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 References: 參考資料
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 tori – occlusal radiography Multiple large exostosis – periapical radiography Refs. 1, 2
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) Multiple cementomas – Note of RL rims – Located in mandibular incisor region – Less frequently in maxilla 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 (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: 2 nd centers of ossification suture lines Ref. 1
Generalized Radiopacities (4) Paget’s disease Enlarged skull & maxilla Exophthalmos, healing aid 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 Commonly involves 5/6 bones at most Ref. 1
Generalized Radiopacities (5) Malignant osteopetrosis (Albers-Schonberg disease, marble bone disease) Almost complete obliteration of medullary portions of femurs & tibiae 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 Involve all the skeletal bones 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 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).
Generalized Radiopacities (6-2) Infantile cortical hyperostosis Ref. 3 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.
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 )