Radio Pa Que Lesions

8/6/2019 Radio Pa Que Lesions

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RadioRadio--opaque lesionsopaque lesions

Periapical radiopacities.


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Idiopathic osteosclerosisIdiopathic osteosclerosisLocation

More common in the mandible.Occurs five times more frequently in

edentulous regions than at the apices of vital

teeth.

Lesions may also occur in the interradicular

spaces.


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Relationship to teeth.

The lesion can be limited to the tooth apex,

inter-radicular region, no apparent

connection to the teeth.

Radiologic features.

The lesion may vary from a few millimeters to

more than 2 cm in diameter.

The area of density is rounded or ovoid, may

be irregular.


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The margins are irregular.

The lamina dura disappears within the

sclerotic mass.

The root outline and the periodontal ligament

space usually can be seen within the

radiopaque area.


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Condensing osteitisCondensing osteitis Radiology

More common in the mandible than the

maxilla.

Equal distribution between men and men.

Seen in people younger than 25 years of age.


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HypercementosisHypercementosis Radiology

The radiologic features of hypercementosisconsist of an area of increased densitysurrounding the root of a tooth.

The periodontal ligament space and laminadura usually are present and of normal

proportions.This is either focal or generalized, when

generalized, it may be a marker of asystemic disease or genetic disorder.


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Location

Permanent teeth are affected much more than

primary teeth.

When local factors are responsible only one

tooth may be affected, at other times the

condition may be billaterally symetrical.


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It is characterised by the deposition of excess

cementum about the root. The hyperplasticcementum is less dense than the adjacentdentin.

The outline of the excess cementum usuallyfollows the shape of the underlying root.

It may be deposited anywhere in the root.


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In the anterior region, hypercementosis may

be laid down in a sperical pattern.

In some instances, hypercementosis is

sufficiently extensive to cause two adjacent

teeth to become attached to each other.


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CementiclesCementicles Cementicles are small foci of calcified

tissue within the periodontal ligament. They

resemble cementum histologically, but they

are thought to represent dystrophic

calcifications resulting from degenerative

changes.


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Radiology

According to shafer cementicles are found within the

periodontal ligament space.

They may be located anywhere along the root or at

the apex. They are 0.2 to 0.3 mm in diameter.

They appear as thin tiny flecks that cause thewidened periodontal ligament space to become

more radiopaque.


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Periapical cemental dysplasia.P

eriapical cemental dysplasia. Most investigators believe pcd is a reactive

disorder rather than a neoplastic process.

The reactive elements consists of theperiodontal ligament, cementum,and bone.

Trauma and infection may stimulate the

reactive process.Occur more commonly in woman

Female to male ratio 10 :1


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They have been described in three stages

1) osteolytic.

2) Cementoblastic

3) mature


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1) Osteolytic stage

loss of lamina dura.

the periodontal ligament may appear

more prominent.

the radiolucent area is well demarcated

with a sclerotic rim.


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2) Cementoblastic stage.

appearance of radiodense mass towards the

centre of the lesion

the outter rim of sclerotic bone is present.

3)mature stage.

a single central mass develops . The massenvelops the apex of the tooth.


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Benign cementoblastomaB

enign cementoblastoma Half of the tumours were detected in

people younger than 20 years.

The most common sign was swelling.

Pain was low grade and often intermittent.

The mandibular first molar site.


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1) uncalcified matrix stage.

2) calcified blastic stage.

3) a mature stage.


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1) stage.

development of a circular radiolucent area

at the apex of a vital tooth.

the apical third of the root may be seen

within the area.

or half of the root length may be resorbed.


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2) blastic stage.

appearance of radiodense material in the

center of the lesion.

as the lesion mineralizes, additionalcementum-like material appears to coalesce

with the central mass. With moremineralization usually developing towardsthe periphery.


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Mature stage.

the lesion becomes completely radiopaque.

the roots of the teeth are obscured.

buccal and lingual expansion of the cortex.

A characteristic finding on occlusal view.-

radiating specules of cementoid materialarising from the central area and radiating tothe periphery.


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Ossifying fibroma

Ossifying fibroma

Cementifying fibroma.

Cemento-ossifying fibroma.

fibro-osseous lesion of periodontal origin,

Clinical features.

average patient age is 36 years.3rd and 4th decade of life

Female is to male ratio- 5 : 1.


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Striking predilection for mandible.

Limited to tooth bearing areas.


unilocular radiolucency containing

radiopaque foci

root divergence or root resorption.

expansile lesion with well defined margins.


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Maxillary lesions are more aggressive.


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FOCAL

RADIOPACITIES


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GARRE`S

OSTE

OMYELITIS.

GARRE`S

OSTE

OMYELITIS.

Periosteal reaction characterized by a focal

gross thickening of the periosteum with

periperal reactive bone formation inresponse to infection.


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Clinical features

The mean patient age is 11 years.

Prediliction for male patients.

Non-tender enlargment of the mandible ispalpable.

It is bony hard swelling.

Observed with carious tooth. Mandibular firstmolar.


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Radiologyonion skin pattern.

a single or several layers of subperiosteal

new bone are seen.the underlying cortex isvisible and intact.

Initial stage the periosteum becomes elevatedand thickened.

Calcification beneath the periosteum becomesevedent as a single curved line of cortexlike bone.


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Same process is reinitiated and results in a

second lamination of subperiosteal newbone formation.

Multiple laminations give the reaction anonion skin appearance.

Radial pattern``. In occlusal view, a radialpatern of bony trabeculae may be seenperpendicular to the long axis of the

mandibular body and cortex andperpendicular to the laminations ofsubperiostel bone formation.


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Socket sclerosis.Socket sclerosis.

Localized osteosclerosis.Localized osteosclerosis. It is a form of osteosclerosis occuring

uniquely in the socket area of previously

extracted teethClinical features.

the patient had a median and average

age of 40 yearsEqually among men and women.

It is asymptomatic.


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Radiological features.They are characterized by a lack of resorption

of the lamina dura and deposition of

sclerotic bone within the confines of thesocket.

The lack of lamina dura resorption is the

earliest sign of socket sclorsis.

In later stages the socket is filled completely

with sclerotic bone.


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Exostosis.Exostosis. They are bony outgrowths from the maxilla

and the mandible.

Their cause is unknown.

Tend to occur in females a possible genetic

origin is suggested.

They may be very small pinpoint size or

occupy an entire quadrant.


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Limited growth potential, reaching a certain

size and remaining stable after that.

The overlying tissue has a normal colour.

On palpation it is bony hard and pain should

not be elicited.

They are usually symmetrically bilateral.


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Radiological features.

they appear as diffuse radiopacities in the

region of the alveolar bone.


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Tori.Tori. Tori are varients of exostosis occuring in a

specifically defined location. In the jaws,

tori are found in two locations.

Mandibular tori or lingual tori occur on the

lingual cortex of the mandible.

Whereas palatal tori are seen on the hardpalate in the midline.


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Woman are affected more than men

Tori arises during adolescence and the peak

incidence occurs at the age of 30.

They may achieve a diameter of

approximately 4 cm.

They may have one,two,four lobes.

They tend to be symetrical in form and size.


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Radiological features.

the features are similar to that of exostosis.

Except tori are seen in specific locations.

It consists of uniform radiodense mass.

As they are present in the outer cortex.they

may extend beyond the limits of alveolar

bone in the image.


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Enostosis.Enostosis. Although the existance of enostosis is

questioned by some people who consider it

to be synonymous with idiopathicosteosclerosis.

Reffered to an inward growth of compact

bone or a mixture of compact andcancellous bone from the endosteal surface

of buccal and lingual cortical plates.


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Occur more frequently in molar premoaler

region.


the radiologic features is indistinguishable

from that of idiopathic osteosclerosis.


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Osteoma.

Osteoma. A benign neoplasm charecterised by

proliferation of compact or cancellous bone,usually in an endosteal or periosteal

location and uncommonly entirely withinthe soft tissue.

Clinical features.

Based on location , osteomas may beclassified as peripheral, central,or withinsoft tissue.

Multiple osteomas of any type may be a sign

of gardners syndrome.


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Most common site of osteomas is the calvaria

of the skull and walls of paranasalsinusis.they are considered rare in the jaws.

Osteomas of the skull.

The frontal sinus is the most commonlyaffected sinus. The margins of the sinusmay expand due to osteoma.


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When calvaria is affected the outer table is

the most common site.

Osteomas in the jaw.

Most common location is the mandible molar

region. Towards the buccal side.

Maxillary antrum.


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Radiologic features of peripheral osteomas

of the jaw.

They usually do not exceed 2 cms , but may

reach massive proportions.

The peripheral osteomas consists of a well

defined area of increased density projecting

beyond the confines of parental bone.

It may be within the confines of bone.

Two types compact and cancellous type.


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The compact type is almost always sessile

and rarely pedunculated.

The compact type has well defined areas of

increased density. Granular or ground glass

apearence can be seen.


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Radiologic features of central osteoma inthe jaw.

Well defined ,localised area of moreradiodense bone.

Margins are well defined and continous withadjacent bone.

A radiolucent line surrounding the lesion isabsent because it is not encapsulated.


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Radiologic features of soft tissue osteomas.

both cancellous and compact subtypes may

be seen.

They rarely exceed 2 cms in diameter.


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O

steoid osteoma.O

steoid osteoma. They occur during secound decade of life.

Males are affected more frequently than

females. The patient complains of pain.

Pain is described as disproportionately

severe with respect to the size of the lesion. It is a slow growing lesion. Includes

swelling, tenderness,and local erythema.


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Radiology .

Occurs in teenage.

Most common site is body of mandible.

The next common site is the condyle and

antrum.Identification of nidus.- the lesional tissue

consists of a round or ovoid radiolucentnidus, surrounded by reactive bone. Thenidus is usually located within or near thecortex. Within the nidus there may be asmall calcification


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An useful adjunct in locating the nidus is

radioisotope imaging. Osteoid osteoma

takes up 99m technetium diphosphonateavidly because of the intense osteoblastic

activity.

The size of the nidus is important because ithelps to differentiate osteoid osteoma from

osteoblastoma.


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If the radiolucent nidus is 1cm or smaller-

osteoid osteoma.

Larger than 2cm osteoblastoma.


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Benign osteoblastoma.Benign osteoblastoma.

It is relatively rare in the skeleton and evenmore uncommon in the jaw.

In jaw lesions there is a male predilection.90% of patients younger than 30 years.

Pain and swelling are common findings.

Swelling is tender on palpation, redness ofthe overlying mucosa, tooth mobility andtenderness on percussion.


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Radiology.

Location.Mandible-premolar and molar region.

Radiologic feature.

Can be completely radiolucent or it maycontain flecks of calcification. They may be

focal or few in number, or may coalesce to

form focal larger areas of calcific material

or lesion may appear completely

radiopaque.


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Aggressive lesions are characterised by

rapid growth, poorly defined margins, more

severe bone destruction,and spread toadjacent anatomic structures. In such cases

the clinician should suspect malignant

changes.


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Chondroma.Chondroma.

It is a benign tumor of cartilage.

Cartilaginous tumors may arise at sites of

cartilaginous rests in the jaw In maxilla-cartilaginous rests are located in the

incisive canal and nasal fossa.

In mandible- meckel`s cartilage in the posterior

body and the coronoid process and condyle.

Extraosseus may occur in the tongue.


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Clinical features.

two types central and peripheral.

Occur in people of any age.

Men and woman are equally affected.

They are slow growing and most likely to be

asymptomatic untill they become largeenough to cause a noticeable swelling.

Swelling is bony hard.


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Radiology.

Location. In maxilla they are found more

frequently in the anterior alveolar ridge with

extension into the sinus. In the mandible,

the common location were in the body in

the body posterior to the canine teeth,coronoid process and condyle.


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The lesions are lytic and may contain calcific

foci this imparts a snow-flake like

appearance.

Margins are sclerotic and may have a

scalloped appearance. They are well

delineated from surrounding bone.


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Slow growing.

Locally destructive.

Chondromas have the potential to destroy a

large segment of the involved jaw.

The most important point-efforts should be

made to rule out recurrence, even after 10

years of surgery.


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Osteosarcoma.Osteosarcoma.

Osteosarcoma is the most frequent primary

malignant tumor.

65% of all osteosarcomas arise in the jaws.

Central osteosarcoma

Parosteal or periosteal osteosarcoma

Extraosseous osteosarcoma.


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Pathological characteristics.

Pathologic factors identified.Radiotherapy-mainly for fibrous dysplasia.

Pre existing benign bone disorders. Fibrousdysplasia , pagets diseases.

Trauma.

48% showed chondroid differentiation-chondrogenic osteosarcoma.

29% showed osteoid production-osteoblasticosteosarcoma.


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Serum alkaline phosphatase levels are often

increased. When the tumor is removed thelevels come back to normal.

Clinical features.

in long bone it usually arises in the secondand third decade of life.

Male predilection.

In the jaws the mean patient age is 30-34years.


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The most common presenting finding in

osteosarcoma of the long bones are swelling

and pain

In jaw lesions swelling is present.

Other symptoms-loose teeth,

paresthesia,tooth-ache,bleeding, nasalobstruction.


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Radiology

Location- maxilla-anterior region and antrum.

mandible-body ,angle and

symphysis.

Other sites- tmj, juxtacortical location, and

soft tissue.


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Radiographic features.

Usually arises in the metaphysis of a longbone.benign bone response may be

identified by the uniformity of their density

and their distinctness of their margins.

The less uniform in density and distinctness

the greater is the likelihood for malignancy.


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In jaw varients three basic paterns are seen

1) Osteolytic pattern-no bone is formed.

2) Mixed pattern-some bone is formed.

3) A sclerotic pattern-entirely bone forming.


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Osteolytic osteosarcoma.

Poorly defined, they extend more deeply intobone. They may have corticated margins in

the tumor, but there is usually some

evidence of a break through.An early finding is the symmetrical widened

periodontal membrane space along the

length of a root of one or several adjacent

teeth. The teeth may be very painfull.


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In maxilla there is complete destruction of

the maxilla and the antral floor.

Mixed pattern-there may be well defined

areas of bone destruction with partially

sclerotic margins. May produce a honeycomb pattern.

A pattern of perpendicular bony striae that

radiate from the surface of bone has beentermed a sun ray or sunburst pattern.


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Sclerotic osteosarcoma.

the whole area may consist of a single

solid mass of dense bone that may affect a

large portion of the mandible or maxilla.


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Chondrosarcoma.Chondrosarcoma.

The premaxilla and maxilla are the primarymembranous bones.

Cartilage from the nasal septum

Cartilage rest cells from the incisive canal

region. Thus they are prone to occur in themaxilla.

In mandible-remenants of meckel`s

cartilage-body mental region coronoid andcondyle.

It is composed of malignant cartilaginoustissue.


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Clinical features.

peak incidence is sixth decade.

The most common presenting sign is

swelling,expansion of buccal and lingual

cortical plates.

The overlying mucosa may be normal. Show

an increased number of telangectatic surface

vessels, or may be ulcerated, or spontaneousbleeding may be present.


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Radiology

Location-in skull the most common location is

the spenoid bone,occipital bone,frontal,parietal bone and temporal bones. May beobserved intracranially also.

In the jaws- maxilla ,nasal cavity,alveolarridge, the palate ,nasal fossa and thesinuses.


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Radiologic feature-

Snow flake cartilagenous calcifications.

First- an osteolytic lesion with a relativelybenign appearance

Lesion is small

Well definedThe secound type- central chondrosarcomas

may be the later phase of the first one.


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The lesions are predominantly osteolytic and

blend with adjacent normal bone, and lack

any evidence of sclerotic margins.They may be small or replace large portions

of bone.

This type contains the irregular snowflaketype calcification.

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Radio Pa Que Lesions