radio session 5

8/8/2019 Radio Session 5

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Session 5 without Questions Third Year Session 5

Cases 2Swellings of the Jaws

In medicine, clinicians are constantlyreminded to look for the horses, not thezebras.While that remains good advice, especiallyto those just beginning their careers, amind that is open to the unusual remainsimportant when developing a differentialdiagnosis.

Tumours

Cysts Non-odontogenic tumours Odontogenic tumours Giant cell lesions Fibro-osseous lesions Metastatic lesions Chronic Osteomyelitis

Dysplastic lesions arising in thetooth-bearing area

Fibrous Dysplasia Periapical cemento-osseous dysplasia

Focal cemento-osseous dysplasia Florid cemento-osseous dysplasia Fibro-osseous neoplasms Cementifying fibroma Ossifying fibroma Cemento-ossifying fibroma

Case 14

Cemento-Osseous Dysplasia


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History

A 45 year-old woman of negro ancestrypresented for routine dental care.

Bony lesions below the apices if the lowerincisors were noted on full mouth p.a.radiographs.

No signs or symptoms associated with thelesions.

The teeth tested vital within normal limits.

Cemento-osseous Dysplasia 2

History

A 55 year old man attended a dentalprosthetist asking for part upper and lowerdentures.

The prosthetist noticed that his lower jawfelt a bit lumpy" and asked the patient tobe examined by his dentist.

There was no pain & the swellings werefirm.

Cemento-osseous dysplasia 3


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History

A 23 year old Indian woman was referredto an oral surgeon for removal oftroublesome lower third molars.

On OPG, there appeared to be wellcorticated lesions surrounding the apicesof 34,36 & 46.

The teeth were non-carious & there wasno advanced periodontal disease.

When tested, the teeth were vital.

Fibrous Dysplasia

History

A 45 year old Caucasian woman wasreferred for oral and maxillofacialevaluation of a recurrent dental conditionby a general dental practitioner.

The dentist had taken a radiograph andthought that the physical findings mayhave been consistent with a fibro-osseouslesion of the jaw.

Fibrous Dysplasia 2


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History

An 40 year old patient broke his denture inan accident & attended asking for areplacement. It was decided to removethe remaining upper tooth & make him F/Pdentures.

Clinical examination revealed a firmswelling on the buccal aspect of themandible on both sides.

Case 15

Salivary Calculus

75 year old man attended complaining ofintermittent swelling in the floor of themouth.

Pain occurs when he goes into the kitchenwhen his wife ispreparing the dinner.

Salivary Calculus


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Sialography

Case 16

HypercementosisBiopsy no:88/48

History

An 45 year old emergency patient attendsfor an extraction of a carious 14.

The tooth was impossible to loosen, andwhen more pressure was applied theadjacent teeth began to wobble

A radiograph was then taken. The patient is then referred to an oral

surgeon.


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Implications of Hypercementosis in a Barbados SlaveSkeletal Collection.

Corruccini RS , Jacobi KP , Handler JS , Aufderheide AC .Department of Anthropology, Southern Illinois University, Carbondale 62901.

Am J Phys Anthropol. 1987 Oct;74(2):179-84.A 17th- to 19th-century cemetery sample of 104 slavesfrom Newton Plantation (Barbados) shows uniquely highhypercementosis prevalence, as well as unexpectedlyhigh and variable skeletal lead content. A variety ofbiological and archeological factors indicates thatindividuals with lower amounts of these anomalies(relative to age at death) were probably African-born,first-generation slaves. The hypercementosis is relatedto the progression of periodontal disease as assessedfrom alveolar bone. Although the hypercementosis isendemic in the Caribbean black population, it does notas yet have a clear explanation. We suggest the etiologymight relate to chronic malnutr ition involving periodic,seasonal rehabilitation.

Case 17

Congenital Syphilis

History

A 16 year old immigrant boy from the Hornof Africa had a routine medicalexamination.

While examining his throat, the doctornoticed that his teeth were of an oddshape and referred him to the dentalhospital.

Congenital Syphilis

Hutchinsons peg shaped incisors Mulberry molars Depressed bridge of nose Prominent frontal bones Abnormal maxilla development Deafness Anterior tibial bowing Clutton joints (arthritis of both knees)


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Case 19

Odontogenic KeratocystBiopsy No: 85/657

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Odontogenic Keratocyst 2


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History

An old patient who has not attended for along time presents complaining of a slowlygrowing swelling on the right hand side ofhis lower jaw.

He also says that he thinks his teeth aremoving.

Clinical exam reveals a smooth painlesslump over the 44,45 region. The overlyingmucosa is normal.

Further Investigations

Following examination of the radiograph,the patient was referred to an oral surgeonwho performed an aspiration biopsy whichproduced a thick, cheesy material thatsmelt like old socks.

Keratocyst 3

History A 8 year old child was brought in for a dental

examination because her mother thought thather teeth were slow. She was concerned thatthe upper lateral incisors might be missing.

Clinical examination revealed the deciduous

lateral incisors to be still in place and firm, andthere was a swelling on the left hand side of themandible.

A radiograph was taken which revealed a largelesion on the lower right hand side. A swellingwas obvious on palpation but the childs faceappeared normal.


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Simple (Traumatic) Bone Cyst

History

A young man of 20 years noticed asmooth swelling in the buccal vestibuleand lower border of the left mandible.

It was not painful nor were there anydental symptoms.

All the teeth on the left hand side werevital.

An aspiration biopsy produced only asmall amount of blood.

Residual Cyst

History

A 35 year old patient attended as she hadnoticed a swelling behind the last standingmolar on the lower left hand side.

It was increasing in size and she wasbeginning to bite on the mucosa whichcaused pain.

She was certain she had had her wisdomteeth extracted some years previously.


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Case 20

Ameloblastoma 1Biopsy No:85/656

Case 21

Ameloblastoma 2Biopsy no:85/211

A 22 year old army cadet had a routinescreening dental examination.

He had no symptoms. A firm mandibular lesion was observed in

the retromolar region of the right mandible It was non-mobile and not tender to

palpation.


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Case 19

Dentigerous Cyst 1

History

A 6 year old child attends the schooldental therapist who notices that 85 hasnot erupted. The mother was unaware ofthis.

Clinical examination reveals a smoothswelling over the area. It is noterythematous nor painful.


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Case 20

Dentigerous cyst 2

History

A new patient attends for an examination. He mentions that he has a swelling at the

back of his last molar on the upper righthand side that seems to be getting biggerand it is now annoying him when he biteson it.

He says he has never had an extraction inthe area.

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Dentigerous Cyst 3

History

An 18-year-old girl was referred by hergeneral dentist to an oral surgeon for theremoval of four third molar teeth.

He had noticed a unilocular radiolucentlesion associated with impacted tooth 48.

The radiolucency was corticated and wasdisplacing 48 inferiorly.

There was no evidence of facial swellingor pain.


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Odontogenic Myxoma

History

A 20 year old patient presents complainingof a swelling on the left hand side of themandible. It is painless but he feels it isgrowing rapidly.

Squamous Cell Carcinoma 1


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History

A fifty-one year old female patient without anymedical history of interest was referred to thedental hospital for extraction of an impacted 38.

The referring dentist had taken a radiograph andformed the tentative diagnosis of a dentigerouscyst.

Clinical examination revealed a bony swelling inthe vestibular region in the left side of the jaw.

The overlying oral mucosa was normal.

Case 21

Squamous Cell Carcinoma 2

History

An elderly homeless patient attends thedental hospital complaining of an ulcer onthe mandibular ridge on the left hand side.

It has been there for a while & he thinks itis getting bigger.

He has a history of tobacco smoking andalcohol abuse.

Case 22

Squamous cell Carcinoma 3


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A forty nine year old male patient was referred tothe oral surgery dept. after having had anextraction of 48.

The pain and swelling in the region of the 48 hadnot resolved after several months following theextraction.

Clinical examination revealed a bony swellingand a normal mucosa.

The patient admitted to a smoking habit of 35cigarettes per day and drinking 4 glasses ofbrandy per day.

Post-operativeLymphatic Drainage of the Head

Acute Osteomyelitis

History A homeless drug addict attended casualty

with a markedly swollen face on the lefthand side. The skin overlying the area waserythemations and there was a drainingfistula anterior to the ear.

He was febrile and foundit difficult to open hismouth.


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OsteonecrosisPhossy Jaw

History

An elderly woman taking phosamax forosteoporosis complains that her jaw hurtswhere she had her teeth out earlier. Shehas a history of having teeth extractedseveral years ago and a denture inserted.

Arrows point to vertical remnants of old extraction sockets stillpresent decades after the teeth were extracted. This "laminar

rain" (lamina dura) is not diagnostic for osteonecrosis but doesshow that something prevented proper remodeling of the boneafter extraction. The "X" overlies an area of mushy, dark, oily

area of "moist rot" of the mandible, i.e. ischemic osteonecrosis.


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Now for something you willnever see!!

Pyknodysostosis

Pyknodysostosis

(PKND) is a rare genetic sclerosing bonedisorder, characterized with generalizeddiffuse osteosclerosis.

A 4-year-old male child, first referred forevaluation with a possible diagnosis ofosteopetrosis, because of his multiplefractures.

Clinical Features Skull deformities

persistent fontanelles (failure of closure of the cranialsutures)

an obtuse gonial angle hypoplastic maxilla hypoplastic paranasal sinus

History of multiple fractures of limbs andclavicles

Oral manifestations anterior crossbite increased incidence of dental caries

radio session 5

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