radiodianosis

1. MAXILLOFACIAL IMAGING
MAXILLARY AND JAW
LESIONS
PRESENTOR-DR SANGEETA JHA
MODERATOR –DR JAYESH MODI

2. IMAGING TECHNIQUES
1)INTRA-ORAL TECHNIQUE-periapical, bitewing and occlusal
projections
• Performed without intensifying screens, and therefore have higher
spatial resolution (of the order of 20 line pairs per millimetre
(lp/mm)) than panoramic radiographs (about 5 lp/mm)
• This also implies a relatively high radiation dose for their small size
• The higher spatial resolution allows detection of small carious lesions
and periapical lucencies which may not always be detectable with
dental panoramic tomography.
• Can not image lesion more than 3cm because of small film size.
Occlusion technique is used to demonstrate intraoral part of posterior
mandible .this projection can also ascess submandibular gland calculi.

3. Intraoral radiographs (A) Periapical view of
mandibular molars showing detailed view
of three teeth with periapical and
interdental tissues
(B) Lower oblique occlusal view
demonstrating the posterior mandible. This
view is also used for evaluating
submandibular gland calculi

4. •2)EXTRA-ORAL TECHNOQUE-
•cephalometric projection (lateral and AP)
•Uses film –screen combination or digital technique
•They are used for orthodontic assessment and are
of value in assessing the dental and skeletal
relationships of the jaws, as well as asymmetric
deformity.

5. Extraoral radiographs
(A) AP view demonstrating the
posterior part of the mandible
(A)lateral oblique view shows
almost the entire hemimandible, except the
midline well. Patient in (B) has odontogenic
myxoma.

6. Dental panoramic tomography
• specialised tomographic extraoral technique used
to produce a flat representation of the curved
surfaces of the jaws.
• provide an overview of the dentition, generalised
pathology such as periodontitis, and odontogenic
and non-odontogenic lesions of the jaws.
•gives a basic assessment of the osseous status of
the temporomandibular joints..

7. Panoramic radiograph giving a global view of upper and
lower jaws as well as the temporomandibular joints

8. 3)CONE BEAM COMPUTED TOMOGRAPHY
•uses a coneshaped X-ray beam (unlike the fan-shaped X-
ray beam used in conventional CT)
•flat detector, during a single 360◦ rotation
•lower radiation dose than conventional CT.
•higher spatial resolution than conventional CT.
•3D and MPR can be done
•CBCT units are smaller and cheaper than conventional CT
scanners
•the patient sits upright, similar to the positioning in a
dental panoramic tomography unit.
•Thick multiplanar reconstructions can be used to produce
lateral and frontal cephalometric images (without
distortion or magnification) for orthodontic assessment.
•It is not good for associated soft tissue imaging.

9. 4)MRI-
•Technique of choice in the evaluation of
temporomandibular joint pathology
detection of internal derangement of the joint
joint effusions
synovitis,
erosions and associated bone marrow oedema.
•extent of soft-tissue invasion by maxillofacial tumours
•provides greater specificity than CT in distinguishing
between odontogenic cysts (which are commoner) and
tumours

10. LESIONS
INFECTIONS
TRAUMA

11. cystic odontogenic Non-odontogenic
Periapical (radicular) cyst
Follicular (dentigerous) cyst
Odontogenic keratocyst(OKC)
Primordial cyst
Residual cyst
Solitary bone cyst (traumatic,
simple, hemorrhagic)
Medullary pseudocyst
Aneurysmal bone cyst
Static bone cyst (Stafne cyst)
Solid lesions
benign
Odontoma
Ameloblastoma
Odontogenic myxoma
Calcifying epithelial
odontogenic tumor
(Pindborg tumor)
Cementoblastoma
Ameloblastic fibroma
Adenomatoid odontogenic
tumor
Osseous lesions
Ossifying fibroma
Juvenile ossifying fibroma
Periapical cemental dysplasia
Florid cemento-osseous
dysplasia
Exostosis (Torus mandibularis)
Osteoma
Fibrous dysplasia
Paget disease
Non-osseous lesions
Central giant cell granuloma
Arteriovenous malformation
(AVM)
Central hemangioma
Neurofibroma, Schwannoma

12. Malignant odontogenic Non-odontogenic
Odontogenic carcinoma
(ameloblastic carcinoma),
sarcoma,
carcinosarcoma
Osteosarcoma
Chondrosarcoma
Metastasis
Fibrosarcoma
Lymphoma, Leukemia
Multiple myeloma,
plasmacytoma
Squamous cell carcinoma
Metabolic bone lesions
Osteoporosis
Osteomalacia
Renal osteodystrophy
Osteitis fibrosa cystica

13. RADIOLOGICAL FEATURES AND APPROACH
ANATOMICAL LOCATION/SITE
RELATION TO DENTITION
RELATION TO MANDIBULAR CANAL
SIZE AND SHAPE
RADIODENSITY AND INTERNAL ARCHITECTURE OF
THE LESION
OUTLINE/DEFINITION /MARGINATION
EFFECT ON SURROUNDING STRUCTURES

15. RELATION TO DENTITION
PERIAPICAL LESIONS PERICORONAL LESIONS

16. PERIAPICAL LESIONS
Periapical granuloma
(commonest)
radicular cyst
Osteomyelitis
simple bone cyst
periapical cemento-
osseous dysplasia
PERICORONAL LESIONS
dentigerous cyst
(commonest)
ameloblastoma
(unicystic)
Odontogenickeratocyst
calcifying odontogenic
cyst (rare)

17. RELATION TO MANDIBULAR CANAL
Lesions above the mandibular or inferior alveolar canal are likely to
be odontogenic
Lesions involving the canal or below it are usually non-odontogenic.

19. OUTLINE/DEFINITION OR MARGINATION
Well defined- benign
Punched out(sharp with no surrounding radio-opaque bone)
Corticated(surrounding radio-opaque bone)
Sclerotic (non uniform radio-opaque boundary)
Encapsulated(surrounding radiolucent line)
Ill-defined border –aggressive lesion, Inflammatory or neoplastic
process.
Moth eaten margins.

20. AFFECT ON SURRPUNDING STRUCTURE
NORMAL MANDIBLE AGGRESSIVE/MALIGNANT LESION OF MANDIBLE
an expansile aggressive cystic lesion
causing displacement of the
inferior alveolar canal and erosion of the
roots of overlying teeth, as well
as tooth displacement

21. EFFECT ON BONE
• Bone expansion in all four directions should be noted, i.e.
buccal, lingual, inferior and superior
• Areas of cortical perforation should be recorded in the
report as they help in guiding management decisions.
• For mandibular lesions, the thickness and integrity of the
inferior cortex is important.
• On the other hand, for maxillary lesions the superior
involvement, i.e. floors of the maxillary antrum, nasal cavity
and orbit need to be commented upon

22. WELL DEFINED RADIOLUCENT LESIONS
ODOTOGENIC CYSTS
• Radicular cyst
• Residual cyst
• Dentigerous cyst
• Odontogenic keratocyst
• Primordial cyst
NON-ODONTOGENIC CYST
• Incisive canal cyst
• Globulomaxillary cyst
• Simple bone cyst
• Aneurysmal bone cyst
• Lingual salivary gland inclusion defect(stafne cyst)

24. RADICULAR(PERIAPICAL) CYST
Most common odontogenic cyst
Related to apex of non vital tooth
Results from chronic inflammation(carries tooth)
Asymptomatic
The peak prevalence is between the fourth and sixth decades
Round or pear-shaped,well-defined radiolucent lesion with sclerotic
borders.
Usually less than diameter 1 cm in ,however can be upto 3cm
Difficult to distuitinguish it from periapical granuloma(however
radicular cyst is often larger than periapical granuloma.)

26. Radicular cyst: Panoramic radiograph
showing a round, welldefined,
smooth, unilocular radiolucent lesion
located in the periapical
region of a grossly carious first molar tooth

27. RESIDUAL CYST
Residual cyst is a term for any cyst that remains after surgical
intervention/removal of the causative root.
Most residual cysts are radicular cysts

29. DENTIGEROUS CYST
Also known as Follicular Cyst
2nd most common type of odontogenic cyst
Most common developmental cyst of the jaws
attached to tooth cervix(enamel-cementum junction)
arises from the reduced enamel epithelium, the tissue
which surrounds the crown of an unerupted tooth.
 encloses crown of unerupted tooth

30. ETIOLOGY
develops from proliferation of enamel organ
remnant or reduced enamel epithelium
related to epithelial proliferation
CLINICAL FEATURES
 commonly seen in
association most
with 3rd molars commonly
impacted
 maxillary canines teeth

31. greater incidence in males
symptoms are generally absent
 delayed eruption being the most common
indication of dentigerous cyst formation
RADIOGRAPHIC FEATURES
 well-defined
 unilocular or ocassionally mutilocular
radiolucency with corticated margins
 associated with crown of unerupted tooth.
 roots of involved cyst is often outside the cyst.

32.  size may vary . cyst larger than 2cm has effect on
surrounding structures.
mandible
radiolucency may extend superiorly from 3rd molar
site into ramus
anteriorly + inferiorly along body of mandible
Maxilla
if involving canine region
extends into maxillary sinus
and orbital floor
 resorption of roots of adjacent erupted teeth may
ocassionally be seen

33. • Extremely large dentigerous cysts often develop undulating
borders due to uneven rates of expansion and simulate an
odontogenic keratocyst or ameloblastoma.
• Rarely, an untreated cyst may develop an ameloblastoma
within its lining referred to as a mural ameloblastoma
• Malignant transformation is very rare.

34. Dentigerous cyst: Lateral oblique view of mandible shows a large expansile, well-
defined, ovoid, unilocular, radiolucent lesion surrounding the crown of an unerupted
last molar tooth

35. Coronal reformatted CT image reveals a cystic lesion with an unerupted tooth in the right
molar region (arrow). The crown of the tooth is contained within the lesion.
Note the presence of bone remodeling rather than expansion.

36. ODONTOGENIC KERATOCYST (KERATOCYSTIC
ODONTOGENIC TUMOR)
• Renamed as Keratocystic odontogenic tumor by the WHO
working group in 2005 to reflect the tumorous nature of the
lesion.
• Most common location -posterior body and ramus of the
mandible.
• develop from the dental lamina, which is found throughout
the jaw and overlying alveolar mucosa Thus, the cysts can
occur throughout periapical or primordial regions.

37. • lined by stratified keratinizing squamous epithelium and
lumen is filled with cheesy material.
• Destructive potential, with a high recurrence rate after
resection
• Unlike follicular cysts, OKCs can expand cortical bone and
erode the cortex .
• Fortunately, malignant transformation of these lesions is
rare.
• The lesion is uni or multiloculated, often with daughter cysts
that extend to the surrounding bone.

38. Multiple OKCs in a young patient should raise the possibility of
basal cell nevus syndrome (Gorlin-Goltz syndrome)
Other findings a/w this syndrome is
nevoid basal cell carcinomas
bifid ribs.
Calcified falx
Enlarged sinuses
On CT-increased areas of attenuation within the cyst due to
high protein content.
On MRI-
T1WI–intermediate to high signal intensity
T2WI-heterogeneous low to high signal intensity
On contrast administration -show thin rim enhancement
Treatment is surgical enucleation with wide bore margins or
marsupialisation.

39. oval, smooth, well-corticated, unilocular cyst located in the posterior body and ramus of
the mandible, extending along the body of the mandible with relatively little medio-lateral
expansion. Another lesion is present in the body of the mandible on the right side.
Axial CT scan of a different patient shows the
characteristic ovoid disposition of an OKC with minimal bucco-lingual expansion.

40. (Gorlin-Goltz syndrome).
CECT shows multiple rim enhancing
cystic lesions(OKC) in the mandible.
CT also demonstrated a
calcified falx and large frontal sinuses,
findings that
helped establish the diagnosis

41. PRIMORDIAL CYST
• uncommon cystic lesion
• which develops instead of a tooth.
• It is believed that the dental follicle forms but subsequently
undergoes cystic degeneration before completion of
odontogenesis.
• These are well-defined, non-expansile, radiolucent lesions
without an associated tooth

44. most common non-odontogenic cyst of oral cavity
 believed to arise from remnants of nasopalatine duct
 embryologic structure
 connects oral + nasal cavities in
area of incisive canal
normally degenerate in human but may leave
epithelial remnants behind in incisive
canals
INCISIVE CANAL CYST/ NASOPALATINE DUCT CYST

45. Clinical Features
almost any age
most common in 4th-6th decades of life
Generally asymptomatic ,discovered on routine
radiograph
May have swelling of anterior palate, drainage or pain
Radiological features
round, ovoid or heart-shaped, (due to superimposition of nasal
spine or because they are notched by nasal septum)
Well defined lucent lesion in the anterior maxilla.
The margin is well-defined, smooth and a dense rim of cortical
bone is often seen along the periphery.

47. GLOBULOMAXILLARY CYST
• cyst is located between the lateral incisor and the canine
tooth of the maxilla (the site thought to correspond to a
developmental fusion line.
• Present day evidence indicates that these cysts do not arise
from ‘‘trapped’’ epithelium but are likely simply cysts of
odontogenic origin (either a radicular cyst or a keratocyst)

48. cyst located between the lateral incisor and canine tooth of the left maxilla.
Coronal CT scan shows its smooth, well-corticated margins
On surgery the lesion proved to be an OKC

49. SIMPLE(TRAUMATIC )BONE CYST
 intraosseous pseudocyst because it lacks an
epithelial lining.
 develop in response to trauma
usually asymptomatic
discovered incidentally in children or young adult.
most common site of occurrence is the
mandible,particularly anteriorly in the
molar/premolar region.
On radiography, these appear as typically
unilocular, lucent defects with a characteristic
scalloped superior margin extending between roots
of teeth.

50. Coronal reformatted CT image demonstrates a cystic lesion (arrows) within
the mandibular body. The mandibular cortex is thinned.
Note the normal tooth (arrowhead) within the lesion, a finding that
helps distinguish the cyst from radicular or other odontogenic

51. LINGUAL SALIVARY GLAND INCLUSION DEFECT
(STAFNE’ CYST)
 A static bone cavity appears as an ovoid or round, well-defined
radiolucent lesion within a cortical defect on the medial surface of
the posterior mandible
 Typically measuring less than 2 cm
 The cavity of this pseudocyst is usually filled with fat but may also
contain submandibular salivary gland tissue.
Stafne’s cyst: Lateral oblique view of
mandible shows an ovoid , well-defined
area of lucency located just above the
inferior border of the mandible, anterior
to the angle of the jaw and inferior to
the mandibular canal

52. Static bone cavity (Stafne cyst) in a
35-year-old man. CT scan reveals a cortical defect
(arrow) in the lingual surface of the right
mandibular angle, a finding that does not represent true cyst

53. AMELOBLASTOMA
arises from the enamel-forming cells of the
odontogenic epithelium that have failed to regress
during embryonic development.
Most commonly occurs in the posterior mandible,
in the third molar region, with associated follicular
cysts or impacted teeth.
3-5th decade of life
Slow growing ,painless mass.
They have a variable imaging appearance
. Typically the lesions are multi-locular with distinct
internal septae giving honeycomb or soap bobble
appearance . The closest differential of such lesions
is OKC.

54.  large tumors may have cortical perforation,
especially on the lingual side with infiltration of
adjacent soft tissues. The adjacent teeth are often
resorbed,displaced and loosened. Erosion of the
roots of adjacent teeth is unique to ameloblastoma
and indicates it aggressive nature.
15% of ameloblastomas are unilocular.
On CT
ameloblastoma reveal a mixed appearance with
cystic areas of low attenuation with iso attenuating
solid regions.
On MRI
show enhancement on Gd-T1WI.

55. multilocular, expansile,radiolucent lesions located in the
ramus and posterior body of mandible
adjacent root resorption is also seen

56. expansile, multilocular radiolucent lesion with multiple areas of cortical
perforation. The lesion encases a tooth (arrow) (while the overlying
teeth are largely missing

57. Unicystic ameloblastoma

58. AMELOBLASTIC FIBROMA
Rare benign mixed odontogenic tumors arising from both
odontogenic epithelium and connective tissue of developing
tooth.
On imaging- closely resemble ameloblastomas,
but occur in a younger age group(children and
adolescent)

59. ADENOMATOID ODONTOGENIC TUMOR
• Rare tumour ,typically diagnosed in the second decade of
life, with the majority found in girls and young women.
• approximately 70% are found in the maxilla.
• Appear as well demarcated radiolucent lesions with varying
amounts of punctate calcifications and can displace or
prevent the eruption of teeth.
• If attached to a tooth, the lesions are found more apically on
the root

60. Adenomatoid odontogenic tumor.
CT scan demonstrates a unilocular radiolucent lesion with a linear calcification
(arrow) centered between the lateral incisor tooth and canine tooth.

62. CEMENTOBLASTOMA
Rare benign periapical odontogenic lesion (1% of all
odontogenic lesion)
75% -in mandible(of those, 90% in the molar or
premolar region )
Children and young adult
At imaging, cementoblastomas appear as a periapical,
sclerotic, sharply marginated lesion with a low-
attenuation halo.
They directly fuse to the root of the tooth

63. periapical sclerotic lesion with sharp margins and a lucent or low-attenuation
halo (arrows) that is fused to the root of the tooth

64. CEMENTO-OSSEOUS DYSPLASIA
• Represents a hamartomatous process that is usually
associated with tooth apices.
• Strong sex and age prevalence -black women of Asian origin
in 4th or 5th decades.
IMAGING
Initially –lytic
Later- mixed lytic
Early (lytic) lesions may be confused with periapical
inflammatory lesions, such as cyst, granuloma, and abscess.
However, in contradistinction to these inflammatory lesions,
cemento-osseous dysplasia is typically associated with a vital
tooth and an intact lamina dura and periodontal ligament

66. Cemento-osseous dysplasia.
(a) Three-dimensional
volume-rendered CT image
shows multifocal periapical
sclerotic lesions with sharp
margins (arrows). Note the
coalescence of adjacent
lesions.
(b) Coronal reformatted CT
image shows a cemento-
osseous dysplasia lesion
(arrows), which does not fuse
to the tooth root, unlike
cementoblastoma.

67. Early cemento-osseous dysplasia.
Coronal CT image shows a low-
attenuation periapical lesion with
central calcification (arrows),
that may be confused with a
periapical inflammatory lesion.
However, periapical inflammatory
lesions are unlikely in vital teeth
(ie, with no caries)

68. • Florid cemento-osseous dysplasia may be complicated by
osteomyelitis and drainage of necrotic bone debris into the oral
cavity or to the skin surface through osteocutaneous sinus tracts.
Coronal reformatted (a) and volume-rendered (b) CT images show an expansile
cemento-osseous dysplasia lesion with associated osteomyelitis(arrow-sinus tract)

69. ODONTOMAS
• most common odontogenic tumor.
• The result of a developmental anomaly (hamartoma), they may
obstruct tooth eruption
• most commonly seen in children
• At imaging, odontomas are usually pericoronal, sharply marginated,
and sclerotic, with a low-attenuation halo.
SIMPLE ,COMPOUND AND COMPLEX ODONTOMAS
• Simple odontomas appear as supernumerary teeth
• Compound odontomas consist of multiple small toothlike
structures called denticles and most commonly arise in the anterior
maxilla.
• Complex odontomas appear as an amorphous hyperattenuating
conglomerate mass of enamel and dentin, most commonly in the
molar regions the jaws

70. A complex odontoma may be confused with an
osteoma; the low-attenuation halo that surrounds
odontoma may help differentiate these lesions from
osteoma

71. several simple odontomas (arrows)
that resemble supernumerary teeth

72. Axial CT image shows multiple small toothlike structures
(arrows), a finding indicative of a compound odontoma

73. Sagittal reformatted CT image shows a conglomerate mass of enamel and dentin
surrounding the crown of the tooth (arrows), a finding indicative of a complex
odontoma. A low-attenuation halo is also seen, a finding that may help differentiate
compound Odontoma from osteoma

74. OSTEOMA
• Non odontogenic
• composed of mature compact or cancellous bone
• They most commonly arise in the craniofacial bones.
• The most common location in the jaw is the posterior
mandibular body or condyle.
• Multiple osteomas may be associated with Gardner
syndrome .
• At imaging, osteomas appear as a non–tooth-related
circumscribed sclerotic mass. Bone expansion may be
present. No perilesional halo is seen,
• Osteomas may demonstrate exophytic growth, and they
may be associated with simple bone cysts

75. Axial CT image shows a well-circumscribed sclerotic mass with smooth
margins in the mandibular ramus
The mass is associated with mild bone expansion.
No low-attenuation halo is seen

76. osteoma (arrowheads) in the posterior mandibular body and
ramus with associated expansile simple bone cysts (arrows).

77. Tori and Exostoses
• Tori and exostoses are protuberances of dense cortical
bone that most commonly seen in adults.
•characterized by slow growth that usually arrests
spontaneously
•usually manifest with no symptoms, except in the case of
trauma, and they may complicate denture fitting.
•buccal exostosis- arises from the buccal cortex of the
maxilla
• torus mandibularis- arises above the mylohyoid line, along
the lingual surface of the mandible
• torus palatinus- arises from the midline hard palate; and
•torus maxillarus-which arises from the lingual surface of
the posterior maxilla

78. Exostoses and tori.
CT images obtained in three
different patients show
torus mandibularis (arrows in
a),
torus palatinus (arrows in b),
and
torus maxillarus (arrows in c).

80. OSSIFYING FIBROMA
• Is a fibro-osseous lesion containing fibrous tissue with
varying amounts of bony trabeculae
• In the craniofacial region, there are two clinicopathologic
variants of ossifying fibroma
1)slow-growing ossifying fibroma (more common)
2nd-4th decades with a female preponderan
2) aggressive juvenile ossifying fibroma,
occur in younger patients, can be locally
destructive have a greater tendency to recur
• most commonly affects the posterior mandible
• significant potential for centrifugal growth perpendicular to
the long axis of bone

81. • At imaging,
It typically appears as a solitary well-defined unilocular focally
expansile lesion with sharp margins, ground-glass attenuation
It appears radiolucent early in its evolution because it
contains non mineralized osteoid. Later, it becomes more
radiopaque as the matrix becomes more mineralized. Areas of
soft-tissue enhancement may be seen, and tooth
displacement and erosion are common
• There is narrow zone of transition.

82. • Hyperparathyroidism–jaw tumor syndrome
multiple ossifying fibromas
renal cysts
Wilms tumors and
results from mutation of the tumor suppressor gene HRPT2.
Parathyroid adenomas or carcinomas may also arise in
patients with hyperparathyroidism–jaw tumor syndrome

83. Axial CT images obtained in two different patients show well-defined, focally expansile,
sharply marginated lesions with predominantly ground-glass attenuation. The presence
of a narrow zone of transition (arrows) helps differentiate ossifying fibroma from fibrous
dysplasia

84. FIBROUS DYSPLASIA
• Fibrous dysplasia is composed of cellular fibrous tissue and
woven bony trabeculae
• Mono-ostotic
• Poly-ostotic-3 types
Craniofacial fibrous dysplasia only affects craniofacial bones
Lichtenstein- Jaffe type of fibrous dysplasia,
affects both craniofacial and noncraniofacial bones.
Patients may present with cutaneous café au lait spots and rare
endocrinopathies
Albright syndrome -severe polyostotic fibrous dysplasia (mostly
unilateral), cutaneous café au lait spots, and various
endocrinopathies (typically in girls with precocious puberty)
Mazabraud syndrome- fibrous dysplasia is associated with soft-
tissue myxomas

85. •At imaging,
• heterogeneous lesion with ground-glass attenuation and a
wide, ill-defined transition zone
• Its cortex remains intact and is often thickened and sclerotic.
• The dental lamina dura may be involved
• The teeth are often not displaced,
• and fibrous dysplasia often encroaches on the orbit,
sinuses, and vascular and neural canals

87. mono-ostotic fibrous dysplasia
Axial CT image shows an expansile lesion with heterogeneous ground-glass
attenuation. The transition zone is wide and ill defined
marked cortical thickening is seen along the lingual mandibular cortex

88. Polyostotic fibrous dysplasia
sagittal CT image show diffuse expansion of multiple facial and cranial bones,
which demonstrate ground-glass attenuation

89. INFECTIONS
• OSTEOMYLITIS
• much more common in the mandible than the maxilla
• Acute osteomyelitis usually has no significant imaging
findings in the early stages
• Chronic osteomyelitis- characterized by a duration longer
than 1 month, complicated by sinuses, fistulae, osseous
sequestra, or pathologic fractures
• Imaging findings
cortical interruption
sclerotic sequestra in low-attenuation zones
periosteal new bone formation
areas of gas attenuation

90. Axial CT image shows sclerotic sequestrum (arrow) with a surrounding low-
attenuation zone and a sinus tract through the buccal lingual cortex
(arrowhead

91. periosteal new bone formation (arrows), a finding referred to as “onion skinning,”
and sequestrum (arrowhead)

92. PROLIFERATIVE PERIOSTITIS
 is a lamellated pattern of periosteal new bone
reaction that produces focal bone expansion .
most commonly occurs in children or young adults
in the molar or premolar regions of the mandible
Underlying causes include dental caries with
periapical inflammatory disease, periodontal
infection, fracture, and nonodontogenic infection.
Most cases are unifocal

93. Proliferative periostitis in a child.
Axial (a) and volume-rendered (b) CT images show focal mandibular buccal cortical
expansion by lamellated periosteal new bone formation

94. THANK YOU