RADIOGRAPHIC ANALYSIS

PATHOLOGY OF THE CRANIOFACIAL REGION

Dr. Kristina Corazon L. Robles

CEU Graduate School

IMAGING MODALITIES

PERIAPICAL AND BITEWING RADIOGRAPHS

Periapical Radiographs
ASSESSMENT OF:

Unerupted Teeth

Carious Lesions

Root Resorption
Alveolar Bone Level

Retained Roots Pre/Post Extraction

Acquired and Developmental Dental Anomalies

Periapical Granuloma And Small Radicular Cysts

Traumatic Injuries To The Teeth And The Alveolar Bone

PANORAMIC

PANORAMIC
EVALUATION OF:
Trauma
Location Of Third Molars
Extensive Dental Or Osseous Disease
Suspected Large Lesions
Retained Teeth Or Root Tips
Temporomandibular Joint (TMJ)
Developmental Anomalies

LATERAL SKULL PROJECTION

(Cephalometric)
INDICATIONS:
- To evaluate facial growth and
development
- Trauma, pathology, and
developmental anomalies
*Demonstrates the facial bones,
skull, and soft tissue profile of the
face

PA occipito-mental
Provides excellent views of upper and
middle thirds of the face
the orbital margins, frontal sinuses,
zygomatic arches and maxillary antra.

2D vs. 3D

Review of the Anatomical Planes

COMPUTED TOMOGRAPHY / CT SCAN

MAIN INDICATIONS OF CT SCAN

Investigation of intracranial
disease including tumours,
hemorrhage and infarcts
suspected intracranial and
spinal cord damage following
trauma to the head and neck

MAIN INDICATIONS OF CT SCAN

Assessment of fractures involving:
The orbits and naso-ethmoidal complex
The cranial base
The odontoid peg
The cervical spine

MAIN INDICATIONS OF CT SCAN

Tumor staging assessment of the site, size
and extent of tumors, both benign and malignant,
affecting:
The maxillary antra
The base of the skull
The pterygoid region
The pharynx
The larynx

MAIN INDICATIONS OF CT SCAN

Investigation of:
tumours and tumour-like discrete
swellings both intrinsic and extrinsic
to the salivary glands

Investigation of osteomyelitis
Investigation of the TMJ

ADVANTAGES OF CT SCAN
Elimination of superimposition of structures
encountered in plain / 2D film imaging
Multiplanar imaging- axial, coronal and
sagittal planes usually with the benefit of a
visual 3D model
High contrast resolution

CONE BEAM COMPUTED TOMOGRAPHY

CONE BEAM COMPUTED TOMOGRAPHY

Digital Volumetric Tomography(DVT)
Digital Volumetric Reconstruction(DVR)

USES IN THE DENTISTRY:

Assessment of impacted and supernumerary teeth
Complex Cases of Skeletal Abnormalities Requiring
Orthodontic and Surgical Management
Bony pathology: Large cysts and odontogenic tumors
Complicated endodontic procedures
Implant dentistry

CONE BEAM COMPUTED TOMOGRAPHY

Images are ready to be

viewed nearly
immediately, are
dimensionally accurate,
and are non-magnified
(Ballrick,
et
al,
2008)
with measurements at a

MAGNETIC RESONANCE IMAGING

Magnetic resonance imaging (MRI) detects the
presence and concentration of hydrogen atoms
within the patients body as they spin randomly
in their own environment.

MAGNETIC RESONANCE IMAGING

There is no ionizing radiation involved
It offers true multiplanar acquisition of data
Excellent soft tissue demonstration
Offers information on bone quality

Examination of soft tissue

pathology:
Developmental: Branchial cleft cysts,
hemangioma and lymphangioma and
venous vascular malformations
Inflammatory: Osteomyelitis, simple
ranula and plunging ranula
Functional analysis
TMJ imaging

MAGNETIC RESONANCE IMAGING

Masseteric hypertrophy
Intracranial pathology
Trigeminal neuralgia (vascular loop)
Benign soft tissue and salivary
tumors
Malignant tumors: Squamous cell
carcinoma, salivary tumors and nodal
staging.

RADIOGRAPHIC INTERPRETATION
SYSTEMATIC RADIOGRAPHIC EXAMINATION

Identify all the normal anatomy present in an image or

set of images
-build up a large mental database of the spectrum of normal anatomic
appearances.

Avoid limiting the attention to one particular region of

the film
- all aspects of each image should be examined systematically.

Analysis of Intraosseous Lesions

Step 1: Localize the Abnormality

Anatomic position
Localized or generalized
Unilateral or bilateral
Single or multifocal
E.g. Stafne's Idiopathic Bone Cavity

Analysis of Intraosseous Lesions

Step 2: Assess the Periphery and Shape
SHAPE
PERIPHERY
Circular
Well defined
Scalloped
Punched out
Irregular
Corticated
Sclerotic
Soft tissue capsule
Ill defined
Blending
Invasive

Analysis of Intraosseous Lesions

Step 3: Analyze the Internal Structure
Totally radiolucent
Totally radiopaque
Mixed (describe pattern)

Analysis of Intraosseous Lesions

Step 4: Analyze the Effects of the Lesion on Surrounding Structures
Teeth, lamina dura, periodontal membrane space
Inferior alveolar nerve canal and mental foramen
Maxillary antrum
Surrounding bone density and trabecular pattern
Outer cortical bone and periosteal reactions

STEP BY STEP
In details

Site or anatomical position

The lesion is sized thru the following:
Measuring the dimensions in centimetres
Describing the boundaries, i.e. the lesion
extends from ... to ... in one dimension and
extends from ... to ... in the other dimension

'It extends from the mesial aspect of 47 up to the sigmoid notch, and from the anterior border
of the ramus down to the IAN canal,' or 'It is approximately 6 cm x 2 cm'

Shape
Monolocular or unilocular
Pseudoloculated
Multilocular
Round
Oval
Scalloped or undulating
Irregular

Outline / edge or periphery

Discrete or well-defined outlines
Smooth
Punched-out, i.e. showing no peripheral bone reaction
Corticated, i.e. having a thick or thin surrounding radiopaque (white) cortex
Sclerotic, i.e. having a non-uniform radiopaque boundary
Encapsulated, i.e. surrounded by a radiolucent (black) line which may be
complete or partial.

Outline / edge or periphery

Non-discrete / poorly defined outlines
Blend in with normal anatomy and
show a gradual change between
trabecular patterns
Show signs of invasion and appear
ragged or moth-eaten.

Internal Structure

Uniformly radiolucent
Radiolucent with patchy opacities
Radiopaque
Fine bone trabeculae, e.g. ground glass appearance

Thick, coarse trabeculae with enlarged

trabecular spaces, e.g. honeycomb appearance

Internal Structure
Homogeneous dense cortical bone
Discrete bony septa, which could be:
thin or coarse
straight or curved
prominent or faint
Cementum oval or round calcification
Identifiable dental tissue enamel /dentin
No specific pattern.

Internal Structure

Ground glass appearance

Effects On Adjacent Surrounding Structures

The teeth

Resorption
Displacement
Delayed eruption
Disrupted development (abnormal shape /density)
Loss of associated lamina dura

Increase in the width of the periodontal ligament space

Alteration in the size of the pulp chamber
Hypercementosis.

Mesiodens

Effects On Adjacent
Surrounding Structures
Surrounding bone
Expansion
Ragged destruction
Increased density (sclerosis)
Subperiosteal new bone formation
An increase in the normal width of the IAN

Irregular bone remodelling, or unusual overall

bone pattern.

Cherubism

Effects On Adjacent
Surrounding Structures
Displacement or involvement of :

Cortex of the inferior dental canal

Mental foramen
Lower border cortex of the mandible
Floor of the antrum
Floor of the nasal cavity
Orbits

SAMPLE CASES

Case Example
A 63-year-old man presented with a
long-standing history of sinusitis
and 3 weeks of frontal headache.
A. Thickening of the outer & inner
tables of the cranial bones,
widening of the diplo

PAGETS DISEASE COTTON WOOL APPEARANCE

B. Bony expansion, cortical bone

thickening, and irregular areas of
sclerosis (arrows).

ORO-ANTRAL COMMUNICATION

PAGETS DISEASE

Condylar Hypoplasia
Underdevelopment or defective formation
of the condyle
Congenital- present at birth
Acquired- occurs from an event that
interferes with development
trauma, infection, radiation, endocrine
disorder, or systemic arthropathy

Condylar Hypoplasia (Panoramic)

Condylar Hypoplasia (MRI)

Condylar Hyperplasia
Excessive growth of one of the
condyles
Most commonly found in adolescents
and young adults
Etiology: Endocrine disturbances and
trauma
Clinical features: Facial asymmetry,
prognathism, crossbite and open bite

Bifid Condyle
Asymptomatic; Rare anatomic
variation of mandibular condyle
No definite etiologic factor
Embryologic Theoryobstruction of the blood supply
to the condyle
Trauma- disruption or
dislocation of joint integrity due
to birth trauma or fracture

Bifid Condyle

Temporomandibular Joint Disorder

Periodontal Defects

Periodontal Defects

RADIOLUCENT
LESIONS

RADIOPAQUE
LESIONS

Dosimetry
ALARA
As Low as Reasonably Achievable

Conclusion
Successful interpretation of radiographs, no matter
what the quality, relies ultimately on clinicians
understanding of the radiographic image, being
able to recognize the range of normal appearances
as well as knowing the features of relevant
pathological conditions.

THANK YOU!

REFERENCES