Radiographic Interpretation of Infections of Jaws

Содержание

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Pericoronitis

Pericoronitis

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Pericoronitis

Erupting or partially impacted third molars
Inflamed gingiva
Trismus
Cellulitis

Pericoronitis Erupting or partially impacted third molars Inflamed gingiva Trismus Cellulitis

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Pericoronitis (R/F)

In early stages, minimal radiographic changes
Radiolucency adjacent to the crown
Ill-defined

Pericoronitis (R/F) In early stages, minimal radiographic changes Radiolucency adjacent to the
periphery
Sclerotic border in late stage
Osteomyelitis, in sever cases

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Normal Follicular Space

Normal Follicular Space

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Acute Suppurative Osteomyelitis

Acute Suppurative Osteomyelitis

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Acute Suppurative Osteomyelitis

Dental infection – most common cause
Other causes: fracture, wound, hematogenous

Acute Suppurative Osteomyelitis Dental infection – most common cause Other causes: fracture,
spread
Common organisms: Staph. aureus, Staph. albus, tuberculosis, actinomycosis, syphilis, mixed organisms

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Suppurative Osteomyelitis

May involve either jaw
Localized in maxilla, diffuse in mandible
Severe pain
temperature,

Suppurative Osteomyelitis May involve either jaw Localized in maxilla, diffuse in mandible
WBC count

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Suppurative Osteomyelitis (R/F)

Early stages: no radiographic changes
Ill-defined periphery
Decrease in the density of

Suppurative Osteomyelitis (R/F) Early stages: no radiographic changes Ill-defined periphery Decrease in
bone
Followed by increased radiolucency
Sclerosis at later stages
Sequestra: nonvital bone

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Suppurative Osteomyelitis (R/F)

Resorption
Periosteal new bone formation
Proliferative periostitis
Fistula formation
Radiographic features similar to malignant

Suppurative Osteomyelitis (R/F) Resorption Periosteal new bone formation Proliferative periostitis Fistula formation
lesions

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Sequestrum

Sequestrum

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In-class Exercise: Case 1

In-class Exercise: Case 1

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4 month old baby
Meningitis

4 month old baby Meningitis

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Nuclear Medicine Study

Nuclear Medicine Study

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In-class Quiz : Case 2

In-class Quiz : Case 2

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Chronic Focal Sclerosing Osteomyelitis

Chronic Focal Sclerosing Osteomyelitis

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Chr. Focal Sclerosing Osteomyelitis

Sclerosing or condensing osteitis
Younger, < 20 yrs
Mostly mandibular first

Chr. Focal Sclerosing Osteomyelitis Sclerosing or condensing osteitis Younger, Mostly mandibular first molar Large carious lesion
molar
Large carious lesion

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Focal Sclerosing Osteomyelitis (R/F)

Initial stage – no radiographic signs
Rarefying osteitis – radiolucent

Focal Sclerosing Osteomyelitis (R/F) Initial stage – no radiographic signs Rarefying osteitis
area
Sclerosing osteitis – dense sclerotic bone, trabeculation difficult to identify
Difference with idiopathic osteosclerosis

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Chronic Diffuse Sclerosing Osteomyelitis

Chronic Diffuse Sclerosing Osteomyelitis

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Chr. Diffuse Sclerosing Osteomyelitis

May not be associated with carious teeth
Intermittent, recurrent episodes

Chr. Diffuse Sclerosing Osteomyelitis May not be associated with carious teeth Intermittent,
of swelling, pain, fever
Any age, mostly elderly patients
Prevalence in African American
Chronic low grade infection
Pain, if present, is often mild
Acute exacerbation

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Chronic Osteomyelitis With Proliferative Periostitis

Garre’s Periostitis

Chronic Osteomyelitis With Proliferative Periostitis Garre’s Periostitis

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Chronic Osteomyelitis With Proliferative Periostitis

Garre’s Periostitis (1893)
Younger, <25 yrs
Mostly mandible

Chronic Osteomyelitis With Proliferative Periostitis Garre’s Periostitis (1893) Younger, Mostly mandible

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Garre’s Periostitis (R/F)

Often associated with a carious tooth
Mottled, predominantly lucent
Focal overgrowth of

Garre’s Periostitis (R/F) Often associated with a carious tooth Mottled, predominantly lucent
bone
“Onion-skin” appearance : layering of cortical bone

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In-class exercise: Case 3

In-class exercise: Case 3

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Osteoradionecrosis

Osteoradionecrosis

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Osteoradionecrosis

Radiotherapy (40 to 80 Gy)
Decreased vascularity
Low defense
High susceptibility to extraction, perio, pulpal

Osteoradionecrosis Radiotherapy (40 to 80 Gy) Decreased vascularity Low defense High susceptibility
disease, denture sore

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Osteoradionecrosis (R/F)

Similar to osteomyelitis
Diagnosis established by history

Osteoradionecrosis (R/F) Similar to osteomyelitis Diagnosis established by history

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Florid Cemento-osseous Dysplasia

Florid Cemento-osseous Dysplasia

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Florid Cemento-osseous Dysplasia

Wide-spread form of periapical cemental dysplasia
Mostly female, middle-aged, African, Asian
May

Florid Cemento-osseous Dysplasia Wide-spread form of periapical cemental dysplasia Mostly female, middle-aged,
not be symptomatic

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Florid Cemento-osseous Dysplasia

Poor vascular supply – prone to infection
Osteomyelitis, if infected
Preventive management

Florid Cemento-osseous Dysplasia Poor vascular supply – prone to infection Osteomyelitis, if infected Preventive management

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Florid C-O Dysplasia (R/F)

Usually bilateral, both jaws
Well-defined sclerotic border
Internal content of mixed

Florid C-O Dysplasia (R/F) Usually bilateral, both jaws Well-defined sclerotic border Internal
density
Large irregular masses
Hypercementosis
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