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??????(2)
Radiologic Interpretation of Malignant Diseases
in Jaws
???????????
????? ?????? ?????
07-31211012755
yukkwa_at_kmu.edu.tw
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(No Transcript)
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? ? ? ?
?????????????
???(Osteosarcoma)??????
???????????????
References
1. ?????????, 2nd edition, Chapter 10, p.191-226
2. Kaohsiung Medical University, Oral Pathology
Department
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(1) ??? (permeated type)????????????,???????????
Inferior alveolar canal
Inferior cortex
Ref. 1
5
(2) ??? (moth-eaten type)??????????,??????????
Inferior alveolar canal
Inferior cortex
Ref. 1
6
(3) ???????(pressure type) ????????,????????????,?
????????,?????????????
Squamous cellcarcinoma
Inferior alveolar canal
Inferior cortex
Ref. 1
7
?????????????????
8
?????????????????
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Case 1 ?????????? (?????)
1 ????????????2 ?????????,????(osteomyelitis)?
?,????,?????????????????3
X???????????????????????? ?????????,????????
4 ???????????(a?)5 ??5?????
Ref. 1
10
Case 1 ?????????? (?????)
??5????????????????????
Ref. 1
11
Case 1 ?????????? (?????)
1 ?????????(infiltrative bone destruction) 2
????? 3 ??????????,??????????????? 4
???????? ???????????????? ????x????(radioluce
ncy)??
Ref. 1
12
Case 1 ?????????? (?????)
d ??????????????X????1 ??6????????????????2
?????????3 ???(calculus)4 ???(external
oblique ridge)
Ref. 1
13
Case 1 ?????????? (?????)
a ??????3??????,???????? 1. ????? 2.
??????????????????(ill-defined and
infiltrative),??5?????????(??)
Ref. 1
14
Case 1 ?????????? (?????)
Nucleons inhabit energy levels in the nucleus
analogous to electron shells. Tc99m(?)is a
metastable(???) isotope in which the nuclear
state is higher than ground state. It decays to
ground state by emitting a ? photon. The
half-life of the metastable state is measured in
days. The half-life of Tc99m is 6.01 h 6.047 h
respectively. The short half-life relatively
low-energy emission make this an ideal isotope
for medical scanning.
Bone Scan
f 99mTc(Technetium)-MDP(?-99m??????)??Scintigram(
???) ??????????Scintigram,????????????????????????
???,?X?????????????????????99mTc-MDP??????????????

Tc 99m decays Tc 99(?????). The Tc 99 isotope is
a ? emitter having a half-life reported as
2.12x105 yrs 2.14x105 yrs respectively. ?
emission is not accompanied by ? radiation.
Ref. 1
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Case 2 ?????????? (?????)
1 ??????????????????,?????? ???????????? 2
???(mandibular canal) 3 ??(mental foramen)
Ref. 1
16
Case 2 ?????????? (?????)
1 ???????????????? ?????? 2
???????????? 3????(tongue) 4 ???(genial
tubercle) ??X????,???????????????,??????????X??
????
Ref. 1
17
Case 2?????????? (?????)
1 ??X??????????????? ,????????????
(infiltrative bone resorption),
???????(pressure type)2 ??????(soft tissue
outline of the tumor) 3 ??8??????hypercemen
tosis
Ref. 1
18
Case 2?????????? (?????)
99mTc-MDP??Scintigram?????? 1
?????(X??????????) 2 ?? (orbit) 3 ?? (nasal
cavity) 4 ??? 5 ?? (cervical spines)
Ref. 1
19
Case 3 ?????????? (?????)
1 ?????????????????????????,?????
?????(pressure type)2 ????????????????(irregular
)3 ???????4 ???????????,?????????????,?????
????????,?????????????????X????,
???????????5 ???????soft tissue mass of the
tumor
Ref. 1
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Case 3 ?????????? (?????)
b ???????(Oblique lateral view)X???? ????????????
???????,????????????,????????????
Ref. 1
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Case 4 ????????????? (?????)
Panorex X?????????????????????????(??)(???????????
?????,????)
Ref. 1
22
Case 4 ?????????????
????X???????????????? ?? 1 ?????????????2
??3??????????????????,?????,
????????(infiltrative bone resorption)3
???????????????4?????????, ??????(spiked
root) 4 ??3????????????(lamina dura),?????
?????????
Ref. 1
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Case 5?????????? (?????)

• ?????????????
• Permeated type
• Pressure type
• Moth-eaten type

Ref. 2
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Our Case

• Delayed healing of extraction wound of left
  lower second molar for about 3 weeks

Ref. 2
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Radiographic Examinations (1)
(mesial-disal dimension)
(buccal-lingual dimension)
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Panoramic Film (1)

• Panorex showed an ill-defined radiolucency
  with ragged, irregular border, approximately 3.0
  x 2.5 cm in diameter over the left mandible body
  area

Ref. 2
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Panoramic Film (2)

• Extending from left superior alveolar ridge down
  to the inferior border of mandible, from
  edentulous tooth 37 area posterior to ramus
  angle
• Loss of cortical outline of ID canal is noted

Ref. 1
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Occlusal Film

• It showed destruction of lingual and buccal
  cortical plates without bony expansion

Ref. 1
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Radiographic Examinations (2)
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Axial CT Scan (1)

• CT scan showed destruction of lingual buccal
  cortical plates

Ref. 2
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Axial CT Scan (2)

• An enlarged lymph node is noted in left
  submandibular area

Ref. 2
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Differential Diagnosis
Ref. 2
33
Inflammation or Neoplasm?

• Fever or local heat (-)
• No purulent drainage was presented
• Destruction of lingual and buccal cortical plates
  without expansion

Neoplasm
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Benign or Malignant?

• Pain ()
• Tenderness ()
• Lymphadenopathy ()
• Numbness of left lower lip
• Ill-defined radiolucency with ragged, irregular
  border
• Destruction of lingual and buccal cortical plates
  without expansion

Malignant
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Peripheral or Intrabony origin?

• Adjacent mucosa seems normal
  appearance
• Induration (-)

Intrabony
,,,,,
Ref. 2
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Working Diagnosis

• Intrabony malignant tumor
• Epithelial origin?Central SCC
• Bone origin?Osteosarcoma
• Fibrous origin?Fibrosarcoma
• Neural origin?neurofibrosarcoma
• Salivary gland origin?mucoepidermoid
  carcinoma or adenoid cystic carcinoma
• Lymphatic origin? Central lymphoma
• Metastatic tumors in jawbone

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Case 6 ??? (osteosarcoma)

1 ?????????????? ??????X?????,??
?????????????X? ???(osteoblastic type or
sclerosing type) 2 ????,??????????
?,?????? 3 ????????,canal??? 4 ?????????
Ref. 1
38
Case 6 ??? (osteosarcoma)

1 ????????????,???sunray appearance
?sunburst appearance?????(periosteal reaction)
2 ????????(loss of bony trabeculation)
Ref. 1
39
Case 6 ??? (osteosarcoma)
c X??????(??) Frontal tomogram 1
?????????????X????? 2 ?? orbit 3 ???? ethmoidal
air cells 4 ??? inferior nasal concha 5
???????????? coronoid process 6 ???? upper third
molar 7 ??????? upper second molar 8 ???? lower
third molar
Ref. 1
40
Case 6 ??? (osteosarcoma)
d ??????X???? (????X????)PA view 1
?PA?????????? ?(??)
Ref. 1
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Case 6 ??? (osteosarcoma)
e ????????X???? 1 ??? sunray appearance(???)
Ref. 1
42
Case 7 ??? (osteosarcoma)

1 ????????X???????2?????,???? ?(mixed
type)????X????,?????,?????2 ???3538???????(wide
ning of periodontal ligament space) 3
36?37?38?????????????,36?37???? (spiked
root)4 ???????????,?????X??,??????
?????????? ??
Ref. 1
43
Case 6 ??? (osteosarcoma)
???X??????????????????,?????
Ref. 1
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Case 7 ??? (osteosarcoma)

?????????,?????????(periosteal reaction)?????(spic
ula)???,?????,?????????
Ref. 1
45
Case 8 ????? (osteosarcoma in femur)
patella
1 ?????(shaft of femur)???????????????X????,????
??(osteolytic type)????X???? 2
???????????????????b?????????????????
(codmans triangle)????(buttress)?????????????????
??? ???????,????????????????????????????
??????????????????,??????????????,????
?????????????????? 3 ????????????????(groomed
whisker???????)????? ?????codman??(???)????s
unray???sunburst appearance? ?????
Ref. 1
46
Case 9 ??? (osteosarcoma)

• ???????X-ray???
• External root resorption
• Floating tooth
• Hypercementosis

Ref. 2
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Ref. 1
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Summaries
Knowing
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