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Monostotic Paget's disease of the mandible
Volume 70 Number 6
Radiology forum
805
6. Shafer WC, Nine MK, Levy BM. A textbook of oral pathology. Philadelphia: WB Saunders Co, 1983. 7. Hiranandani LW, Melgiri RD. Supernumerary tooth in the floor of the nose. J Laryngol 1968;82:845-8.
MONOSTOTIC MANDIBLE
A
3. Intranasal view of tooth by basal pharyngoscope. Nasal septum on right. Inferior turbinate on left.
Fig.
intranasal teeth. The etiology of intranasal teeth is controversial. Many theories have been proposed, including developmental disturbances, trauma, infection, crowding, or dense bone. Symptoms of intranasal teeth range from none to such symptoms as pain, nasal obstruction, or epistaxis, and signs include deviation of the external nares and septum. The diagnosis of intranasal teeth may be made from either clinical examination or radiographic examination. Clinically, examination would reveal a tooth in the floor or lateral wall of the nasal cavity, with possible granulation tissue present. The tooth may or may not have dental caries. Radiographically, intranasal teeth may show up on panoramic x-ray films, occlusal x-ray films, or other facial x-ray films. Examination with fiberoptic assistance is helpful. Treatment of intranasal teeth is usually surgical removal, especially if there is a sign of infection or dental caries. If the tooth is not removed, close radiographic follow-up is recommended. Douglas D. Carver, DDS Sharon Peterson, DDS Terry Owens, MD 12121 Richmond, Suite 316 Houston, TX 77082 REFERENCES
1. Smith RA, Gordon NC, DeLuchi SF. Intranasal teeth: report of two cases and review of the literature. ORAL SURG ORAL MED
ORAL
PATHOL
1979;47:120-2.
2. Spencer MG, Couldery MG. Nasal tooth. J Laryngol Otol 1985;99:
1147-50.
Martinson FD, Cockshott WP. Ectopic nasal dentition. Clin Radio1 1972;23:451-4. 4. Thawley SE, LaFerriere KA. Supernumerary nasal tooth. Laryngoscope 1977;87:1770-3. 5. Murty PS, Hazarika P, Hebbar GK. Supernumerary nasal teeth Ear Nose Throat J 1988;67:128-9. 3.
PAGET’S
DISEASE
OF THE
76-year-old white man complained of left mandibular aching of several days’ duration. He also reported an increasing swelling in the area during the preceding 24 hours. His medical history included an allergy to penicillin, treatment of hypertension with hydrochlorothiazide and potassium, and removal of a basal cell carcinoma from his face 2 years earlier. His vital signs were within normal limits with the exception of an elevated temperature of 100” F. Clinically, the patient had a Class III jaw relationship with multiple diastemata. The moderate swelling in the body of the left mandible was warm to the touch but not fluctuant. Panoramic and periapical radiographs showed hypercementosis, loss of lamina dura, loss of normal trabeculation, osteolytic and osteosclerotic areas, and generalized loss of cortical bone limited to the mandible. Root resorption of the left mandibular second premolar was also nated (Figs. 1 and 2). The patient was referred to an internal medicine department for evaluation. The physician recommended radiographic examination of the skull, chest, and lumbosacral region after emergency dental treatment. The left mandibular second premolar and second molar were extracted in fragments. Pus from the extraction sites was cultured, and the tooth and bone fragments were sent for biopsy. The extraction sites healed well, and all symptoms resolved. The report on the culture stated “normal flora.” Microscopically, the description of the tooth and bone fragments was consistent with Paget’s disease of bone. Fibrous dysplasia and chronic osteomyelitis were thought to be less likely possibilities. A bone scan revealed “markedly increased activity” in the mandible and some activity in the great toe of the right foot that was attributed to “hammer toe.” No other areas of abnormal activity were seen in the skeleton, including the skull. A serum alkaline phosphatase test showed an elevated level of 182 U/L, with a normal adult range of 50 to 136 U/L. The incidence of monostotic Paget’s disease of the mandible with progressive resorption of the teeth is reportedly rare. l-3 In this case results of the bone scan,
806
Radiology forum
0w.t
SCRC; ORAL
Mw
ORAL PATIIOL December 1990
2. Stafne EC, Gibilisco JA, eds. Oral roentgenographic diagnosis. 4th ed., Philadelphia: WB Saunders Co. 1975:304-6. 3. Smith NHH. Monostotic Paget’s disease of the mandible presenting with progressive resorption of the teeth. ORAL SURG ORAL MED ORAL PATHOL 1978;46:246-53. 4. Rose LR, Kaye D, eds. Internal medicine for dentistry. St Louis: CV Mosby Co, 1983:86-S, 1 14. 115. 5. Shirazi PH, Ryan WG, Fordham EW. Bone scanning in evaluation of Paget’s disease of bone. CRC Crit Rev Clin Radio1 Nucl Med 1974;5:523-58.
CALCIFIED
Fig. 1. Panoramic radiograph shows hypercementosis, loss of lamina dura, loss of normal trabeculation, osteolytic and osteosclerotic areas, and generalized loss of cortical bone limited to the mandible.
Fig. 2. Periapical radiograph of left cond premolar shows root resorption.
mandibular
THYROID
CARTILAGE
A
48-year-old Hispanic woman was referred to the department of oral and maxillofacial surgery for preprosthetic evaluation. The cephalometric radiograph showed a well-marginated homogeneous radiopacity consistent with a calcified thyroid cartilage (Fig. 1). The patient’s medical history was noncontributory, and the results of physical examination were negative. No further workup was performed. Calcification of the thyroid cartilage is normal and increases with age. In the hyaline cartilages of the larynx, calcification does not always precede ossification and there is little correlation between the two. The thyroid and cricoid cartilages have been found to undergo a greater frequency of calcification
se-
dental and skeletal radiographs, biopsy, and serum alkaline phosphatase confirmed the diagnosis.3-5 James M. Gergely, MAJ, DC, USA U.S. Army DENTAC Fort Bragg, NC 28307-5000
3EFERENCES 1. Shafer WG, Hine MK, Levy pathology. 4th ed. Philadelphia: 92.
BM, eds. A textbook of oral WB Saunders Co, 1983;688-
Fig.
1
Radiology forum
805
6. Shafer WC, Nine MK, Levy BM. A textbook of oral pathology. Philadelphia: WB Saunders Co, 1983. 7. Hiranandani LW, Melgiri RD. Supernumerary tooth in the floor of the nose. J Laryngol 1968;82:845-8.
MONOSTOTIC MANDIBLE
A
3. Intranasal view of tooth by basal pharyngoscope. Nasal septum on right. Inferior turbinate on left.
Fig.
intranasal teeth. The etiology of intranasal teeth is controversial. Many theories have been proposed, including developmental disturbances, trauma, infection, crowding, or dense bone. Symptoms of intranasal teeth range from none to such symptoms as pain, nasal obstruction, or epistaxis, and signs include deviation of the external nares and septum. The diagnosis of intranasal teeth may be made from either clinical examination or radiographic examination. Clinically, examination would reveal a tooth in the floor or lateral wall of the nasal cavity, with possible granulation tissue present. The tooth may or may not have dental caries. Radiographically, intranasal teeth may show up on panoramic x-ray films, occlusal x-ray films, or other facial x-ray films. Examination with fiberoptic assistance is helpful. Treatment of intranasal teeth is usually surgical removal, especially if there is a sign of infection or dental caries. If the tooth is not removed, close radiographic follow-up is recommended. Douglas D. Carver, DDS Sharon Peterson, DDS Terry Owens, MD 12121 Richmond, Suite 316 Houston, TX 77082 REFERENCES
1. Smith RA, Gordon NC, DeLuchi SF. Intranasal teeth: report of two cases and review of the literature. ORAL SURG ORAL MED
ORAL
PATHOL
1979;47:120-2.
2. Spencer MG, Couldery MG. Nasal tooth. J Laryngol Otol 1985;99:
1147-50.
Martinson FD, Cockshott WP. Ectopic nasal dentition. Clin Radio1 1972;23:451-4. 4. Thawley SE, LaFerriere KA. Supernumerary nasal tooth. Laryngoscope 1977;87:1770-3. 5. Murty PS, Hazarika P, Hebbar GK. Supernumerary nasal teeth Ear Nose Throat J 1988;67:128-9. 3.
PAGET’S
DISEASE
OF THE
76-year-old white man complained of left mandibular aching of several days’ duration. He also reported an increasing swelling in the area during the preceding 24 hours. His medical history included an allergy to penicillin, treatment of hypertension with hydrochlorothiazide and potassium, and removal of a basal cell carcinoma from his face 2 years earlier. His vital signs were within normal limits with the exception of an elevated temperature of 100” F. Clinically, the patient had a Class III jaw relationship with multiple diastemata. The moderate swelling in the body of the left mandible was warm to the touch but not fluctuant. Panoramic and periapical radiographs showed hypercementosis, loss of lamina dura, loss of normal trabeculation, osteolytic and osteosclerotic areas, and generalized loss of cortical bone limited to the mandible. Root resorption of the left mandibular second premolar was also nated (Figs. 1 and 2). The patient was referred to an internal medicine department for evaluation. The physician recommended radiographic examination of the skull, chest, and lumbosacral region after emergency dental treatment. The left mandibular second premolar and second molar were extracted in fragments. Pus from the extraction sites was cultured, and the tooth and bone fragments were sent for biopsy. The extraction sites healed well, and all symptoms resolved. The report on the culture stated “normal flora.” Microscopically, the description of the tooth and bone fragments was consistent with Paget’s disease of bone. Fibrous dysplasia and chronic osteomyelitis were thought to be less likely possibilities. A bone scan revealed “markedly increased activity” in the mandible and some activity in the great toe of the right foot that was attributed to “hammer toe.” No other areas of abnormal activity were seen in the skeleton, including the skull. A serum alkaline phosphatase test showed an elevated level of 182 U/L, with a normal adult range of 50 to 136 U/L. The incidence of monostotic Paget’s disease of the mandible with progressive resorption of the teeth is reportedly rare. l-3 In this case results of the bone scan,
806
Radiology forum
0w.t
SCRC; ORAL
Mw
ORAL PATIIOL December 1990
2. Stafne EC, Gibilisco JA, eds. Oral roentgenographic diagnosis. 4th ed., Philadelphia: WB Saunders Co. 1975:304-6. 3. Smith NHH. Monostotic Paget’s disease of the mandible presenting with progressive resorption of the teeth. ORAL SURG ORAL MED ORAL PATHOL 1978;46:246-53. 4. Rose LR, Kaye D, eds. Internal medicine for dentistry. St Louis: CV Mosby Co, 1983:86-S, 1 14. 115. 5. Shirazi PH, Ryan WG, Fordham EW. Bone scanning in evaluation of Paget’s disease of bone. CRC Crit Rev Clin Radio1 Nucl Med 1974;5:523-58.
CALCIFIED
Fig. 1. Panoramic radiograph shows hypercementosis, loss of lamina dura, loss of normal trabeculation, osteolytic and osteosclerotic areas, and generalized loss of cortical bone limited to the mandible.
Fig. 2. Periapical radiograph of left cond premolar shows root resorption.
mandibular
THYROID
CARTILAGE
A
48-year-old Hispanic woman was referred to the department of oral and maxillofacial surgery for preprosthetic evaluation. The cephalometric radiograph showed a well-marginated homogeneous radiopacity consistent with a calcified thyroid cartilage (Fig. 1). The patient’s medical history was noncontributory, and the results of physical examination were negative. No further workup was performed. Calcification of the thyroid cartilage is normal and increases with age. In the hyaline cartilages of the larynx, calcification does not always precede ossification and there is little correlation between the two. The thyroid and cricoid cartilages have been found to undergo a greater frequency of calcification
se-
dental and skeletal radiographs, biopsy, and serum alkaline phosphatase confirmed the diagnosis.3-5 James M. Gergely, MAJ, DC, USA U.S. Army DENTAC Fort Bragg, NC 28307-5000
3EFERENCES 1. Shafer WG, Hine MK, Levy pathology. 4th ed. Philadelphia: 92.
BM, eds. A textbook of oral WB Saunders Co, 1983;688-
Fig.
1