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Practical oral radiology 2 2016
- 1. Practical Oral Radiology 2 Ahmed A.Abdelazim
- 2. Total: 5 marks 1- Benign tumors 2-Malignant tumors
- 3. 3 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.
- 4. 4 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.
- 5. 5 Most common sites of ameloblastoma 80% 20%
- 6. 6 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.
- 7. 7 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.
- 8. 8 Ameloblastoma • Ameloblastoma at the angle of the mandible. • Expansive form with oval RL traversed by few very thin septa
- 9. 9 Ameloblastoma • Soap-like form of ameloblastoma of the molar region.
- 10. 10 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.
- 11. 11 • Ameloblastoma in early stages with lobular pattern
- 12. 12 Ameloblastoma
- 13. 13 • Large ameloblastoma in the right ascending ramus of the mandible
- 14. 14 Ameloblastoma
- 15. 15 Ameloblastoma
- 16. 16 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
- 17. 17 • 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
- 18. 18 Odontogenic myxoma • It is a benign, mucous- containing tumor that originates from the tooth bud. • It appears as a soap bubble-like appearance.
- 19. 19 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
- 20. 20 R.L R.L+R.O
- 23. 23 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%).
- 24. 24 Cementoblastoma • Appears as a well defined RO area with a thin RL band around it • May cause external root resorption
- 25. 25 Cementoblastoma • It not removed after tooth extraction • Remarks the RL related to canine and second premolar, it is another cementoblastoma in the fibrous stage.
- 26. 26 Cementoblastoma • Another case remaining after tooth extraction. • It surrounded by the radiographic signs of chronic inflammation. • Periapical cemental dysplasia related to 4 tooth
- 27. Ossama El-Shall Odontoma • Most common sites Tumor characterized by production of enamel, dentin, cementum and pulp tissue
- 32. 32 Compound odontoma in maxillary tubrosity
- 33. 33 Complex odontoma in maxillary tubrosity
- 34. 34 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.
- 36. 36 Central Osteoma anterior to remaining roots of lower 7
- 37. 37 Peripheral osteoma located in maxillary sinus
- 38. 38 Peripheral osteoma in right angle of the mandible It may confused with calcified lymph noads
- 39. 39 Osteoma
- 40. 40 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.
- 41. 5/4/2016 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.
- 44. 44 Malignant tumors • Sarcoma • Carcinoma. • Metastasis.
- 45. Benign tumors • Growth by direct extension • Insidious onset • Well defined borders • Rl + RO • Tooth displacement, or root resorption • Expansion or thinning of cortical bone 45 Malignant tumors Growth by infeltration and distruction Sudden onset Ill defined borders Punched out borders Totally RL Destruction of alveolar bone, teeth floating or displaced occlusally Erosion and destruction of cortical bone
- 46. 46 Sarcoma This 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
- 47. 47 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)
- 48. 1-Benign Tumors
- 49. • 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
- 50. Ameloblastoma
- 51. Ameloblastoma
- 52. 1- Ameloblastoma Multilocular (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
- 58. The shape of the septa Ameloblastoma Thick- Coarse & Curved Well defined in mandible but tend to be ill defined in maxilla
- 59. Multicystic Am.
- 60. 2- Calcifyingepithelial odontogenictumor (CEOT)= Pindborgtumor
- 61. CEOT Unilocularor 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
- 62. CEOT
- 63. 3- Adenomatoidodonotgenictumor (AOT) Radiolucent area surrounding impacted tooth
- 64. AOT • Wide age range: around 16 years Females > Males • Mainly anterior maxilla • ⅔ Mixed (RL +RO): RL surrounds more than the crown: not at CEJ RO: Dense clusters OR Faint foci (Snow flecks appearance)
- 65. AOT in mandible
- 66. 2- MixedOdontogenicTumors 1- Odontoma 2- Ameloblastic fibroma 3- Ameloblastic fibro-odontoma
- 67. 1- Odontoma Odontomas are developmental malformation ( hamartoma) of dental tissue, it is not neoplasm Very important - very common – children Two main Types Compound = normal arrangement of dental tissues Complex = abnormal mass of Calcification
- 68. 1- Odontoma Complex odontomas Compound odontomas
- 69. 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
- 71. 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
- 72. 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
- 75. 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 growth RL
- 77. 3- MesenchymalTumors 1-Odontogenic Myxomas 2-Benign Cementoblastoma 3-Central Odontogenic Fibroma
- 79. 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
- 80. Multilocular
- 81. • Radiography: • Typically appears as multi locular radiolucent area with well defined scalloped margin or soap bubble.
- 82. A lateral radiograph of a surgical specimen of a myxoma An occlusal view shows buccal expansion
- 83. 2- Cementoblatoma • ♂ >♀ • No race predilection • Wide age range • Vital teeth, Painful • Mand. Premolars & 1st molars • Fused with the roots • Roots resorbed or obscured
- 88. Cementoma or Periapical cemental dysplasia ?
- 90. Tori - Exostosis - Enostosis Known from clinical examination by: •Their location, •Lobulated shape, • Adherent normally appearing mucosa •Asymptomatic •Accidentally discovered •Intra-bony
- 91. 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)
- 92. A panoramic radiograph shows an osteoma in the right mandibular angle region
- 93. Osteoma
- 95. Cherubism
- 101. 2- Malignant Tumors
- 102. Well defined borders
- 106. 106 Clinical photograph shows leukoplakia that transformed to gingival cancer Intraoral panoramic view shows diffuse bone destruction
- 113. 113
- 114. 114
- 122. Osteosarcoma
- 124. 124 Effects on surrounding structures: i-Early :widening of the periodontal membrane • Loss of cortices and lamina dura. • Floating or hanging teeth
- 125. 125 ii-Late : • poorly defined osteolytic, osteoblastic • mixed pattern of involvement
- 126. Naglaa S. El Kilani 126
- 127. Naglaa S. El Kilani 127 “Sunray” Periosteal Reaction • Osteosarcoma • Chondrosarcoma • Ewing’s Sarcoma
- 128. 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.
- 129. Metastatic tumors
- 130. Metastatic tumors
- 131. Metastatic tumors
- 132. Multiple Myeloma
- 135. Naglaa S. El Kilani 135
- 136. Naglaa S. El Kilani 136 Punched Out” Skill Lesions • Multiple Myeloma • Langerhans Cell Histiocytosis • Metastatic Carcinoma • Neuroblastoma
- 137. Describe? D.D? • Solitary ill defined radiolucent area related to lower right molars and causing invasion of the IAC.
- 138. What is the view? Describe? D.D? • Inflammatory 1. Chronic osteomyelitis 2. Osteoradionecrosis • Neoplastic 1. Squamous cell carcinoma 2. Metastatic tumors to the jaws 3. Osteosarcoma and chondrosarcoma
- 139. 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)
- 140. What is D.D?
- 143. 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?