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:
1. Wood, Goaz. Differential diagnosis of oral lesions. Mosby, 3rd ed., Chapter 27, p.
610-9
2. Kaohsiung Medical University, Department of Oral Pathology
3. Golan I et al. Dentomaxillofacial variability of cleidocranial dysplasia:
clinicoradiological presentation and systematic review. Dentomaxillofac Radiol
2003;32:347-54
4. Golan I et al. Early craniofacial signs of cleidocranial dysplasia. Int Pediatr
Denti2004;14:49–53
5. Ribeiro ACP et al. Oral cysticercosis: case report. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2007;104:e56-e58
Multiple Separated Radiopacities (1)

Most common lesions

1. Tori and exostoses
2. Multiple retained roots
3. Multiple socket sclerosis
4. Multiple mature cementomas
5. Multiple periapical condensing osteitis
6. Multiple embedded or impacted teeth
7. Cleidocranial dysostosis (dysplasia)
Ref. 1
 Multiple Separated Radiopacities (2)

Multiple large Multiple large

tori – exostosis –
occlusal periapical
radiography radiography

Refs. 1, 2
Multiple Separated Radiopacities (3)

Multiple root fragments –

readily identified

Multiple root fragments –

not readily identified

Ref. 1
 Multiple Separated Radiopacities (4)

Multiple socket sclerosis

1. 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
Multiple Separated Radiopacities (5)

– Note of RL rims
– Located in mandibular
incisor region
– Less frequently in maxilla

Multiple cementomas

Ref. 1
 Multiple Separated Radiopacities (6)
Multiple idiopathic osteosclerosis

1. 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
Multiple Separated Radiopacities (6)
Multiple periapical condensing
osteitis

1. Non-vital or degenerating pulp

2. Found surrounding multiple root fragments

Ref. 1
 Multiple Separated Radiopacities (7)

Multiple embedded/impacted teeth (no syndrome)

1. 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
 Multiple Separated Radiopacities (8-1)

Cleidocranial dysostosis –
1. Numerous impacted teeth
2. Partially or complete absence of clavicles
3. 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
Multiple Separated Radiopacities (8-2)
Cleidocranial dysostosis- Dentomaxillofac Radiol
2003;32:347-54

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

Ref. 3
 Multiple Separated Radiopacities (8-4)
Cleidocranial dysostosis- Int J Pediatric Dent 2004;14:49-53

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

Ref. 4
 Multiple Separated Radiopacities (9-1)

Multiple calcified LN –
Cysticercosis – TB history
many small RO foci scattered
within the cranium

Ref. 1
Multiple Separated Radiopacities (9-2)
Cysticercosis –
Frequent in developing countries
A parasitic infection rarely involves the mouth

Ref. 5
Multiple Separated Radiopacities (10)

Multiple phleboliths
Multiple sialoliths
Bilateral

Ref. 1
Multiple Separated Radiopacities (11)

Multiple RO - Paget’s disease

Ref. 1
 Summaries
明白多個分開之X光不
透過影像的鑑別診斷。
 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
 學 習 目 標
Understanding:
1. 廣泛性X光不透過影像的鑑別診斷

Ref. 1
 參考資料
References:
1. Wood, Goaz. Differential diagnosis of oral lesions. Mosby, 3rd ed., Chapter 28, p.
620-630
2. Dutta S et al. Infantile cortical hyperostosis- Indian Pediatric 2005;42:64-6
3. Ramaglia L et al. Gardner’s syndrome – Oral Med Oral Pathol Oral Radiol Endod
2007;103:e30-e34
4. Wong YK & Cheng JCF. Infantile cortical hyperostosis of the mandible. Br J Oral &
Maxillofac Surg 2008;46:497-8
Generalized Radiopacities (1)

Most common lesions

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

Florid cemento-osseous dysplasia

1. Restricted to jawbones
2. Vast majority of patients > 30y/o
3. A marked predilection for females & blacks
4. 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
Generalized Radiopacities (3)

Florid cemento-osseous dysplasia

Ref. 1
 Generalized Radiopacities (4)
Exophthalmos, Cotton wool
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
 Generalized Radiopacities (5)

Malignant osteopetrosis
(Albers-Schonberg Almost complete obliteration of
disease, marble bone medullary portions of femurs & tibiae
disease) Involve all the skeletal bones
Two main types (Normal serum chemistry levels):
1. Clinically benign dominantly inherited form: develop later
in life, less severe, fractures on minor trauma
2. 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
 Generalized Radiopacities (6-1)

Infantile cortical hyperostosis

1. Proliferation of cortices
2. Almost completely obliterated the shadows of the
medullary cavities
3. Soft tissue swellings, fever and irritability

Ref. 1
 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
 Generalized Radiopacities (6-2)

Infantile cortical hyperostosis

Ref. 3
 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
 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
Generalized Radiopacities (7-1)

Gardner’s syndrome –
multiple osteomas
Ref. 1
 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
Generalized Radiopacities (7-3)
Generalized Radiopacities (8)

Unusual large & numerous exostoses & tori

 Systematic approach
to
differentiate radiopacities

1. Attached or not attached to tooth apices

2. Which tooth/teeth involved?
3. Vitality of the attached tooth
4. Degree of opacities
5. Presence of radiolucent rim (margin) or not
6. Number of opacities (multiple quadrants)
7. Clinical symptom of infection exist?
(必考)
 Summaries
明白廣泛性X光不透過
影像。
*各位同學
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