口腔診斷學

陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

Multiple Separated Radiopacities

多個分開之 X 光不透過影像

Understanding:

1. 多個分開之 X 光不透過影像的鑑別診斷

學 習 目 標學 習 目 標

1. Wood, Goaz. Differential diagnosis of oral lesions. Mosby, 3rd ed., Chapter 27, p. 610-9

2. Kaohsiung Medical University, Department of Oral Pathology3. Golan I et al. Dentomaxillofacial variability of cleidocranial dysplasia:

clinicoradiological presentation and systematic review. Dentomaxillofac Radiol 2003;32:347-54

4. Golan I et al. Early craniofacial signs of cleidocranial dysplasia. Int Pediatr Denti2004;14:49–53

5. Ribeiro ACP et al. Oral cysticercosis: case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e56-e58

References:References:

參考資料

Multiple Separated Radiopacities (1)

Most common lesions1. Tori and exostoses2. Multiple retained roots3. Multiple socket sclerosis4. Multiple mature cementomas5. Multiple periapical condensing osteitis6. Multiple embedded or impacted teeth7. Cleidocranial dysostosis (dysplasia)

Ref. 1

Multiple Separated Radiopacities (2)

Multiple large tori –occlusalradiography

Multiple large exostosis –periapical radiography

Refs. 1, 2

Multiple Separated Radiopacities (3)

Multiple root fragments –readily identified

Multiple root fragments –not readily identified

Ref. 1

Multiple Separated Radiopacities (4)

Multiple socket sclerosis

1. May be mistaken for retained roots (both have identical shape)2. If PDL space not apparent, should be identified as socket sclerosis (except for ankylosed root)3. Not require definitive treatment4. Suspect for a GI malabsorption or a renal malady

Ref. 1

Multiple Separated Radiopacities (5)

Multiple cementomas

– Note of RL rims– Located in mandibular incisor region – Less frequently in maxilla

Ref. 1

Multiple Separated Radiopacities (6) Multiple idiopathic osteosclerosis

1. Bilaterally & in multiple separate areas in mandibular molar or premolar region2. Dense, irregularly shaped RO3. Vary from 0.5 to ~2.0 cm in diameter4. Found at the periapices of vital teeth

Ref. 1

Multiple Separated Radiopacities (6) Multiple periapical condensingosteitis

1. Non-vital or degenerating pulp2. Found surrounding multiple root fragments

Ref. 1

Multiple Separated Radiopacities (7)

Multiple embedded/impacted teeth (no syndrome)

1. Embedded tooth: fail to erupt due to imbalance in the coordinated forces responsible for the axial movement of teeth2. Impacted tooth: prevented from erupting by a physical barrier in the path of eruption3. D.D. from partial anodontia, cretinism (hypothyroidism in young children), cleidocranial dysostosis

Ref. 1

Multiple Separated Radiopacities (8-1)

Cleidocranial dysostosis –

1. Numerous impacted teeth2. Partially or complete absence of clavicles3. Skull: enlarged but a shorter than normal P dimension (brachycephaly)4. Frontoparietal bossing5. Delayed fontanelle closure (may be open throughout life)6. Unusual no. of wormian bone: 2nd centers of ossification suture lines

Ref. 1

Multiple Separated Radiopacities (8-2) Cleidocranial dysostosis- Dentomaxillofac Radiol 2003;32:347-54

Ref. 3

Multiple Separated Radiopacities (8-3) Cleidocranial dysostosis- Dentomaxillofac Radiol 2003;32:347-54

Ref. 3

Multiple Separated Radiopacities (8-4) Cleidocranial dysostosis- Int J Pediatric Dent 2004;14:49-53

Ref. 4

Multiple Separated Radiopacities (8-4) Cleidocranial dysostosis- Int J Pediatric Dent 2004;14:49-53

Ref. 4

Multiple Separated Radiopacities (9-1)

Cysticercosis – many small RO foci scatteredwithin the cranium

Multiple calcified LN – TB history

Ref. 1

Multiple Separated Radiopacities (9-2) Cysticercosis – Frequent in developing countriesA parasitic infection rarely involves the mouth

Ref. 5

Multiple Separated Radiopacities (10)

Multiple phlebolithsMultiple sialoliths

Bilateral

Ref. 1

Multiple Separated Radiopacities (11)

Multiple RO - Paget’s disease

Ref. 1

SummariesSummaries明白多個分開之 X 光不

透過影像的鑑別診斷。

口腔診斷學

陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

Generalized Radiopacities

廣泛性 X 光不透過影像

Understanding:

1. 廣泛性 X 光不透過影像的鑑別診斷

學 習 目 標學 習 目 標

Ref. 1

1. Wood, Goaz. Differential diagnosis of oral lesions. Mosby, 3rd ed., Chapter 28, p. 620-630

2. Dutta S et al. Infantile cortical hyperostosis- Indian Pediatric 2005;42:64-63. Ramaglia L et al. Gardner’s syndrome – Oral Med Oral Pathol Oral Radiol

Endod 2007;103:e30-e344. Wong YK & Cheng JCF. Infantile cortical hyperostosis of the mandible. Br J Oral &

Maxillofac Surg 2008;46:497-8

References:References:

參考資料

Generalized Radiopacities (1)

Most common lesions1. Florid cemento-osseous dysplasia2. Paget’s disease (mature stage)3. OsteopetrosisRarities1. Infantile cortical hyperostosis (Caffey disease)2. Gardner’s syndrome3. Multiple large exostoses and tori4. Metastatic carcinoma of prostate Ref. 1

Generalized Radiopacities (2)

Florid cemento-osseous dysplasia

1. Restricted to jawbones2. Vast majority of patients > 30y/o3. A marked predilection for females & blacks4. Mandible > maxilla5. Early or mild cases: symptomless & found on routine

X-ray check6. Advanced lesions: painless expansion (may complain constant need for adjustment of prosthesis) Ref. 1

Generalized Radiopacities (3)

Florid cemento-osseous dysplasia

Ref. 1

Generalized Radiopacities (4)

Paget’s disease

Enlarged skull & maxilla

Exophthalmos,healing aid

Cotton wool Cotton wool

Cotton wool

Cotton wool

D.D. with polyostotic fibrous dysplasia: involves a section of a bone rather than the complete bone, asymmetric enlargement, serum chemistry if present will be slight

Commonly involves 5/6 bones at most

Ref. 1

Generalized Radiopacities (5)

Malignant osteopetrosis(Albers-Schonberg disease, marble bone disease)

Almost complete obliteration of medullary portions of femurs & tibiae

Two main types (Normal serum chemistry levels): 1. Clinically benign dominantly inherited form: develop later

in life, less severe, fractures on minor trauma2. Clinically malignant recessively inherited form: present at

birth or in early childhood, severe & debilitating, die <20 y/o, neurologic/hematologic disorders, pathological fx

Involve all the skeletal bones

Ref. 1

Generalized Radiopacities (6-1)

Infantile cortical hyperostosis

1. Proliferation of cortices2. Almost completely obliterated the shadows of the

medullary cavities3. Soft tissue swellings, fever and irritability

Ref. 1

Generalized Radiopacities (6-2) Infantile cortical hyperostosis- Indian Pediatric 2005;42:64-6

Radionuclide bone scan (posterior view) on day 85 showing involvement of all ribs on the right side,lowest rib on the left and the mandible

Plain X-ray of the chest (antero-posterior view)showing cortical hyperostosis of the ribs

Ref. 2

Generalized Radiopacities (6-2)

Infantile cortical hyperostosis

Ref. 3

Generalized Radiopacities (6-2) Infantile cortical hyperostosis

Ref. 3

The child may present with hyperirritability, fever, facial swelling, pain, malaise, erythema, or poor appetite, and non-specific laboratory abnormalities including leukocytosis, thrombocytopenia, and increased erythrocyte sedimentation rate (ESR).

Generalized Radiopacities (6-2) Infantile cortical hyperostosis

Ref. 3

Treatment with amoxycilln/clavulanic acid (Augmentin)for two weeks resulted in remission. However, symptomsrecurred two weeks after discharge. Indometacin was then started orally at 2.3 mg/kg/day divided into three doses a day.The left facial swelling resolved after five days and treatment continued for four weeks. The ESR and C-reactive protein (CRP) concentration level returned to within normal limits. There was no recurrence over a nine-month period with no resultant facial asymmetry.

Generalized Radiopacities (7-1)

Gardner’s syndrome – multiple osteomas

Ref. 1

Generalized Radiopacities (7-2) Gardner’s syndrome – Oral Med Oral Pathol Oral Radiol

Endod 2007;103:e30-e34 1. A hereditary disorder inherited as autosomal dominant with complete pentrance & variable expression 2. A variant of familial adenomatous polyposis characterized by extracolonic manifestations including osteomas, dental anomalies, and epidermoid cysts

Ref. 3

Generalized Radiopacities (7-3)

Generalized Radiopacities (8)

Unusual large & numerous exostoses & tori

Systematic approachto

differentiate radiopacities

1. Attached or not attached to tooth apices2. Which tooth/teeth involved?3. Vitality of the attached tooth 4. Degree of opacities5. Presence of radiolucent rim (margin) or not6. Number of opacities (multiple quadrants)7. Clinical symptom of infection exist?

( 必考 )

SummariesSummaries明白廣泛性 X 光不透過

影像。

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