This document discusses various types of soft tissue calcification that can occur in the oral and facial regions. It describes dystrophic calcification, idiopathic calcification, and metastatic calcification. Specific examples covered include general dystrophic calcification, calcified lymph nodes, tonsilloliths, cysticercosis, and arterial calcification. The clinical features, radiographic appearance, and management are summarized for each condition.
mixed radiolucent and radiopaque lesions / oral surgery coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
brief description about CONTENTS Introduction Principles of panoramic imaging Image layer Panoramic machines Panoramic film Patient positioning Interpreting the panoramic imaging INDICATION Advantages Disadvantages Conclusion References
3. INTRODUCTION • Panoramic imaging also called pantomography is a technique for producing a single tomographic image of facial structures that includes both the maxillary and mandibular dental arches and their supporting structures . • This is a curvilinear variant of conventional tomography.
4. PRINCIPLES OF PANORAMIC IMAGE FORMATION • Patero and Numata - describe the principles of panoramic radiography • based on the principle of reciprocal movement of x-ray source and an image receptor around a central point or plane called the image layer, in which the OBJECT of image is located. • OBJECT in front or behind this image are not clearly captured because of their movement relative to the centre of rotation of the receptor and the x-ray source.
5. The film and x-ray tubehead move around the patient in opposite directions in panoramic radiography
6. ROTATION CENTER The pivotal point or axis around which the cassette carrier and tube head rotate is termed rotation center Three basic rotation center used in panoramic radiography Double centre rotation Triple centre rotation moving centre rotation The location and number of rotational centers INFLUENCE size and shape of focal trough
7. IMAGE LAYER • Also known as focal trough • It is a three dimensional curved zone where the structures lying within this layer are reasonably well defined on final panoramic image. • The structures seen on a panoramic image are primarily those located within image layer. • OBJECTSoutside the image layer are blurred magnified are reduced in size. Even distorted to the extent of not being recognizable. • This shape of image layer varies with the brand of equipment used.
8. FOCAL TROUGH
9. FACTORS AFFECTING SIZE OF IMAGE LAYER: Arc path Velocity of receptor and X-ray tube head Alignment of x-ray beam Collimator width The location of image layer change with extensive machine used so recalibration may be necessary if consistently suboptimal images are produced. As a position of object is moved within the image layer size and shape of image layer change.
10. PANORAMIC UNIT
11. A, Orthophos XG Plus extraoral x-ray machine. B, Orthoralix 8500 extraoral x-ray machine. C, Example of a digital panoramic system
12. PARTS OF PANORAMIC UNITS a. x-ray tube head b. head positioner: chin rest notched bite block forehead rest lateral head support c. exposure controls
13. X-RAY TUBE HEAD: • Similar to intraoral x-ray tube head • Each has a filament to produce electrons and a target to produce x-rays • Collimator is a lead plate with narrow vertical slit • Narrow x-ray beam emerges from collimator minimize patient exposure to radiation
1
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Soft tissue calcifications and ossifications / oral surgery courses Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
mixed radiolucent and radiopaque lesions / oral surgery coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
brief description about CONTENTS Introduction Principles of panoramic imaging Image layer Panoramic machines Panoramic film Patient positioning Interpreting the panoramic imaging INDICATION Advantages Disadvantages Conclusion References
3. INTRODUCTION • Panoramic imaging also called pantomography is a technique for producing a single tomographic image of facial structures that includes both the maxillary and mandibular dental arches and their supporting structures . • This is a curvilinear variant of conventional tomography.
4. PRINCIPLES OF PANORAMIC IMAGE FORMATION • Patero and Numata - describe the principles of panoramic radiography • based on the principle of reciprocal movement of x-ray source and an image receptor around a central point or plane called the image layer, in which the OBJECT of image is located. • OBJECT in front or behind this image are not clearly captured because of their movement relative to the centre of rotation of the receptor and the x-ray source.
5. The film and x-ray tubehead move around the patient in opposite directions in panoramic radiography
6. ROTATION CENTER The pivotal point or axis around which the cassette carrier and tube head rotate is termed rotation center Three basic rotation center used in panoramic radiography Double centre rotation Triple centre rotation moving centre rotation The location and number of rotational centers INFLUENCE size and shape of focal trough
7. IMAGE LAYER • Also known as focal trough • It is a three dimensional curved zone where the structures lying within this layer are reasonably well defined on final panoramic image. • The structures seen on a panoramic image are primarily those located within image layer. • OBJECTSoutside the image layer are blurred magnified are reduced in size. Even distorted to the extent of not being recognizable. • This shape of image layer varies with the brand of equipment used.
8. FOCAL TROUGH
9. FACTORS AFFECTING SIZE OF IMAGE LAYER: Arc path Velocity of receptor and X-ray tube head Alignment of x-ray beam Collimator width The location of image layer change with extensive machine used so recalibration may be necessary if consistently suboptimal images are produced. As a position of object is moved within the image layer size and shape of image layer change.
10. PANORAMIC UNIT
11. A, Orthophos XG Plus extraoral x-ray machine. B, Orthoralix 8500 extraoral x-ray machine. C, Example of a digital panoramic system
12. PARTS OF PANORAMIC UNITS a. x-ray tube head b. head positioner: chin rest notched bite block forehead rest lateral head support c. exposure controls
13. X-RAY TUBE HEAD: • Similar to intraoral x-ray tube head • Each has a filament to produce electrons and a target to produce x-rays • Collimator is a lead plate with narrow vertical slit • Narrow x-ray beam emerges from collimator minimize patient exposure to radiation
1
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Soft tissue calcifications and ossifications / oral surgery courses Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Congenital neck mass radiology pk final is very good power point presentation for radiologist, radiology resident, student and even ent surgeon or resident doctor.. Every disease of neck lesion is properly describe with multi usg, ct and MRI images. this will help a lot. thanks.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. DR ARAVIND B S
SECOND YEAR PG
DEPT. OF ORAL MEDICINE AND RADIOLOGY
Guided by
Dr. TATU .E. JOY
PROFESSOR AND HOD
DEPT OF ORAL MEDICINE AND RADILOGY
2. DYSTROPHIC CALCIFICATION
CALCIFICATION IDIOPATHIC CALCIFICATION
METASTATIC CALCIFICATION
MINERALISATION
Soft tissue calcifications in the orofacial region are
uncommon and are usually asymptomatic in nature.
3. Classification
A .Dystrophic Calcifications
• General dystrophic calcification of the oral regions
• Calcified lymph nodes
• Dystrophic calcification in the tonsils
• Cysticercosis
• Arterial calcification
- Monckerberg's medial calcinosis (Arteriosclerosis)
- Calcified Atherosclerotic plaque
B. Idiopathic calcifications
• Sialoliths
• Phleboliths
• Laryngeal cartilage calcifications
• Rhinolith/Antrolith
C. Metastatic calcifications
• Ossification of the styloid ligament
• Osteoma cutis Myositis ossificans
4. GENERAL DYSTROPHIC CALCIFICATION OF ORAL REGIONS
-Precipitation of calcium salts into primary sites of chronic
inflammation or dead and dying tissue.
Associated with a high concentration of phosphatase
Increase in local alkalinity.
Common location -long standing chronically inflamed cyst
5. CLINICAL FEATURES
COMMON SITES – Gingiva, tongue, lymph nodes and cheek
COMMONLY FOUND IN DISEASES
- Tuberculosis
- Necrosis
- Atherosclerosis
-Scars And Areas Of Fatty
Degeneration
Occasionally the area Is Enlarged, ulcerated Or Palpable.
6. Radiographic features
common sites -long standing chronically inflamed cysts.
Appearance- varies from fine grains of radiopacities to
larger irregular radiopaque particles that rarely exceed
0.5 cm in diameter.
One or more of the radiopacities may be seen,
homogenous or may contain punctate areas.
The outline is usually irregular or indistinct.
7. Calcified Lymph Nodes
Calcification occurs in lymph nodes that have been chronically
inflamed because of various diseases (usually granulomatous
disorders).
The lymphoid tissue is replaced by hydroxyapatite, like calcium
salts nearly effacing all of the nodal architecture.
The common disease that cause calcified lymph nodes are,
tuberculosis (scrofula or cervical tuberculous adenitis),BCG
vaccination, sarcoidosis, cat-scratch disease, lymphoma treated
with radiation therapy, fungal infections, and metastases from
distant calcifying neoplasms.
10. Clinical Features
The most commonly involved nodes are submandibular and
cervical nodes (superficial and deep) and less commonly the
preauricular and submental nodes.
There are no significant signs or symptoms.
They are most often detected as an incidental finding during
panoramic radiographic examination.
• On palpation these nodes, which may be single or multiple or
sometimes chain of nodes, which are found to be mobile, hard,
round or oblong masses, whose outline is well contoured and
well defined.
11. The most common site is the submandibular region,
either at or below the inferior border of the mandible
near the angle, or between the posterior border of the
ramus and cervical spine.
The image of the calcified node may sometimes overlap
the inferior aspect of the ramus.
The node calcification may be single, or a series of nodes
called lymph node chaining.
Radiographic Features
12. The periphery may be well-defined, irregular and
sometimes may even have a lobulated appearance
(cauliflower like). The irregular outline helps to
differentiate lymph node calcification from other
potential soft tissue calcification in the area.
It may have a varying degree of radiopacity, giving an
impression of a collection of spherical or irregular masses,
which may look like mass of coral.
Occasionally the lesion may have a laminated appearance.
13. Radiographic Features
Calcified lymph nodes located inferior to the angle of the
mandible. Prior chronic infection of the lymph nodes may result
in calcification of the nodes. A history of successfully treated
tuberculosis is often associated with this calcification. This
asymptomatic condition may involve a single node or a chain of
nodes.
14. OPG showing two calcified lymph nodes in the left cervical chain
(solid arrows).
Note also the ghost shadows of the lymph nodes on the right
premolar/canine region (open arrows)
15. A lateral cervical radiograph shows a chain of calcified
lymph nodes.
16. Management
Usually require no treatment, but the underlying cause
should be determined in case treatment is required; as
in the case of lymphoma.
17. Dystrophic Calcification in the Tonsils
(tonsillar calculi, tonsil concretions, tonsilloliths)
Tonsillar calculi are formed when repeated bouts of
inflammation enlarge the tonsillar crypts. Incomplete
resolution of dead bacteria and pus serve as the nidus
for dystrophic calcification.
18. Clinical Features
Age group - 20 to 68 years of age, more in the older age group.
Tonsilloliths are usually hard, round, white or yellow objects
projecting from the tonsillar crypts.
The small calculi may not produce any signs or symptoms.
In case of larger calcifications, pain, swelling, fetor oris
dysphagia and a foreign body feeling on swallowing has been
reported.
In rare cases there may be giant tonsilloliths, which stretch the
lymphoid tissue, resulting in ulcerations and extrusion
21. Radiographic Features
On the panoramic film, tonsilloliths appear as single or
multiple radiopacities that overlap the mid portion of the
mandibular ramus in the region where the image of the
dorsal surface of the tongue crosses the ramus in the
palatoglossal air spaces.
It appears as clusters of multiple small ill-defined
radiopacities. This may vary from 0.5 cm to 14.5 cm in
diameter.
The radiopacity is of the same density as that of cortical
bone, and a little more radiopaque than cancellous bone.
22. Digital panoramic radiography with image suggesting
multiple tonsilloliths in the lower one third of the
mandibular ramus on both sides.
23. Left side of an OPG showing the typical appearance
of tonsillar calcifications (arrowed) overlying the ramus of the
mandible
24. NOTE:- A right angled view to the panoramic field such
as a posterior skull view or an open Towne's view may
help to differentiate whether the calcification lies to the
medial aspect of the ramus.
Management
Larger calcifications with associated symptoms should
be removed surgically.
25. Cysticercosis
When eggs or gravid proglottids from Taenia Solium (pork
tapeworm) are ingested by human, their covering is digested
in the stomach and the larval form cysticercus cellulosae) of
the parasite is hatched. These larvae penetrate the mucosa,
enter the blood vessels and lymphatics and are distributed in
the tissues all over the body, but preferentially locate to the
brain, muscle, skin and heart. They are also found in the oral
and perioral tissues, especially the muscles of mastication.
After the larva die, they are treated as foreign bodies causing
granuloma formation, scarring and calcification, this takes
approximately 3 months. These areas in the tissues are called
cysticerci.
26. Clinical Features
Multiple small nodules may be felt in the region of the masseter and
suprahyoid muscles and in the buccal mucosa and lip.
Examination of the head and neck region may disclose palpable, well
circumscribed soft fluctuant swellings, which resemble a mucocele.
Mild cases are completely asymptomatic.
Moderate cases have symptoms that range from mild to severe
gastrointestinal upset with epigastric pain and severe nausea and
vomiting.
Invasion of the brain may result in seizures, headaches, visual
disturbances, acute obstructive hydrocephalus, irritability and loss
of consciousness.
28. Radiographic Features
When alive the larva is not visible radiographically.
They are usually found in the muscles of mastication and
facial expression, the suprahyoid muscle, and the
postcervical musculature.
They appear as multiple, well-defined, elliptical,
homogeneous, radiopacities, which resemble grains of
rice.
29. Cysticercosis proglottids— A. Shows calcified nodules near the
inferior border of the mandible, which represents calcific
degeneration of the larval stage. B. Shows similar ovoid calcifications
of the shoulder and thoracic region
30. Radiograph of a patient with cysticercosis. Thevcalcified encysted
larvae are clearly seen in the soft tissues.
A single calcification in the area of the Whartons duct may be
easily mistaken for a sialolith on an intraoral film
31. Management
Medical management by using an antihelmintic, in the
initial stage.
After the larvae have settled and calcified in the oral
tissues, they are harmless.
32. Arterial Calcification
There are two different patterns of arterial calcifications
which can be identified both radiographically and
histologically; Monckerberg's Medial Calcinosis and
Calcified Atherosclerotic Plaque.
Monckerberg's Medial Calcinosis
(Arteriosclerosis)
This is characterized by the fragmentation, degeneration
and eventual loss of elastic fibers followed by the
deposition of calcium within the medial coat of the vessel.
33. Clinical Features
• Initially most patients are asymptomatic.
Eventually they may develop cutaneous gangrene,
peripheral vascular disease and myositis due to vascular
insufficiency.
• Patients with Sturge-Weber syndrome also develop
intracranial arterial calcifications.
34. Radiographic Features
• Those involving the facial or the carotid artery may be
seen on the panoramic radiographs.
• The calcific deposits in the walls of the artery outline
an image of the artery.
• From the side, it may appear as a parallel pair of thin,
radiopaque lines, that may have a straight or tortuous
path (pipe stem or tram track appearance).
• In cross section the involved vessels display a circular
ring like pattern.
35. Calcification of the facial artery. It may occur in
arteriosclerosis and represents an inflammatory process.
37. Management
Evaluation of the patient for occlusive arterial disease,
and in some cases hyperparathyroidism should be
considered as medial calcinosis frequently develops as a
metastatic calcification in these patients.
38. Calcified Atherosclerotic Plaque
This is found in the extracranial carotid vasculature and
is a major contributing source of cerebrovascular
embolic and occlusive disease.
Dystrophic calcifications can occur in the evolution of
plaque within the intima of the involved vessel.
39. Radiographic Features
• This first develops at the arterial bifurcation as a result of
increased endothelial damage at these sites.
• When calcification occurs, these lesions may be visible on
the panoramic radiograph in the soft tissues of the neck
adjacent to the greater cornu of the hyoid bone and the
cervical vertebrae C3, C4 or the intervertebral space between
them.
• The soft tissue calcifications are usually seen as
heterogeneous radiopacities, which are multiple and irregular
in shape, sharply defined from the surrounding soft tissues
and have a vertical linear distribution.
42. Management
The patient should be referred to the physician for
cerebrovascular and cardiovascular workup.
43. Idiopathic Calcification (or calcinosis)
This results from deposition of calcium in normal tissue
despite normal serum calcium phosphate levels. (e.g.
chondrocalcinosis, phleboliths)
Sialoliths (Salivary Gland Stone, Salivary Gland
Calculus)
Sialolithiasis is the formation of calcified obstruction within
the salivary duct resulting in chronic retrograde infection
because of a decreased salivary flow.
Sialoliths may also form in any of the major or minor salivary
glands (glandular sialolith) or their ducts (ductal sialolith),
usually only one gland is involved.
44. Mechanical conditions contributing to the slow flow
rate and physiochemical characteristics of the gland
secretions both contribute to the formation of a nidus
and subsequent precipitation of calcium and phosphate
salts.
Accordingly, the submandibular gland and ductal
system lie in a dependent position. The Wharton duct is
long and has an irregular tortuous course, an uphill flow
in the proximal portion and the orifice is much smaller
than the lumen. The salivary secretion of the
submandibular gland is more viscous and has higher
mineral content.
45. The sialolith is made up of laminated layers of organic
material covered with concentric shells of calcified
material, which is crystalline in structure
(Hydroxyapatite crystals with octacalcium and
phosphate).
The chemical composition is principally of calcium
phosphate and carbon with traces of magnesium,
potassium, chloride and ammonium.
46. • These are common in the middle age with a slight
predilection for men.
• The submandibular gland and the Wharton duct are
by far the most frequently involved (83% of the cases),
followed by the parotid (10%) and sublingual (7%)
glands. About half of the submandibular stones lie in
the distal portion of the Wharton's duct, 20% in the
proximal portion, and 30% in the gland.
Clinical Features
47. • The patient may be asymptomatic, or they may history
of pain and swelling in the floor of the mouth and in the
involved gland. Intra glandular stones cause less severe
symptoms than the extra glanular or the intraductal
types.
• The discomfort may intensify at meal times, when the
salivary flow is stimulated.
48. • If the blockage is partial, then the pain and swelling
gradually subsides.
• 9% of patients have recurrent sialolithiasis and 10% have
nephrolithiasis.
• Pus may exude from the duct orifice, the surrounding soft
tissue may be inflamed, and tender, and the overlying
mucosa may ulcerate.
• Stones in the more peripheral portion of the duct may be
palpated, if it is of sufficient size.
• Sialolithiasis of minor salivary gland is a rare occurrence,
the most common site being buccal mucosa either near the
commissure or in the proximity to the mandibular
mucobuccal fold.
49.
50.
51.
52. The sialoliths located in the duct of the submandibular
glands are usually cylindrical. But they may vary in
shape from long cigar shapes to oval or round shapes.
• Stones that form in the hilus of the submandibular
gland tend to be larger and more irregularly shaped.
• The stones are homogeneously radiopaque, and show
evidence of multiple layers.
• Less than 20% of the submandibular gland and 40% of
the parotid gland sialoliths are radiolucent because of
the low mineral content of parotid secretions.
Radiographic Features
53. CT: also helps to detect minimally calcified sialoliths
which are not visible on plain films.
USG: is of limited use in the diagnosis of
inflammatory and obstructive diseases, but if the
stone is large (2 mm), it will be detected as a
characteristic acoustic shadow showing echodense
spots.
54. • A periapical film, placed in the buccal vestibule, with
reduced exposure and time and the central ray directed
through the cheek, helps to demonstrate stones in the
parotid gland duct.
• An anteroposterior skull view, of the patient with "blow-
out" cheek , or an open-mouth lateral skull projection, helps
to demonstrate stones in the parotid duct. When producing
radiographs to detect sialoliths, the exposure time should be
reduced to about half of normal, this helps to detect stones
that are highly calcified.
55. If non calcified stone are suspected, then Sialography; is
helpful in locating obstructions that are undetectable with
plain radiography. The contrast agent usually flows around the
sialolith, filling the duct proximal to the obstruction. The
ductal system is frequently dilated proximal to the obstruction
and infers the presence of an obstruction even when is not
visible. The contrast agent that flows around the sialolith is
more radiopaque and may obscure small sialoliths.
Radiolucent sialoliths appear as ductal filling defects.
Sialography should not be performed if the radiopaque stone is
shown by plain radiography to be in the distal portion of the
duct, because the procedure may displace it proximally into the
ductal system, complicating its subsequent removal.
56. Additional Imaging
• On the periapical view, there may be superimposition of the
stone over the mandibular premolar and molar apices.
• A standard mandibular occlusal view, using half the usual
exposure time, displays the floor of the mouth without overlap
of the mandible and is the best view for visualizing stones in
the distal portion of the Wharton's duct.
• A lateral oblique view or a panoramic view, helps to
visualize stones in a more posterior location.
57. Radiographic Features
Mandibular occlusal projection shows a sialolith
(salivary calculus) in the duct of the submandibular
gland (Wharton's duct).
59. Sialolith with in Stensons duct of the parotid gland.
Other calcifications such as phleboliths or osteoma on
the pterygoid process can occur in the region. With the
help of a tangential zygoma projection (phleboliths) or
an axial skull film or with CT (osteoma on the pterygoid
process), the differential diagnosis can be determined
60. On periapical radiographs, the
radiopacity may be
misdiagnosed as osteosclerosis.
To differentiate an
osteosclerosis from a sialolith,
take two radiographs using
different vertical (or horizontal)
angulations of the x-ray beam.
If the radiopacity changes its
position in relation to the
adjoining teeth, as shown here,
the radiopacity is a sialolith in
the floor of the oral cavity
(Clark's rule: same lingual,
opposite buccal). Another
method to identify a
submandibular sialolith is to
take an occlusal projection.
61. A sialolith on a panoramic radiograph may be misdiagnosed
as a calcified lymph node. In the absence of clinical signs and
symptoms it is difficult to differentiate the two types of
calcifications unless a sialogram is made.
62. A. Right side of an OPG showing a large radiopacity in
the lower premolar region (arrowed).
B. Lower 90° occlusal of the same patient showing the
opacity to be a large stone in the right submandibular
duct
63. Sialogram showing an obstruction in the Wharton's duct
preventing the flow of the radiopaque dye into the
submandibular salivary gland. The stone (arrow) is blended
with the radiopaque dye.
64. Digital panoramic radiography with image suggesting
a single sialolith in the right submandibular gland.
65. Digital panoramic radiography showing a image suggesting
a calcification in the right parotid gland and in its duct.
66. Digital panoramic radiography with image suggesting
multiple microliths in the parotid gland on both sides.
67. Differential Diagnosis
• Gas bubble; these are more easily removed and are more
circular than sialoliths.
• Hyoid bone; these are seen bilaterally on the panoramic film.
• Myositis ossificans; there will be restriction of mandibular
movements.
• Phleboliths; there will be no sialadenitis, and these are more or
less rounded and contain laminations or central dark
(radiolucent) areas.
• Calcific submandibular lymph nodes; if there is presence of
pain then it is suggestive of a sialolith. The calcified lymph
nodes appear to be cauliflower shaped.
68. • Chondrodystrophia calcificans congenita; this is
associated with calcifications in the neck which
resemble the submaxillary calculi in the radiographs.
• Palatine tonsillitis; on the panoramic image it has a
similar location to parotid sialoliths, superimposed
over the ramus, but can be differentiated in that they
are typically multiple and punctate.
69. Other Causes of Obstructions
• Mucous plugs; these are incompletely mineralized
sialoliths.
• Strictures and Stenosis; this may be papillary or ductal
obstruction due to chronic irritation, acute trauma or
presence of intra ductal growth or tumor.
• Foreign bodies; food particles, toothbrush bristles, tooth
picks.
• Extra ductal causes; like muscle pressure, tumors, lymph
nodes and denture flanges.
70. Parotid fistula; this may open into the oral cavity or on to
the exterior of the face. It may be due to trauma, rupture
of parotid abscess or complication of superficial
parotidectomy.
Management: It is best to encourage spontaneous
discharge through the use of sialogogues or piezoelectric
extracorporeal shock wave lithotripsy or surgical removal
is indicated.
71. Pheboliths
Intravascular thrombi, which arise secondary to venous
stagnation, may get organized or mineralized. The
mineralization begins at the core of the thrombus and
consists of crystals of apatite with calcium phosphate and
calcium carbonate. Phleboliths are calcified thrombi
found in veins, venulae, or the sinusoidal vessels of
hemangiomas (especially the cavernous type).
72. Clinical Features
• In the head and neck region , phleboliths always indicate
the presence of a hemangioma.
• In an adult it may be the sole residua of a childhood
hemangioma, which has long since regressed.
• The involved soft tissue may be swollen, throbbing or
discolored by the presence of veins or a soft tissue
hemangioma, which often fluctuate in size, associated with
changes in body position or during a Valsalva maneuver.
The vascular nature may be confirmed by the presence of
blanching or change in color on applying pressure.
Auscultation may reveal bruit in case of cavernous
hemangioma but not in the capillary type.
74. Multiple phleboliths of various sizes in cavernous
hemangioma of the face. The radiograph is of the patient's
cheek.
75. Oblique lateral showing multiple phleboliths
(arrowed) associated with a hemangioma. Note the
typical target appearance of some of the calcifications
77. • These are commonly found in hemangiomas.
• In cross section the shape is round or oval, up to 6 mm in
diameter with a smooth periphery. If the involved blood
vessel is viewed from the side, the phlebolith may resemble
a straight or a slightly curved sausage.
It may be homogeneously radiopaque but more commonly
has the appearance of laminations, giving phleboliths a
bull's eye or target appearance. A radiolucent center may be
seen, which may represent the remaining patent portion of
the vessel.
Radiographic Features
78. Differential Diagnosis
• Sialolith; these usually occur singly, if multiple
sialoliths are present, they are usually oriented in a
single line, whereas phleboliths are usually multiple
and have a more random, clustered distribution, and is
usually associated with a vascular lesion.
79. Laryngeal Cartilage Calcifications
Both the thyroid and the triticeous (means grain of wheat)
cartilages (found within the lateral thyrohyoid ligaments)
consist of hyaline cartilage, which has a tendency to calcify
or ossify with advancing age.
80. Clinical Features
• Has no clinical features and usually is an incidental radiographic finding.
Radiographic Features
• The calcified cartilage is located on a lateral view within the pharyngeal air
space inferior to the greater cornu of the hyoid bone and adjacent to the
superior border of C4. The superior cornu of a calcified thyroid cartilage
appears medial to C4 and is superimposed on the prevertebral soft tissue.
• The triticeous cartilage measures 7 to 9 mm in length and 2 to 4 mm in
width. The periphery is well defined and smooth, and only the top 2 to 3 mm
of the calcified thyroid cartilage is visible at the lower edge of a panoramic
radiograph.
• The calcified tracheal cartilages usually present a homogeneous
radiopacity, with an occasional outer cortex.
82. Ossified thyroid and cricoid cartilages in a 40-year-old
female patient demonstrated on a lateral cephalometric
radiograph.
83.
84. Digital panoramic radiography with image suggesting
triticeous cartilage on both sides (between the greater horn
of the hyoid and superior horn of the thyroid cartilage).
85. Differential Diagnosis
• Calcified Atheromatous Plaque in the carotid bifurcation,
the calcified triticeous cartilage has a solitary nature and
an extremely uniform shape and size.
Management: No treatment required.
86. Rhinolith/Antrolith
Hard calcified bodies or stones that occur in the nose
(rhinoliths) or the antrum (antroliths) arise from the
deposition of mineral salts such as calcium phosphate,
calcium carbonate, and magnesium around a nidus.
In case of a rhinolith the nidus is usually an exogenous
foreign body (coin, beads etc) whereas the nidus for an
antrolith is usually endogenous (root tip, bone fragment,
masses of stagnated mucus, etc.).
87. Clinical Features
• The patient may be asymptomatic initially.
• With the increase in size of the expanding mass, it
may impinge on the mucosa, producing pain,
congestion and ulceration.
• The patient may develop a unilateral purulent
rhinorrhea, sinusitis, headache, epistaxis, nasal
obstruction, anosmia, fetor, fever and facial pain.
88.
89. Radiographic Features
• These stones have a variety of shapes and sizes. They have
well-defined smooth or irregular borders.
• They may be homogeneous or heterogeneous radiopacities,
depending on the nature of the nidus and sometimes have
laminations. Occasionally the density may exceed the
surrounding bone.
• Antroliths occur within the maxillary sinus above the floor of
the antrum and may be seen on the periapical, occlusal and
panoramic radiographs.
• Rhinoliths are seen in the nasal fossae. A posteroanterior
skull view will help to identify the location of a rhinolith.
90. Antrolith (stone in maxillary sinus) on the floor of the sinus.
It is asymptomatic.
91.
92. A. Rhinolith in the maxillary sinus, seen on an OPG. The
rhinolith is seen located at the posterior wall of the right
maxillary sinus (arrow), B. Rhinolith in the maxillary sinus
of the same patient, seen on Waters Projection, this
projection also reveals the presence of chronic sinusitis
93. Differential Diagnosis
• Osteoma
• Healing odontogenic cyst
• Mycolith
• Root fragments; should be differentiated from antroliths
by the presence of the root anatomy and presence of a root
canal. A displaced fragment in the sinus will move when the
radiography is performed with the head in different
positions, unless it is lodged between the bone and the
sinus lining.
94. Management
Patients should be referred to an otorhinolaryngologist for
the removal of the stone.
Metastatic calcification results when minerals precipitate
into normal tissue as a result of higher than normal serum
calcium (e.g. hyperparathyroidism, hypercalcemia of
malignancy) or phosphate (e.g. chronic renal failure).
Metastatic calcifications usually occur bilaterally and
symmetrically. The deposits of calcium occur in the kidney,
lung, gastric mucosa and media of blood vessels.
95. Ossification of the Styloid Ligament
Ossification of the styloid ligament usually extends
downwards from the base of the skull and commonly occurs
bilaterally. In rare cases the ossification begins at the lesser
horn of the hyoid or in the central area of the ligament. The
associated conditions are Eagle's Syndrome, Styloid
Syndrome and Styloid Chain Ossification.
96. Clinical Features
• Patients are more than 40 years of age and are usually
clinically symptom less.
• It may be detected by palpation over the tonsil as a
hard pointed structure.
• The patient may present with a complaint of a vague
nagging to intense pain in the pharynx on swallowing,
turning the head or opening the mouth, especially on
yawning.
97. • The elongated styloid process and local scar tissue probable
cause symptoms by impinging on the glossopharyngeal nerve.
• Similar clinical findings without a history of neck trauma
constitute stylohyoid (carotid artery) syndrome.
– The patient may also describe attacks of otalgia, tinnitus,
temporal headache and vertigo or transient syncope.
– The pain may be produced by mechanical irritation of
sympathetic nerve tissue in the arterial wall, producing
regional carotidynia.
– This condition is more prevalent than Eagle's syndrome.
98. Radiographic Features
• The styloid ligament ossification is quite common in
individuals of any age and may be detected as an incidental
feature on any panoramic radiograph.
• In the panoramic image it is seen as a linear, long,
tapering, thin, radiopaque process that is thicker at its
base, extending forward from the region of the mastoid
process and crosses the posteroinferior aspect of the ramus
towards the hyoid bone. The hyoid bone is positioned
approximately parallel to or superimposed on the posterior
aspect of the inferior cortex of the mandible.
99. • The ossified ligament has a more or less straight
outline, but it may sometimes show irregularity in the
outer surface. The further the radiopaque ossified
ligament extends towards the hyoid bone, the more
likely it is that it will be interrupted by radiolucent, joint
like junctions (pseudo articulations).
• Small ossifications of the styloid ligament appear
homogeneously radiopaque. As the ossification increases
in length and girth, the outer cortex of this bone appears
as a radiopaque band at the periphery.
102. Patient with Eagle’s syndrome. The stylohyoid ligaments are
bilaterally calcified.
103. Differential Diagnosis
• Temporomandibular joint dysfunction; there is no
radiographic evidence of ligament ossification.
Management: Amputation of the stylohyoid process.
104. Osteoma Cutis
These are sites of normal bone formation in abnormal
locations. It is a rare soft tissue calcification in the skin.
It may develop secondary to acne of long duration. In a
scar or chronic inflammatory dermatosis.
Histologically these are seen as areas of dense viable bone
in the dermis or subcutaneous tissue. They are
occasionally found in diffuse scleroderma, replacing the
altered collagen in the dermis and subcutaneous septa.
105. Clinical Features
• It may occur on the face (extraoral) in the cheek and lip
region, and tongue (intraoral) where it may be called
osteoma mucosae or osseous choristoma.
• It does not cause any visible change in the overlying skin,
except in some cases where the color may change to
yellowish white.
• It varies in size from 0.1 mm to 5 cm in diameter, if the
lesion is large. The individual osteoma may be palpated. A
needle inserted into one of the papules usually meets with
stone like resistance.
106. • Osteoma may be single or multiple.
• Some patients develop numerous lesions (dozens to
hundreds)
Usually on the face in females and on the scalp or chest
in males. This is known as multiple miliary osteoma
cutis.
107.
108. Radiographic Features
• An intraoral film placed between the cheek and the
alveolar bone gives accurate localization.
• A posteroanterior skull view with the cheek blown
outward using a soft tissue technique of 60 kVp helps
localize osteomas of the skin.
• If present in the cheek or lip region the shadow may be
superimposed over a tooth root or alveolar process, giving
the appearance of dense bone.
• The osteoma cutis appears as smoothly outlined,
radiopaque, washer-shaped images.
109. •The single or multiple radiopacities of various sizes.
• It appears as a homogeneous radiopacity with a
radiolucent center that represents normal fatty marrow,
giving the lesion a dough-nut appearance radiographically.
• Trabeculae usually develop in the marrow cavity of the
larger osteomas.
• Lesions of calcified cystic acne resemble a snowflake
radiopacity which corresponds to the clinical location of
the scar.
110.
111. Differential Diagnosis
• Myositis ossificans; is of greater proportions, in some
cases causing noticeable deformity of the facial contour.
• Calcinosis cutis
• Osteoma mucosae; if the blown out cheek technique is
used, the lesions of osteoma cutis. appear much more
superficial than mucosal lesions.
112. Management:
They may be removed for cosmetic reasons. The
methods used are excision, resurfacing of the skin with
erbium:YAG laser using tretinoin cream (especially in
cases of multiple miliary osteomacutis).
113. Myositis Ossificans
In this case, the fibrous tissue and heterotopic bone form
within the interstitial tissue of the muscle and associated
tendons and ligaments. There is secondary destruction and
atrophy of the muscle as the fibrous tissue and bone
interdigitate and separate the muscle fibers. It is of two
types:
– Localized myositis ossificans
– Progressive myositis ossificans
114. Localized Myositis Ossificans (post-traumatic
myositis, myositis ossificans, Solitary myositis)
This results due to acute or chronic trauma, heavy muscular
strain, muscle injury which may lead to considerable
hemorrhage into the muscle or associated tendons or fascia.
The hemorrhage organizes and undergoes progressive scarring.
During the healing process, heterotopic bone and in some cases
cartilage is formed. There is no inflammation (the term
myositis is thus misleading).
The fibrous tissue and bone form within the interstitial tissue of
the muscle, there is no actual ossification of the muscle fibers.
115. Clinical Features
• It may develop at any age, in either gender, but is more common in
young men who engage in vigorous activities. The commonly
involved oral sites are, the masseter, sterno-cleidomastoid and
lateral pterygoid muscle.
• The site of the precipitating trauma remains swollen, tender and
painful for a long time. The overlying skin may be red and inflamed.
• If the lesion involves a muscle of mastication, opening the jaw may
be difficult.
• After a period of 2-3 weeks the area of ossification may become
apparent, as a firm, intramuscular palpable mass, which enlarges
slowly, but eventually stops growing. The lesion may appear fixed or
may be freely movable on palpation.
116.
117. Radiographic Features
• A radiolucent band may be seen between the areas of
ossification and adjacent bone, and the heterotopic bone
may lie along the long axis of the muscle. The periphery is
more radiopaque than the internal structure. The shape
may vary from irregular, oval to linear streaks
(psuedotrabeculae) running in the same direction as the
normal muscle fibers.
• The internal structure varies with time:
– In the third or fourth week after injury, the appearance is
faintly homogeneous radiopacity.
118. – By the second month, it is organized and appears as
delicate lacy or feathery radiopaque internal structure,
which indicate the formation of bone. This bone does not
have a normal appearing trabecular pattern.
– Gradually the image becomes denser and better defined,
maturing fully in about 5-6 months.
– After this the lesion may shrink.
119. Myositis Ossificans , this could be due to trauma or
repeatedly occurring inflammatory events. In this case there
is ossification of the masseter muscle causing limited ability
to open the mouth. A. shows a section of an OPG (arrow). B.
shows the massive ossification in a tangential zygoma
projection (arrow)
120. Ossification of muscle attachments on the mental spine; the
genioglossus muscle and the geniohyoid muscle may
become ossified where they attach to the mental spine, and
this may provide difficulties for denture wearers. This may
represent a form of myositis ossificans, which is a
heterotopic accumulation of the bone at the attachment of
the musculature
122. Differential Diagnosis
•Ossification of the stylohyoid ligament, dystrophic calcifications
in areas of necrosis, pathological calcifications, phleboliths. The
form and location of myositis ossifications and the presence of
psuedotrabeculae are enough to differentiate it from them.
• Bone forming tumors; although tumors like osteogenic sarcoma
can form a linear bone. pattern, the tumor is contiguous with the
adjacent bone and signs of bone destruction are present.
Management: Sufficient rest to the injured part, and if
necessary excision.
123. Progressive Myositis Ossificans
This is a rare disease of unknown cause that usually affects
children before 6 years of age, and occasionally as early as
infancy.
Progressive formation of heterotopic bone occurs within
the interstitial tissue of muscles, tendons, ligaments and
fascia, and the involved muscle atrophies.
This condition may be inherited or may be a spontaneous
mutation affecting the mesenchyma.
124. Clinical Features
• It usually affects children before 6 years of age, and
occasionally as early as infancy, males are more affected.
It may affect the striated muscles including the heart
and diaphragm.
• It starts in the muscles of the neck and upper back and
moves to the extremities.
• It begins as a soft tissue swelling that is tender and
painful and may show redness and heat, indicating the
presence of inflammation.
• As the acute symptoms subside, a firm mass remains in
the tissue.
125. •Sometimes the spread of ossification is limited, in other
cases it may be very extensive; affecting, almost all the
muscles of the body, resulting in stiffness and limitation
of motion of the neck, chest, back and extremities
(especially the shoulders), which gradually increases.
• Advanced stages of the disease result in the “petrified
man” like appearance.
• During the third decade the process may spontaneously
arrest, however most of the patients die young during the
3rd or 4th decade, due to respiratory embarrassment or
from inanition through the involvement of the muscles of
mastication.
126. Radiographic Features
• The radiographic appearance is similar to that of localized
myositis ossificans.
• The heterotopic bone more commonly is oriented along the
long axis of the involved muscle, with coarser linear striae of
increased density which represent new bone formation, and
there is evidence of dense osseous replacement of the greater
part or whole of the muscle.
• The bone that is laid down does not show normal bone
structure, and appears as a rather structure less mass of variable
density.
• Osseous malformations of the regions of muscle attachment,
such as the mandibular condyles, may also be seen.
• Skeleton becomes osteoporotic because of lack of function as
muscles atrophy and joints become ankylosed.
127. Differential Diagnosis
• Rheumatoid arthritis; in the initial stage it may be
difficult but as the disease progresses specific anomalies
confirm the diagnosis.
• Calcinosis; the deposists of amorphous calcium salts
frequently resorb, but in progressive myositis ossificans
that bone never disappears.
Management: There is no effective treatment. The
treatment is symptomatic and supportive as per the
requirement of each case. Nodules that are traumatized
and then ulcerate should be excised.
128. References
Shenoy N, Ahme J, Sumanth K N, Srikant N S, Rai S, Yadiyal M . Prevalence of
Laryngeal Cartilage Calcifications in Mangalore population; a Radiographic
Study.Otolaryngology online journal.2014;4(4):74-80
Mupparapu M, Vuppalapati A. Ossification of Laryngeal Cartilages on Lateral
Cephalometric Radiographs. Angle orthod.2005;75(2):196-201
White SC, Pharoa MJ. Oral Radiology: Principles and Interpretation. 6th ed. Saint
Louis: Mosby; 2007
Haring JI, Jansen L. Dental radiography: principles and techniques. 2nd ed.
Philadelphia:Saunders; 2000. 569 p.
Langland OE, Langlais RP, Preece JW. Principles of dental imaging. 2nd ed.
LippincottWilliams & Wilkins; 2002. 459 p.