11: Assessment/Interpretation of Pathology of the Jaws

Chapter 11 Assessment/Interpretation of Pathology of the Jaws

Learning Objectives

1. Recognize abnormal features in the jaws
2. Recognize cysts of the jaws
3. Know the features of tumors of the jaws
4. Recognize developmental or genetically related disorders
5. Identify fibro-osseous conditions
6. Recognize inflammatory disorders and infections
7. Review the most common pathologic abnormalities affecting the jaws

Goal

To know how to assess and/or interpret radiographic images for the presence of disease

Instructions

The questions are short and to the point. They do contain clues such as the age and sex of the patient, laboratory values, and even in the patient’s name! So watch for the clues.

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CASE 11-1 Bill is an asymptomatic 47-year-old who presented for routine dental treatment. This radiograph was taken as part of the full mouth survey.

1. On what side of the mandible (buccal or lingual) is the radiolucent lesion in the canine area located?
2. What developmental anomaly do you think this finding represents?
3. What treatment (if any) would you recommend?

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CASE 11-2 Mary is a 67-year-old who was referred to the periodontist. As part of the radiographic examination, this small radiolucent lesion was detected. The teeth were vital.

1. Give a differential diagnosis for this lesion. Include three conditions, stating your most likely choice first and least likely last.
2. Considering the patient’s age and the location, size, and clinical findings, what is your diagnostic impression?
3. What treatment would you recommend? Why?

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CASE 11-3 This is a 35-year-old asymptomatic woman who has slight buccal and palatal enlargement of the alveolar bone in this area. Other studies indicated portions of the zygoma were involved. This condition was first detected at age 19 years and is slowly progressive. Her alkaline phosphatase was normal to high-normal, and the serum calcium was normal.

1. Describe the significant radiographic findings.
2. Give a differential diagnosis consisting of three conditions, with your best choice first.
3. What is your diagnostic impression?
4. What treatment (if any) would you recommend?

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CASE 11-4 This 72-year-old woman presented with loose 20-year-old dentures and slight intermittent pain under the lower denture. She stated she had her teeth extracted because of severe untreated caries and abscessed teeth. The radiolucent lesion was detected on a radiograph of the painful area.

1. Describe the lesion.
2. What is your diagnostic impression?
3. Name several other lesions that could look like this.
4. What treatment would you recommend?

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CASE 11-5 Mary is a 55-year-old who is about to have dentures made.

1. Study this radiograph and determine what significant factor might affect the treatment plan.

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CASE 11-6 This 6-year-old boy presented with intermittent pain in the left posterior mandible. A clinically missing lower left 1st molar was noted, and the other three 1st molars were erupted. No bony expansion was in this area (arrows); however, the tissue at the crest of the ridge was slightly reddish and swollen.

1. What is the cause of the patient’s pain?
2. Describe the lesion causing the delayed eruption.
3. Give a differential diagnosis of four conditions.
4. What is the most probable diagnosis?
5. Upon removal of the mass, will the 1st molar erupt?

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CASE 11-7 This asymptomatic patient is a 45-year-old woman. Her routine radiographs indicated several periapical radiolucencies in the lower anterior region.

1. What is the probable race of this patient?
2. What condition is present?
3. In all likelihood, are the teeth vital?
4. If applicable, what stage(s) is (are) present?
5. What treatment (if any) would you recommend?

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CASE 11-8 This patient is missing all of his lower molars bilaterally, and a removable partial denture is being planned.

1. What (if any) treatment plan modification(s) would you consider after studying this radiograph? Comment on the prognosis of your treatment plan.

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CASE 11-9 This is a 16-year-old female with a lesion in the left mandible. All of the teeth are vital.

1. Describe the lesion.
2. Give a differential diagnosis of five conditions in a descending order of certainty.
3. State your diagnostic impression.
4. Discuss the certainty and prognosis of your diagnostic impression.

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CASE 11-10 Terry is a 12-year-old boy with intermittent pain and swelling in the right posterior mandible.

1. Describe the lesion.
2. Give a differential diagnosis.
3. State your diagnostic impression.
4. What is the treatment, and state the prognosis?

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CASE 11-11 Clara is a 72-year-old who reports pain and slight facial swelling in the right maxilla. Clinically, you could see swelling at the mucobuccal fold between the 1st molar and 2nd premolar. Her history revealed she had a Caldwell-Luc procedure performed on the right maxillary sinus some 20 years ago.

1. Based on this history and radiographic findings, what lesion is present?
2. Briefly describe the three variations in location with which this lesion presents.

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CASE 11-12 George is a 41-year-old with slight discomfort in the area of this 15-year-old bridge. Clinically, the gingiva beneath the pontic was red and swollen.

1. What condition do you think is present?
2. What is the treatment and prognosis?

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CASE 11-13 Ollie is 64 years old. He has a removable partial denture with bilateral free end bases, which he has worn for years. Look at the most distal tooth in the lower right quadrant; it was the only tooth affected.

1. What condition affects the root of this tooth?
2. What is the characteristic radiographic appearance?
3. With what systemic disease is this associated, and do you think this case applies?
4. Comment on how this may have developed.
5. Has the dilacerated root developed in association with this condition or its history?

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CASE 11-14 Mr. X is a 59-year-old homeless person. He recently had his remaining mandibular teeth extracted for tenderness, redness, swelling, and intraoral and submandibular fistula formation in the right quadrant. However, the pain has not regressed. Now paresthesia has developed in the lower right lip. The radiograph revealed a possible partially healed fracture of the mandible in the right canine region, the cause of which the patient could neither affirm nor deny.

1. Describe the radiographic findings.
2. State your diagnostic impression.
3. In normal extraction socket healing, how long does it take for the lamina dura to disappear?
4. How would you treat this?

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CASE 11-15 Denis is a 13-year-old boy with a slightly swollen face on the right side. Clinically, a non-tender, bony, hard swelling was in the mucobuccal fold adjacent to the 1st molar. There was a history of past toothache, but it went away.

1. Describe the significant radiographic findings.
2. State your diagnostic impression.
3. How would you treat this?
4. With successful treatment, how long would you expect it to take for the swelling to go away?
5. Describe the radiographic evidence of resolution.

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CASE 11-16 Denise is a 27-year-old who complained her “front tooth” seemed to be getting “crooked.” The radiolucency in the right maxilla was a serendipitous finding.

1. Regarding the lesion, what diagnostic test would you perform?
2. What is your diagnostic impression?
3. How would you manage this case? Remember the chief complaint!

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CASE 11-17 This 52-year-old man gave us the okay for a fixed prosthesis to replace the lower left molar. Everybody was surprised to find the radiolucent lesion at the inferior border of the mandible.

1. What is your diagnostic impression?
2. How would you manage this lesion?
3. About the bridge, can the angular relationship of teeth (such as abutment tooth parallelism) be assessed accurately from a panoramic radiograph?

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CASE 11-18 Mrs. Sally S. is 42 years old. She complained that her overdenture no longer fit well and chewing was painful. Clinically, a reddish, slightly swollen area was at the crest of the edentulous ridge in the right posterior mandible.

1. Describe the lesion.
2. What is your diagnostic impression?
3. How would you manage this case?

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CASE 11-19 This patient is a 16-year-old male. He complained of pain on chewing, and his mother noticed the left side of his face seemed a bit swollen. He had never been to the dentist. At surgery, some straw-colored fluid could be aspirated.

1. Describe the lesion.
2. Give a differential diagnosis of five lesions.
3. State your diagnostic impression.
4. How would you manage this case?

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CASE 11-20 Normie is an 11-year-old boy who presented with a slowly progressive facial swelling over the past 6 to 8 months and mild pain on chewing.

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Related posts:

  1. 9: Radiation Health
  2. 2: Materials and Foreign Objects
  3. 8: Panoramic Digital Imaging
  4. 1: Normal Anatomy
  5. 13: Radiographic Assessment and Interpretation
  6. 6: Panoramic Radiography: Clinical Technique

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Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 11: Assessment/Interpretation of Pathology of the Jaws

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