis
2-4mm is normal
>4 mm is pathological mucositis (still asymptomatic)
Maxillary sinusitis
What is it?
Causes?
Generalised inflammation of sinus mucosa
Caused by allergens, bac, virus
Inflammation from dental origin in 10% of cases - will require dental tx
What is pansinusitis?
All sinuses involved
Acute vs chronic sinusitis
Acute - <2 weeks
Chronic - >3 months
Clinical features of acute sinusitis
- Stuffiness
- Clear nasal discharge or pharyngeal drainage
- Pain/tenderness/swelling over involved sinus
- Effect on dental aspect
Dental manifestations of acute sinusitis
- Pain may be referred to premolar and molar teeth on affected side
- Teeth may be TTP
- Nothing wrong with teeth (vital, healthy)
What to do in clinic to ensure acute sinusitis is not actually dental related
- Get pt to jump → if this causes pain in tooth → sinus problem
- No caries
- No perio pockets
Clinical features of chronic sinusitis
No external signs
Except during periods of acute exacerbations → increased pain and discomfort
How can you test for chronic sinusitis clinically
Ask pt to bend down head for 2-3 minutes,
Ask if they have pain in the mx sinus area
Palpate each side individually and ask if there is pain
Radiographic features of sinusitis (5)
- Localised mucosal thickening on sinus floor
- Generalised thickening around entire wall of sinus
- Complete radiopacity of sinus
- Uniform cloudiness in sinus
- Fluid level seen (lowest portion of sinus)
Sinusitis
note the cloudiness and haze
Treatment for sinusitis
Refer to GP / ENT
Sinusitis
Air-fluid level in mx sinus
How are retention pseudocysts formed
Blockage of secretory ducts of seromucous glands in sinus mucosa
- Ducts in sinus frequently get blocked in winter (cold) → mucin builds up
Retention pseudocyst
Why is it a pseudocyst
Symptoms
Tx
Pseudocyst bc it does not have epithelial lining
Asymptomatic until if completely fills mx sinus
No tx required - self limiting
Radiographic appearance of retention pseudocyst
- ranges from finger tip size to full sinus
- Non corticated, dome shaped radiopacity in the antrum
Retention pseudocyst
Retention pseudocyst
Retention pseudocyst
Treatment of retention pseudocyst
If small - no tx, CBCT not required, recommended monitoring if symptomatic
If large - CBCT and remove vis endoscopic sinus surgery and curettage
Features of mucocele
Symptoms
Location
Cause
- Painful, expanding, destructive lesion
- Ethmoidal, frontal and maxillary sinuses
- Caused by a blocked sinus ostium
Where does the mx sinus open
Middle meatus
Mucocele
- note the radiopacity causing expansion and thinning of the walls
Pneumatization of mx sinus
- normal response to extracted teeth
What should be written on radiograph report regarding pneumatisation of sinus
Exam question
“if extractions or implants or any surgical intervention in this area, there is maxillary sinus pneumatisation- take special care”
Pneumsatisation of maxillary sinus (RHS)
*notice it dropping down
Periostitis
- Sinus floor has lifted as result of inflammation
- will drop back down after inflammation is resolved
How to differentiate a cyst from the floor of the antrum
Cyst - borders are smooth, straight, clear outline
Sinus - irregular outline
Aspiration yield yellow straw colored fluid & subsequent injection
of radiopaque contrast medium will remain in the cyst rather than
drain out through the ostium
Periapical cyst
- Uniform radiolucency bordered by thin well defined radiopaque margin that pushes mx sinus upward
- Non vital tooth
Write an OPG report
Periapical cyst
- Uniform radiolucency bordered by thin well defined radiopaque margin that pushes mx sinus upward
- Non vital tooth
