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Radiology of inflammatory lesions of the jaws Dr. Ghaida

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Radiology of inflammatory lesions of the jaws Dr. Ghaida AlJamal, BDS., MS., Dip (ABOMR) Most common pathologic conditions of jaws Body responds to chemical ... – PowerPoint PPT presentation

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Title: Radiology of inflammatory lesions of the jaws Dr. Ghaida


1
Radiology of inflammatory lesions of the jaws
  • Dr. Ghaida AlJamal, BDS., MS., Dip (ABOMR)

2
  • Most common pathologic conditions of jaws
  • Body responds to chemical, physical, or
    microbiologic injury with inflammation

3
Homeostasis
  • Balance of osteoclastic bone resorption and
    osteoblastic bone production
  • Mediators of inflammation tip this balance to
    favor either bone resorption or bone formation

4
Periapical inflammatory lesion
  • Source is necrotic pulp
  • Lesion restricted to the region of the tooth

5
Example
6
Osteomyelitis
  • Infection spreads in bone marrow
  • Lesion is no longer contained

7
Example
8
Periodontal lesions pericoronitis
  • Lesion extended into overlying soft tissues
  • Arises in the tissues surrounding the crown of
    the PE tooth

9
Radiographic features
  • Location
  • Periphery
  • Internal structure
  • Effects on surrounding structures

10
Periapical inflammatory lesions
  • Acute apical periodontitis
  • Chronic apical periodontitis
  • Periapical abscess
  • Periapical granuloma

11
Periapical inflammatory lesions
  • Rarefying oseitis/sclerosing osteitis

12
Periapical inflammatory lesions
  • Def local response of bone around apex of tooth
    that occurs 2 to necrosis of pulp or destruction
    of PA tissues by extensive periodontal disease

13
  • Caries acute
  • Necrotic pulp apical periodontitis
  • Trauma chronic

Periapical abcess
Osteomyelitis
Periapical granuloma
Periapical cyst
14
Clinical features
  • Asymptomatic .severe pain w, w/o
  • facial swelling, fever, lymphadenopathy

15
Radiographic features
  • Location
  • Apex of involved tooth
  • Cervically up the tooth root

16
Radiographic features
  • Periphery
  • Ill defined
  • Well defined

17
Radiographic features
  • Internal structure
  • Early ..no changes
  • Loss of bone density (widening of PDL at apex)
  • Larger diameter involvement
  • Mixture of sclerosis and rarefaction

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Differential diagnosis
  • Periapical cemental dysplasia
  • Enostosis, osteosclerosis

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  • Small, radiolucent periapical lesions with well
    defined periphery.
  • granuloma or cyst

26
Differential diagnosis
  • Surgical scar
  • Mets leukemia

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Pericoronitis
  • Inflammation of the tissues surrounding the crown
    of a partially erupted tooth

29
Radiographic features
  • No changes
  • localized rarefaction and sclerosis..
  • osteomyelitis

30
Radiographic features
  • Enlargement of follicular space with ill defined
    periphery and gradual transition of the normal
    trabecular pattern

31
Radiographic features
  • Surrounding bone rarefaction or sclerosis
  • Periosteal new bone formation

32
Differential diagnosis
  • Enostosis
  • FD
  • Oseosarcoma
  • SCC

33
Osteomyelitis
  • Inflammation of bone (marrow, cortex, cancellous
    portion periosteum)
  • Source pyogenic
  • hematogenous

34
Osteomyelitis
  • Hallmark is sequestra
  • It is a segment of bone that has become necrotic
    because of ischemic injury caused by inflammation

35
Acute Osteomyelitis
  • Predominantly neutrophils
  • From non vital teeth most commonly

36
Radiographic features
  • Very early no change
  • Ill defined periphery
  • Decrease in density
  • Loss of sharpness of trabeculae

37
Radiographic features
  • Maxilla is rare
  • Bone destruction area of radiolucency
  • Sclerotic regions
  • Sequestra maybe present.

38
Radiographic features
  • Cortical bone may be resorbed
  • Bone formation (involucrum).
  • Onion-skin appearance (proliferative periostitis
  • Effects on teeth lamina dura.

39
Differential diagnosis
  • FD
  • Malignancies (OS, SCC)
  • LCH
  • Lymphoma, luekemia

40
Chronic Osteomyelitis
  • De novo
  • Or sequela of inadequately treated acute
    Osteomyelitis

41
Diffuse sclerosing osteomyelitis
  • Bone metabolism shifts toward increased bone
    formation..
  • Symptoms are less severe .

42
Radiographic features
  • Posterior mandible most commonly
  • Periphery better defined..
  • Regions of greater and lesser radiopacity
  • More chronic lesions are exceedingly radiopaque

43
Radiographic features
  • Sequestrum.
  • Periosteal new bone (similar to onion skin)
  • Outer contour of mandible altered
  • External resorption, LD less apparent, PDL
    enlarged
  • May develop draining fistula

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Differential diagnosis
  • FD
  • Paget disease of bone
  • OS
  • LCH, leukemia, lymphoma

47
Osteoradionecrosis
  • Inflammatory condition of bone that occurs after
    bone has been exposed to therapeutic doses of
    radiation

48
Osteoradionecrosis
  • Radiation causes damage to bone w hypoxia,
    hypocellularity and hypovascularity
  • Delayed or lack of healing.

49
Clinical and radiographic features
  • Posterior mandible
  • Bone exposure
  • Pathologic fracture
  • Pain or no pain

50
Radiographic features
  • Similar to chronic osteomyelitis
  • Ill defined periphery
  • More bone formation sclerotic appearance

51
Radiographic features
  • Scattered regions of radiolucency w, w/o central
    sequestra
  • Uncommon inflammatory new bone.
  • Rare bone formation on outer cortex

52
Differential diagnosis
  • Malignant neoplasm
  • Chronic osteomyelitis (history)

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