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Radiological Interpretation of Maxillofacial
Lesions
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????? ?????? ????? 07-31211012755
yukkwa_at_kmu.edu.tw
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References
1. Eric Whaites Essentials of dental radiography
radiology 3rd edition, Chapter 1, 18, 24 p.
3-12 p. 211-215, p. 285-289
2. http//ddmfr.net
3. www.dent.ucla.edu/sod/depts/oral_rad/courses/DS
422b/
4. Farman AG et al. A sequential approach to
radiological interpretation. Dent Maxillofac
Radiol 200231291-298
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? ? Dental Radiography--- Techniques
Radiography is the photographically recording of
images of the teeth and surrounding structures
with use of x-ray Can be done by hygienists and
assistants
Radiology is the use of radiant energy (x-ray) in
the diagnosis and treatment of disease Only
dentist can practice radiology as it involves
diagnosis and treatment
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? ? 7 ? ? ?

1. ???(????)
2. ???(????)
3. Seminar
4. ????
5. ???
6. ????
7. ??? (optional)

6-1. ?????????????????????????,????? 6-2.
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7-1. ?????????????????????????????????? 7-2.
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Objects of same shape, different materials
Objects of same shape materials, different
densities
Front view
Front view
Metal
Plaster of Paris
Plaster of Paris
Wood
Hollow Plastic
Plan view
Plan view
Predict (??)
Ref. 1
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Objects of same shape, same materials, different
diameter
Objects of different shape, same materials
Front view
Front view
Plaster of Paris
Plaster of Paris
Plan view
Plan view
Predict (??)
Ref. 1
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Similar images
Mass of head in a different position different
shape
What kind of x-ray radiography may be taken
without taken two different images?
Ans. Computed tomography (CT) (CT) or cone beam
CT
Ref. 1
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Normal exposure
Under exposure
Over exposure
Distorted images
Shortening
Elongation
Ref. 1
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Different views
Illusion
Many ships? or Many arches
Different views Artifacts Illusion
Artifacts
Ref. 1
Internet data anonymous,
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SSSORE Site (Location) Size Shape Outline
(Border) Relative density Effects on adjacent
surrounding structures
Ref. 1
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• Monolocular/unilocular
• Multilocular
• Pseudoloculated
• Round
• Oval
• Scalloped/undulating
• Irregular

Monolocuar
Pseudolocuar
(??????)
Multilocuar
Ref. 1
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Well-defined with a corticated margin
Well-defined without corticated margin
Poorly (ill)-defined
Poorly (ill)-defined
Ref. 1
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1. Bony expansion

2. Downward displacement ofinferior alveolar
canal
3. Thinning of cortex

1. Tooth displacement

Ref. 1
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Principles of description of bony lesions
affecting the jaws- more information
1 Site size of the lesion
2 Shape of the lesion
3 Borders (outline) of the lesion
4 Relative radiodensity internal structure of the lesion
5 Effects on surrounding bone
6 Effects on the bony cortex
7 Effects on adjacent teeth
8 Periosteal reaction
Ref. 2
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Principles of description of bony lesions
affecting the jaws - more information
1. Site (location) and size of the lesion
The size the location of a lesion in relation to the adjacent teeth anatomic structures provide significant information about the type of the underlying condition.
2. Shape of the lesion
The shape of the lesion can provide information about the degree the rate of development of the lesion.
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Principles of description of bony lesions
affecting the jaws - more information
3. Border (outline) of the lesion
The border of the lesion provide information about the slow or rapid growing of the pathological condition and may help in many cases to differentiate between benign or malignant lesion.
4. Relative radiodensity internal structure of
the lesion
3. Borders of the lesion
The relative radiolucency or radiopacity of the lesion compared to the surrounding bone.
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Principles of description of bony lesions
affecting the jaws - more information
5. Effects on surrounding bone
Features that should be examined are alterations in the size and distribution of trabeculation, existence or not of sclerotic bone rim (corticated margin).
6. Effects on the bony cortex
The effects of the lesion on the bony plates of the jaws (expansion, thinning, erosion, perforation).
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Principles of description of bony lesions
affecting the jaws - more information
7. Effects on adjacent teeth
There may be evidence of root resorption, displacement, delayed eruption, loss of lamina dura.
8. Periosteal reaction(????)
The relation of the lesion to possible periosteal
reaction (lamellar, sunburst, onion skin,
hair-on-end).
???? (Ref 6-1 6-2)
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Question Please describe the lesion as
indicated by yellowish arrow
Site
Size
Shape
Outline
Relative density
Effect on adjacent structure
?! ?!?!
Downward displacement
There is a well-defined unilocular round shaped
circumcoronal radiolucency with a corticated
margin over the submerged tooth 38 extending from
left retromolar area down to the mandibular angle
and from distal aspect of tooth 37 up to
two-third of left ramus area, measuring
approximately 3 ? 5 cm in diameter.
Ref. 3
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More descriptions on
1. Effect on adjacent structure
2. Development of submerged tooth
There is a well-defined unilocular round shaped
circumcoronal radiolucency with a corticated
margin over the well-developed submerged tooth 38
(pushed downward to the inferior cortex)
extending from left retromolar area down to the
mandibular angle and from distal aspect of tooth
37 up to two-third of the left ramus area,
measuring approximately 3 ? 5 cm in diameter.
Downward displacement of left inferior alveolar
canal and thinning of the left external oblique
ridge are also noted
Ref. 3
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A sequential approach to radiological
interpretation
Panoramic radiography revealed the patient to be
fully edentulous. All bony outlines were within
the normal range except for a 4.5 x 3.0 cm
well-demarcated, unilocular homogeneous
radiolucency with smooth well-corticated outline
in the left body of the mandible. The lesion
extended from the premolar region back to 1.5
cm anterior to the posterior margin of the
mandibular ramus. There was slight expansion of
the cortical outline of the lower border in the
left antigonial notch region.
Ref. 4
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A sequential approach to radiological
interpretation
The adjacent mandibular canal was inferiorly
displaced. Canal cortical outlines were intact
with no evidence of resorption and the paranasal
sinuses were clear. A root fragment was noted in
the region of the radiolucency in the left
mandible, and there were several areas of the
well- delineated radiolucency in the left
mandible was that of a benign cyst or tumor.
Ref. 4
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A sequential approach to radiological
interpretation
Panoramic radiography also revealed a
well-delineated radiolucency rimmed by an ovoid
3.5 x 2.5 cm calcified margin, superimposed over
the left mandibular ramus. The radiographic
shadow of the calcified soft tissue
lesion extended superiorly to the level of the
mandibular sigmoid notch and 1.5 cm below the
head of the left mandibular condyle, and
inferiorly to 1 cm below the left mandibular
foramen and lingula
Ref. 4
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A sequential approach to radiological
interpretation
The principal differential interpretations were
carotid aneurysm and calcified lymph
node. Although carotid bruit was not clinically
detected, the risk of a carotid aneurysm
mandated prompt investigation of
this radiographic finding. To elucidate further
the position of this calcified soft-tissue
lesion and the boundaries of the mandibular
radiolucency, an axial CT examination was
performed.
Ref. 4
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A sequential approach to radiological
interpretation
The CT confirmed the presence of the
calcified-rimmed soft tissue ventral and lateral
of the first cervical vertebral body and skull
base. This was interpreted as compatible with
aneurysm or psedoaneurysmal dilation of the
internal carotid artery, measuring as large as
2.4 cm. Degenerative changes in the cervical
spine were noted.
Ref. 4
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A sequential approach to radiological
interpretation
Lower CT slices through the body of the mandible
confirmed the homogeneously radiolucent cystic
lesion with a benign appearance. There was
evidence of buccal and lingual cortical expansion
with attenuation. In view of the report of a
probable carotid aneurysm, CT angiography was
prescribed to relate this lesion to
its surrounding structures.
Ref. 4
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A sequential approach to radiological
interpretation
CT angiography revealed the calcified mass was
intimately related to tortuous internal and
external carotid arteries. Careful reformatting
at various angulations failed to demonstrate a
direct continuity between the internal carotid
and the presumed aneurysm however due to
structural superimposition CT failed to provide a
definite answer. MRI was selected to elucidate
further structures obscured in the CT angiograms.
Ref. 4
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A sequential approach to radiological
interpretation
MRI revealed bright signals for the carotid
artery and jugular veins bilaterally, but failed
to demonstrate an aneurysm. The contents of the
lesion in the left mandibular body had
intermediate signal intensity
Ref. 4
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A sequential approach to radiological
interpretation
Angio MaxIP MRI revealed the carotids were found
to be tortuous. There was no evidence of an
aneurysm of the left internal carotid
artiery. The surgeon wanted additional
verification of the absence of a carotid
aneurysm and ordered ultrasonography.
Ref. 4
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A sequential approach to radiological
interpretation
Ultrasound images showed no evidence of aneurysm.
Both carotid bifurcations were tortuous. There
was evidence of atherosclerotic plaque in the
left and right carotid bifurcation bulbs and the
proximal region of the left internal carotid
artery. The systolic velocity ratio of right
internal to common carotid artery was 0.59
whereas the diastolic velocity ratio was 0.78
for the left side the respective ratios were 0.96
and 1.47. These ratios are within the normal
range.
Ref. 4
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A sequential approach to radiological
interpretation
Final Diagnosis
Mandibular lesion
Glandular odontogenic cyst
Neck lesion
The calcified lesion in the soft tissues adjacent
to the first cervical vertebra and extending to
the carotid space was not a carotid aneurysm, but
rather a calcifying cystic mass probably
representing a lymph node.
Ref. 4
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More examples
Ref. oralpathol.dlearn.kmu.edu.tw
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Summaries
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THANKS FOR ATTENTION
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