1 / 41

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:.

sharne
Download Presentation

口腔診斷學

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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!)

More Related