Radigraphical appearance of head and neck diseases

1. A multilayered periosteal reaction, also known as a lamellated or onion skin periosteal reaction, demonstrates multiple concentric parallel layers of new bone adjacent to the cortex, reminiscent of the layers on an onion. The layers are thought to be the result of periods of variable growth .





2. onion peel appearence DD: Osteomyelitis ,FD,Malignancies (OS, SCC),LCH,Lymphoma, luekemia


3. aneurysmal bone cyst:a benign osteolytic lesion consisting of blood-filled spaces, and separated by fibrous tissue containing multinucleated giant cells; such cyst's cause swelling, pain, and tenderness.
On a radiograph, well-defined, expansile, lytic lesion is observed. Expansion of cortex gives the lesion a balloon-like appearance. Larger lesions may appear septated
It is common in age group of 10-30 years
Treatment by curettage,it is performed on some patients,and is sufficient for inactive lesions.


4. Radiography of the skull A showed thickening of the outer and inner tables of the cranial bones, widening of the diploë, and a “cotton wool” appearance caused by irregular areas of sclerosis (arrows). Computed tomography of the skull B confirmed bony expansion, cortical bone thickening, and irregular areas of sclerosis (arrows). These imaging findings reflect the mixed osteolytic and osteoblastic phases of Paget's disease, resulting in accelerated bone turnover with bone deposition and expansion. The patient was treated with alendronate, which resulted in improvement in frontal headache



5. Computed tomography scan of a mandibular osteosarcoma with sunray appearance
Osteosarcomas (OS) of all sites account for approximately 40% to 60% of primary malignant bone tumors. About 10% of OS occur in the head and neck; most are located in the mandible or maxilla
Osteosarcoma of the jaws (JOS) is a rare, aggressive, malignant mesenchymal tumour which is characterized by the formation of osteoid tissue,
The main clinical manifestations of JOS are pain of variable intensity, swelling of the bone and the adjacent soft tissues, tooth bulging and dislocation, lack of healing and swelling at the site of the tooth extraction, trismus and hypoesthaesia or paresthaesia in the case of the mandibular tumours, and nasal obstruction in the maxillary tumours
The radiological appearances manifest as mixed, radiolucent/radiopaque lesions, periodontal ligament widening, radiopaque masses with a moth eaten appearance and sunburst appearance


6. Radiographic findings of Ameloblastoma

1. The ameloblastoma presents a unilocular
(monocystic) or multilocular (multicystic) radiolucency
in several different forms and shapes.
2. 50% ameloblastomas appear as multilocular
radiolucent lesions with sharp borders. 2% of the
ameloblastomas are peripheral. 6% appear as
unicystic lesions.
3. The apparent lesional edge may be distinct or هndistinct.
4. Multilocular cyst like radiolucency with compartmentalized
appearance due to bony septa.
(Honey comb or soap bubble appearance)
resembles fibromyxoma, giant cell lesions.
5. Small or large unilocular or multilocular lesion
may contain unerupted deciduous or permanent
teeth and may resemble a dentigerous cyst.
6. Lesions in dentulous area cause root resorption
(30%) and tooth displacement.
7. Buccolingual cortical expansion (80%), this
tendency is stronger than a cyst.
8. The displacement of neurovascular bundle at the
inferior border is often seen
9. Maxillary lesions often involve the maxillary
sinus and change the normal radiolucency of the
sinus to a more opacified appearance.
10. The radiographic image of ameloblastoma is at
the most suggestive and not pathognomonic. CT
scan with 3D reconstruction will show the exact
extent of the lesion.
11. One of the variants of the ameloblastoma – the
desmoplastic ameloblastoma most often found
in the anterior maxilla or mandible appears as a
relatively radiopaque lesion because of its dense
connective tissue content (solid type lesion)
12. Differential Diagnosis – Multilocular lesion –
Dentigerous cyst, odontogenic keratocyst,
cherubism, giant cell granuloma, odontogenic
myxoma, aneurysmal bone cyst.

 

The black eyebrow sign of intra-orbital emphysema, almost always in the context of an orbital fracture, in which air has leaked into the orbit from the ethmoidal or maxillary sinus.
It may be an isolated fracture or in the context of an orbital blow out fracture



branchless fruit laden tree appearance in Sjögren's syndrome




Skull, hair-on-end: Thin fine linear extensions radiating out from the skull that look on an X-ray like hair standing "on-end" from the skull, an appearance associated with hemolytic anemias such as sickle cell disease and thalassemia.





Radiographic findings of Ameloblastoma
1. The ameloblastoma presents a unilocular
(monocystic) or multilocular (multicystic) radiolucency in several different forms and shapes.

2. 50% ameloblastomas appear as multilocular radiolucent lesions with sharp borders. 2% of the ameloblastomas are peripheral. 6% appear as unicystic lesions.

3. The apparent lesional edge may be distinct or indistinct.

4. Multilocular cyst like radiolucency with compartmentalized
appearance due to bony septa. (Honey comb or soap bubble appearance) resembles fibromyxoma, giant cell lesions.

5. Small or large unilocular or multilocular lesion
may contain unerupted deciduous or permanent teeth and may resemble a dentigerous cyst.

6. Lesions in dentulous area cause root resorption
(30%) and tooth displacement.

7. Buccolingual cortical expansion (80%), this tendency is stronger than a cyst.

8. The displacement of neurovascular bundle at the inferior border is often seen.

9. Maxillary lesions often involve the maxillary sinus and change the normal radiolucency of the sinus to a more opacified appearance.

10. The radiographic image of ameloblastoma is at the most suggestive and not pathognomonic. CT scan with 3D reconstruction will show the exact extent of the lesion.


11. One of the variants of the ameloblastoma – the
desmoplastic ameloblastoma most often found
in the anterior maxilla or mandible appears as a
relatively radiopaque lesion because of its dense connective tissue content (solid type lesion)


12. Differential Diagnosis – Multilocular lesion –
Dentigerous cyst, odontogenic keratocyst,
cherubism, giant cell granuloma, odontogenic myxoma, aneurysmal bone cyst.




Radiological features The nasopalatine duct cyst is seen as a well-defined cystic outline, between or above the roots of the maxillary central incisor teeth. It can be
round or ovoid, some may appear as heart-shaped, because during expansion, they may become notched by the nasal septum or the nasal spine may be superimposed on the radiolucent area or there may be bilateral cysts developing in both Stenson canals.




nasopalatine duct cyst
A small cyst can be confused with a large incisive foramen and the ‘rule of thumb’ is that the foramen is not likely to be greater than 6 mm in diameter. As with cysts arising in the gingival areas it is important to exclude other cysts, in this case radicular cysts. Precise midline positioning, positive vitality tests and intact lamina dura around the roots of the related teeth go a long way to confirming the diagnosis.

Treatment is by enucleation and given the relationship to the canal and therefore to the neurovascular bundle postoperative loss of sensation in the anterior palate is probable. Although this is unlikely to impact significantly on the patient, they must be advised of the possibility and that it may be permanent. Access
is from the palatal side unless the cyst is large when both palatal and labial fl aps are required. Palatal dissection is difficult and on occasions the neurovascular bundle must be divided.

 

Cementoblastoma. radiograph show a periapical sclerotic lesion with sharp margins and a lucent or low-attenuation halo (arrows) that is fused to the root of the tooth. Cementoblastoma arises in the molar or premolar region in 90% of cases.






Radiological features of dentigerous cyst : Radiographs will generally reveal a unilocular radiolucency associated with crowns of unerupted impacted teeth; at times a multilocular effect can be seen, when the cyst is of irregular shape due to bony trabeculations. Cysts have a well defined sclerotic margin, unless when they are infected then the margins are poorly defined. With
the pressure of an enlarging cyst, the unerupted tooth can be pushed away from its direction of eruption, e.g. the lower third molar may be pushed to the inferior border, or into the ascending ramus, whereas the upper cuspid or incisor may be pushed up into the maxillary sinus or floor of the nose. As compared to the other
jaw cysts, dentigerous cysts have a higher tendency to
cause root resorption of adjacent teeth. Radiologically, the dental follicle may expand around the unerupted or impacted tooth in three variations, i.e. (a) circumferential (b) lateral (c) central or coronal .




This x ray showing the typical multilocular appearance of a large
ameloblastoma at the angle of the mandible, with extensive expansion (solid arrows) and resorption of adjacent teeth (open arrow).

Typical radiographic features of "Ameloblastoma

This is an aggressive but non-metastasizing tumour originating from remnants of the odontogenic epithelium of the enamel organ or dental lamina.
• Peak age: Adults, about 40 years old.
• Frequency: Rare, but still the most common odontogenic tumour.
• Site: Posterior body/angle/ramus of mandible, very occasionally involves the maxilla.
• Size: Very variable depending on the age of the lesion, may become very large if neglected and cause gross facial asymmetry.
• Shape: — Multilocular, distinct septa dividing the lesion into compartments with large, apparently discrete areas centrally and with smaller areas on the periphery

— Occasionally monolocular in early stages
— Rarely honeycomb or soap-bubble appearance or multicystic — shape varies with different histological subtypes.

• Outline: — Smooth and scalloped
— Well defined
— Well corticated.
• Radiodensity: Radiolucent with internal radiopaque septa.

• Effects: — Adjacent teeth displaced, loosened, often resorbed
— Extensive expansion in all dimensions
— Maxillary lesions can extend into the paranasal sinuses, orbit or base of the skull.

Note: The so-called unicystic ameloblastoma accounts for about 10-15% of all ameloblastomas.
It usually presents as a monolocular radiolucency associated with the crown of an unerupted lower third molar, resembling a
dentigerous cyst, or as a monolocular radiolucency at the apices of the teeth, resembling a radicular cyst. Since different ameloblastomas can mimic a large variety of other radiolucent





Osteosarcoma "Radiographical Features "

Rare, rapidly destructive malignant tumour of bone. From a radiological viewpoint, there are three main types:

• Osteolytic — no neoplastic bone formation
• Osteosclerotic — neoplastic osteoid and bone formed
• Mixed lytic and sclerotic — patches of neoplastic bone formed.

• Site: Usually the mandible.

Early features:
All very variable depending on the type of
lesion (lytic or sclerotic) and how long it has been present.

Non-specific, poorly defined radiolucent area around one or more teeth.
Widening of the periodontal ligament space.

Later features:
• Osteolytic lesion:
— Monolocular, ragged area of radiolucency
— Poorly defined, moth-eaten outline.
— So-called spiking resorption and/or loosening of associated teeth.

• Osteosclerotic and mixed lesions:
— Poorly defined radiolucent area
— Variable internal radiopacity with obliteration of the normal trabecular pattern
— Perforation and expansion of the cortical margins by stretching the periosteum, producing the classical, but rare sun ray or sunburst appearance
— Spiking resorption and/or loosening of associated teeth
— Distortion of the alveolar ridge.

In this pic/Gnathic osteosarcoma




Ameloblastoma radiographic appearance