Practical oral radiology 2 2016
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Transcript of Practical oral radiology 2 2016
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Practical Oral Radiology 2
Ahmed A.Abdelazim
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Total: 5 marks1- Benign tumors
2-Malignant tumors
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Odontogenic Tumors• They develops as neoplasias from the dental
lamina. They are usually benign but several of them have the tendency towards malignant transformation.
• Because growth occurs only slowly, asymptomatically and without any changes in mucosal appearance,
• The existence of such lesions in their early stages is usually detected only by chance, or after the development of some structural deformation.
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Ameloblastoma• Benign but locally invasive neoplasm.• Arises from epithelial remnants of
dental lamina or dental organ.• Cells do not differentiate enough to
form enamel.• Extreme expansion of bone, • Resorption of adjoining roots. • May cause perforation of cortical bone.• Average age at discovery: 35-40 years.
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Most common sites of ameloblastoma
80%
20%
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Ameloblastoma (Cont.)• Occasionally develops in the wall of
dentigerous cyst (mural Ameloblatoma).
• 80% in mandible. ¾ of these in molar-ramus area.
• Pain and paresthesia not common.• Extremely high recurrence rate.
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Ameloblastoma (Cont.)• Most often a well-corticated multilocular
radiolucency. • “Honey-comb”, “soap-bubble” or “tennis-
racket” appearance.• May be a well-corticated unilocular lesion
resembling a cyst.Honeycomb-like small
ameloblastoma at early stage with evidence of root resorption.
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Ameloblastoma• Ameloblastoma at the
angle of the mandible.• Expansive form with
oval RL traversed by few very thin septa
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Ameloblastoma
• Soap-like form of ameloblastoma of the molar region.
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Ameloblastoma Large multilocular soap bubble appearance. Typically located in the molar region, angle of the
mandible and ascending ramus Thin not penetrated cortical plate. Impacted or neighboring teeth are displaced with
roots often resorped.
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• Ameloblastoma in early stages with lobular pattern
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Ameloblastoma
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• Large ameloblastoma in the right ascending ramus of the mandible
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Ameloblastoma
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Ameloblastoma
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Ameloblastic fibroma
• Appears as a follecular cystic cavity surrounding a crown of a tooth.
• In early stages appears as a hat upon the occlusal surface of affected tooth
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• More advanced case of ameloblastic fibroma demonstrates how the follicular sac is opened.
• Note also the displacement of the tooth bud of lower 8 in the ascending ramus
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Odontogenic myxoma
• It is a benign, mucous-containing tumor that originates from the tooth bud.
• It appears as a soap bubble-like appearance.
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Cementoma• Usually appears at lower
anterior area.• First appears as fibrous
tissue stage, which may confused with a granuloma (vitality test).
• The second stage is characterized with accumulation of calcified materials.
• The third stage consists of radio-opaque materials.
Early stage
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R.L R.L+R.O
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Periapical cemental dysplasia
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Periapical Cemental Dysplasia
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Cementoblastoma( True Cementoma )
• Slow growing neoplasm composed of cementum.
• Usually solitary lesion seen as a growth on root of tooth.
• Most common in mandible, premolar or 1st molar (80%).
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Cementoblastoma• Appears as a well
defined RO area with a thin RL band around it
• May cause external root resorption
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Cementoblastoma
• It not removed after tooth extraction
• Remarks the RL related to canine and second premolar, it is another cementoblastoma in the fibrous stage.
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Cementoblastoma
• Another case remaining after tooth extraction.
• It surrounded by the radiographic signs of chronic inflammation.
• Periapical cemental dysplasia related to 4 tooth
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Ossama El-Shall
Odontoma
• Most common sites
Tumor characterized by production of enamel, dentin, cementum and pulp tissue
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Odontoma
Complex type
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Odontoma
Intermediate type
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Odontoma
Intermediate type
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Odontoma
Compound type
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Compound odontoma in maxillary tubrosity
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Complex odontoma in maxillary tubrosity
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Compound Composite Odontoma
• Composed of enamel and dentin.
• Enamel and dentin are laid down in an orderly fashion so that the mass has some similarity to normal teeth.
• Appears like a bunch of small teeth.
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Compound Composite Odontoma
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Central Osteoma anterior to remaining roots of lower 7
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Peripheral osteoma located in maxillary sinus
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Peripheral osteoma in right angle of the mandible
It may confused with calcified lymph noads
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Osteoma
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Central Hemangioma• Tumor characterized
by proliferation of blood vessels.
• Central hemangiomas of jaws uncommon.
• 50% occur in children and teens.
• More common in females and mandible.
• Well-defined or ill-defined, unilocular or multilocular radiolucency.
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05/02/2023 Ossama El-Shall 41
Central Hemangioma (Cont.)
• May cause expansion of bone and resorption of teeth.
• Early treatment is desirable in order to avoid profuse bleeding due to accidental trauma. Aspiration prior to surgical procedure is advised.
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Central Hemangioma (Cont.)
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Central Hemangioma (Cont.)
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Malignant tumors
• Sarcoma• Carcinoma.• Metastasis.
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Benign tumors• Growth by direct extension• Insidious onset• Well defined borders• Rl + RO• Tooth displacement, or
root resorption• Expansion or thinning of
cortical bone
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Malignant tumorsGrowth by infeltration and
distructionSudden onsetIll defined bordersPunched out bordersTotally RLDestruction of alveolar
bone, teeth floating or displaced occlusally
Erosion and destruction of cortical bone
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SarcomaThis tumor, which affects males twice
as females, exhibit a predilection for the mandible.
Radiographically, bone destruction as well as new bone formation and osteolysis can be observed, along with perforation of the compact bone with spicules (sunrays effect), where the lesion borders on the soft tissues
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Mixed form of ostiosarcoma: In addition to areas of new bone formation, osteolysis and destruction of the compact bone can be observed. Note the areas of spicules (arrows)
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1-Benign Tumors
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• Ameloblastoma • CEOT• AOT
• Odontoma• Ameloblastic fibro-
odontoma• Ameloblastic fibroma• COC
• Odontogenic Myxoma• Odontogenic Fibroma• Cementoblastoma
1. Od. Epithelium
2. Od. Epithelium+ CT Mesenchyme
3. Od. CT Mesenchyme
Odontogenic Tumors
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Ameloblastoma
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Ameloblastoma
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1- AmeloblastomaMultilocular (Soap bubble> honey comb))
origin (dental lamina and dental organ)
• 40 y (Middle age)• Males • Mand. Molar Ramus area• Sever expansion +Perforation• Root Resorption• Teeth Displacement• Negative aspiration
Unicystic (Rare) Inter radicular (Uncommon)
Solitary Periapical Pericoronal
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Mural ameloblastoma
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Mural (Unicystic) Ameloblastoma
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Mural ameloblastoma
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The shape of the septa
AmeloblastomaThick- Coarse & Curved
Well defined in mandible but tend to be ill defined in maxilla
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Multicystic Am.
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2- Calcifying epithelial odontogenic tumor (CEOT) = Pindborg tumor
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CEOTUnilocular or Multiocular + RO Foci
• 40 y.• Males • Mand. Molar Ramus area• Mostly Related to impacted/ unerupted tooth (50%)• Calcific foci are numerous closely located to the crown
(snow driven appearance)• Sever expansion (less than ameloblastoma) +
maintenance of cortical boundaries• Teeth Displacement
Rare tumor
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CEOT
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3- Adenomatoid odonotgenic tumor (AOT)
Radiolucent area surrounding impacted tooth
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AOT
• Wide age range: around 16 years Females > Males
• Mainly anterior maxilla • ⅔ Mixed (RL +RO):
RL surrounds more than the crown: not at CEJRO: Dense clusters OR Faint foci (Snow flecks appearance)
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AOT in mandible
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2- Mixed Odontogenic Tumors
1- Odontoma
2- Ameloblastic fibroma
3- Ameloblastic fibro-odontoma
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1- OdontomaOdontomas are developmental malformation ( hamartoma) of dental tissue, it is not neoplasm
Very important - very common – children
Two main Types
Compound = normal arrangement of dental tissuesComplex = abnormal mass of Calcification
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1- Odontoma
Complex odontomas
Compound odontomas
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Odontoma
• 2nd decade (young age )• Complex: ♀ Compound ♀=♂ Mand. Molar Max. Ant.• Maturtion:RL…Mixed…..RO • Surrounded by RL rim• Discovered while searching for the cause of
unerupted permanent or retained deciduous• Easily identified upon Shape & Density• It’s the most common odontogenic tumor
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Odontomas
The compound type shows apparent tooth shapes while the complex type appears as uniform opaque mass with no apparent tooth shapes present
Compound Complex
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2-Ameloblastic Fibroma
• 2nd decade• ♀ = ♂• Mand. Molar - premolar • Discovered while searching for the cause of unerupted tooth or because of the facial
swelling & Occ. pain they cause• Identified upon:
-Outwards growth from the follicle-Grows towards the alveolar process
• Hat cap like RL
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Ameloblastic fibroma
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Ameloblastic fibroma
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3-Am. Fibro-Odontoma
• 2nd decade• ♀ = ♂• Mand. Molar - premolar • Discovered while searching for the cause of unerupted tooth• Identified upon:
-Outwards growth from the follicle-Grows towards the alveolar process-RO: discrete foci 1 – 2 if small lesion extensive calcification if large
40 y, ♂, Not as an outward growthRL
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Fibroma or fibro-odontoma ?
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3- Mesenchymal Tumors1-Odontogenic Myxomas2-Benign Cementoblastoma3-Central Odontogenic Fibroma
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1- Odontogenic myxoma
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Od. Myxoma Multilocular (Soap bubble > Tennis-racket)
Pericoronal to unerupted tooth or from a tooth that failed to develop
• 2nd- 3rd decade, ♀ • Mand. > Max. Molar – premolar. • Discovered while searching for the cause of unerupted tooth• Identified upon:
-Grows along the bone, lees likely to expand-Grows around teeth causing scalloping, loosening, displacement of teeth but rarely resorption
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Multilocular
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• Radiography:• Typically appears as multi
locular radiolucent area with well defined scalloped margin or soap bubble.
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A lateral radiograph of a surgical specimen of a myxoma
An occlusal view shows buccal expansion
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2- Cementoblatoma
• ♂ >♀• No race predilection• Wide age range
• Vital teeth, Painful• Mand. Premolars & 1st molars• Fused with the roots• Roots resorbed or obscured
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Cementoma orPeriapical cemental dysplasia ?
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Periapical cemental dysplasia
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Tori - Exostosis - Enostosis
Known from clinical examination by:•Their location, •Lobulated shape,• Adherent normally appearing mucosa •Asymptomatic
•Accidentally discovered•Intra-bony
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Osteoma
• ♂ >♀, 40 y & above• Asymptomatic until interferes with function• Overlying mucosa is normal and freely mobile.• Mand. > Max. & Paranasal sinuses
frontoethmoidal • Well-defined, RO (Compact),
Internal RL core (Cancellous)
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A panoramic radiograph shows an osteoma in the right mandibular angle region
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Osteoma
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Cherubism
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2- Malignant Tumors
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Well defined borders
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106Clinical photograph shows leukoplakia that transformed to gingival cancer
Intraoral panoramic view shows diffuse bone destruction
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Primary intra-osseous Carcinoma
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Osteosarcoma
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Effects on surrounding structures:i-Early :widening of the
periodontal membrane• Loss of cortices and lamina dura. • Floating or hanging teeth
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ii-Late : • poorly defined osteolytic,
osteoblastic • mixed pattern of
involvement
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Naglaa S. El Kilani
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“Sunray” Periosteal Reaction • Osteosarcoma • Chondrosarcoma • Ewing’s Sarcoma
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D-Ewing’s sarcoma-It is a rare highly malignant tumor of long bones and is relatively rare in the jaws.-The arise in the medullary portion of bone and spread to the endosteal and later periosteal surfaces.
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Metastatic tumors
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Metastatic tumors
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Metastatic tumors
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Multiple Myeloma
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Punched Out” Skill Lesions • Multiple Myeloma • Langerhans Cell Histiocytosis • Metastatic Carcinoma • Neuroblastoma
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Describe? D.D?
• Solitary ill defined radiolucent area related to lower right molars and causing invasion of the IAC.
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What is the view? Describe? D.D?• Inflammatory1. Chronic osteomyelitis 2. Osteoradionecrosis • Neoplastic 1. Squamous cell
carcinoma 2. Metastatic tumors to
the jaws 3. Osteosarcoma and
chondrosarcoma
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Describe? D.D?• What is the D.D? Solitary irregular periapical
radiolucent area related to upper left lateral and causing extensive interproximal bone loss of the adjacent tooth.
D.D:• Chronic alveolar abscess• Chronic osteomyelitis• Osteoradionecrosis• Squamous cell carcinoma• Metastatic tumors to the jaws• Osteosarcoma and
chondrosarcoma• Fibrous dysplasia (early stage)
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What is D.D?
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Multiple punched out radiolucent areas: Myeloma
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Case study• A 20-year old male patient
reported to the Department of Oral Medicine, with chief complaint of swelling in the lower half of the left side of and inability to chew food at the same side.
• What is the D.D?