Radiologic Signs for Maxillofacial Diagnosis

Dental Signs

Dental signsNumber of teethTooth sizeTooth morphologyTooth structureTooth eruption patternTooth positionRegressive changes

Large Teeth

Large Teeth SINGLEMacrodontiaConnationFusionGeminationSingle central incisor short stature syndromeMULTIPLENormal variantAdjacent to benign vascular, lymphatic or neural tumorLipomatosisUnilateral hyperplasiaPituitary giantism

Small Teeth SINGLEMULTIPLE

Small Teeth SINGLEMicrodontia (e.g. peg lateral)Supernumerary teethMULTIPLENormal variantDentinogenesis imperfectaTrisomy 21Facial hypoplasiaPituitary dwarfismVascular tumors

Single/Few Teeth of Altered Form

Single/Few Teeth of Altered Form(Common) Turners tooth (acquired enamel hypoplasia)DilacerationTaurodontismEnamel invaginations (dens in dente)Peg lateral incisorsEnlarged cingulumEnamel evaginations (Leungs premolar)Shovel-shaped incisors

Single/Few Teeth of Altered Form(Uncommon)Connation (fusion and gemination)ConcrescenceTwinningTuberculated maxillary lateral/talon cuspHutchinsons teeth and mulberry molars (congenital syphilis)Premolarization of canines and molarization of premolars

Single/Few Teeth of Altered Form(Rare)Secondary to mutilating surgerySecondary to radiation therapySecondary to chemotherapy

Hypercementosis

HypercementosisPhysiologic with passive eruptionIdiopathicPeriodontal diseasePagets disease of boneAcromegalyBenign tumor (cementoblastoma)Apparent in periapical cemental dysplasia

Hypodontia/Oligodontia

Hypodontia/Oligodontia(common)Previously extracted teethIdiopathicEctodermal dysplasiasPrevious radiation therapyTrisomy 21 (Downs syndrome)

Hypodontia/Oligodontia(uncommon)Chondroectodermal dysplasiaFacial hypoplasiaIncontinentia pigmentiiOral-facial-digital (Mhrs) syndromeOculodento-osseous dysplasiaOculomandibulodyscephaly syndrome (Hallerman-Streiff) /continued

Hypodontia/Oligodontia(uncommon)Oligodontia and primary mesodermal iris dysgenesis (Riegers syndrome)PHC syndrome (Bks syndrome)Craniofacial dysostosis (Crouzons Sx)Ehlers-Danlos syndromeFocal dermal hypoplasia syndrome (Goltz syndrome) /continued

Hypodontia/Oligodontia(uncommon)PyknodysostosisProgeria (Hutchinson-Gilford syndrome)HypoparathyroidismInverted Marfans syndrome

Hyperodontia/Supernumeraries

Hyperodontia/Supernumeraries (common) IdiopathicCleft palateCompound odontomaCleidocranial dysplasia

Hyperodontia/Supernumeraries (uncommon) Osteomatosis intestinal polyposis syndrome (Gardners syndrome)Oculomandibulodyscephaly syndrome (Hallerman-Streiff syndrome)Oral-facial-digital syndromeDistomusAchondroplasiaEhlers-Danlos syndrome

Natal teethNormal variantChondro-ectodermal dysplasia (Ellis van Crevald syndrome)

Single Failure in Eruption

Failure in eruption - single(common)IdiopathicSupernumerary teethHypodontia (non-development of tooth)Mechanical obstruction by other toothRetained primary tooth or tooth rootDentigerous and eruption cysts

/continued

Failure in eruption - single(common)Benign tumor (e.g. odontoma, ameloblastic fibroma, ameloblastic fibro-odontoma, adenomatoid odontogenic tumor)Odontogenic keratocyst Cleft palateAnkylosis and submersionInflammation coronal to erupting toothOverlying tooth with pulpotomy

Failure in eruption - single(uncommon) Odontogenic myxomaCherubismUnicystic ameloblastomaLangerhans cell diseaseOssifying fibromaMalignancy and radiation therapyFibrous dysplasiaPost-extraction scar

Failure in eruption - multiple

Failure in eruption - multiple(common) Fibromatosis gingivaeDrug-induced gingival hyperplasiaCleidocranial dysplasiaCondylar hypoplasia and ankylosisCherubism

Failure in eruption - multiple(uncommon)Osteomatosis intestinal polyposis syndrome (Gardners syndrome)Acrocephalysyndactyly (Aperts syndrome)Gingival hyperplasia syndromesChondroectodermal dysplasia Ellis-van Crevald syndrome)Trisomy 21/continued

Failure in eruption - multiple(uncommon)Focal dermal hypoplasia (Goltz syndrome)OsteopetrosisRegional odontodysplasiaProgeria ( Hutchinson-Gilford syndrome)PseudohypoparathyroidismPyknodysostosisJuvenile hypothyroidism (cretinism)Ectodermal dysplasias Vitamin D deficiency syndromes

Premature Eruption

Premature Eruption (common) Normal variantEarly loss of primary teeth

Premature Eruption (uncommon) Adjacent benign vascular or neural tumorUnderlying malignant tumorUnderlying osteomyelitisHyperthyroidismPituitary giantismPrevious radiation therapyHypergonadismCushings syndromeAdrenogenital syndrome

Early Tooth Loss

Early Tooth Loss (common) Rampant dental cariesDentofacial traumaJuvenile periodontosis/periodontitis

Early Tooth Loss (uncommon)Langerhans cell diseaseFactitial injuryCyclic neutropeniaMalignancy (leukemia, lymphoma, neuroblastoma, rhabdomyosarcoma)Hyper keratosis palmoplantaris and periodontoclasia in childhood (Papillon- Lefeuvre syndrome)/continued

Early Tooth Loss (uncommon)Radicular dentin dysplasiaAcrodynia (pink disease)Other heavy metal poisoningAcatalasiaHyperparathyroidism

Early Tooth Loss (rare)Acro-osteolysisSevere RicketsPituitary cachexia syndrome (Simmonds syndrome)Chediak-Higashi syndrome

Displaced Teeth/Tooth Buds

Displaced Teeth/Tooth Buds (common)Normal variantMalocclusion ImpactionDentigerous cystsOther cystsTraumatic displacementSubmergence

Displaced Teeth/Tooth Buds (uncommon)CherubismLateral inflammatory odontogenic cyst of the mandible (Stonemans cyst)Benign giant cell tumorAmeloblastoma and ameloblastic odontomaMelanotic neuro-ectodermal tumor of infancy/continued

Displaced Teeth/Tooth Buds (uncommon)Other benign tumorsOsteomyelitis including osteomyelitis of the maxilla in the newbornLangerhans cell diseaseMalignant tumors (e.g. Burkitts lymphoma, lymphosarcoma, neuroblastoma, rhabdomyosarcoma)

Coronal Radiolucency in Tooth (common)Dental cariesRadiolucent resin restorationsCervical burnout and Mach phenomenonProximal overlap artifactEnamel hypoplasiaAbrasion, attrition and erosionDens in dente

Coronal Radiolucency in Tooth (common)Dental cariesRadiolucent resin restorationsCervical burnout and Mach phenomenonProximal overlap artifactEnamel hypoplasiaAbrasion, attrition and erosionDens in dente

Coronal Radiolucency in Tooth (uncommon)Idiopathic internal resorptionExternal resorptionRadiation cariesPulpal diverticulaLeungs premolar (evagination of pulp)Radiolucent internal enameloma

Enlarged dental pulp

Enlarged dental pulp (common)Rotation of anterior teethDeveloping teethNormal variant (large cornua)TaurodontismInternal resorptionMacrodontia Connation (fusion and gemination)

Enlarged dental pulp (uncommon)Enamel evagination (Leungs premolar)Vitamin D resistant RicketsShell teeth of RushtonHypophosphatasiaRenal osteodystrophyPulpal extension into enamel pearl

Small dental pulp

Small dental pulp (common)Normal variantTeeth in elderly (secondary dentin)Reactive to dentin cariesTraumatically inducedDentinogenesis imperfecta

Small dental pulp (uncommon)Osteogenisis imperfectaDentin dysplasias

Dental Enamel Aberrations

Dental Enamel Aberrations (common)Dental cariesEnvironmental enamel hypoplasia (Turners tooth; neonatal disease; exanthematous fevers; nutritional deficiency; metabolic disease; drug induced; fluorosis)Amelogenesis imperfectas

Dental Enamel Aberrations (uncommon)Mucopolysacchaidoses IV (Morquio-Brailsford syndrome)Ehlers-Danlos syndromeHypophosphatasiaHypoparathyroidismRadiation therapy during tooth development

Dentin Aberrations (common)Dental cariesIdiopathic internal resorptionDentinogenesis imperfectaRegional odontodysplasia

Dentin Aberrations

Dentin Aberrations (uncommon)Osteogenesis imperfectaDentin dysplasiasShell teeth of RushtonEhlers-Danlos syndromeRadiation therapy during tooth development

Persistent Open Root Apex

Persistent Open Root Apex

Normal variationPost-dentition supernumerary toothNon-vital toothPeriapical pathosis (cyst; granuloma; abscess)Dens evaginatus (Leungs premolar)Idiopathic internal resorption

Prematurely Closed Root Apex

Prematurely Closed Root Apex

Previous trauma to toothRadiation therapy during tooth developmentDentinogenesis imperfectaOsteogenesis imperfectaRadicular dentin dysplasia

Calcified pulp tissue

Calcified pulp tissue

Pulp stoneNormal variant for elderlyProjection artifact (molars)Reaction to dentin caries or deep restoration Subsequent to traumaCalcareous degenerationSuperimposition of enamel pearlDentin dysplasias Dentinogenesis imperfecta

Fractured Tooth AppearanceTrue fractured toothPeriodontal ligament shadow from adjacent toothOverlying lip, cheek or nose lineBone trabecular pattern or nutrient canalAccessory lateral pulp canalAlveolar bone fractureRadiographic artifact (film crimp; static, etc.)

External Root Resorption

External Root Resorption(normal variants)Physiologic resorption (primary teeth)Traumatic occlusionAberrant resorption of mesial root of lower first molarNormal variant (pulpotomy of primary tooth)Projection artifact (foreshortening)Incomplete formation (tooth development)

External Root Resorption(common pathologic)Apical pathosis (cyst; granuloma; abscess)Iatrogenic - excessive orthodontic forceIdiopathic - uncertain causeRe-implantation of avulsed toothRoot canal therapyBenign odontogenic cysts and tumors (especially dentigerous cyst, ameloblastoma and central giant cell granuloma)

External Root Resorption(uncommon pathologic)Factitial injuryInostosisMalignant tumors (e.g. lymphoma)OxalosisHyperparathyroidismPeriodontal diseaseForeign body reactionIdiopathic internal resorption

Internal Tooth Resorption

Internal Tooth Resorption

IdiopathicTrauma-inducedCaries-inducedCauses of enlarged pulpsPulpal diverticuliExternal resorptionOdontomalacia

Dental calculus and look-alikesTrue dental calculusRestoration overhangsBony ledges adjacent teethEnamel pearl

Tooth-like Structures (near oral cavity)Avulsed tooth or tooth fragment (trauma or iatrogenic)Supernumerary teethCleft palate associatedCompound odontomaDistomusEpignathus

Tooth-like Structures (distant from oral cavity)LithopedionOvarian teratomaOther teratoma (e.g. intra-cranial)

Periodontal Signs

Radiologic Signs Concerning the PeriodontiumLoss of lamina dura (local)Loss of lamina dura (general)Accentuation of lamina duraWidened periodontal ligament spaceAnkylosisCrestal lucency leading to decreased alveolar bone

Localized Loss of Lamina Dura

Localized Loss of Lamina Dura(normal variations and confusing shadows)Apex of maxillary canine (canine fossa)Tooth rotationMaxillary premolars before maturationProjection over maxillary sinusTongue out of roof of mouth during panoramicProjection over mandibular canalProjection over mental foramen

Localized Loss of Lamina Dura(common pathlogic)Inflammatory periapical pathosis (apical granuloma, cyst or abscess)Simple (traumatic) bone cystPeriapical cemental dysplasiaFocal osteomyelitis

Localized Loss of Lamina Dura(uncommon pathlogic)Malignant tumor (e.g. osteogenic sarcoma)Fibrous histiocytomaLangerhans cell disease

Generalized Loss of Lamina Dura

Generalized Loss of Lamina Dura(common pathlogic)IdiopathicOsteoporosisPagets disease of boneLeukemia

Generalized Loss of Lamina Dura(uncommon pathlogic)Metastatic malignancy (especially breast)HyperparathyroidismHypoparathyroidismMultiple myelomaOsteomalaciaRickets (including vitamin D resistant form)Cushings syndrome/continued

Generalized Loss of Lamina Dura(uncommon pathlogic)Renal acidosisAcromegalyOxalosisHypervitaminosis DHypovitaminosis CScleroderma (systemic sclerosis)HyperphosphatasiaBurkitts lymphomaThalassemia

Accentuation of Lamina Dura

Accentuation of Lamina Dura

Normal variantScleroderma (systemic sclerosis)

Widened PDL Space

Widened PDL Space(common)Projection effectNormal finding around necks of teethPeriodontal disease (furcation involvement)Periapical inflammationTraumatic occlusionDental trauma (avulsion or fractured root)Jaw fracture through tooth socketRoot shadow cast over sinusScleroderma (systemic sclerosis)

Widened PDL Space(uncommon)Re-implantation of avulsed toothDiabetes mellitusPeriodontosisOsteomyelitisMalignant tumors (especially osteogenic sarcoma)Fibrous histiocytomaCystinosisActinomycotic infection

Suspision of Tooth Ankylosis

Suspision of Tooth Ankylosis True ankylosis of retained primaryTraumaRe-implantationObscuring condensing osteitisInfectionInostosisSocket sclerosis (false ankylosis)Obscuring idiopathic osteosclerosis COMMON UNCOMMON

Crestal Radiolucency

Crestal Radiolucency(common)Early destructive periodontal diseaseHyperemic decalcificationJuvenile periodontosisFactitial injuryAcute necrotizing ulcerative gingivitis

Crestal Radiolucency(uncommon)Langerhans cell diseaseHyperkeratosis palmoplantaris and periodontoclasia in children (Papillon-Lefevre syndrome)LeukemiaLocal malignancy (central or peripheral)Previous radiation therapyHypothuroidism (cretinism/myxedema)/continued

Crestal Radiolucency(uncommon)HyperthyroidismHyperparathyroidismPeripheral giant cell granuloma (epulis)Other epulidesCyclic neutropeniaHypophosphatasiaAcrodynia/continued

Crestal Radiolucency(uncommon)Acro-osteolysisSelf-mutilative syndromesAcatalasiaPituitary cachexia (Simmonds disease)Chediak-Higashi syndrome

Jaw Structure Fine Signs

RadiolucencyPeriapical radiolucencyPericoronal radiolucencyRadiolucency lateral to toothSolitary radiolucency (well-defined) not necessarily associated with toothSolitary radiolucency with ragged bordersRadiolucency in maxillary lateral incisor regionNon-cyst-like radiolucency of bone

/continued

RadiolucencyRarefying osteitisBlurring of trabecular patternDiminished number of trabeculaeGeneralized rarefactionMultilocular radiolucencyAmeloblastoma-like radiolunencyRadiolucency below mandibular canalExpansile jaw lesionsLesions\with undulating/crenulated margins/continued

RadiolucencyLytic lesions with wide band-like bordersWidened mandibular canalScattered bone destruction separated by normal or near-normal boneShort linear area of radiolucency in inferior cortex of mandibleCyst-like radiolucency with window-like cortical breachingThinned mandibular lower cortex/continued

RadiolucencyBallooned mandibular lower cortexAttenuation of shadow of follicle wallDiscontinuity of antral or nasal wallSuspected daughter cystsExternal erosion of boneLesion with no internal structureMultiple separate well-defined lucenciesMultiple osteolytic lesions with punched-out margins

Radiopacity and Mixed Radiopacity/RadiolucencyPeriapical mixed lucent/opaquePericoronal mixed lucent/opaquePeriapical homogeneous radiopacitiesSolitary mixed lucent/opaque lesion not necessarily contacting toothMixed lucent/opaque lesion of TMJSclerosing osteitisIncreased girth of individual trabeculae

/continued

Radiopacity and Mixed Radiopacity/RadiolucencyGranular boneSolitary opacity not contacting teethCompound odontomaComplex odontomaOpacity denser than normal boneMultiple separate opacitiesRoot-like density in bonePossible causes of root in bone appearance/continued

Radiopacity and Mixed Radiopacity/RadiolucencySuspected foreign body (metallic or non-metallic)Sequestra-like densityTarget lesion (radiopacity with peripheral shadow)Excrescence with bone densityThickened mandibular lower cortexLaminar periosteal new bone/continued

Radiopacity and Mixed Radiopacity/RadiolucencyNew periosteal bone with internal lysisSunray spiculation (new bone perpendicular to cortex)Lesions with internal spindly trabeculaeLesions with septae or pseudoseptaeLesions with honeycombed internal structureLesions with wispy internal structure/continued

Radiopacity and Mixed Radiopacity/RadiolucencyLesions with internal residual boneLesions with tubular internal structureLesions with internal rounded dense opacitiesLinear striations (driven snow) within jawboneSuspected osteoblastic metastases

Radiolucent Lesions

Periapical Radiolucency

Periapical Radiolucency (normal)Marrow spacePapillae of developing teethMaxillary sinusIncisive foramenNasolacrimal canalsSubmandibular fossaSublingual fossaMandibular canal and mental foramen/continued

Periapical Radiolucency (normal)Mental depression (chin)Tomographic plane (including panoramic) artifactProcessing errors ( e.g. developer splash)

Periapical Radiolucency (common pathologic)Periapical cyst, granuloma or abscessFibrous healing defectPeriapical cemental dysplasia (early)Periodontal abscess

Periapical Radiolucency (uncommon pathologic)Dentigerous cyst of underlying toothTraumatic (simple) bone cystOther cystsOsteomyelitisUnderlying benign tumor (e.g. cementifying/ossifying fibroma)Primary malignant tumor (e.g. leukemia)

/continued

Periapical Radiolucency (uncommon pathologic)Central giant cell granulomaLangerhans cell diseaseLingual salivary gland depression (Stafnes bone cavity)Multiple myelomaMetastatic malignancy (especially breast)/continued

Periapical Radiolucency (uncommon pathologic)Early cementoblastoma or osteoblastomaRadicular dentin dysplasiaEarly odontomas

Pericoronal Radiolucency

Pericoronal Radiolucency (common)Normal dental follicle spaceDentigerous cystEnvelopmental odontogenic keratocystAdenomatoid odontogenic tumorEarly odontoma or ameloblastic fibro-odontoma

Pericoronal Radiolucency (uncommon single)Ameloblastic fibromaAmeloblastomaEarly calcifying epithelial odontogenic tumor (Pindborg tumor)Mucopolysaccharidoses (I-H) - Hurlers syndromeEarly calcifying odontogenic cyst

Pericoronal Radiolucency (multiple)Dental follicle spacesMultiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Osteomastosis- intestinal polyposis syndrome (Gardners syndrome)MucopolysaccharoidosesRegional odontodysplasia

Radiolucency Lateral to Tooth

Radiolucency Lateral to Tooth (common)Lateral periodontal abscessLateral periodontal cystEndodontic perforationExtension of disease from adjacent tooth

Radiolucency Lateral to Tooth (uncommon)Lateral canal periapical cystOdontogenic keratocystNeurofibroma or neurilemmomaGiant cell granulomaUnilocular ameloblastomaLangerhans cell disease Hyperparathyroidism

Well-defined solitary lucency not necessarily contacting teeth (uncommon)Odontogenic keratocystAmeloblastomaGiant cell granulomaEarly ossifying/cementifying fibromaEarly fibrous dysplasiaEosinophilic granuloma

/continued

Well-defined solitary lucency not necessarily contacting teeth (uncommon)NeurofibromaOdontogenic myxomaCentral hemangioma

Well-defined solitary lucency not necessarily contacting teeth (rare)Aneurysmal bone cystChondrosarcomaCentral fibromaTuberculous osteomyelitisHydatid cystEarly calcifying epithelial odontogenic tumor (Pindborgs tumor)

Single Radiolucency with Ragged Borders

Single Radiolucency with Ragged Borders (common)Chronic osteitisOsteomyelitisPeripheral squamous cell carcinomaInfected radicular, residual or other cyst

Single Radiolucency with Ragged Borders (uncommon)Early fibrous dysplasiaMetastatic carcinomaMalignant salivary gland tumor involving boneOsteolytic osteosarcomaMultiple myelomaChondrosarcoma/continued

Single Radiolucency with Ragged Borders (uncommon)FibrosarcomaLymphosarcomaMelanotic neuroectodermal tumor of infancyLeukemia or Ewings sarcoma Aneurysmal bone cystNeurofibromaOdontogenic myxoma

Radiolucency in Region of Maxillary Lateral Incisor

Radiolucency in Region of Maxillary Lateral Incisor (common)Incisive fossa/foramenCanine fossaPeriapical cyst, granuloma or abscessRarefying osteitis from adjacent centralOther periapical radiolucencies

Radiolucency in Region of Maxillary Lateral Incisor (uncommon)CleftsAberrant foramina in anterior maxillaNasopalatine duct cystOdontogenic keratocystDepression from nasolabial cystPost-surgical defect

Non-Cystlike Radiolucency of Bone

Non-Cystlike Radiolucency of BoneFocal osteoporotic defectLarge marrow spaceNormal variant of tuberositySparse trabeculation in childMaxillary sinusForaminaSubmandibular fossa/continued

Non-Cystlike Radiolucency of BoneSublingual fossaPost-coronoid depressionSigmoid notch shadowAcute osteomyelitisHealing surgical defectDecalcification secondary to overlying inflammation

Rarefying Osteitis - Focal Osteomyelitis

Rarefying Osteitis - Focal Osteomyelitis (common)Foramina or dental PapillaAntrum or nasal passageMandibular canal or mental foramenLarge marrow spacePeriodontal abscess Apical cyst, granuloma or abscessEarly periosteal cemental dysplasia Healing surgical defect

Rarefying Osteitis - Focal Osteomyelitis (uncommon)ActinomycosisPrevious radiation therapyLeukemiaMetastatic malignancy (especially breast)Langerhans cell disease

Blurring of Trabecular Pattern

Blurring of Trabecular PatternOsteomyelitisDecalcification secondary to inflamed adjacent tissuesRadiodontic pitfall (e.g. motion unsharpness; bend artifact)

Diminished Number of Trabeculae

Diminished Number of Trabeculae(common)Normal variant in childrenInflammatory diseaseOsteopenic metabolic diseases(uncommon)Anaplastic anemiasPrevious radiation therapyVitamin D deficiency syndromeThalassemia and Sickle cell anemiaNeurofibroma

Decreased Size of Trabeculae

Decreased Size of Trabeculae(common)Normal variation Infection and inflammationDisuse atrophy of alveolus

(uncommon)Previous radiation therapyVitamin D deficiency syndromeThalassemia

Generalized Rarefaction

Generalized Rarefaction (common)OsteoporosisCortisone therapyRheumatoid arthritisProlonged immobilizationMalignant and other cachetic diseases

Generalized Rarefaction (uncommon)Cushings syndromeHyperparathyroidismVitamin D deficiency syndromeAcromegalyPancreatitisMalnutritionPregnancy-related changes/continued

Generalized Rarefaction (uncommon)Diabetes mellitusScurvyInherited anemiasLeukemiaLangerhans cell diseaseMultiple myelomaPagets disease of boneOsteogenesis imperfectaRenal acidosis

Generalized Rarefaction (rare) HypophosphatasiaHyperphosphatasiaHypoparathyroidismThyrotoxicosisHypogonadismAgranulocytosisOxalosisPrevious radiation therapy

Multilocular Radiolucency

Multilocular Radiolucency(common unilateral)Aberrant normal anatomy (maxillary antrum)AmeloblastomaOdontogenic keratocystCentral giant cell granulomaOdontogenic myxomaMultilocular radicular or residual cyst

Multilocular Radiolucency(uncommon unilateral)Mucoepidermoid tumorAneurysmal bone cystArterio-venous malformationCentral hemangiomaAmeloblastic fibromaCalcifying odontogenic cystEarly fibrous dysplasiaDeveloping odontomaLangerhans cell disease

Multilocular Radiolucency(rare unilateral)Calcifying epithelial odontogenic tumor (Pindborg tumor)Central fibromaChondromaSporotrichosisCerebroside lipoidosis (Gauchers disease)Oxalosis

Multilocular Radiolucency(bilateral)Normal variation for maxillary sinusesCherubismCerebroside lipoidosis (Gauchers disease)Multiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Oxalosis

Ameloblastoma-like Radiolucency- Soap Bubble Appearance

Ameloblastoma-like Radiolucency- Soap Bubble Appearance (common)AmeloblastomaOdontogenic keratocystGiant cell granulomaMultilocular large radicular or residual cyst

Ameloblastoma-like Radiolucency(uncommon)Ameloblastic fibromaTraumatic (simple) bone cystLangerhans cell diseaseOssifying fibromaFibrous dysplasiaCalcifying odontogenic cystSporotrichosisOxalosis

Lucency Below Mandibular Canal

Lucency Below Mandibular Canal (common)Normal variationSubmandibular fossaLingual salivary gland defect (Stafne)

(uncommon)Eosinophilic granulomaBenign tumor of salivary gland originSubperiosteal neurofibromaBenign vascular tumor

Expansile Jaw Lesions

Expansile Jaw Lesions(common)Laminar periosteal new bone ( e.g. osteitis proliferans)AmeloblastomaRadicular or residual cystCentral giant cell granulomaDentigerous cystFibrous dysplasiaCherubism

Expansile Jaw Lesions(uncommon)Hemangioma NeurfibromaOsteosarcoma or lymphosarcomaOssifying fibromaAneurysmal bone cyst(rare)Traumatic (simple) bone cystBurkitts lymphoma

Lesions with Crenulated (Undulating) Margins

Lesions with Crenulated (Undulating) MarginsAmeloblastomaCentral giant cell granulomaOdontogenic myxomaOther benign tumorsOdontogenic keratocystBotyroid lateral periodontal cyst

Lytic Lesions with Wide Band-like Borders

Lytic Lesions with Wide Band-like BordersInfected cystLateral inflammatory odontogenic cystFibrous dysplasiaGiant cell tumorAneurysmal bone cystOssifying fibroma(common) (uncommon)(rare)OsteoblastomaOsteoid osteoma

Widened Mandibular Canal

Widened Mandibular CanalNormal variantNeurilemmomaNeurofibromaVascular tumor, hamartoma or malformationMalignant tumor (primary, extension or metastasis)Lymphoma(common) (uncommon)

Scattered Bone Destruction Separated by Normal Bone

Scattered Bone Destruction Separated by Normal BoneAcute osteomyelitisMultiple myelomaSquamous cell carcinomaActinomycosisOsteoradionecrosisMetastatic carcinomaOxalosisTuberculous osteomyelitis(common) (uncommon)

Short Linear Area of Radiolucency in Inferior Cortex

Short Linear Area of Radiolucency in Inferior CortexAcute osteomyelitisSquamous cell carcinoma extending into boneOther local malignant destruction (e.g osteogenic sarcoma)

Cyst-like Radiolucency with Window-like Cortical Breaching

Cyst-like Radiolucency with Window-like Cortical BreachingAmeloblastomaLarge radicular or residual cystOdontogenic myxomaCentral giant cell granulomaNeurofibroma

Thinned Lower Cortex (Mandible)

Thinned Lower Cortex (Mandible)Multiple myelomaRheumatoid arthritisDiseases associated with generalized rarefactionLangerhans cell diseaseHyperparathyroidismThalassemiaSickle cell anemia(common) (uncommon)(rare)Hemifacial atrophy (Romberg disease) Osteogenesis imperfacta

Ballooned Inferior Cortex

Ballooned Inferior Cortex(common)Dentigerous cystPeriostitis ossificansLarge radicular or residual cystFibrous dysplasiaCementifying/ossifying fibromaAmeloblastoma Odontogenic myxoma

Ballooned Inferior Cortex(uncommon)Central giant cell granulomaNeurofibroma (blister lesion)Hyperparathyroidism (Brown tumor)HemangiomaAmeloblastic fibromaCalcifying odontogenic cyst

Ballooned Inferior Cortex(rare)Aneurysmal bone cystBurkitts lymphoma Central fibromaCalcifying epithelial odontogenic tumor (Pindborg tumor)Osteogenic sarcoma

Attenuation of Shadow of Follicle Wall

Attenuation of Shadow of Follicle Wall (common)Localized infection of primary toothEruption cystAcute osteomyelitis

Attenuation of Shadow of Follicle Wall (uncommon)Vitamin D deficiency syndromesLeukemiaLangerhans cell diseaseBurkitts lymphomaLymphosarcomaHyperparathyroidism

Attenuation of Shadow of Follicle Wall (rare)Melanotic neuroectodermal tumor of infancyRhabdomyosarcomaNeuroblastoma

Discontinuity of Nasal or Antral WallApical inflammationProjection artifactOsteomyelitisOdontogenic myxomaAmeloblastomaInvasive squamous cell carcinomaInvasive salivary gland malignancyLong-standing antritisPrevious surgery(common) (uncommon)(rare)Osteogenic sarcomaLangerhans cell diseaseLymphosarcomaAntral mucocele

Suspected Daughter Cysts

Suspected Daughter CystsOdontogenic keratocystAmeloblastomaMucoepidermoid tumor (central)Central hemangiomaBotyroid lateral periodontal cyst(common) (uncommon)

External Erosion of Bone

External Erosion of Bone

Adjacent squamous cell carcinomaScleroderma (systemic sclerosis) Cystic hygromaSecondary to pulsatile vesselHodgkins diseaseEosinophilic granulomaAdjacent malignant adjacent lymph nodeMetastatic malignancy Secondary to PVC poisoningIdiopathic

Lesion with no Internal Structure

Lesion with no Internal Structure Odontogenic cystNon-odontogenic cyst Traumatic bone cystAmeloblastomaOdontogenic myxomaHemangiomaNeurofibromaOsteolytic osteogenic sarcomaAmeloblastic fibromaEarly calcifying cyst or tumor(common) (uncommon)

Multiple Separate Well Defined Radiolucencies

Multiple Separate Well Defined Radiolucencies(common)Normal variationMultiple periapical pathoses (cysts, granulomas or abscesses)Multiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Early stages of periapical cemental dysplasia

Multiple Separate Well Defined Radiolucencies(uncommon) (rare)CherubismMultiple myelomaMetastatic carcinomaLangerhans cell disease LymphosarcomaLeukemiaAmeloblastomasSkip lesion of osteosarcomaNiemann-Pick diseaseCerebroside lipoidosis (Gauchers disease)MucopolysaccharoidosesHyperparathyroidism

Multiple Osteolytic Lesions with Punched Out Margins

Multiple Osteolytic Lesions with Punched Out MarginsMultiple MyelomaLangerhans cell diseaseMetastatic carcinomaHemangiomaBurkitts lymphoma

Radiopaque and Mixed Radiolucent/Radiopaque Lesions

Periapical Mixed Lucency/Opacity

Periapical Mixed Lucency/Opacity Dental cryptRarefying osteitis plus tooth rootMixed rarefying -sclerosing osteitisPeriapical cemental dysplasiaForeign body (e.g. root canal filling material)

Cementifying/ ossifying fibromaCementoblastomaPagets disease of boneComplex odontomaCompound odontomaCalcifying odontogenic cyst(common) (uncommon)

Pericoronal Mixed Lucency/Opacity

Pericoronal Mixed Lucency/Opacity Complex odontomaCompound odontomaAdenomatoid odontogenic tumorAmeloblastic fibro-odontomaCalcifying odontogenic cystOdontogenic fibromaCystic odontomaCalcifying epithelial odontogenic tumor (Pindborg tumor)(common) (uncommon)

Periapical Radiopacity

Periapical Radiopacity(common)Anatomic superimpositionsTori and exostosesRetained roots or unerupted toothRadiographic artifactSclerosing osteitisMature periapical cemental dysplasiaHypercementosisForeign body

Periapical Radiopacity(uncommon)Superimposed soft tissue calcificationCementoblastomaOsteoblastomaCementifying/ossifying fibromaMature complex odontomaOsteoblastic metastasesPagets disease of bone

Single Mixed Lucency/Opacity Not Necessarily Contacting Tooth

Single Mixed Lucency/Opacity Not Necessarily Contacting Tooth(common)Dense bone island/osteosclerosisSclerosing/condensing osteitisOsseous excrescenceFibrous dysplasiaPeriapical cemental dysplasiaHealing surgical defectDeveloping odontomasCementifying/ossifying fibroma

Single Mixed Lucency/Opacity Not Necessarily Contacting Tooth(uncommon)Chronic osteomyelitisPagets disease of boneAmeloblastic fibro-odontomaComplex odontomaCompound odontomaCalcifying odontogenic cystSuperimposed soft tissue calcification

Single Mixed Lucency/Opacity Not Necessarily Contacting Tooth(rare)OsteoblastomaOsteoid osteomaOsteogenic sarcomaChondrosarcomaOsteoblastic metastases

Mixed Lucency/Opacity in Region of Mandibular Condyle Head

Mixed Lucency/Opacity in Region of Mandibular Condyle Head

OsteochondromaChondrometaplasiaOsteomyelitis from middle earHealing traumatic injury to TMJFibrous dysplasiaOssifying fibromaOsteoblastomaOsteogenic sarcoma or ChondrosarcomaCharcots joint

Simulating Sclerosing Osteitis

Simulating Sclerosing Osteitis(common)Normal variation of trabeculation Superimposed normal structure or toriFocal sclerosing osteomyelitis (condensing osteitis)Florid osseous dysplasia or periapical cemental dysplasia (late stage)Fibrous dysplasiaPagets disease of boneIatrogenic (orthodontic treatrment)

Simulating Sclerosing Osteitis(uncommon)Superimposed osteomaSecondary hyperparathyroidismIdiopathic hypercalcemiaSuperimposed submandibular gland stone (sialolithiasis)

Simulating Sclerosing Osteitis(rare)OsteopetrosisInfantile cortical hyperostosisOsteoradionecrosisOsteogenic sarcomaOsteoblastic metastasesOsteoblastoma and osteoid osteitisMelorrheostosisMyelosclerosisHealing syphilitic gumma

Increased Girth of Individual Trabeculae

Increased Girth of Individual Trabeculae Condensing osteitis (focal sclerosing osteomyelitis)Central hemangiomaNeurofibromaFluorosisMyelosclerosisOsteoblastic metastases(common) (uncommon)

Granular Bone Fibrous dysplasiaOsteomyelitis (bone replacing sequestrum)Post-surgical defectPagets disease of boneThalassemiaCementifying/ossifying fibromaOsteogenic sarcomaChondrosarcomaHodgkins diseaseRenal osteodystrophy recovery phaseGroundou(common) (uncommon)

Granular Bone

Solitary Opacity Not Necessarily Contacting Tooth

Solitary Opacity Not Necessarily Contacting Tooth(common)Anatomic superimpositionRadiodontic pitfall (fixer splash)Osteosclerosis, exostosis or torusUnerupted tooth or retained rootSclerosing osteitis or socket sclerosisBenign cemental massOdontomaForeign body

Solitary Opacity Not Necessarily Contacting Tooth(uncommon)Cementifying/ossifying fibromaCompact osteomaOsteogenic sarcomaChondrosarcomaOsteoblastomaOsteoid osteomaSuperimposed soft tissue calcification

Simulating Compound Odontoma

Simulating Compound Odontoma Compound odontomaSupernumerary teethComplex odontomaAdenomatoid odontogenic tumorAmeloblastic fibro-odontomaAmeloblastic odontomaDistomusTeratomaEpignathion(common) (uncommon)

Simulating Complex Odontoma

Simulating Complex Odontoma Complex odontomaPeriapical cemental dysplasia (late phase)Florid osseous dysplasiaCompound odontomaCondensing osteitisCompact osteomaCementifying/ossifyingfibromaOsteogenic sarcomaOsteochondromaAmeloblastic odontomaFibrous dysplasia (late)

(common) (uncommon)

Opacity Denser than Normal Bone

Opacity Denser than Normal Bone Foreign body (e.g. fragment of metallic restorative material)OdontomasFlorid osseous dysplasia or periapical cemental dysplasia (late phase)Focal sclerosing osteitisOsteopetrosisFibrous dysplasia PyknodysostosisCompact osteomaOsteogenic sarcomaOsteomastosis-intestinal polyposis syndrome (Gardner Sx)Occulodento-osseous dysplasia

(common) (uncommon)

Multiple Separate Radiopacities

Multiple Separate Radiopacities Tori and exostosesPeriapical cemental dysplasiaFlorid osseous dysplasiaMultiple retained roots or impacted teethMultiple socket sclerosisOsteosclerosis including condensing osteitis

Calcinosis cutisOsteomatosis-intestinal polyposis (Gardner) syndromeEnchondromatosis and hemongiomatosis (Maffuci syndrome)Gigantiform cementomaOverlying soft tissue calcification(common) (uncommon)

Root-like Density in Bone

Root-like Density in Bone Retained rootDense bone island (osteosclerosis)Coronoid superimpositionRoot displaced in soft tissues/fascial planeSocket sclerosis

AntrolithBony spicule in antrumPterygoid hamulus superimpositionSuperimposed sialolithOther soft tissue calcificationOsteochondroma

(common) (uncommon)

Causes of Root in BoneSecondary to carious destruction of tooth crownTraumatic injury with tooth fractureIatrogenic (incomplete extraction)Displacement of root into adjacent soft tissues or sinus (superimposition)

Suspected Metallic Foreign Body

Suspected Metallic Foreign Body Amalgam fragmentBody jewelryOther restoratives or dental instrumentsArtifact (scratched cassettes, fixer splash, panoramic ghosts, etc.)NeedlesShot-gun pelletsLeaded glass fragmentsPaper in cassetteMetal fragment in path of primary beam(common) (uncommon)

Suspected Non-Metallic Foreign Body

Suspected Non-Metallic Foreign Body Calcified acneCarotid atherosclerosisSialolithiasisCalcified lymph nodeTooth fragmentOsteosclerosisSubclinical fibrous dysplasiaCysticercosisPhlebolithMyositis ossificans(common) (uncommon)

Sequestra-like density

Sequestra-like density Acute osteomyelitisChronic osteomyelitisOsteoradionecrosisOsteogenic sarcoma

Also see Single Large Opacities listTuberculosisActinomycosisSyphilisMercury poisoningPhosphorus poisoning (phossy jaw)(common) (uncommon)

Target Lesion (Radiopacity with Peripheral Shadow

Target Lesion (Radiopacity with Peripheral ShadowRetained primary rootInfection around retained tooth rootSequestraPeriapical cemental dysplasiaOdontomaCementoblastomaCementifying/ossifying fibromaFibrous dysplasia(common) (uncommon)(rare)Brodies abscessOsteoblastomaOsteoid osteoma

Excrescence with Density of Bone

Excrescence with Density of Bone IdiopathicTori and exostosesOssifying fibrous epulisOsteochondroma

Soft tissue calcificationsHyperostosisFibrous dysplasiaOsteomatosis-intestinal polyposis syndrome (Gardner/s syndrome)Peripheral chondromaChondrosarcoma(common) (uncommon)

Thickened Mandibular Inferior Cortex

Thickened Mandibular Inferior CortexSickle cell anemiaSecondary to osteomyelitisFluorosisPhosphorus poisoningMyelosclerosisSclerostosisRarely a variant of normal

Laminar Periosteal New Bone

Laminar Periosteal New Bone(common)OsteomyelitisPeriostitis ossificans (Garrs osteomyelitis)

Laminar Periosteal New Bone(uncommon)Infantile cortical hyperostosisLateral inflammatory odontogenic cyst of the mandible (Stonemans cyst)Superficial surface injuries to faceCervicofacial actinomycosisTuberculosis affecting jaw Syphilitic periostitisEosinophilic granuloma/continued

Laminar Periosteal New Bone(uncommon)Hypervitaminosis A or ScurvyLeukemia (single new layer)Osteogenic sarcomaEwings sarcomaNeostosis secondary to hemodialysisIdiopathic periostitis with dysproteinemia (Goldblooms syndrome)Diffuse idiopathic skeletal hyperostoses Sx

New Periosteal Bone with InternalDestruction

New Periosteal Bone with InternalDestructionChronic osteomyelitisTuberculous osteomyelitisOsteogenic sarcoma

New Bone Perpendicular to Original Cortex

New Bone Perpendicular to Original Cortex Sickle cell anemiaOsteogenic sarcomaChondrosarcomaOsteoblastic metastasesReticulum cell sarcomaNeuroblastomaThalassemiaSpherocytosisEwings sarcomaBurkitts lymphoaSyphilitic periostitisMeningiomaHemangiomaOssifying fibrous epulisOsteoma

(common) (uncommon)

Lesions with Internal Spindly Trabeculae

Lesions with Internal Spindly TrabeculaeOdontogenic myxomaCentral hemangiomaCentral giant cell granuloma (unusual) Ameloblastoma (unusual)

Lesions with Septae or Pseudo Septae AmeloblastomaCentral giant cell granulomaOdontogenic myxomaOdontogenic keratocystTraumatic (simple) bone cystCherubismCentral hemangiomaFibrous dysplasiaChondroma(common) (uncommon)

Lesions with Honeycombed Internal Structure

Lesions with Honeycombed Internal Structure Odontogenic myxomaCentral hemangiomaEwings sarcomaAneurysmal bone cystAmeloblastomaCentral giant cell granulomaNeurofibromaFibrous dysplasiaOsteogenic sarcoma(common) (uncommon)

Lesions with Wispy Internal Structure

Lesions with Wispy Internal StructureOdontogenic myxomaCentral giant cell granulomaFibrous dysplasiaNeurofibroma

Lesions with Internal Residual Bone

Lesions with Internal Residual Bone Odontogenic myxomaAmeloblastomaCentral hemangiomaInvasive squamous cell carcinomaFibrous dysplasiaOssifying fibromaOsteochondromaHodgkins diseaseLymphoma(common) (uncommon)

Lesions with Tubular Internal Structure

Lesions with Tubular Internal Structure Normal vascular channels (nutrient canals)Central hemangiomaArteriovenous malformationSturge-Weber syndrome (tram track calcifications in brain)

Central giant cell granulomaAmeloblastomaNeurofibroma(common) (uncommon)

Lesions with Internal Rounded Dense Radiopacities

Lesions with Internal Rounded Dense Radiopacities OdontomasPeriapical cemental dysplasiaFlorid osseous dysplasiaAdenomatoid odontogenic tumorPagets disease of boneFibrous dysplasiaOsteogenic sarcomaChondrosarcomaChondrometaplasia(common) (uncommon)

Linear Striations within Jawbone

Linear Striations within JawboneNormal variant (infant mandible)Pagets disease of bone (driven snow appearance)Craniometaphyseal dysplasia (Pyles disease)

Suspected Osteoblastic MetastasesBreastProstateLiverLungRectum and colonNeuroblastomaOsteogenic sarcomaLeiomyosarcomaHodgkins disease(common) (uncommon)

Jaw Structure Gross Changes

Gross Structural ChangesPrognathism or retrognathiaMicrognathiaUnilateral small jawEnlargement of part of jawObtuse or aberrant gonial anglePersistent mandibular midline sutureAbsent coronoid(s)Deviation of chinDeformed mandible/continued

Gross Structural ChangesIncreased vertical depth of mandibleUnilateral or bilateral absence of condyleCondylar hyperplasiaSuspected jaw fracture(s)Pathologic fractureSuspected hyoid fracturesRadiolucency in condylar neck/headTrue and false TMJ ankylosisIncreased or decreased TMJ space/continued

Gross Structural ChangesLimited or increased TMJ movementSmall or enlarged antrumSuspected antral foreign bodyAntral opacification with normal wallsAntral opacification with abnormal wallsAntral opacification with breached corticesAbsent nasal bones Depressed nasal bridgeHypoplasia of maxilla and zygomasClefts

Prognathism

Prognathism(common)Normal variationRacial variance (Scandinavian and African)Edentulous mandible (apparent)Relative prognathism (e.g. retrognathic midface secondary to cleft)Acromegaly

Prognathism(uncommon)Pagets disease of bonePituitary giantismHemifacial hyperplasiaLymphangioma of tongue or cystic hygroma

Prognathism(rare)Multiple nevoid multiple basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Craniometaphyseal dysplasia (Pyles disease)Beckwith-Wiedemann syndromeXXXXY syndromeWaardenburg syndrome

Retrognathism

RetrognathismNormal variantRelative to protrusion of midfaceTMJ ankylosisJuvenile rheumatoid arthritisHemifacial hypoplasiaSubluxation in infancyHypopituitarismProgressive hemiatrophyAgenesis/dysgenesis of mandibleAgnathiaMicrognathia-related (common) (uncommon)

Micrognathia

MicrognathiaMandibulofacial dysostosis (Treacher-Collins syndrome)Gonadal dysgenesis (Turners syndrome)Juvenile rheumatoid arthritis (Stills Sx)Cleft lip, micrognathia and glossoptosis (Pierre-Robin syndrome)Oculoauricularvertebral dysplasia (Goldenhars Sx) XX and XY Turner phenotype syndrome (Noonans syndrome) Oculomandibulodyscephaly (Hallerman-Streiff Sx)Pyknodysostosis(common) (uncommon)

Micrognathia(rare)Bird-headed dwarfismCongenital telangiectatic erythema with growth retardation (Blooms syndrome)5P - (cric du chat) syndromeChondrodysplasia punctata (Conradi-Hnermann syndrome)De Langes syndromeDiastrophic dwarfism/continued

Micrognathia(rare)G syndromeCleft palate, flattened facies and multiple congenital dislocations (Larsens Sx)Long arm 21 deletion syndromeMesomelic dwarfismOrofacial digital syndromeOsteodysplasiaProgeria (Hutchinson-Gilford syndrome)/continued

Micrognathia(rare)Rubinstein-Taybi syndromeRussell-Silver syndromeShort arm deletion 18 syndromeSmith-Lemli-Opitz syndromeThrombocytopenia-absent radius syndromeTrisomy 13 syndromeTrisomy 18 syndrome

Unilateral Small Jaw

Unilateral Small JawLateral facial dysplasiaUnilateral TMJ ankylosisForceps delivery traumaRadiation therapy in infancyHemifacial hypoplasiaHemifacial atrophy (Rombergs disease)Partial mandibular agenesisLinear scleroderma(common) (uncommon)(rare)Central hemangiomaNeurofibroma

Enlargement of Part of Jaw (anatomically correct)

Enlargement of Part of Jaw (anatomically correct)Adjacent hemangiomaAdjacent neurofibromaFibrous dysplasiaHemifacial hyperplasiaPagets disease of bone

Obtuse Gonial Angle

Obtuse Gonial AngleNormal age changeEdentulous mandibleCondylar hyperplasia - contralateral condyleTrisomy 21Scleroderma (systemic sclerosis)Mucopolysaccharidoses I-H (Hurlers syndrome)Craniometaphyseal dysplasia (Pyles disease)OsteopetrosisHemifacial hypoplasia(common) (uncommon)

Aberrant Gonial Angle

Aberrant Gonial AngleNormal variantTMJ ankylosisJuvenile rheumatoid arthritisMandibulofacial dysostosis (Treacher-Collins syndrome)SclerodermaNeurofibromaTrisomy 21Marfans syndromeIsolated anomaly(common) (uncommon)

Persistent Mandibular Midline Suture

Persistent Mandibular Midline SutureNormal

Absent or Diminished Coronoids

Absent or Diminished CoronoidsPrevious surgeryPanoramic radiograph - outside focal troughLateral facial dysplasiaScleroderma (systemic sclerosis)Radiation therapy in childhood

Hemifacial atrophy (Rombergs disease)Local or metastatic malignancy related erosionAgnathiaAgenesis(common) (uncommon)

Deviation of Chin Towards Affected SideNormal variantMalocclusion (cross-bite)Unilateral TMJ ankylosisCondylar hypoplasiaLateral facial dysplasiaChildhood or forceps fracture of condyleTorticollisHemifacial atrophy (Rombergs disease)Congenital unilateral facial hypoplasiaPartial mandibular agenesis (common) (uncommon)

Deviation of Chin Away From Affected SideNormal variantMalocclusion Condylar hyperplasiaSplinting reaction to TMJ painCongenital unilateral hyperplasiaJoint effusion due to traumaHemangioma or neurfibroma induced jaw hyperplasiaTumor in TMJ region (benign or malignant) (common) (uncommon)

Deformed Mandibular ShapeCondylar hyperplasiaTrauma with mal-unionCondylar ankylosis (early)Mandibulofacial dysostosis (Treacher-Collins syndrome)Cystic hygromaFlawed panoramic techniqueNeurofibromaHemignathiaCongenital hypo- or hyperplasia of condyleHemifacial atrophy (Rombergs disease)Klippel-Feil anomaladCongenital scapular elevationTorticollisElectrical or thermal burnsRadiation therapy in childhood (common) (uncommon)

Increased Vertical Depth of MandibleNormal variantPrognathismAnatomic enlargement of jawPeriostitis ossificansBenign tumor (e.g. ameloblastoma; ossifying fibroma)ThalassemiaOther congenital anemiasSclerosteosisVan Buchems disease (common) (uncommon)

Unilateral Failure of Condylar Development

Unilateral Failure of Condylar DevelopmentEarly trauma (e.g. forceps delivery)Childhood infections around TMJ (e.g. mastoiditis; otitis media or externa; dental or skin abscess)Lateral facial dysplasiaRadiation therapy in childhoodHemifacial hypoplasiaLinear sclerodermaBenign tumorLocal malignant tumor destruction of growth centerMetastatic malignancy (common) (uncommon)

Bilateral Failure of Condylar Development

Bilateral Failure of Condylar DevelopmentTraumaMandibulofacial dysostosis (Treacher-Collins Sx)Cleft palate, micrognathia and glossoptosis (Pierre-Robin) syndromeJuvenile rheumatoid arthritis (Stills disease)

Congenital dwarfismMucopolysacharidosesChildhood radiotherapyProgeria (Hutchinson-Gilford syndrome)Oculomandibulodycephaly (Hallerman-Streiff Sx)Agnathia or micrognathiaCockaynes syndrome

(common) (uncommon)

Condylar Hyperplasia

Condylar HyperplasiaHypertrophic arthritisMalignant tumor (e.g. chondrosarcoma)Fibrous dysplasiaPagets disease of bone

(common) (uncommon)True hyperplasiaBenign tumor (e.g. osteochondroma)Influence of adjacent vascular or neural tumorAcromegaly

Prognathism

Multiple Jaw Fractures

Multiple Fractures (common) (uncommon)Severe traumaChild abuseOsteogenesis imperfecta Juvenile idiopathic osteoporosisAchondrogenesisOsteopetrosisPyknodysostosisMucolipidosesMetaphyseal dysplasiaHomocystinuriaIdiopathic

Suspected Jaw Fractures (common)True fracturesSuture linesVascular channelsFistulous tractsSymphysis menti (neonate)Osteomyelitis with fragmentationPharyngeal air space shadowVertebral superimpositionsBase of skull superimpositions

Suspected Jaw Fractures (uncommon)Previous radiation therapyHyoid bone superimpositionRadiodontic artifactLarge sequestraPathologic fracture

Pathologic Fractures

Pathologic Fractures (common) (uncommon)Oral squamous cell carcinomaCentral bone malignancy (e.g. multiple myeloma)Metastatic carcinomaOsteoradionecrosis Severe osteomyelitisMarked alveolar atrophyScleroderma (systemic sclerosis)Langerhans cell disease

Suspected Hyoid Fracture Normal cartilagenous septaeSuperimposition artifactSevere blunt traumaHanging (often suicide)Homicide (strangulation)

Radiolucency in Condylar Head

Radiolucency in Condylar HeadElys cyst of degenerative joint diseaseRheumatoid arthritisProjection artifact (e.g. pterygoid pit; air cells extending into zygomatic arch)Bifid condylePrevious traumaVillonodular synovitisCentral giant cell granuloma/continued

Radiolucency in Condylar HeadBenign tumor (e.g. myxoma)Primary malignancy (e.g. osteogenic sarcoma; chondrosarcoma; synovial sarcoma; multiple myeloma; adjacent rhabdomyosarcoma; adjacent glandular carcinomas; lymphoma)Metastatic malignancy (e.g. hypernephroma; carcinoma from lower gastrointestinal tract)

True TMJ Ankylosis

True TMJ Ankylosis (Common)OsteomyelitisTonsillitisOtitis media or externaMastoiditisAdjacent soft tissue infectionDental abscessTuberculosisRheumatoid arthritis (Stills disease)Ankylosing spondylitis(infection) (traumatic)(other)Mandibular fractureForceps delivery

True TMJ Ankylosis (Uncommon)Syphilic gummaCancrum oris (noma)TyphoidMasseter cellulitisRheumatic feverMeaslesSecondary to burnCongenital fusion of gums(infection) (traumatic)(other)IatrogenicTemporal muscle fibrosisChronic dislocation of mandible(neoplasia)Invasive malignancyOsteochondroma

False TMJ Ankylosis

False TMJ Ankylosis (common) (uncommon)Splinting due to TMJ painMalar fracture (fibrous or bony union subsequent to)Coronoid hyperplasiaCoronoid hyperplasia with campylodactylyOsteochondroma

Scleroderma (systemic sclerosis)Hysterical trismusTemporal muscle fibrosisMyositis ossificans progressivaTorticollisCongenital elevation of scapula

Increased TMJ Space

Increased TMJ Space (common) (uncommon)Normal variantNon-uniform patient positioningProjection effect (beam angulation)Posturing of jaw by patientDisplaced articular diskEffusion into joint Hemorrhage into jointLoose body in jointAcute suppurative arthritisDisplacement due to fracture of condyle or glenoid fossaMandibular partial agenesisMucopolysaccharidoses

Increased Anterior TMJ Space Normal variantBeam angulation or patient position artifactInternal derangement of TMJRetracted position of condyle due to dental occlusionDeep overbiteOverclosure of mandible (especially in edentulous)Rheumatoid arthritisAbsent middle ear

Decreased TMJ Space

Decreased TMJ Space (common) (uncommon)Excessive vertical angulation of beam during transcranial projectionArthritis (any kind)Gross disk displacement Previous surgical removal of diskBony or other true ankylosis

Limited TMJ Movement (common)Normal variantPain reactionInternal derangement of jointTrue or false ankylosis

Limited TMJ Movement (uncommon) Scar tissueScleroderma (systemic sclerosis)Fractured zygomatic archCoronoid hyperplasiaMalignancy in joint areaFacial ParalysisTorticollisMyositis osificans progressivaSubmucous fibrosisSecondary to high dose radiation

Excessive Translation of TMJ

Excessive Translation of TMJ (common) (uncommon)Normal variantLax TMJ capsule Recurrent dislocationsNeurosisEhlers-Danlos syndrome

Small Antrum (Normal in Shape)

Small Antrum (Normal in Shape) (uncommon)Hemifacial hypoplasia (congenital)Craniometaphyseal dysplasia (Pyles disease)Cleidocranial dysplasiaCraniofacial dysostosis (Crouzons Sx)Other craniostenosesThalassemia and other congenital anemiasHemifacial atrophy (Rombergs disease)Oculomandibulodyscephaly (Hallerman-Streiff syndrome)

Suspected Antral Foreign Bodies

Suspected Antral Foreign Bodies(common) (uncommon)Tooth root, or restoration fragment (superimposed or real) Panoramic ghost shadowAntrolithBony excrescence/septumOverlying soft tissue calcificationPellets; bullets; shrapnel; auto glass

Displaced toothBroken dental instrumentDrainage tubesHeavy cosmetics or eyeglass shadowAspergillosis

Antral Opacification (Normal Walls)

(common) (uncommon)Infectious antritisAllergic antritisMucous retention phenomenonMucositis secondary to dental apical pathosis or periodontitisHemorrhage following trauma

Antral Opacification (Normal Walls) Antral polypBlocked ostiaAntral polyposisCystic fibrosisMucocele (blocked ostia and antral expansion)Apical dental cyst (rare)Aspergillosis

Antral Opacification (Abnormal Walls)

(common) (uncommon)Radicular cystOther benign cyst or tumorFibrous dysplasia (thicker)Antral hypoplasia (thicker)Antral malignancy (e.g. carcinoma; lymphoma)

Antral Opacification (Abnormal Walls) Inverted papillomaOsteomyelitisThalassemiaAgenesis of antrumMucormycosis

Antral Opacification (Breached Walls)

(common) (uncommon)Oral-antral fistulaDental abscessAntral carcinomaOral squamous cell carcinoma Salivary gland malignancy

Antral Opacification (Breached Walls) Infectious antritisTrue mucoceleBenign odontogenic tumor (ameloblastoma; myxoma, etc.)Lymphoma or sarcoma

Absent Nasal Bones Severe trauma Prior surgeryFacial cleft syndromesArhinencephaly

(common) (uncommon)Facial cleft syndromesPrevious surgeryPrevious traumaAchondroplasiaCleidocranial dysplasiaEctodermal dysplasiasCongenital syphilis

Depressed/Absent Nasal Bones Idiopathic hypercalcemiaCraniometaphyseal dysplasia (Pyles disease)ArhinencephalyAcrodysostosis

Hypoplasia of Maxillary and Malar Bones (common) Mandibulofacial dysostosis (Treacher-Collins syndromeAchondroplasiaCraniofacial dysostosis (Crouzons syndrome)Acrocephalysyndactyly (Aperts syndrome)

Hypoplasia of Maxillary and Malar Bones (uncommon) Bird-headed dwarfismCongenital telangiectatic erythema with growth retardation (Blooms syndrome)Cochaynes syndromeDe Lange syndromeOculoauriculovertebral dysplasia (Goldenhars syndromeLeprechaunism (Donohues syndrome)Long arm 18 deletion syndromeLong arm 21 deletion syndrome /continued

Hypoplasia of Maxillary and Malar Bones (uncommon) Marshall syndromeMietens-Weber syndromeOculodento-osseous dysplasiaOculomandibulodyscephaly (Hallerman-Streiff syndrome)Oral-facial-digital syndromeOropalatal digital syndromeProgeria (Hutchinson-Gilford syndrome) /continued

Hypoplasia of Maxillary and Malar Bones (uncommon) PyknodysostosisRubenstein-Taybi syndromeRussel-Silver syndromeTrisomy 13Trisomy 18Weill-Marchesani syndrome

Enlarged Maxilla

(common) (uncommon)Normal variantRelative to mandible (see retrognathia)Influence of adjacent or contiguous vascular tumorPagets disease of boneFibrous dysplasiaOsteopetrosis

Enlarged Maxilla Juvenile hypothyroidism (cretinism)ThalassemiaInfluence of adjacent or contiguous neural tumorCraniopharyngioma

(common) (uncommon)Cleft lip and palate Isolated cleft palate (unilateral vs bilateral; anterior vs posterior; complete vs incomplete)

Cleft Palate ArhinencephalyCleft palate, micrognathia and glossoptosis (Pierre-Robin syndrome)Miscellaneous other craniofacial syndromes

Soft Tissue SignsCopyright of Allan G. Farman

Radiologic Signs Concerning Facial Soft TissuesCalcifications of facial soft tissuesCalcifications in muscle and subcutaneous tissuesWidespread soft tissue calcificationSolitary large calcified mass adjacent boneLymph node calcificationsCalcifications in submandibular gland region/continued

Radiologic Signs Concerning Facial Soft TissuesCalcification in parotid duct regionSialolithiasisAir in soft tissueNasopharyngeal massMacroglossiaSalivary gland enlargementDuctal stricture on sialography/continued

Radiologic Signs Concerning Facial Soft TissuesIncreased retropharyngeal space (child)Increased retropharyngeal space (adult)Soft tissue mass with underlying bone involvementSuspected soft tissue tumor shadow

Calcification in Facial Soft Tissues

(common) (uncommon)

Calcified acneCalcified lymph node (often post tuberculosis)PhlebolithsCalcified hematomaCalcified adipose tisssueNon-calcification (e.g. tooth displaced into soft tissues)

Calcification in Facial Soft Tissues Myositis ossificans (traumatic)Myositis ossificans progressivaEhlers-Danlos syndromeScleroderma (systemic sclerosis)Calcinosis universalisCysticercosisHypervitaminosid D

Calcifications in Muscles and Subcutaneous Tissues

Calcifications in Muscles and Subcutaneous Tissues (common)Dermatolysis and calcinosisGoutScleroderma (systemic sclerosis)Vascular calcificationsRheumatoid arthritisHealing abscess

Calcifications in Muscles and Subcutaneous Tissues (uncommon) HyperparathyroidismHypoparathyroidismMultiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Ehlers-Danlos syndromeIdiopathic hypercalcuriaMyositis ossificans (traumatic and progressiva) /continued

Calcifications in Muscles and Subcutaneous Tissues (uncommon) ParaplegiaCalcified parasites (e.g. cysticercosis)Carbon monoxide poisoningFracture segmentTumoral calcinosisSecondary to thermal burn or frostbiteBenign or malignant soft tissue tumorLupus erythrematosus

Widespread Calcification in Soft Tissues

(uncommon)Calcinosis universalisHypoparathyroidismScleroderma (systemic sclerosis)Multiple vascular calcifications

Widespread Calcification in Soft TissuesGoutHyperparathyroidismImmobilizationLupus erythematosusCysticercosisTumoral calcinosisIdiopathic hypercalcemiaGross metabolic bone breakdown/metastatic calcification (common)

Vascular Calcification

(uncommon)Carotid atherosclerosisHemangiomaRanine varicesPhlebolithsFamilial arteriosclerosis Vascular Calcification Monkbergs sclerosisEnchondromatosis-hemangiomata Sx (Maffucis syndrome)AneurysmProgeria (Hutchinson-Gilford syndrome)LipodystrophyRenal transplantationWerners syndromeGeneralized calcification of infancy (common)Secondary arteriosclerosis (e.g. diabetes; Cushings Sx; nephrotic Sx)(rare)

Solitary Large Calcified Mass Adjacent to Bone

(uncommon)Sialolithiasis in Whartons duct (superimposition) Calcified fatCalcified hematoma Solitary Large Calcified Mass Adjacent to BoneScleroderma (systemic sclerosis)OsteochondromaGoutHyperparathyroidismSoft tissue osteo- or chondrosarcomaTumoral calcinosisMyositis ossificansForeign body (common)

Calcification in Lymph Nodes of Face

(uncommon)Tuberculosis (active or scar)SarcoidosisIdiopathic Calcification in Lymph Nodes of Face HistoplasmosisBCG vaccinationCoccidiomycosisFiliarisLymphomaOsteoblastic metastases (common)

Calcification in Submandibular Area

(uncommon)Sialolithiasis (in duct or gland)Root or tooth displaced in soft tissuesCalcified lymph nodeForeign bodyCalcification in Submandibular Area Chondrodystrophica calcificans congenitaMyossitis ossificans (common)PhlebolithCalcinosis universalisSclerodermaRadiographic artifact(rare)

Calcification in Parotid Area

(uncommon)Sialolithiasis (in duct or gland)ArtifactPhlebolithForeign bodyCalcification in Parotid Area (common)Calcinosis universalisMyossitis ossificansOther soft tissue calcifications including metastatic calcification related to metabolic disease

Sialolith Appearance

(uncommon)True sialolithFilm artifactSuperimposition of tooth in soft tissue or in boneSuperimposed tori, exostoses or osteosclerosisCalcified lymph nodeForeign body

Sialolith AppearanceGoutHyperparathyroidismImmobilizationLupus erythematosusCysticercosisTumoral calcinosisIdiopathic hypercalcemiaGross metabolic bone breakdown/metastatic calcification (common)

(uncommon)Gas producing odontogenic infectionSurgical emphysema from air rotor or during endodonticsProjection of air in sulci in occlusal view Air/Gas in Soft TissueCraters of ulcerative malignancyCrushing injury to thoraxPersistent severe coughingLipomatous accumulation projected over muscle(common)

Nasopharyngeal Mass (common)Adenoids/tonsillar tissue (especially in adolescence)InfectionsProjection of posterior aspect of inferior turbinates

Nasopharyngeal Mass (uncommon) HematomaMalignant nasopharyngeal neoplasm (carcinoma; lymphoma; lymphoepithelioma; multiple myeloma; chordoma)Benign nasopharyngeal neoplasm (juvenile angiofibroma; neurilemmoma, angioma)Dermoid cyst /continued

Nasopharyngeal Mass (uncommon) Extension of neoplasm from sphenoid sinusExtension of neoplasm from nasal passageAntral-choanal polyp (rare)Sarcoidosis or tuberculosisMeningioma extending from base of skullEncephalocoele

Macroglossia (common)Normal variant or spread following loss of teethTrisomy 21 (Downs syndrome)AcromegalyHamartoma (lymphangioma or hemangioma)NeurofibromaEdema following trauma or allergic reactionPrimary or secondary amyloidosisLingual thyroid

Macroglossia (uncommon)Juvenile hypothyroidism (cretinism)Glycogen storage diseaseAngioneurotic edemaInfant of diabetic motherMucopolysaccharoidosesMuscular dystrophyHappy-puppet syndromeBeckwith-Wiedemann syndrome

Salivary Gland Enlargement (common)Paramyxovirus parotitis (mumps)SialolithiasisIdiopathicSjgrens syndromeSuppurative sialadenitisPleomorphic adenoma

Salivary Gland Enlargement (uncommon)Chronic alcoholismHormonal imbalanceMalnutrition (e.g. protein deficiency)Mikuliczs syndromeHashimotos diseaseTuberculosis or sarcoidosisBenign or malignant tumorsOncocytosisMucoviscoidoses

(uncommon)InflammationSialolithiasis Stricture of Salivary DuctNormal variantCarcinomaTrauma including factitial injury and surgeryRadiation therapy(common)

(uncommon)Enlarged adenoids and tonsilsArtifactRetropharyngeal extension of upper respiratory tract disease or odontogenic infection Increased Retropharyngeal Space (childhood)Juvenile nasopharyngeal angiofibromaSevere chest traumaCretinismCystic hygroma or hemangiomaForeign body impactionRetropharyngeal goiterSpinal lesion(common)

(uncommon)Infections extending from upper respiratory tractInfections extending from odontogenic causes Increased Retropharyngeal Space (adulthood)ChordomaCarcinomaRetropharyngeal goiterZenkers diverticulumRheumatoid arthritis of spine(common)

Soft Tissue Mass with Underlying Bone Erosion

Soft Tissue Mass with Underlying Bone Erosion Oral squamous cell carcinomaKaposis sarcoma (often in AIDS)Nasolabial cystPyogenic granuloma including pregnancy epulisOther gingival epulides and denture-induced gingival hyperplasiaNeurofibromatosis (blister region)Salivary gland malignancyMetastatic malignancy (in extraction site)(common)

Soft Tissue Mass with Underlying Bone Erosion Lymphoma in soft tissuesMalignant lymph nodeAmyloidosisAngiomaFungal diseasesHemophiliaSarcoma in soft tissues(uncommon)

Suspected Soft Tissue Tumor Shadow in Facial Region Primary soft tissue tumors casting their own radiographic shadows are all uncommon in the oral cavity

Key to relative frequency in next 5 charts: * = relatively common; ** = uncommon; *** = rare

Suspected Soft Tissue Tumor Shadow in Facial Region (Muscle) Rhabdomyosarcoma**Leiomyoma***Leiomyosarcoma***(Fat)Lipoma*Liposarcoma***

Suspected Soft Tissue Tumor Shadow in Facial Region

Fibromatosis*Fibrosarcoma**Fibrous histiocytoma **Other aggressive fibrous lesions**(Connective tissue)

Suspected Soft Tissue Tumor Shadow in Facial Region

Neurofibroma *Neurilemmoma**Neurosarcoma***Neuroblastoma**(Neural tissue)(Vascular)

Hemangioma* Hemangiopericytoma**Angiosarcoma***Kaposis sarcoma*

Suspected Soft Tissue Tumor Shadow in Facial Region Oral squamous cell carcinoma*Salivary gland tumors*Metastatic malignancy** (male = lung; prostate; kidney; colon; rectum; liver/female = breast; lung; thyroid; kidney; colon; rectum) (Epithelial)

Suspected Soft Tissue Tumor Shadow in Facial Region

Acute (e.g. cellulitis)*Chronic (e.g. fibro-epithelial polyp)*Condylomata/warts*Other epulides*(Inflammatory)Hematoma*Aneurysms***Mesenchymoma***Soft tissue sarcoma***Accessory muscle mass*** Dermatologic lesions*

(Miscellaneous)

Part 6: Skull SignsCopyright of Allan G. Farman

Radiologic Signs Concerning the SkullCraniostenosesMicrocephaly and macrocephalyFrontal bossingBasilar invaginationHypoplasia of skull baseLocalized increase in calvarial densityGeneralized increase in calvarial density/continued

Radiologic Signs Concerning the SkullLocalized increased density of skull baseGeneralized increased density of skull baseLocalized thinning of calvariaGeneralized thinning of calvariaGranular bone in skullErosion of inner diploeButton sequestra/continued

Radiologic Signs Concerning the SkullSolitary calvarial radiolucencyRadiolucent skull defect in childhoodMultiple calvarial radiolucenciesEnlargement or destruction of sellaSmall sella and J-shaped sellaMultiple wormian bonesPresence of fontanelle shadows/continued

Radiologic Signs Concerning the SkullDefective cranial ossificationHair-on-end calvarial densitySolitary intracranial opacityMultiple intracranial opacitiesBasal ganglia calcificationHypertelorismHypotelorism/continued

Radiologic Signs Concerning the SkullBrachycephalyDolichocephalyTrigonocephalyTurricephaly and acrocephalyCopper-beaten appearance

CraniostenosisCraniofacial dysostosis (Crouzons disease)Acrocephalosyndactyly (Aperts syndrome)Acrocephalopolysyndactyly (Carpenters Sx)Chotzens syndromePfeiffers syndromeCraniometaphyseal dysplasia (Pyles disease) /continued

CraniostenosisDiaphyseal dysplasia (Engelmanns Sx)Idiopathic microcephalyIdiopathic hypercalcemiaHypophosphatasiaHyperthyroidismHypervitaminosis D /continued

CraniostenosisMandibulofacial dysostosis (Treacher-Collins syndrome)MucopolysaccharidosesRubenstein-Taybi syndromeVan Buchems diseaseTrisomy 21 (Downs syndrome)Head binding/papoose board

Microcephaly (Small Skull)

Microcephaly (Small Skull)Craniosynostosis syndromesArhinencephalyCockaynes syndromeCri du chat syndromeDe Lange syndromeDysautonomia (Riley-Day syndrome)Focal dermal hypoplasia (Goltz syndrome) /continued

Microcephaly (Small Skull)Hypospadias-dysphagia (G syndrome)HomocystinuriaIdiopathic small brain and anencephalyIncontinentia pigmentii (Bloch-Sulzberger syndrome)Myotonic dystrophy (Steinerts syndrome)Nanocephalic dwarfism (Seckels syndrome) /continued

Microcephaly (Small Skull)Pancytopenia-dysmelia (Fanconis Sx)PhenylketonuriaPrenatal and neonatal irradiation or infection (e.g. toxoplasmosis)Smith-Lemli-Opitz syndromeTrisomy 13, trisomy 18 or trisomy 21Tuberous sclerosis (Bourneville-Pringle Sx)Normal variant

Macrocephaly (Large Skull)

Macrocephaly (Large Skull)Hydrocephalus (including Dandy-Walker Sx)Achondroplasia or achondrogenesisCleidocranial dysplasiaCongenital anemiasCraniometaphyseal dysplasia (Pyles disease)Diaphyseal dysplasia (Engelmanns disease)Cerebral giantism (Sotos syndrome) /continued

Macrocephaly (Large Skull)Familial macroencephalyIntracranial tumor or subdural hematoma in childhoodBeckwith-Wiedmann syndromeMucopolysaccharidosesPituitary dwarfismRussel-Silver syndrome Apparent with certain craniostenoses

Frontal Bossing

Frontal BossingEctodermal dysplasiasMultiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)AchondroplasiaCleidocranial dysplasiaOculomandibulodyscephaly (Hallerman-Streiff syndrome) /continued

Frontal BossingOsteopetrosisRubenstein-Taybi syndromeOtopalatodigital syndromeOral-facial-digital syndromeHemolytic anemiasHealed ricketsMucopolysaccharidosesCongenital syphilis

Basilar invagination

Basilar invaginationAchondroplasiaAnkylosing spondylitisCleidocranial dysplasiaKlippel-Feil anomaladOsteogenesis imperfectaOsteomalaciaPagets disease of bone

/continued

Basilar invaginationLangerhans cell diseaseMucopolysaccharidosesOsteopetrosisOsteoporosisPyknodysostosisRheumatoid arthritisSyphilis or tuberculosisTrauma-induced

Hypoplasia of Skull Base

Hypoplasia of Skull BaseAchodroplasiaChondroectodermal dysplasia

Localized Increase in Calvarial Density

Localized Increase in Calvarial DensityFibrous dysplasiaHyperostosis frontalis internaCalcifying epithelioma of MalherbeDense bone island as normal variantOsteoblastic metastasisSuperimposed soft tissue calcification (scalp or brain)Late sequel after electrical burn

Generalized Increase in CalvarialDensity

Generalized Increase in CalvarialDensityAcromegalyAnemias (sickle cell anemia; thalassemia; congenital spherocytosis; elliptocytosis)Childhood cerebral atrophyCongenital cyanotic heart diseaseChronic increased intracranial pressureCranial hemiatrophy /continued

Generalized Increase in CalvarialDensityCraniometaphyseal dysplasia (Pyles disease)Craniostenoses (all causes)Diaphyseal dysplasia (Engelmanns disease)Dilantin medicationMyotonic dystrophy (Steinerts syndrome)Fibrous dysplasiaHyperostosis frontalis interna /continued

Generalized Increase in CalvarialDensityHyperparathyroidismHyperphosphatasiaHypervitaminosis DHypo/ pseudohypoparathyroidism IdiopathicIdiopathic hypercalcemiaMelorrheostosis /continued

Generalized Increase in CalvarialDensityMeningiomaMicrocephalyMucopolysaccharoidosesMyelosclerosisOsteoblastic metastasesOsteogenesis imperfectaOsteopetrosis /continued

Generalized Increase in CalvarialDensityOtopalataldigital syndromePagets disease of boneSclerosteosisSecondary polycythemiaSyphilitic osteitisTreated hydrocephalusTreated rickets /continued

Generalized Increase in CalvarialDensityTuberous sclerosis (Bourneville-Pringle syndrome)Van Buchems disease

Generalized Increase Opacification of Skull Base

Generalized Increase Opacification of Skull BaseCraniometaphyseal dysplasia (Pyles disease)Diaphyseal dysplasia (Engelmanns disease)Fibrous dysplasiaFluorosisHealed vitamin D resistant ricketsHyperparathyroidism (following treatment)Hypervitaminosis D /continued

Generalized Increase Opacification of Skull BaseIdiopathic hypercalcemiaJuvenile hypothyroidism (cretinism)MelorrheostosisMeningiomaNeurofibromatosisOsteodysplasiaPagets disease of boneSevere anemia

Localized Increase Opacification of Skull Base

Localized Increase Opacification of Skull BaseAcromegalyChondrosarcomaChordoma with calcificationChronic periostitisFibrous dysplasiaLymphomaMastoiditis

MeningiomaNasopharyngeal carcinomaOsteoblastic metastasesOsteochondromaOsteogenic sarcomaSclerosteitisSphenoid sinusitis

Generalized Thinning of Calvarium

Generalized Thinning of CalvariumNormal variant (parietal thinning)Chronic subdural hematomaCongenital arachnoid cystLeptomeningeal cystLocalized temporal lobe hydrocephalusNeurofibromatosisPorencephalic cystSlow-growing intracranial tumor

Localized Thinning of Calvarium

Localized Thinning of CalvariumCleidocranial dysplasiaCraniolacunaHydrocephalusHypophosphatasiaOsteogenesis imperfectaProgeria (Hutchinson-Gilford Sx)Vitamin D deficiency syndromes

Granular Bone in Skull

Granular Bone in SkullElectrical burnHereditary anemiaHyperparathyroidism (primary or secondary)IdiopathicLeukemiaLong term steroidsMetastatic carcinoma or neuroblastoma Multiple myelomaOsteomalaciaOsteomyelitisOsteoporosisPagets diseaseMeningiomaOsteoradionecrosisSyphilis

Erosion of Inner Diploe

Erosion of Inner DiploeArteriovenous malformationChronic subdural hematomaCisterna magna anomalyEosinophilic granulomaEpidermoid cystGliomaHemangioma of skullMeningioma MetastasisNeoplasm of duraPacchionian granulationPorencephalySinus pericranii

So-called Button Sequestra

So-called Button SequestraEosinophilic granulomaHemangiomaMetastatic carcinomaOsteomyelitisSurgical defectRadiation necrosisSyphilisTuberculosis

Solitary Radiolucency in Calvarium

Solitary Radiolucency in CalvariumArachnoid cystArteriovenous malformationBenign tumor of scalpCarcinoma of scalpCholesteatomaDermal sinusFibrous dysplasia

/continued

Solitary Radiolucency in CalvariumFractureHemangiomaHyperparathyroidismIdiopathicLymphomaLangerhans cell diseaseMeningoceleMetastasis

Multiple myeloma NeurofibromatosisNormal variant (venous lake)Osteogenic sarcomaOsteomyelitisPost-surgical defectSarcoidosis, syphilis or tuberculosis

Radiolucent Defect in Skull of Child

Radiolucent Defect in Skull of ChildArteriovenous malformationCentral or peripheral hemangiomaEpidermoid cystFibrous dysplasiaHemophilic pseudotumorLangerhans cell diseaseNeurofibromatosis (blister lesion) /continued

Radiolucent Defect in Skull of ChildNormal fontanelleNormal variant (venous lake)OsteomyelitisMetastatic neuroblastomaOsteogenic sarcomaSurgical defect

Multiple Calvarial Radiolucent Defects

Multiple Calvarial Radiolucent DefectsCerebroside lipoidosis (Gauchers disease)CraniolacunaHyperparathyroidismLangerhans cell diseaseLeukemia or lymphomaLipid reticuloendothelioses (Niemann-Pick disease) /continued

Multiple Calvarial Radiolucent DefectsMetastatic malignancyMultiple myelomaOsteoradionecrosisOsteomyelitisPacchionian granulationsNormal variant (parietal foramina)Sarcoidosis, syphilis or tuberculosisSurgical defects

Enlarged or Eroded Sellae

Enlarged or Eroded SellaeBenign tumor of base of skullChordomaCraniopharyngiomaEmpty sella syndromeEnlargement of internal carotid arteryHyperparathyroidismHypogonadismIncreased intracranial pressure /continued

Enlarged or Eroded SellaeJuvenile hypothyroidism (cretinism)Juxtasellar or suprasellar tumorsMucopolysaccharoidoses I-H (Hurlers syndrome)Metastatic malignancyNasopharyngeal or sphenoid sinus neoplasmOptic sheath tumorOsteomyelitis /continued

Enlarged or Eroded SellaePituitary tumorRathkes cleft cystTumor of frontal lobe of brain

Small Sella

Small SellaCushings syndromeMyotonic dystrophy (Steinerts syndrome)Genetic dwarfismHypopituitarismJuvenile hypothyroidism (cretinism)Normal variant /continued

Small SellaPost-partum pituitary necrosis (Sheehans syndrome)Prader-Willi syndromeRadiation therapy in childhoodTrisomy 21

J-Shaped Sella

J-Shaped SellaHydrocephalusJuvenile hypothyroidism (cretinism)Mucopolysaccharoidosis I-H (Hurlers syndrome)NeurofibromaNormal variantPituitary tumorSuprasellar tumor

Multiple Calvarial Wormian Bones

Multiple Calvarial Wormian BonesCleidocranial dysplasiaHypophosphatasiaJuvenile hypothyroidism (cretinism)Normal variantOsteogenesis imperfectaOculomandibuldyscephaly (Hallermann-Streiff syndrome) /continued

Multiple Calvarial Wormian BonesOtopalatodigital syndromePachydermoperiostitisPrader-Willi syndromeProgeria (Hutchinson-Gilford syndrome)PyknodysostosisTrisomy 21Vitamin D deficiency syndromes

Presence of Fontanelle Shadows

Presence of Fontanelle ShadowsNormal in early infancyCerebrohepatorenal syndromeCleidocranial dysplasiaCutis laxaDysplasia epiphysealis punctata (Conradis disease)Frontonasal dysplasiasHypophosphatasia

/continues

Presence of Fontanelle ShadowsIntracranial tumorsJuvenile hypothyroidism (cretinism)Oculomandibulodyscephaly (Hallermann-Streiff syndrome)OsteodysplasiaOsteogenesis imperfectaOtopalatodigital syndromePachydermoperiostitis

/continues

Presence of Fontanelle ShadowsPediatric rubella infectionProgeria (Hutchinson-Gilford syndrome)PyknodysostosisRubenstein-Taybi syndromeRussel-Silver syndromeTrigonocephaly causesTrisomy 13, trisomy 18 or trisomy 21

Defective Cranial Ossification

Defective Cranial OssificationCleidocranial dysplasiaHydrocephalusJuvenile hypothyroidism (cretinism)Langerhans cell disease (Letterer-Siewe variety)NeurofibromatosisOsteogenesis imperfectaPachydermoperiostitis

/continued

Defective Cranial OssificationPrematurityProgeria (Hutchinson-Gilford Sx)PyknodysostosisRenal osteodystrophyVitamin D deficiency syndromes

Hair on End Calvarium

Hair on End CalvariumHereditary anemias (thalassemia; sickle cell anemia; spherocytosis; elliptocytosis)Congenital heart diseaseEwings sarcomaHemangiomaIron deficiency anemiaMeningioma

/continued

Hair on End CalvariumMetastatic neuroblastomaMetastatic thyroid carcinomaMultiple myelomaOsteogenic sarcoma ChondrosarcomaPolycythemia vera

Solitary Intracranial Opacity

Solitary Intracranial OpacityArachnoid granulationArteiovenous malformationAtherosclerosisCalcified choroid plexusCalcified cerebral infarctCalcified diaphragma sellaCalcified dura (falx; tentorium; sagittal sinus)

/continued

Solitary Intracranial OpacityCalcified hematomaCalcified petroclonoid or interclinoid ligamentChondrosarcoma of skull baseCraniopharyngiomaCysticercosisEncephalofacial angiomatosis (Strurge-Weber syndrome) /continues

Solitary Intracranial OpacityEpendyomaEpidermoid or dermoid cystForeign body (e.g. artery clip)Healed granuloma or abscessHemangioma (sclerosing)IdiopathicMeningiomaMetastatic neoplasm /continued

Solitary Intracranial OpacityOsteochondromaOsteoradionecrosisPineal gland Pituitary adenomaRubellaSyphilitic gummaTuberous sclerosis (Bourneville-Pringle Sx)

Multiple Intracranial Opacities

Multiple Intracranial OpacitiesAneurysmAtherosclerosisBasal ganglia calcificationsIdiopathicEncephalofacial angiomatosis (Sturge-Weber syndrome)Healed brain abscessesCarbon monoxide intoxication

/continued

Multiple Intracranial OpacitiesCockaynes syndromeCytomegalo virus inclusion diseaseEncephalitisHematomasHepatolenticular degeneration (Wilsons disease)HyperparathyroidismHypervitaminosis D

/continued

Multiple Intracranial OpacitiesLipoid proteinosisMetastatic malignancyMultiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Multiple tumors (e.g. meningiomas)NeurofibromatosisParasitic diseaseToxoplasmosisTuberous sclerois

Basal Ganglia Calcifications

Basal Ganglia CalcificationsBirth anoxiaCarbon monoxide poisoningCockaynes syndromeEncephalitisHemorrhageHypoparathyroidismIdiopathicLead intoxicationParkinsonism /continued

Basal Ganglia CalcificationsPrevious radiation therapyPseudohyperparathyroidismToxoplasmosisTuberous sclerosis

Hypertelorism(increasedinterorbitalwidth)

HypertelorismAcrocephalysyndactyly (Aperts Sx)Anterior meningocoeleCentral facial hypoplasiaCerebral giantism (Sotos syndrome)Cleidocranial dysplasiaCraniostenosis causesCri du chat syndromeDe Langes syndromeDysplasia epiphysealis punctata (Conradis syndrome)

/continued

HypertelorismFacial duplicationFibrous dysplasiaHypertelorism-hypospadias syndromeIdiopathicLarsens syndromeMetaphyseal chondrodysplasiaMetaphyseal dysplasiaMidline dermoid or teratomaMulopolysaccharidoses I-H (Hurlers Sx)

/continued

HypertelorismMultiple nevoid basal cell carcinoma syndrome (Gorlin and Goltz syndrome)Noonans syndromeOrofacial digital syndromeOsteogenesis imperfectaOtopalatodigital syndromeThalassemiaMandibulofacial dysplasia (Treacher-Collins syndrome)Turners syndrome

Hypotelorism(decreasedinterorbitalwidth)

HypotelorismArhinencephalyGlycogen storage diseaseOculodento-osseous dysplasiaPhenylketinuriaTrigonocephaly Trisomy 13Trisomy 21

Unilateral Exophthalmos

Unilateral ExophthalmosCraniostenosis causesDermoid cystEpidermoidFibrous dysplasiaFracture with retro-orbital blood or airHemangiomaHyperthyroidismLacrimal gland tumorMeningioma

/continued

Unilateral ExophthalmosMetastatic diseaseMucoceleMucormycosisNeurofibromatosisOrbital meningocoeleBenign tumor (e.g. ossifying fibroma)Osteoma of paranasal sinusOsteomyelitisPagets disease of bone

/continued

Unilateral ExophthalmosPrimary orbital soft tissue diseasePseudotumor of orbitRetro-orbital abscess or cellulitisSinusitis

Destructive Lesions with Exophthalmos

Destructive Lesions with ExophthalmosChloromaLangerhanss cell diseaseLymphomaMetastatic neuroblastomaMetastatic carcinomaPrimary carcinomaBurkitts lymphoma

Enlargement of Superior Orbital Fissure

Enlargement of Superior Orbital FissureAneurysm of internal carotid arteryChordomaCraniopharyngiomaExtension of orbital malignancyLangerhans cell diseaseMeningiomaMetastatic carcinoma to sphenoid boneMiddle cranial fossa mass /continued

Enlargement of Superior Orbital FissureNeurofibromaNeurofibromatosisNormal variantPituitary tumorPosterior orbital encephalocele

Prominent Muscle Attachment

Prominent Muscle AttachmentAcromegalyNormal variantAnkylosisPseudo-ankylosisMasseteric hypertrophy

**