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MANIFESTED
IN THE JAWS
Endocrine disorders
1. Parathyroid gland: hyper & hypoparathyroidism
2. Pituitry gland: hyper & hypopituitarism
3. Thyroid gland: hyper & hypo thyroidism
4. Adrenal gland: Cushing syndrome
Bone metabolism disorders
5. Vitamin D related: Rickets, Osteomalacia. Renal osteodystrophy,
Hypophosphatemia
6. Osteoporosis, hypophosphatasia : Bone loss
7. Osteopetrosis: Lack of resorption> increased bone
Blood disorders & others
8. Sickle cell anaemia
9. Thalassemia
10.Progressive systemic sclerosis
Radiographic Features
The general changes include the following:
1. A change in size and shape of the bone
2. A change in the number, size, and orientation of
trabeculae
3. Altered thickness and density of cortical structures
4. An increase or decrease in overall bone density
HYPERPARATHYROIDISM
Radiographic Features
Only about one in five patients with hyperparathyroidism has
radiographically
observable bone changes.
General Radiographic Features. The following are the major
manifestations of hyperparathyroidism:
1. The earliest and most reliable changes of hyperparathyroidism
are subtle erosions of bone from the subperiosteal surfaces of the
phalanges of the hands.
2. Demineralization of the skeleton results in an unusual radiolucent
appearance.
3. Osteitis fibrosa cystica are localized regions of bone loss produced
by osteoclastic activity resulting in a loss of all apparent bone
structure.
4. Brown tumors occur late in the disease and in about 10% of
cases. These peripheral or central tumors of bone are radiolucent.
The gross specimen has a brown or reddish-brown color.
5. Pathologic calcifications in soft tissues have a punctate or nodular
HYPERPARATHYROIDISM
HYPOPARATHYROIDISM AND
PSEUDOHYPOPARATHYROIDISM
Most often this includes sharp flexion (tetany)
of the wrist and ankle joints (carpopedal
spasm).
Some patients have sensory abnormalities
consisting of paresthesia of the hands, feet, or
the area around the mouth
The principal radiographic change is
calcification of the basal ganglia. On skull
radiographs this calcification appears flocculent
and paired within the cerebral hemispheres on
the posteroanterior view.
Radiographic
examination of the
jaws may reveal
dental enamel
hypoplasia, external
root resorption,
delayed eruption, or
root dilaceration
HYPERPITUITARISM
Acromegaly and Giantism
Radiographic Features of
the Jaws
The increase in the length of the dental arches results in
spacing of the teeth
In acromegaly the angle between the ramus and body of
the mandible may increase
in combination with enlargement of the tongue
(macroglossia), may result in anterior flaring of the teeth
and the development of an anterior open bite
class III skeletal relationship between the jaws. The
thickness and height of the alveolar processes may also
increase.
The tooth crowns are usually normal in size, although the
roots of posterior teeth often enlarge as a result of
hypercementosis.
HYPOPHOSPHATASIA
Hypophosphatasia is a rare inherited disorder that is caused by
either a reduced production or a defective function of alkaline
phosphatase
Radiographic Features
long bones show irregular defects in the epiphysis, and
the skull is poorly calcified.
In older children with premature closure of the skull
sutures, multiple lucent areas of the calvarium may exist,
called gyral or convolutional markings. These markings
resemble hammered copper
skull may assume a brachycephalic shape
A generalized reduction in bone density
Jaws. A generalized radiolucency of the mandible and
maxilla is evident. The cortical bone and lamina dura are
thin, and the alveolar bone is poorly calcified and may
appear deficient.
Teeth. Both primary and permanent teeth have a thin
enamel layer and large pulp chambers and root canals
HYPOPHOSPHATEMIA
Vitamin D resistant rickets and hypophosphatemic rickets
OSTEOPETROSIS
Albers-Schnberg and marble bone disease
Osteopetrosis,
showing dense
calcifi cation of all
the bones.
A, Skull and
facial bones. B,
Chest.
C, Pelvis and
femurs (note the
fracture of the
proximal right
femur).
Differential Diagnosis
The differential diagnosis includes other sclerosing
bone dysplasias
sclerosteosis,
infantile cortical hyperostosis,
pyknodysostosis,
craniometaphyseal dysplasia,
diaphyseal dysplasia, melorheostosis,
osteopathia striata.
Osteosclerosis from fluoride poisoning and
secondary hyperparathyroidism from renal disease
also may have a general sclerotic appearance.
THALASSEMIA
Cooley s anemia, Mediterranean anemia, and
erythroblastic anemi