Oral Cavity: The Jaw and Teeth



10.1055/b-0034-87903

Oral Cavity: The Jaw and Teeth





























Table 4.41 Cystic lesions: dental

Diagnosis


Findings


Comments


Periodontal/radicular cyst/periapical cyst


Radiograph (panorex): well-circumscribed radiolucency around apex of tooth surrounded by thin rim of cortical bone.


Most common cyst.


Associated with carious teeth.


If large may displace teeth.


Dentigerous/follicular cyst


Fig. 4.149


Plain radiograph/panorex/CT: well-defined unilocular cyst, which incorporates the crown of the unerrupted tooth.


Vary in size.


More common in mandible.


If maxillary, may project into antrum.


Odontogenic keratocyst/primordial cyst


Multiple indicates Gorlin syndrome


Radiograph/CT: expansile cystic lesion, uni-multiloculated, smooth/scalloped border, ± impacted tooth.


Characteristically in body/ramus of mandible.


Often recurs.


Aggressive.


Residual cyst



A cyst that remains or develops after surgical removal of a tooth.

Fig. 4.149 Left dentigerous cyst with opacification of adjacent maxillary sinus on coronal CT of face (bone window).
















































Table 4.42 Cystic lesions: nondental

Diagnosis


Findings


Comments


Fissural cyst


Radiograph/panorex: round or ovoid midline cyst near anterior palatine papilla.


Unusual in children.


Developmental cyst in incisive canal.


Often incidental.


Aneurysmal bone cyst


Radiograph/panorex: large, multiloculated.


CT: cystic, expansile, multiple fluid-fluid levels.


More common in females.


Rapidly growing, painless.


Giant cell granuloma


Plain radiograph/CT: Expansile, multilocular radiolu-cent lytic lesion with tiny bone septa traversing lesion. Contains intralesional mineralization. Enhances postcontrast.


MRI: T1 and T2 hypointense, enhances postcontrast.


Rare, benign, slow-growing lesion in mandible/maxilla.


Present with swelling and pain.


Teeth and root displacement occurs.


LCH


Fig. 4.150


Radiograph/CT: Lytic destructive bone lesion with resorption of lamina dura resulting in floating teeth appearance. Associated heterogeneously enhancing soft-tissue mass.


MRI: T1 iso-/hypointense mass, T2 hyperintense, variable CE.



Hemangioma


Radiograph/CT: Radiolucent area traversed by t rabeculae forming various sized cavities. If trabeculae arranged in radiating pattern, then sunburst appearance.


Rare.


Rapid proliferation phase followed by slower involution phase.


Metastasis


Radiograph/CT: fairly well-defined, lytic mass with soft-tissue component.



Bone cyst due to trauma/injury


Radiograph/panorex: slightly irregular cyst with poorly defined borders and scalloped margins between the roots.


Often incidental.


May regress spontaneously.


Fibrous dysplasia


Fig. 4.151


CT: Depends on fibrous vs osseous component. Varies from radiolucent to ground-glass.


Uni-/multilocular lesion, well-defined margin.


MRI: sharply demarcated mass, variable signal intensity, diffuse CE.



Pain, swelling, and displacement of teeth.


Active growth in childhood.


Malignant transformation in polyostotic variant described.



Fig. 4.150 Right mandibular bone destruction with floating tooth characteristic of Langerhans cell histiocytosis on 3D CT reconstruction of face.
Fig. 4.151 Axial CT of mandible (bone window) showing a diffuse, expansile, ground-glass bone lesion with large osseous component on left, which is characteristic of fibrous dysplasia.
















































Table 4.43 Tumor/tumorlike lesions

Diagnosis


Findings


Comments


Burkitt lymphoma


Fig. 4.152


Radiograph: Poorly-defined destructive, mottled bone lesion with root resorption and loss of lamina dura of developing teeth. Associated cortical loss.


CT: destructive soft-tissue mass with extension into surrounding soft tissue.


MRI: diffuse infiltration, heterogenous mass with CE.


African variant most common childhood malignancy in Africa.


African Burkitt strongly associated with Epstein-Barr virus (EBV).


LCH


Fig. 4.150, p. 387


Radiograph/CT: Lytic destructive bone lesion with resorption of lamina dura resulting in floating tooth appearance. Associated heterogeneously enhancing soft-tissue mass. MRI: T1 iso-/hypointense mass, T2 hyperintense, variable CE.



Osteosarcoma


Radiograph/CT: lytic bone destruction with ill-defined margins (osteolytic type) or areas of sclerosis (o steoblastic type) with aggressive periosteal reaction, ± sunburst effect, ± cortical breakthrough, and ± calcification/osteoid formation.


MRI: heterogeneous mass.


NM: increased uptake, identifies other bone lesions.


Prone to recurrence and metastases.


Rhabdomyosarcoma


CT: Soft-tissue mass with variable but diffuse CE, ± bone erosion. May extend to involve mandible depending on site. MRI: T1 isointense, T2 hyperintense, variable but diffuse CE.


Forty percent occur in head and neck.


May extend intracranially.


Leukemia


Radiograph/CT: loss of lamina dura, varying degree of lytic bone destruction.



Odontoma


Fig. 4.153


Radiograph/panorex: initially radiolucent then calcified, with the calcified portion separated from expanded cortex by a radiolucent zone ± impacted, unerrupted tooth.


Benign tumor made up of various components of teeth (enamel, dentin, cementum, pulp).


Located between roots of teeth.


May be associated with unerupted tooth.


Metastasis


Radiograph/CT: fairly well-defined, lytic mass with soft-tissue component.



Cementoma: cementifying fibroma


Radiograph/panorex: Early—well-circumscribed, well-demarcated radiolucent lesion with no internal radiopacities.


Late—contains internal radiopacities.


Slow growing: 1–2 cm.


Benign cementoblastoma (true cementoma)


Fig. 4.154


Well-defined, dense radiopaque material attached to tooth root with surrounding radiolucent zone.


Rare.


Mandibular first molar most frequently involved.

Fig. 4.152 Burkitt lymphoma with floating tooth and loss of lamina dura and cortical resorption on oblique radiograph of mandible.
Fig. 4.153 Oblique radiograph of mandible showing expanded radio-lucent lesion with calcification and unerupted tooth consistent with an odontoma. Note how the calcified portion is separated from the cortex by a radiolucent zone.
Fig. 4.154 Well-defined dense radiopaque material attached to tooth root is characteristic of a true cementoma on panorex view of the right mandible.
































Table 4.44 Floating teeth

Diagnosis


Findings


Comments


LCH


Fig. 4.150, p. 387


Radiograph/CT: Lytic destructive bone lesion with resorption of lamina dura resulting in floating tooth appearance. Associated heterogeneously enhancing soft-tissue mass. MRI: T1 iso-/hypointense mass, T2 hyperintense, variable CE.



Metastasis


Radiograph/CT: aggressive bone destruction, no periosteal reaction/calcification.



Leukemia


Radiograph/CT: loss of lamina dura, varying degree lytic bone destruction.


CT: permeative bone destruction.


MR: T1—leukemic infiltrate of low signal replacing normal fatty marrow. T2—increased signal.



Burkitt lymphoma


Fig. 4.152


Radiograph: Poorly defined destructive, mottled bone lesion with root resorption and loss of lamina dura of developing teeth. Associated cortical loss.


CT: destructive soft-tissue mass with extension into surrounding soft tissue.


MRI: diffuse infiltration, heterogenous mass with CE.


African variant most common childhood malignancy in Africa.


African Burkitt strongly associated with EBV.


Desmoplastic fibroma


Radiograph/CT: destructive, expansile mass, contains lacelike calcification.


Aggressive, high recurrence rate.

































Table 4.45 Hyperostosis/sclerosis/destruction

Diagnosis


Findings


Comments


Osteomyelitis


Radiograph: sclerosis or mixed sclerotic/lucent.


Primary chronic osteomyelitis: nonsuppurative, noninfectious.


Actinimycosis occurs in mandible.


Infantile cortical hyperostosis (Caffey disease)


Fig. 4.155, p. 390


Radiograph: periosteal thickening, dense laminated subperiosteal new bone formation of mandible, may cause mandibular asymmetry.



Fibrous dysplasia


Fig. 4.151, p. 387


CT: Depends on fibrous vs. osseous component. Varies from radiolucent to ground-glass.


Uni-/multilocular lesion, well-defined margin.


MRI: sharply demarcated mass, variable signal intensity, diffuse CE.



Camurati-Engelmann disease


Radiograph: sclerosis of base of the skull (BOS) ± cranial vault and facial bones.



Van Buchem disease


Radiograph: osteosclerosis and hyperostosis of mandible, endosteal sclerosis of cranium.


Fig. 4.155 AP radiograph of mandible shows diffuse periosteal thickening of mandible with dense laminated subperiosteal new bone formation, which is characteristic of Caffey disease.




























































































Table 4.46 Congenital abnormalities: affecting size and symmetry

Diagnosis


Findings


Comments


Down syndrome


Radiograph: hypoplasia of the facial bones and sinuses, short hard palate, hypotelorism, dental abnormalities (delayed tooth eruption, anodontia).



Pierre Robin syndrome


Fig. 4.156


Radiograph: mandible hypoplasia, obtuse mandibular angle, cleft palate.



Alcohol embryopathy


Radiograph: mandible hypoplasia, microcephaly.


Growth retardation.


DiGeorge syndrome


Radiograph: mandible hypoplasia, hypertelorism. Thymic aplasia.



Crouzon syndrome


Radiograph: premature closure any/all sutures, hypoplasia of the maxillomalar facial mass, recession malar bone, short and distorted zygomatic arches.



MPS (Hurler syndrome)


Radiograph: short wide mandible with obtuse angle, short rami, and flat/concave condyles. Premature closure of sutures, thickened calvarium at base, J-shaped sella.



Mandibulofacial dysostosis


Radiograph: hypoplasia/agenesis of malar bones, cleft palate.


Abnormality of first and second pharyngeal pouch, groove and arch structures.


Seckel syndrome


Radiograph: hypoplasia maxilla and mandible, microcrania, hypertelorism.


“Bird-headed appearance.”


Acrofacial dysostosis


Radiograph: mandible hypoplasia, craniosynostosis.



Melnick-Needles syndrome


Radiograph: mandible hypoplasia, BOS sclerosis.



Goldenhar syndrome


Radiograph: hypoplasia maxilla ± mandible and temporal bones.


Usually unilateral.


Caffey disease


Fig. 4.155


Radiograph: periosteal thickening and dense, laminated, subperiosteal new bone formation of mandible causing mandibular asymmetry.


Mandible, clavicles, and ribs most commonly involved.


Trisomy 13/15


Radiograph: mandible hypoplasia.



Trisomy 17/18


Radiograph: mandible and maxilla hypoplasia, J-shaped sella, thin calvaria.



Pyknodysostosis


Fig. 4.157


Radiograph: mandible hypoplasia, obtuse or absent angle of mandible, wormian bones, dental abnormalities.


Generalized osteosclerosis.


Hallermann-Streiff syndrome


Radiograph: mandible hypoplasia, anterior displacement of temporomandibular joint, brachycephaly.



Campomelic dysplasia


Radiograph: mandible hypoplasia, antegonal notching of mandible, macrocephaly.



Metaphyseal chondrodysplasia (Jansen type)


Radiograph: mandible hypoplasia with irregular mineralization, brachycephaly, platybasia.



Russell-Silver syndrome


Radiograph: mandible hypoplasia.


Two-thirds have partial or total asymmetry of face, small triangular face.


Rubenstein-Taybi syndrome


Radiograph: mild retrognathia, mandible hypoplasia, cleft palate.


Fig. 4.156 Lateral radiograph of face shows mandibular hypoplasia in a patient with Pierre Robin syndrome.
Fig. 4.157 Mandibular hypoplasia with absent angle of mandible in a patient with pyknodysostosis. Note the osteosclerotic bones on lateral radiograph of skull and face.

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Jul 12, 2020 | Posted by in PEDIATRIC IMAGING | Comments Off on Oral Cavity: The Jaw and Teeth
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