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DS4101 > W6 - Soft Tissue Calcification Part II - Amar > Flashcards

W6 - Soft Tissue Calcification Part II - Amar Flashcards

1
Q

general note**

A

Always add negative findings when describing pathology

Ex. “no evidence of calcification”

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2
Q

What is a phlebolith?

A

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
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3
Q
A

multiple phleboliths in cavernous hemangioma

  • radiograph of pts cheek
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4
Q
A

multiple phleboliths on RHS

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5
Q

Describe the periphery and shape of phleboliths

A

Round/oval shape

Up to 6mm in diameter

Smooth periphery

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6
Q

Describe the internal structure of phleboliths

A
  • Can appear as homogeneously radiopaque
  • More frequently - laminations - bulls eye look
  • May have radiolucent centre - remaining patent portion of vessel
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7
Q

Why is diagnosing phleboliths important for dentists?

A

Identifying phleboliths will identify possible vascular lesion (haemangioma)

  • Critical if surgical procedures are in tx plan
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8
Q

Where is the triticeous cartilage?

A

between greater cornu of hyoid and superior horn of thyroid cartilage

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9
Q

What causes triticeous cartilage calcifications?

A

Age

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10
Q

Periphery and shape of triticious cartilage calcification

A

7-9 mm in length

2-4 mm in width

Periphery is well-defined and smooth

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11
Q

Where does triticious cartilage calcification appear radiographically? (OPG)

A

Within pharyngeal air space

Inferior to greater cornu of hyoid

Adjacent to superior border of C4

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12
Q
A

Triticeous cartilage

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13
Q

Differential diagnosis of calcified triticeous cartilage

A
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14
Q

Managment of calcified triticeous cartilage

A

No tx required

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15
Q

What are the arrows pointing towards?

A

Black - epiglottis

White - Thyroid cartilage

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16
Q

Rhinolith vs Antrolith

A

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)
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17
Q

Symptoms of rhinolith/antrolith

A
  • Initially asymptomatic
  • As it grows → pain, congestion, ulceration
  • Unilateral purulent rhinorrhea
  • Sinusitis
  • Headace
  • Epistaxis
  • Nasal obstruction
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18
Q
A

rhinolith

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19
Q

Periphery and shape of rhinolith

A

Variety of shapes and sizes

Well-defined smooth or irregular borders

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20
Q
A

antrolith

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21
Q
A

antrolith

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22
Q
A

rhinolith

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23
Q

Differential diagnosis of rhinolith and antrolith

A

Osteoma

Root fragments

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24
Q

Managment of rhinolith / antrolith

A

Referral to GP / ENT

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25
Q

What are the 3 conditions associated with ossification of the styloid ligament

A

If it measures more than 30 mm → pathology

Styloid chain ossification

Eagle’s syndrome

Styloid syndrome

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26
Q

Pt is >40 yo

Hard pointed structure discovered via palpation over tonsil

Symptomless

Dx?

A

Styloid chain ossification

Giveaway is the asymptomatic

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27
Q

Pt has vague nagging to intense pain in pharynx when swallowing, turning head and opening mouth (yawn)

Pt had tonsillectomy recently

Dx?

A

Eagle’s Syndrome

  • Elongated styloid process pressing on scar tissue from neck trauma causes symptoms by pressing on glossopharyngeal nerve
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28
Q

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?

A

Stylohyoid (carotid artery) syndrome

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29
Q

What causes the pain and symptoms in stylohyoid syndrome

A

Mechanical irritation of sympathetic nerve tissue in arterial wall

  • causes regional carotidynia (unilateral tenderness of carotid artery)
30
Q
A

Could be:

  1. Styloid chain ossification
  2. Eagle’s syndrome
  3. Stylohyoid syndrome

Depending on pt history

31
Q

Significance of size of these calcifications

A

Doesn’t matter

May or may not induce symptoms

Depends on whether its impinging on glossopharyngeal nerve

32
Q
A

Could be:

  1. Styloid chain ossification
  2. Eagle’s syndrome
  3. Stylohyoid syndrome

Depending on pt history

33
Q

Describe the internal structure of styloid ligament ossification conditions

A

Homogenously radiopaque

34
Q

Differential diagnosis of styloid process conditions

A

TMJ - pain on opening

However, ther will be no radiographic evidence for TMJ

35
Q

Managment of styloid conditions

A

Referral to ENT for amputation of stylohyoid process

36
Q
A
37
Q
A

Nothing wrong

Normal variation of mx sinus

38
Q
A

Nothing wrong

Normal variation of maxillary sinus

39
Q

Features of mucositis (symptoms, tx, radiographic appearance)

A
  • Asymptomatic
  • No tx required
  • R/F - non corticated band paralleling the bony wall of the sinus
40
Q
A

Mucositis

2-4mm is normal

>4 mm is pathological mucositis (still asymptomatic)

41
Q

Maxillary sinusitis

What is it?

Causes?

A

Generalised inflammation of sinus mucosa

Caused by allergens, bac, virus

Inflammation from dental origin in 10% of cases - will require dental tx

42
Q

What is pansinusitis?

A

All sinuses involved

43
Q

Acute vs chronic sinusitis

A

Acute - <2 weeks

Chronic - >3 months

44
Q

Clinical features of acute sinusitis

A
  • Stuffiness
  • Clear nasal discharge or pharyngeal drainage
  • Pain/tenderness/swelling over involved sinus
  • Effect on dental aspect
45
Q

Dental manifestations of acute sinusitis

A
  • Pain may be referred to premolar and molar teeth on affected side
  • Teeth may be TTP
  • Nothing wrong with teeth (vital, healthy)
46
Q

What to do in clinic to ensure acute sinusitis is not actually dental related

A
  • Get pt to jump → if this causes pain in tooth → sinus problem
  • No caries
  • No perio pockets
47
Q

Clinical features of chronic sinusitis

A

No external signs

Except during periods of acute exacerbations → increased pain and discomfort

48
Q

How can you test for chronic sinusitis clinically

A

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

49
Q

Radiographic features of sinusitis (5)

A
  • 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)
50
Q
A

Sinusitis

note the cloudiness and haze

51
Q

Treatment for sinusitis

A

Refer to GP / ENT

52
Q
A

Sinusitis

Air-fluid level in mx sinus

53
Q

How are retention pseudocysts formed

A

Blockage of secretory ducts of seromucous glands in sinus mucosa

  • Ducts in sinus frequently get blocked in winter (cold) → mucin builds up
54
Q

Retention pseudocyst

Why is it a pseudocyst

Symptoms

Tx

A

Pseudocyst bc it does not have epithelial lining

Asymptomatic until if completely fills mx sinus

No tx required - self limiting

55
Q

Radiographic appearance of retention pseudocyst

A
  • ranges from finger tip size to full sinus
  • Non corticated, dome shaped radiopacity in the antrum
56
Q
A

Retention pseudocyst

57
Q
A

Retention pseudocyst

58
Q
A

Retention pseudocyst

59
Q

Treatment of retention pseudocyst

A

If small - no tx, CBCT not required, recommended monitoring if symptomatic

If large - CBCT and remove vis endoscopic sinus surgery and curettage

60
Q

Features of mucocele

Symptoms

Location

Cause

A
  • Painful, expanding, destructive lesion
  • Ethmoidal, frontal and maxillary sinuses
  • Caused by a blocked sinus ostium
61
Q

Where does the mx sinus open

A

Middle meatus

62
Q
A

Mucocele

  • note the radiopacity causing expansion and thinning of the walls
63
Q
A

Pneumatization of mx sinus

  • normal response to extracted teeth
64
Q

What should be written on radiograph report regarding pneumatisation of sinus

Exam question

A

“if extractions or implants or any surgical intervention in this area, there is maxillary sinus pneumatisation- take special care”

65
Q
A

Pneumsatisation of maxillary sinus (RHS)

*notice it dropping down

66
Q
A

Periostitis

  • Sinus floor has lifted as result of inflammation
  • will drop back down after inflammation is resolved
67
Q

How to differentiate a cyst from the floor of the antrum

A

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

68
Q
A

Periapical cyst

  • Uniform radiolucency bordered by thin well defined radiopaque margin that pushes mx sinus upward
  • Non vital tooth
69
Q

Write an OPG report

A
70
Q
A

Periapical cyst

  • Uniform radiolucency bordered by thin well defined radiopaque margin that pushes mx sinus upward
  • Non vital tooth

DS4101 (43 decks)

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