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口腔診斷學

口腔診斷學. Multiple Separated Radiopacities. 多個分開之 X 光不透過影像. 陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw. 學 習 目 標. Understanding: 1. 多個分開之 X 光不透過影像的鑑別診斷. 參考資料. References:.

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口腔診斷學

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  1. 口腔診斷學 Multiple Separated Radiopacities 多個分開之X光不透過影像 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

  2. 學 習 目 標 Understanding:1. 多個分開之X光不透過影像的鑑別診斷

  3. 參考資料 References: • Wood, Goaz. Differential diagnosis of oral lesions. Mosby, 3rd ed., Chapter 27, p. 610-9 • Kaohsiung Medical University, Department of Oral Pathology • Golan I et al. Dentomaxillofacial variability of cleidocranial dysplasia: clinicoradiological presentation and systematic review. Dentomaxillofac Radiol 2003;32:347-54 • Golan I et al. Early craniofacial signs of cleidocranial dysplasia. Int Pediatr Denti2004;14:49–53 • Ribeiro ACP et al. Oral cysticercosis: case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e56-e58

  4. Multiple Separated Radiopacities (1) • Most common lesions • Tori and exostoses • Multiple retained roots • Multiple socket sclerosis • Multiple mature cementomas • Multiple periapical condensing osteitis • Multiple embedded or impacted teeth • Cleidocranial dysostosis (dysplasia) Ref. 1

  5. Multiple Separated Radiopacities (2) Multiple large tori – occlusal radiography Multiple large exostosis – periapical radiography Refs. 1, 2

  6. Multiple Separated Radiopacities (3) Multiple root fragments – readily identified Multiple root fragments – not readily identified Ref. 1

  7. Multiple Separated Radiopacities (4) Multiple socket sclerosis • 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 treatment • 4. Suspect for a GI malabsorption or a renal malady Ref. 1

  8. Multiple Separated Radiopacities (5) – Note of RL rims – Located in mandibular incisor region – Less frequently in maxilla Multiple cementomas Ref. 1

  9. Multiple Separated Radiopacities (6) Multiple idiopathic osteosclerosis • Bilaterally & in multiple separate areas in mandibular • molar or premolar region • 2. Dense, irregularly shaped RO • 3. Vary from 0.5 to ~2.0 cm in diameter • 4. Found at the periapices of vital teeth Ref. 1

  10. Multiple Separated Radiopacities (6) Multiple periapical condensingosteitis • Non-vital or degenerating pulp • 2. Found surrounding multiple root fragments Ref. 1

  11. Multiple Separated Radiopacities (7) Multiple embedded/impacted teeth (no syndrome) • Embedded tooth: fail to erupt due to imbalance in the • coordinated forces responsible for the axial movement • of teeth • 2. Impacted tooth: prevented from erupting by a physical • barrier in the path of eruption • 3. D.D. from partial anodontia, cretinism (hypothyroidism • in young children), cleidocranial dysostosis Ref. 1

  12. Multiple Separated Radiopacities (8-1) Cleidocranial dysostosis – • Numerous impacted teeth • Partially or complete absence of clavicles • Skull: enlarged but a shorter than normal P dimension • (brachycephaly) • 4. Frontoparietal bossing • 5. Delayed fontanelle closure (may be open throughout life) • 6. Unusual no. of wormian bone: 2nd centers of ossification • suture lines Ref. 1

  13. Multiple Separated Radiopacities (8-2) Cleidocranial dysostosis- Dentomaxillofac Radiol 2003;32:347-54 Ref. 3

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

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

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

  17. Multiple Separated Radiopacities (9-1) Multiple calcified LN – TB history Cysticercosis – many small RO foci scattered within the cranium Ref. 1

  18. Multiple Separated Radiopacities (9-2) Cysticercosis – Frequent in developing countries A parasitic infection rarely involves the mouth Ref. 5

  19. Multiple Separated Radiopacities (10) Multiple phleboliths Multiple sialoliths Bilateral Ref. 1

  20. Multiple Separated Radiopacities (11) Multiple RO - Paget’s disease Ref. 1

  21. Summaries 明白多個分開之X光不透過影像的鑑別診斷。

  22. 口腔診斷學 Generalized Radiopacities 廣泛性X光不透過影像 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

  23. 學 習 目 標 Understanding:1. 廣泛性X光不透過影像的鑑別診斷 Ref. 1

  24. 參考資料 References: • Wood, Goaz. Differential diagnosis of oral lesions. Mosby, 3rd ed., Chapter 28, p. 620-630 • Dutta S et al. Infantile cortical hyperostosis- Indian Pediatric 2005;42:64-6 • Ramaglia L et al. Gardner’s syndrome – Oral Med Oral Pathol Oral Radiol Endod 2007;103:e30-e34 • Wong YK & Cheng JCF. Infantile cortical hyperostosis of the mandible. Br J Oral & Maxillofac Surg 2008;46:497-8

  25. Generalized Radiopacities (1) • Most common lesions • Florid cemento-osseous dysplasia • Paget’s disease (mature stage) • Osteopetrosis • Rarities • Infantile cortical hyperostosis • (Caffey disease) • 2. Gardner’s syndrome • 3. Multiple large exostoses and tori • 4. Metastatic carcinoma of prostate Ref. 1

  26. Generalized Radiopacities (2) Florid cemento-osseous dysplasia • Restricted to jawbones • Vast majority of patients > 30y/o • A marked predilection for females & blacks • Mandible > maxilla • 5. Early or mild cases: symptomless & found on routine X-ray check • 6. Advanced lesions: painless expansion (may complain • constant need for adjustment of prosthesis) Ref. 1

  27. Generalized Radiopacities (3) Florid cemento-osseous dysplasia Ref. 1

  28. Generalized Radiopacities (4) Cotton wool Exophthalmos,healing aid Enlarged skull & maxilla Paget’s disease Commonly involves 5/6 bones at most 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 Ref. 1

  29. Generalized Radiopacities (5) Malignant osteopetrosis (Albers-Schonberg disease, marble bone disease) Almost complete obliteration of medullary portions of femurs & tibiae Involve all the skeletal bones • Two main types (Normal serum chemistry levels): • Clinically benign dominantly inherited form: develop later in life, less severe, fractures on minor trauma • Clinically malignant recessively inherited form: present at birth or in early childhood, severe & debilitating, die <20 y/o, neurologic/hematologic disorders, pathological fx Ref. 1

  30. Generalized Radiopacities (6-1) Infantile cortical hyperostosis • Proliferation of cortices • Almost completely obliterated the shadows of the medullary cavities • Soft tissue swellings, fever and irritability Ref. 1

  31. 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

  32. Generalized Radiopacities (6-2) Infantile cortical hyperostosis Ref. 3

  33. Generalized Radiopacities (6-2) Infantile cortical hyperostosis 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). Ref. 3

  34. Generalized Radiopacities (6-2) Infantile cortical hyperostosis Treatment with amoxycilln/clavulanic acid (Augmentin) for two weeks resulted in remission. However, symptoms recurred 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. Ref. 3

  35. Generalized Radiopacities (7-1) Gardner’s syndrome – multiple osteomas Ref. 1

  36. 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

  37. Generalized Radiopacities (7-3)

  38. Generalized Radiopacities (8) Unusual large & numerous exostoses & tori

  39. Systematic approach to differentiate radiopacities • Attached or not attached to tooth apices • Which tooth/teeth involved? • Vitality of the attached tooth • Degree of opacities • Presence of radiolucent rim (margin) or not • Number of opacities (multiple quadrants) • Clinical symptom of infection exist? (必考)

  40. Summaries 明白廣泛性X光不透過影像。

  41. *各位同學 要坐上此架飛機,遨遊.飛越美國(Flying over America!)

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