Radiologic Signs For Maxillofacial Diag

Radiologic Signs for
Maxillofacial Diagnosis
Dental Signs
Dental signs
Number of teeth
Tooth size
Tooth morphology
Tooth structure
Tooth eruption
pattern
Tooth position
Regressive changes
Large Teeth

Large Teeth
SINGLE
Macrodontia
Connation
Fusion
Gemination
Single central incisor
short stature syndrome
MULTI PLE
Normal variant
Adjacent to benign
vascular, lymphatic or
neural tumor
Lipomatosis
Unilateral hyperplasia
Pituitary giantism
Small Teeth
SI NGLE MULTI PLE
Small Teeth
SI NGLE
Microdontia (e.g. peg
lateral)
Supernumerary teeth
MULTI PLE
Normal variant
Dentinogenesis
imperfecta
Trisomy 21
Facial hypoplasia
Pituitary dwarfism
Vascular tumors
Single/Few Teeth of Altered Form

(Common)
Turners tooth (acquired enamel hypoplasia)
Dilaceration
Taurodontism
Enamel invaginations (dens in dente)
Peg lateral incisors
Enlarged cingulum
Enamel evaginations (Leungs premolar)
Shovel-shaped incisors
(Uncommon)
Connation (fusion and gemination)
Concrescence
Twinning
Tuberculated maxillary lateral/talon cusp
Hutchinsons teeth and mulberry molars
(congenital syphilis)
Premolarization of canines and
molarization of premolars
(Rare)
Secondary to mutilating surgery
Secondary to radiation therapy
Secondary to chemotherapy
Hypercementosis

Hypercementosis
Physiologic with passive eruption
Idiopathic
Periodontal disease
Pagets disease of bone
Acromegaly
Benign tumor (cementoblastoma)
Apparent in periapical cemental dysplasia
Hypodontia/Oligodontia

(common)
Previously extracted teeth
Idiopathic
Ectodermal dysplasias
Previous radiation therapy
Trisomy 21 (Downs syndrome)
(uncommon)
Chondroectodermal dysplasia
Facial hypoplasia
Incontinentia pigmentii
Oral-facial-digital (Mhrs) syndrome
Oculodento-osseous dysplasia
Oculomandibulodyscephaly syndrome
(Hallerman-Streiff)
/continued
(uncommon)
Oligodontia and primary mesodermal iris
dysgenesis (Riegers syndrome)
PHC syndrome (Bks syndrome)
Craniofacial dysostosis (Crouzons Sx)
Ehlers-Danlos syndrome
Focal dermal hypoplasia syndrome (Goltz
syndrome)
/continued
(uncommon)
Pyknodysostosis
Progeria (Hutchinson-Gilford syndrome)
Hypoparathyroidism
Inverted Marfans syndrome
Hyperodontia/Supernumeraries

(common)
Idiopathic
Cleft palate
Compound odontoma
Cleidocranial dysplasia
(uncommon)
Osteomatosis intestinal polyposis syndrome
(Gardners syndrome)
Oculomandibulodyscephaly syndrome
(Hallerman-Streiff syndrome)
Oral-facial-digital syndrome
Distomus
Achondroplasia
Natal teeth
Normal variant
Chondro-ectodermal dysplasia
(Ellis van Crevald syndrome)
Single
Failure in
Eruption

Failure in eruption - single
(common)
Idiopathic
Supernumerary teeth
Hypodontia (non-development of tooth)
Mechanical obstruction by other tooth
Retained primary tooth or tooth root
Dentigerous and eruption cysts

/continued
(common)
Benign tumor (e.g. odontoma, ameloblastic
fibroma, ameloblastic fibro-odontoma,
adenomatoid odontogenic tumor)
Odontogenic keratocyst
Cleft palate
Ankylosis and submersion
Inflammation coronal to erupting tooth
Overlying tooth with pulpotomy
(uncommon)
Odontogenic myxoma
Cherubism
Unicystic ameloblastoma
Langerhans cell disease
Ossifying fibroma
Malignancy and radiation therapy
Fibrous dysplasia
Post-extraction scar
Failure in eruption - multiple

(common)
Fibromatosis gingivae
Drug-induced gingival hyperplasia
Condylar hypoplasia and ankylosis
Cherubism
(uncommon)
Osteomatosis intestinal polyposis syndrome
(Gardners syndrome)
Acrocephalysyndactyly (Aperts syndrome)
Gingival hyperplasia syndromes
Chondroectodermal dysplasia Ellis-van
Crevald syndrome)
Trisomy 21
/continued

(uncommon)
Focal dermal hypoplasia (Goltz syndrome)
Osteopetrosis
Regional odontodysplasia
Progeria ( Hutchinson-Gilford syndrome)
Pseudohypoparathyroidism
Pyknodysostosis
Juvenile hypothyroidism (cretinism)
Vitamin D deficiency syndromes
Premature Eruption

Premature Eruption
(common)
Normal variant
Early loss of primary teeth
Premature Eruption
(uncommon)
Adjacent benign vascular or neural tumor
Underlying malignant tumor
Underlying osteomyelitis
Hyperthyroidism
Pituitary giantism
Hypergonadism
Cushings syndrome
Adrenogenital syndrome
Early Tooth Loss

Early Tooth Loss
(common)
Rampant dental caries
Dentofacial trauma
Juvenile periodontosis/periodontitis
Early Tooth Loss
(uncommon)
Factitial injury
Cyclic neutropenia
Malignancy (leukemia, lymphoma,
neuroblastoma, rhabdomyosarcoma)
Hyper keratosis palmoplantaris and
periodontoclasia in childhood (Papillon-
Lefeuvre syndrome)
/continued

Early Tooth Loss
(uncommon)
Radicular dentin dysplasia
Acrodynia (pink disease)
Other heavy metal poisoning
Acatalasia
Hyperparathyroidism
Early Tooth Loss
(rare)
Acro-osteolysis
Severe Rickets
Pituitary cachexia syndrome (Simmonds
syndrome)
Chediak-Higashi syndrome
Displaced Teeth/Tooth Buds

(common)
Normal variant
Malocclusion
Impaction
Dentigerous cysts
Other cysts
Traumatic displacement
Submergence
(uncommon)
Cherubism
Lateral inflammatory odontogenic cyst of
the mandible (Stonemans cyst)
Benign giant cell tumor
Ameloblastoma and ameloblastic odontoma
Melanotic neuro-ectodermal tumor of
infancy
/continued

(uncommon)
Other benign tumors
Osteomyelitis including osteomyelitis of the
maxilla in the newborn
Malignant tumors (e.g. Burkitts lymphoma,
lymphosarcoma, neuroblastoma,
rhabdomyosarcoma)
Coronal Radiolucency in Tooth
(common)
Dental caries
Radiolucent resin restorations
Cervical burnout and Mach phenomenon
Proximal overlap artifact
Enamel hypoplasia
Abrasion, attrition and erosion
Dens in dente
(common)
Dental caries
Radiolucent resin restorations
Cervical burnout and Mach phenomenon
Proximal overlap artifact
Enamel hypoplasia
Abrasion, attrition and erosion
Dens in dente
(uncommon)
Idiopathic internal resorption
External resorption
Radiation caries
Pulpal diverticula
Leungs premolar (evagination of pulp)
Radiolucent internal enameloma
Enlarged dental
pulp

Enlarged dental pulp
(common)
Rotation of anterior teeth
Developing teeth
Normal variant (large cornua)
Taurodontism
Internal resorption
Macrodontia
Connation (fusion and gemination)
Enlarged dental pulp
(uncommon)
Enamel evagination (Leungs premolar)
Vitamin D resistant Rickets
Shell teeth of Rushton
Hypophosphatasia
Renal osteodystrophy
Pulpal extension into enamel pearl
Small dental
pulp

Small dental pulp
(common)
Normal variant
Teeth in elderly (secondary dentin)
Reactive to dentin caries
Traumatically induced
Dentinogenesis imperfecta

Small dental pulp
(uncommon)
Osteogenisis imperfecta
Dentin dysplasias
Dental Enamel
Aberrations

Dental Enamel Aberrations
(common)
Dental caries
Environmental enamel hypoplasia (Turners
tooth; neonatal disease; exanthematous
fevers; nutritional deficiency; metabolic
disease; drug induced; fluorosis)
Amelogenesis imperfectas
Dental Enamel Aberrations
(uncommon)
Mucopolysacchaidoses IV (Morquio-
Brailsford syndrome)
Hypophosphatasia
Hypoparathyroidism
Radiation therapy during tooth development
Dentin Aberrations
(common)
Dental caries
Dentin Aberrations

Dentin Aberrations
(uncommon)
Osteogenesis imperfecta
Dentin dysplasias
Shell teeth of Rushton
Radiation therapy during tooth development
Persistent Open
Root Apex

Persistent Open Root Apex

Normal variation
Post-dentition supernumerary tooth
Non-vital tooth
Periapical pathosis (cyst; granuloma;
abscess)
Dens evaginatus (Leungs premolar)
Prematurely Closed Root Apex

Prematurely Closed Root Apex

Previous trauma to tooth
Radiation therapy during tooth
development
Calcified pulp
tissue

Calcified pulp tissue

Pulp stone
Normal variant for elderly
Projection artifact (molars)
Reaction to dentin caries or deep restoration
Subsequent to trauma
Calcareous degeneration
Superimposition of enamel pearl
Dentin dysplasias
Fractured Tooth Appearance
True fractured tooth
Periodontal ligament shadow from adjacent
tooth
Overlying lip, cheek or nose line
Bone trabecular pattern or nutrient canal
Accessory lateral pulp canal
Alveolar bone fracture
Radiographic artifact (film crimp; static, etc.)

External Root
Resorption

External Root Resorption
(normal variants)
Physiologic resorption (primary teeth)
Traumatic occlusion
Aberrant resorption of mesial root of lower
first molar
Normal variant (pulpotomy of primary
tooth)
Projection artifact (foreshortening)
Incomplete formation (tooth development)
(common pathologic)
Apical pathosis (cyst; granuloma; abscess)
Iatrogenic - excessive orthodontic force
Idiopathic - uncertain cause
Re-implantation of avulsed tooth
Root canal therapy
Benign odontogenic cysts and tumors
(especially dentigerous cyst, ameloblastoma
and central giant cell granuloma)
(uncommon pathologic)
Factitial injury
Inostosis
Malignant tumors (e.g. lymphoma)
Oxalosis
Hyperparathyroidism
Periodontal disease
Foreign body reaction
Internal Tooth
Resorption

Internal Tooth Resorption

Idiopathic
Trauma-induced
Caries-induced
Causes of enlarged pulps
Pulpal diverticuli
External resorption
Odontomalacia
Dental calculus and look-alikes
True dental calculus
Restoration overhangs
Bony ledges adjacent teeth
Enamel pearl
Tooth-like Structures
(near oral cavity)
Avulsed tooth or tooth fragment
(trauma or iatrogenic)
Supernumerary teeth
Cleft palate associated
Compound odontoma
Distomus
Epignathus

Tooth-like Structures
(distant from oral cavity)
Lithopedion
Ovarian teratoma
Other teratoma (e.g. intra-cranial)
Periodontal Signs
Radiologic Signs Concerning
the Periodontium
Loss of lamina dura (local)
Loss of lamina dura (general)
Accentuation of lamina dura
Widened periodontal ligament space
Ankylosis
Crestal lucency leading to decreased alveolar
bone
Localized Loss of
Lamina Dura

Localized Loss of Lamina Dura
(normal variations and confusing shadows)
Apex of maxillary canine (canine fossa)
Tooth rotation
Maxillary premolars before maturation
Projection over maxillary sinus
Tongue out of roof of mouth during panoramic
Projection over mandibular canal
Projection over mental foramen
(common pathlogic)
Inflammatory periapical pathosis (apical
granuloma, cyst or abscess)
Simple (traumatic) bone cyst
Periapical cemental dysplasia
Focal osteomyelitis
(uncommon pathlogic)
Malignant tumor (e.g. osteogenic sarcoma)
Fibrous histiocytoma
Generalized Loss
of Lamina Dura

Generalized Loss of Lamina Dura
(common pathlogic)
Idiopathic
Osteoporosis
Leukemia
Metastatic malignancy (especially breast)
Hyperparathyroidism
Hypoparathyroidism
Multiple myeloma
Osteomalacia
Rickets (including vitamin D resistant form)
Cushings syndrome
/continued

Renal acidosis
Acromegaly
Oxalosis
Hypervitaminosis D
Hypovitaminosis C
Scleroderma (systemic sclerosis)
Hyperphosphatasia
Burkitts lymphoma
Thalassemia
Accentuation of
Lamina Dura

Accentuation of Lamina Dura

Normal variant
Widened PDL
Space

Widened PDL Space
(common)
Projection effect
Normal finding around necks of teeth
Periodontal disease (furcation involvement)
Periapical inflammation
Traumatic occlusion
Dental trauma (avulsion or fractured root)
Jaw fracture through tooth socket
Root shadow cast over sinus
Widened PDL Space
(uncommon)
Re-implantation of avulsed tooth
Diabetes mellitus
Periodontosis
Osteomyelitis
Malignant tumors (especially
osteogenic sarcoma)
Fibrous histiocytoma
Cystinosis
Actinomycotic infection
Suspision of
Tooth Ankylosis

Suspision of Tooth Ankylosis
True ankylosis of
retained primary
Trauma
Re-implantation
Obscuring condensing
osteitis
Infection
Inostosis
Socket sclerosis (false
ankylosis)
Obscuring idiopathic
osteosclerosis
COMMON UNCOMMON
Crestal
Radiolucency

Crestal Radiolucency
(common)
Early destructive periodontal disease
Hyperemic decalcification
Juvenile periodontosis
Factitial injury
Acute necrotizing ulcerative gingivitis
(uncommon)
Hyperkeratosis palmoplantaris and
periodontoclasia in children (Papillon-
Lefevre syndrome)
Leukemia
Local malignancy (central or peripheral)
Hypothuroidism (cretinism/myxedema)
/continued
(uncommon)
Hyperthyroidism
Hyperparathyroidism
Peripheral giant cell granuloma (epulis)
Other epulides
Cyclic neutropenia
Hypophosphatasia
Acrodynia
/continued
(uncommon)
Acro-osteolysis
Self-mutilative syndromes
Acatalasia
Pituitary cachexia (Simmonds disease)
Chediak-Higashi syndrome
Jaw Structure
Fine Signs
Radiolucency
Periapical radiolucency
Pericoronal radiolucency
Radiolucency lateral to tooth
Solitary radiolucency (well-defined) not
necessarily associated with tooth
Solitary radiolucency with ragged borders
Radiolucency in maxillary lateral incisor
region
Non-cyst-like radiolucency of bone

/continued

Radiolucency
Rarefying osteitis
Blurring of trabecular pattern
Diminished number of trabeculae
Generalized rarefaction
Multilocular radiolucency
Ameloblastoma-like radiolunency
Radiolucency below mandibular canal
Expansile jaw lesions
Lesions\with undulating/crenulated margins
/continued
Radiolucency
Lytic lesions with wide band-like borders
Widened mandibular canal
Scattered bone destruction separated by
normal or near-normal bone
Short linear area of radiolucency in inferior
cortex of mandible
Cyst-like radiolucency with window-like
cortical breaching
Thinned mandibular lower cortex
/continued
Radiolucency
Ballooned mandibular lower cortex
Attenuation of shadow of follicle wall
Discontinuity of antral or nasal wall
Suspected daughter cysts
External erosion of bone
Lesion with no internal structure
Multiple separate well-defined lucencies
Multiple osteolytic lesions with punched-
out margins
Radiopacity and Mixed
Radiopacity/Radiolucency
Periapical mixed lucent/opaque
Pericoronal mixed lucent/opaque
Periapical homogeneous radiopacities
Solitary mixed lucent/opaque lesion not
necessarily contacting tooth
Mixed lucent/opaque lesion of TMJ
Sclerosing osteitis
Increased girth of individual trabeculae

/continued

Granular bone
Solitary opacity not contacting teeth
Compound odontoma
Complex odontoma
Opacity denser than normal bone
Multiple separate opacities
Root-like density in bone
Possible causes of root in bone appearance
/continued

Suspected foreign body (metallic or non-
metallic)
Sequestra-like density
Target lesion (radiopacity with peripheral
shadow)
Excrescence with bone density
Thickened mandibular lower cortex
Laminar periosteal new bone
/continued
New periosteal bone with internal lysis
Sunray spiculation (new bone
perpendicular to cortex)
Lesions with internal spindly trabeculae
Lesions with septae or pseudoseptae
Lesions with honeycombed internal
structure
Lesions with wispy internal structure
/continued
Lesions with internal residual bone
Lesions with tubular internal structure
Lesions with internal rounded dense
opacities
Linear striations (driven snow) within
jawbone
Suspected osteoblastic metastases
Radiolucent Lesions
Periapical
Radiolucency

Periapical Radiolucency
(normal)
Marrow space
Papillae of developing teeth
Maxillary sinus
Incisive foramen
Nasolacrimal canals
Submandibular fossa
Sublingual fossa
Mandibular canal and mental foramen
/continued
(normal)
Mental depression (chin)
Tomographic plane (including
panoramic) artifact
Processing errors ( e.g. developer
splash)
(common pathologic)
Periapical cyst, granuloma or abscess
Fibrous healing defect
Periapical cemental dysplasia (early)
Periodontal abscess
Dentigerous cyst of underlying tooth
Traumatic (simple) bone cyst
Other cysts
Osteomyelitis
Underlying benign tumor (e.g.
cementifying/ossifying fibroma)
Primary malignant tumor (e.g.
leukemia)

/continued
Central giant cell granuloma
Lingual salivary gland depression
(Stafnes bone cavity)
Multiple myeloma
Metastatic malignancy (especially
breast)
/continued

Early cementoblastoma or
osteoblastoma
Early odontomas
Pericoronal Radiolucency

(common)
Normal dental follicle space
Dentigerous cyst
Envelopmental odontogenic
keratocyst
Adenomatoid odontogenic tumor
Early odontoma or ameloblastic
fibro-odontoma
(uncommon single)
Ameloblastic fibroma
Ameloblastoma
Early calcifying epithelial
odontogenic tumor (Pindborg tumor)
Mucopolysaccharidoses (I-H) -
Hurlers syndrome
Early calcifying odontogenic cyst
(multiple)
Dental follicle spaces
Multiple nevoid basal cell carcinoma
syndrome (Gorlin and Goltz syndrome)
Osteomastosis- intestinal polyposis
syndrome (Gardners syndrome)
Mucopolysaccharoidoses
Radiolucency Lateral to Tooth

(common)
Lateral periodontal abscess
Lateral periodontal cyst
Endodontic perforation
Extension of disease from adjacent
tooth
(uncommon)
Lateral canal periapical cyst
Neurofibroma or neurilemmoma
Giant cell granuloma
Unilocular ameloblastoma
Hyperparathyroidism
Well-defined solitary lucency not
necessarily contacting teeth
(uncommon)
Ameloblastoma
Early ossifying/cementifying fibroma
Early fibrous dysplasia
Eosinophilic granuloma

/continued
(uncommon)
Neurofibroma
Odontogenic myxoma
Central hemangioma
(rare)
Aneurysmal bone cyst
Chondrosarcoma
Central fibroma
Tuberculous osteomyelitis
Hydatid cyst
Early calcifying epithelial odontogenic
tumor (Pindborgs tumor)
Single Radiolucency with Ragged
Borders

Borders (common)
Chronic osteitis
Osteomyelitis
Peripheral squamous cell carcinoma
Infected radicular, residual or other
cyst
Borders (uncommon)
Metastatic carcinoma
Malignant salivary gland tumor
involving bone
Osteolytic osteosarcoma
Multiple myeloma
Chondrosarcoma
/continued
Borders (uncommon)
Fibrosarcoma
Lymphosarcoma
Melanotic neuroectodermal tumor of
infancy
Leukemia or Ewings sarcoma
Neurofibroma
Odontogenic myxoma
Radiolucency in Region of
Maxillary Lateral Incisor

(common)
Incisive fossa/foramen
Canine fossa
Periapical cyst, granuloma or abscess
Rarefying osteitis from adjacent
central
Other periapical radiolucencies
(uncommon)
Clefts
Aberrant foramina in anterior maxilla
Nasopalatine duct cyst
Depression from nasolabial cyst
Post-surgical defect
Non-Cystlike Radiolucency of
Bone

Bone
Focal osteoporotic defect
Large marrow space
Normal variant of tuberosity
Sparse trabeculation in child
Maxillary sinus
Foramina
Submandibular fossa
/continued
Bone
Sublingual fossa
Post-coronoid depression
Sigmoid notch shadow
Acute osteomyelitis
Healing surgical defect
Decalcification secondary to
overlying inflammation
Rarefying Osteitis - Focal
Osteomyelitis

Osteomyelitis (common)
Foramina or dental Papilla
Antrum or nasal passage
Mandibular canal or mental foramen
Large marrow space
Periodontal abscess
Apical cyst, granuloma or abscess
Early periosteal cemental dysplasia
Osteomyelitis (uncommon)
Actinomycosis
Leukemia
Metastatic malignancy (especially breast)
Blurring of Trabecular Pattern

Blurring of Trabecular Pattern
Osteomyelitis
Decalcification secondary to inflamed
adjacent tissues
Radiodontic pitfall (e.g. motion
unsharpness; bend artifact)
Diminished Number of Trabeculae

Diminished Number of Trabeculae
(common)
Normal variant in children
Inflammatory disease
Osteopenic metabolic diseases
(uncommon)
Anaplastic anemias
Vitamin D deficiency syndrome
Thalassemia and Sickle cell anemia
Neurofibroma
Decreased Size of Trabeculae

Decreased Size of Trabeculae
(common)
Normal variation
Infection and inflammation
Disuse atrophy of alveolus

(uncommon)
Thalassemia
Generalized Rarefaction

(common)
Osteoporosis
Cortisone therapy
Rheumatoid arthritis
Prolonged immobilization
Malignant and other cachetic diseases
(uncommon)
Cushings syndrome
Hyperparathyroidism
Acromegaly
Pancreatitis
Malnutrition
Pregnancy-related changes
/continued

(uncommon)
Diabetes mellitus
Scurvy
Inherited anemias
Leukemia
Multiple myeloma
Renal acidosis
(rare)
Hypophosphatasia
Hyperphosphatasia
Hypoparathyroidism
Thyrotoxicosis
Hypogonadism
Agranulocytosis
Oxalosis
Multilocular Radiolucency

(common unilateral)
Aberrant normal anatomy (maxillary antrum)
Ameloblastoma
Odontogenic myxoma
Multilocular radicular or residual cyst
(uncommon unilateral)
Mucoepidermoid tumor
Arterio-venous malformation
Central hemangioma
Calcifying odontogenic cyst
Developing odontoma
(rare unilateral)
Calcifying epithelial odontogenic tumor
(Pindborg tumor)
Central fibroma
Chondroma
Sporotrichosis
Cerebroside lipoidosis (Gauchers disease)
Oxalosis
(bilateral)
Normal variation for maxillary sinuses
Cherubism
Oxalosis
Ameloblastoma-like Radiolucency
- Soap Bubble Appearance

- Soap Bubble Appearance
(common)
Ameloblastoma
Multilocular large radicular or residual cyst
(uncommon)
Ossifying fibroma
Fibrous dysplasia
Sporotrichosis
Oxalosis
Lucency Below Mandibular Canal

Lucency Below Mandibular Canal
(common)
Normal variation
Submandibular fossa
Lingual salivary gland defect (Stafne)

(uncommon)
Benign tumor of salivary gland origin
Subperiosteal neurofibroma
Benign vascular tumor

Expansile Jaw
Lesions

Expansile Jaw Lesions
(common)
Laminar periosteal new bone
( e.g. osteitis proliferans)
Ameloblastoma
Radicular or residual cyst
Dentigerous cyst
Fibrous dysplasia
Cherubism
Expansile Jaw Lesions
(uncommon)
Hemangioma
Neurfibroma
Osteosarcoma or lymphosarcoma
Ossifying fibroma
(rare)
Burkitts lymphoma

Lesions with
Crenulated
(Undulating)
Margins

Lesions with Crenulated
(Undulating) Margins
Ameloblastoma
Odontogenic myxoma
Other benign tumors
Botyroid lateral periodontal cyst
Lytic Lesions with Wide Band-like
Borders

Lytic Lesions with Wide Band-like
Borders
Infected cyst
Lateral inflammatory
odontogenic cyst
Fibrous dysplasia
Giant cell tumor
Ossifying fibroma
(common) (uncommon)
(rare)
Osteoblastoma
Osteoid osteoma
Widened Mandibular Canal

Widened Mandibular Canal
Normal variant
Neurilemmoma
Neurofibroma
Vascular tumor,
hamartoma or
malformation
Malignant tumor
(primary, extension or
metastasis)
Lymphoma
(common) (uncommon)
Scattered Bone Destruction
Separated by Normal Bone

Scattered Bone Destruction
Separated by Normal Bone
Acute osteomyelitis
Multiple myeloma
Squamous cell
carcinoma
Actinomycosis
Osteoradionecrosis
Oxalosis
Tuberculous
osteomyelitis
(common) (uncommon)
Short Linear Area of Radiolucency
in Inferior Cortex

Short Linear Area of Radiolucency
in Inferior Cortex
Acute osteomyelitis
Squamous cell carcinoma extending into bone
Other local malignant destruction
(e.g osteogenic sarcoma)
Cyst-like Radiolucency with
Window-like Cortical Breaching

Cyst-like Radiolucency with
Window-like Cortical Breaching
Ameloblastoma
Large radicular or residual cyst
Odontogenic myxoma
Neurofibroma
Thinned Lower Cortex (Mandible)

Thinned Lower Cortex (Mandible)
Multiple myeloma
Diseases associated
with generalized
rarefaction
Hyperparathyroidism
Thalassemia
Sickle cell anemia
(common) (uncommon)
(rare)
Hemifacial atrophy (Romberg disease)
Osteogenesis imperfacta
Ballooned Inferior Cortex

(common)
Dentigerous cyst
Periostitis ossificans
Large radicular or residual cyst
Fibrous dysplasia
Cementifying/ossifying fibroma
Ameloblastoma
Odontogenic myxoma
(uncommon)
Neurofibroma (blister lesion)
Hyperparathyroidism (Brown tumor)
Hemangioma
(rare)
Burkitts lymphoma
Central fibroma
Calcifying epithelial odontogenic
tumor (Pindborg tumor)
Osteogenic sarcoma
Attenuation of Shadow of Follicle Wall

(common)
Localized infection of primary
tooth
Eruption cyst
Acute osteomyelitis
(uncommon)
Leukemia
Burkitts lymphoma
Lymphosarcoma
Hyperparathyroidism
(rare)
Melanotic neuroectodermal
tumor of infancy
Rhabdomyosarcoma
Neuroblastoma
Discontinuity of Nasal or Antral Wall
Apical inflammation
Projection artifact
Osteomyelitis
Odontogenic myxoma
Ameloblastoma
Invasive squamous
cell carcinoma
Invasive salivary
gland malignancy
Long-standing antritis
Previous surgery
(common) (uncommon)
(rare)
Osteogenic sarcoma
Langerhans cell
disease
Lymphosarcoma
Antral mucocele
Suspected Daughter Cysts

Suspected Daughter Cysts
Odontogenic
keratocyst
Ameloblastoma
Mucoepidermoid
tumor (central)
Central hemangioma
Botyroid lateral
periodontal cyst
(common) (uncommon)
External
Erosion of Bone

External Erosion of Bone

Adjacent squamous cell carcinoma
Cystic hygroma
Secondary to pulsatile vessel
Hodgkins disease
Adjacent malignant adjacent lymph node
Metastatic malignancy
Secondary to PVC poisoning
Idiopathic
Lesion with no Internal Structure

Lesion with no Internal Structure
Odontogenic cyst
Non-odontogenic
cyst
Traumatic bone cyst
Ameloblastoma
Odontogenic myxoma
Hemangioma
Neurofibroma
Osteolytic osteogenic
sarcoma
Early calcifying cyst
or tumor
(common) (uncommon)
Multiple Separate Well Defined
Radiolucencies

Radiolucencies
(common)
Normal variation
Multiple periapical pathoses (cysts,
granulomas or abscesses)
Early stages of periapical cemental
dysplasia
Radiolucencies
(uncommon) (rare)
Cherubism
Multiple myeloma
Metastatic
carcinoma
Langerhans cell
disease
Lymphosarcoma
Leukemia
Ameloblastomas
Skip lesion of
osteosarcoma
Niemann-Pick disease
Cerebroside lipoidosis
(Gauchers disease)
Hyperparathyroidism
Multiple Osteolytic Lesions with
Punched Out Margins

Multiple Osteolytic Lesions with
Punched Out Margins
Multiple Myeloma
Hemangioma
Burkitts lymphoma
Radiopaque and Mixed
Radiolucent/Radiopaque
Lesions
Periapical Mixed
Lucency/Opacity

Periapical Mixed Lucency/Opacity
Dental crypt
Rarefying osteitis plus
tooth root
Mixed rarefying -
sclerosing osteitis
Periapical cemental
dysplasia
Foreign body (e.g.
root canal filling
material)

Cementifying/
ossifying fibroma
Cementoblastoma
Pagets disease of
bone
Complex odontoma
Compound odontoma
Calcifying
odontogenic cyst
(common) (uncommon)
Pericoronal Mixed Lucency/Opacity

Pericoronal Mixed Lucency/Opacity
Complex odontoma
Compound odontoma
Adenomatoid
odontogenic tumor
Ameloblastic fibro-
odontoma
Calcifying
odontogenic cyst
Odontogenic fibroma
Cystic odontoma
Calcifying epithelial
odontogenic tumor
(Pindborg tumor)
(common) (uncommon)
Periapical
Radiopacity

Periapical Radiopacity
(common)
Anatomic superimpositions
Tori and exostoses
Retained roots or unerupted tooth
Radiographic artifact
Sclerosing osteitis
Mature periapical cemental dysplasia
Hypercementosis
Foreign body

Periapical Radiopacity
(uncommon)
Superimposed soft tissue calcification
Cementoblastoma
Osteoblastoma
Mature complex odontoma
Osteoblastic metastases
Single Mixed Lucency/Opacity
Not Necessarily Contacting Tooth

(common)
Dense bone island/osteosclerosis
Sclerosing/condensing osteitis
Osseous excrescence
Fibrous dysplasia
Periapical cemental dysplasia
Developing odontomas
(uncommon)
Chronic osteomyelitis
Ameloblastic fibro-odontoma
Complex odontoma
Compound odontoma
(rare)
Osteoblastoma
Osteoid osteoma
Osteogenic sarcoma
Chondrosarcoma
Mixed Lucency/Opacity in Region
of Mandibular Condyle Head

Mixed Lucency/Opacity in Region
of Mandibular Condyle Head

Osteochondroma
Chondrometaplasia
Osteomyelitis from middle ear
Healing traumatic injury to TMJ
Fibrous dysplasia
Ossifying fibroma
Osteoblastoma
Osteogenic sarcoma or Chondrosarcoma
Charcots joint
Simulating
Sclerosing
Osteitis

Simulating Sclerosing Osteitis
(common)
Normal variation of trabeculation
Superimposed normal structure or tori
Focal sclerosing osteomyelitis
(condensing osteitis)
Florid osseous dysplasia or periapical
cemental dysplasia (late stage)
Fibrous dysplasia
Iatrogenic (orthodontic treatrment)

(uncommon)
Superimposed osteoma
Secondary hyperparathyroidism
Idiopathic hypercalcemia
Superimposed submandibular gland
stone (sialolithiasis)
(rare)
Osteopetrosis
Infantile cortical hyperostosis
Osteoradionecrosis
Osteogenic sarcoma
Osteoblastoma and osteoid osteitis
Melorrheostosis
Myelosclerosis
Healing syphilitic gumma
Increased Girth of Individual
Trabeculae
Increased Girth of Individual
Trabeculae
Condensing osteitis
(focal sclerosing
osteomyelitis)
Central hemangioma
Neurofibroma
Fluorosis
Myelosclerosis
(common) (uncommon)
Granular Bone
Fibrous dysplasia
Osteomyelitis (bone
replacing sequestrum)
Pagets disease of
bone
Thalassemia
Cementifying/ossifying
fibroma
Osteogenic sarcoma
Chondrosarcoma
Hodgkins disease
recovery phase
Groundou
(common) (uncommon)
Granular Bone

Solitary Opacity Not Necessarily
Contacting Tooth

Contacting Tooth
(common)
Anatomic superimposition
Radiodontic pitfall (fixer splash)
Osteosclerosis, exostosis or torus
Unerupted tooth or retained root
Sclerosing osteitis or socket sclerosis
Benign cemental mass
Odontoma
Foreign body

Contacting Tooth
(uncommon)
Compact osteoma
Osteogenic sarcoma
Chondrosarcoma
Osteoblastoma
Osteoid osteoma

Simulating Compound Odontoma

Simulating Compound Odontoma
Compound odontoma
Supernumerary teeth
Complex odontoma
Adenomatoid
odontogenic tumor
Ameloblastic fibro-
odontoma
Ameloblastic odontoma
Distomus
Teratoma
Epignathion
(common) (uncommon)
Simulating Complex Odontoma

Simulating Complex Odontoma
Complex odontoma
Periapical cemental
dysplasia (late phase)
Florid osseous
dysplasia
Compound odontoma
Condensing osteitis
Compact osteoma
fibroma
Osteogenic sarcoma
Osteochondroma
Ameloblastic odontoma
Fibrous dysplasia (late)

(common) (uncommon)
Opacity Denser than Normal Bone

Opacity Denser than Normal Bone
Foreign body (e.g.
fragment of metallic
restorative material)
Odontomas
Florid osseous
dysplasia or periapical
cemental dysplasia
(late phase)
Focal sclerosing
osteitis
Osteopetrosis
Fibrous dysplasia
Pyknodysostosis
Compact osteoma
Osteogenic sarcoma
Osteomastosis-
intestinal polyposis
syndrome (Gardner Sx)
Occulodento-osseous
dysplasia

(common) (uncommon)
Multiple Separate Radiopacities

Multiple Separate Radiopacities
Tori and exostoses
Periapical cemental
dysplasia
Florid osseous dysplasia
Multiple retained roots
or impacted teeth
Multiple socket sclerosis
Osteosclerosis including
condensing osteitis

Calcinosis cutis
Osteomatosis-intestinal
polyposis (Gardner)
syndrome
Enchondromatosis and
hemongiomatosis
(Maffuci syndrome)
Gigantiform cementoma
Overlying soft tissue
calcification
(common) (uncommon)
Root-like Density in Bone

Root-like Density in Bone
Retained root
Dense bone island
(osteosclerosis)
Coronoid
superimposition
Root displaced in soft
tissues/fascial plane
Socket sclerosis

Antrolith
Bony spicule in antrum
Pterygoid hamulus
superimposition
Superimposed sialolith
Other soft tissue
calcification
Osteochondroma

(common) (uncommon)
Causes of Root in Bone
Secondary to carious destruction of tooth
crown
Traumatic injury with tooth fracture
Iatrogenic (incomplete extraction)
Displacement of root into adjacent soft
tissues or sinus (superimposition)
Suspected Metallic Foreign Body

Suspected Metallic Foreign Body
Amalgam fragment
Body jewelry
Other restoratives or
dental instruments
Artifact (scratched
cassettes, fixer splash,
panoramic ghosts, etc.)
Needles
Shot-gun pellets
Leaded glass fragments
Paper in cassette
Metal fragment in path
of primary beam
(common) (uncommon)
Suspected Non-Metallic Foreign Body

Suspected Non-Metallic Foreign Body
Calcified acne
Carotid atherosclerosis
Sialolithiasis
Calcified lymph node
Tooth fragment
Osteosclerosis
Subclinical fibrous
dysplasia
Cysticercosis
Phlebolith
Myositis ossificans
(common) (uncommon)

Acute osteomyelitis
Osteoradionecrosis
Osteogenic sarcoma

Also see Single Large
Opacities list
Tuberculosis
Actinomycosis
Syphilis
Mercury poisoning
Phosphorus
poisoning (phossy
jaw)
(common) (uncommon)
Target Lesion (Radiopacity with
Peripheral Shadow

Target Lesion (Radiopacity with
Peripheral Shadow
Retained primary root
Infection around
retained tooth root
Sequestra
Periapical cemental
dysplasia
Odontoma
Cementoblastoma
fibroma
Fibrous dysplasia
(common) (uncommon)
(rare)
Brodies abscess
Osteoblastoma
Osteoid osteoma
Excrescence
with Density
of Bone

Excrescence with Density of Bone

Idiopathic
Tori and exostoses
Ossifying fibrous epulis
Osteochondroma

Soft tissue
calcifications
Hyperostosis
Fibrous dysplasia
Osteomatosis-intestinal
polyposis syndrome
(Gardner/s syndrome)
Peripheral chondroma
Chondrosarcoma
(common) (uncommon)
Thickened Mandibular Inferior
Cortex

Thickened Mandibular Inferior
Cortex
Sickle cell anemia
Secondary to osteomyelitis
Fluorosis
Phosphorus poisoning
Myelosclerosis
Sclerostosis
Rarely a variant of normal
Laminar
Periosteal
New Bone

Laminar Periosteal New Bone
(common)
Osteomyelitis
(Garrs osteomyelitis)

(uncommon)
Infantile cortical hyperostosis
Lateral inflammatory odontogenic cyst of
the mandible (Stonemans cyst)
Superficial surface injuries to face
Cervicofacial actinomycosis
Tuberculosis affecting jaw
Syphilitic periostitis
/continued
(uncommon)
Hypervitaminosis A or Scurvy
Leukemia (single new layer)
Osteogenic sarcoma
Ewings sarcoma
Neostosis secondary to hemodialysis
Idiopathic periostitis with dysproteinemia
(Goldblooms syndrome)
Diffuse idiopathic skeletal hyperostoses Sx
New Periosteal Bone with Internal
Destruction

New Periosteal Bone with Internal
Destruction
Tuberculous osteomyelitis
Osteogenic sarcoma
New Bone Perpendicular to Original
Cortex

New Bone Perpendicular to Original
Cortex

Sickle cell anemia
Osteogenic sarcoma
Chondrosarcoma
Reticulum cell sarcoma
Neuroblastoma
Thalassemia
Spherocytosis
Ewings sarcoma
Burkitts lymphoa
Syphilitic periostitis
Meningioma
Hemangioma
Ossifying fibrous epulis
Osteoma

(common) (uncommon)
Lesions with Internal Spindly
Trabeculae

Lesions with Internal Spindly
Trabeculae
Odontogenic myxoma
Central hemangioma
Central giant cell granuloma (unusual)
Ameloblastoma (unusual)
Lesions with Septae or Pseudo Septae
Ameloblastoma
Central giant cell
granuloma
Odontogenic myxoma
Odontogenic
keratocyst
Traumatic (simple)
bone cyst
Cherubism
Central hemangioma
Fibrous dysplasia
Chondroma
(common) (uncommon)
Lesions with Honeycombed Internal
Structure

Lesions with Honeycombed Internal
Structure
Odontogenic myxoma
Central hemangioma
Ewings sarcoma
Ameloblastoma
Central giant cell
granuloma
Neurofibroma
Fibrous dysplasia
Osteogenic sarcoma
(common) (uncommon)
Lesions with Wispy Internal
Structure

Lesions with Wispy Internal
Structure
Odontogenic myxoma
Fibrous dysplasia
Neurofibroma
Lesions with Internal Residual Bone

Lesions with Internal Residual Bone
Odontogenic myxoma
Ameloblastoma
Central hemangioma
Invasive squamous
cell carcinoma
Fibrous dysplasia
Ossifying fibroma
Osteochondroma
Hodgkins disease
Lymphoma
(common) (uncommon)
Lesions with Tubular Internal
Structure

Lesions with Tubular Internal
Structure
Normal vascular
channels (nutrient
canals)
Central hemangioma
Arteriovenous
malformation
Sturge-Weber
syndrome (tram track
calcifications in brain)

Central giant cell
granuloma
Ameloblastoma
Neurofibroma
(common) (uncommon)
Lesions with Internal Rounded Dense
Radiopacities

Lesions with Internal Rounded Dense
Radiopacities
Odontomas
Periapical cemental
dysplasia
Florid osseous dysplasia
Adenomatoid
odontogenic tumor
Fibrous dysplasia
Osteogenic sarcoma
Chondrosarcoma
Chondrometaplasia
(common) (uncommon)
Linear Striations
within Jawbone

Linear Striations within Jawbone
Normal variant (infant
mandible)
Pagets disease of bone (driven
snow appearance)
Craniometaphyseal dysplasia
(Pyles disease)

Suspected Osteoblastic Metastases
Breast
Prostate
Liver
Lung
Rectum and colon
Neuroblastoma
Osteogenic sarcoma
Leiomyosarcoma
Hodgkins disease
(common) (uncommon)
Jaw Structure
Gross Changes
Gross Structural Changes
Prognathism or retrognathia
Micrognathia
Unilateral small jaw
Enlargement of part of jaw
Obtuse or aberrant gonial angle
Persistent mandibular midline suture
Absent coronoid(s)
Deviation of chin
Deformed mandible
/continued

Increased vertical depth of mandible
Unilateral or bilateral absence of condyle
Condylar hyperplasia
Suspected jaw fracture(s)
Pathologic fracture
Suspected hyoid fractures
Radiolucency in condylar neck/head
True and false TMJ ankylosis
Increased or decreased TMJ space
/continued

Limited or increased TMJ movement
Small or enlarged antrum
Suspected antral foreign body
Antral opacification with normal walls
Antral opacification with abnormal walls
Antral opacification with breached cortices
Absent nasal bones
Depressed nasal bridge
Hypoplasia of maxilla and zygomas
Clefts
Prognathism

Prognathism
(common)
Normal variation
Racial variance (Scandinavian and
African)
Edentulous mandible (apparent)
Relative prognathism (e.g.
retrognathic midface secondary to
cleft)
Acromegaly
Prognathism
(uncommon)
Pituitary giantism
Hemifacial hyperplasia
Lymphangioma of tongue or cystic
hygroma
Prognathism
(rare)
Multiple nevoid multiple basal cell
carcinoma syndrome (Gorlin and Goltz
syndrome)
Craniometaphyseal dysplasia (Pyles
disease)
Beckwith-Wiedemann syndrome
XXXXY syndrome
Waardenburg syndrome
Retrognathism

Retrognathism
Normal variant
Relative to protrusion
of midface
TMJ ankylosis
Juvenile rheumatoid
arthritis
Hemifacial hypoplasia
Subluxation in infancy
Hypopituitarism
Progressive
hemiatrophy
Agenesis/dysgenesis of
mandible
Agnathia
Micrognathia-related
(common) (uncommon)
Micrognathia

Micrognathia
Mandibulofacial
dysostosis (Treacher-
Collins syndrome)
Gonadal dysgenesis
(Turners syndrome)
Juvenile rheumatoid
arthritis (Stills Sx)
Cleft lip, micrognathia
and glossoptosis (Pierre-
Robin syndrome)
Oculoauricularvertebral
dysplasia (Goldenhars Sx)
XX and XY Turner
phenotype syndrome
(Noonans syndrome)
Oculomandibulodyscephaly
(Hallerman-Streiff Sx)
Pyknodysostosis
(common) (uncommon)
Micrognathia
(rare)
Bird-headed dwarfism
Congenital telangiectatic erythema with
growth retardation (Blooms syndrome)
5P - (cric du chat) syndrome
Chondrodysplasia punctata (Conradi-
Hnermann syndrome)
De Langes syndrome
Diastrophic dwarfism
/continued

Micrognathia
(rare)
G syndrome
Cleft palate, flattened facies and multiple
congenital dislocations (Larsens Sx)
Long arm 21 deletion syndrome
Mesomelic dwarfism
Orofacial digital syndrome
Osteodysplasia
/continued
Micrognathia
(rare)
Rubinstein-Taybi syndrome
Russell-Silver syndrome
Short arm deletion 18 syndrome
Smith-Lemli-Opitz syndrome
Thrombocytopenia-absent radius syndrome
Trisomy 13 syndrome
Trisomy 18 syndrome
Unilateral Small Jaw

Unilateral Small Jaw
Lateral facial dysplasia
Unilateral TMJ
ankylosis
Forceps delivery trauma
Radiation therapy in
infancy
Hemifacial atrophy
(Rombergs disease)
Partial mandibular
agenesis
Linear scleroderma
(common) (uncommon)
(rare)
Central hemangioma
Neurofibroma
Enlargement of Part of Jaw
(anatomically correct)

Enlargement of Part of Jaw
(anatomically correct)
Adjacent hemangioma
Adjacent neurofibroma
Fibrous dysplasia
Hemifacial hyperplasia
Obtuse Gonial Angle

Obtuse Gonial Angle
Normal age change
Edentulous mandible
Condylar hyperplasia -
contralateral condyle
Trisomy 21
Scleroderma (systemic
sclerosis)
Mucopolysaccharidoses
I-H (Hurlers syndrome)
Craniometaphyseal
dysplasia (Pyles
disease)
Osteopetrosis
(common) (uncommon)
Aberrant Gonial Angle

Aberrant Gonial Angle
Normal variant
TMJ ankylosis
Juvenile rheumatoid
arthritis
Mandibulofacial
Collins syndrome)
Scleroderma
Neurofibroma
Trisomy 21
Marfans syndrome
Isolated anomaly
(common) (uncommon)
Persistent Mandibular Midline
Suture

Persistent Mandibular Midline
Suture
Normal <6 months age
Midline fracture
Mandibular midline
cleft
Normal variant
(common) (uncommon)
Absent or Diminished Coronoids

Absent or Diminished Coronoids
Previous surgery
Panoramic radiograph -
outside focal trough
sclerosis)
childhood

Hemifacial atrophy
(Rombergs disease)
Local or metastatic
malignancy related
erosion
Agnathia
Agenesis
(common) (uncommon)
Deviation of Chin Towards
Affected Side
Normal variant
Malocclusion (cross-
bite)
Unilateral TMJ
ankylosis
Condylar hypoplasia
Childhood or forceps
fracture of condyle
Torticollis
Hemifacial atrophy
(Rombergs disease)
Congenital unilateral facial
hypoplasia
Partial mandibular agenesis
(common) (uncommon)
Deviation of Chin Away From
Affected Side
Normal variant
Malocclusion
Splinting reaction to
TMJ pain
Congenital unilateral
hyperplasia
Joint effusion due to
trauma
Hemangioma or
neurfibroma induced jaw
hyperplasia
Tumor in TMJ region
(benign or malignant)
(common) (uncommon)
Deformed Mandibular Shape
Trauma with mal-union
Condylar ankylosis
(early)
Mandibulofacial
Collins syndrome)
Cystic hygroma
Flawed panoramic
technique
Neurofibroma
Hemignathia
Congenital hypo- or hyperplasia
of condyle
Hemifacial atrophy (Rombergs
disease)
Klippel-Feil anomalad
Congenital scapular elevation
Torticollis
Electrical or thermal burns
Radiation therapy in childhood
(common) (uncommon)
Increased Vertical Depth of Mandible
Normal variant
Prognathism
Anatomic enlargement
of jaw
Benign tumor (e.g.
ameloblastoma;
ossifying fibroma)
Thalassemia
Other congenital anemias
Sclerosteosis
Van Buchems disease
(common) (uncommon)
Unilateral Failure of Condylar
Development

Unilateral Failure of Condylar
Development
Early trauma (e.g.
forceps delivery)
Childhood infections
around TMJ (e.g.
mastoiditis; otitis
media or externa;
dental or skin abscess)
childhood
Linear scleroderma
Benign tumor
Local malignant tumor
destruction of growth
center
(common) (uncommon)
Bilateral Failure of Condylar
Development

Bilateral Failure of Condylar
Development
Trauma
Mandibulofacial dysostosis
(Treacher-Collins Sx)
Cleft palate, micrognathia
and glossoptosis (Pierre-
Robin) syndrome
Juvenile rheumatoid
arthritis (Stills disease)

Congenital dwarfism
Mucopolysacharidoses
Childhood radiotherapy
Progeria (Hutchinson-Gilford
syndrome)
Oculomandibulodycephaly
(Hallerman-Streiff Sx)
Agnathia or micrognathia
Cockaynes syndrome

(common) (uncommon)
Condylar Hyperplasia

Condylar Hyperplasia
Hypertrophic arthritis
Malignant tumor (e.g.
chondrosarcoma)
Fibrous dysplasia

(common) (uncommon)
True hyperplasia
Benign tumor (e.g.
osteochondroma)
Influence of adjacent
vascular or neural
tumor
Acromegaly

Prognathism
Multiple Jaw Fractures

Multiple Fractures
(common) (uncommon)
Severe trauma
Child abuse
Osteogenesis
imperfecta

Juvenile idiopathic
osteoporosis
Achondrogenesis
Osteopetrosis
Pyknodysostosis
Mucolipidoses
Metaphyseal dysplasia
Homocystinuria
Idiopathic
Suspected Jaw Fractures
(common)
True fractures
Suture lines
Vascular channels
Fistulous tracts
Symphysis menti (neonate)
Osteomyelitis with fragmentation
Pharyngeal air space shadow
Vertebral superimpositions
Base of skull superimpositions
Suspected Jaw Fractures
(uncommon)
Hyoid bone superimposition
Radiodontic artifact
Large sequestra
Pathologic fracture
Pathologic Fractures

Pathologic Fractures
(common) (uncommon)
Oral squamous cell
carcinoma
Central bone
malignancy (e.g.
multiple myeloma)
Osteoradionecrosis

Severe osteomyelitis
Marked alveolar
atrophy
sclerosis)
Langerhans cell
disease
Suspected Hyoid Fracture

Normal cartilagenous septae
Superimposition artifact
Severe blunt trauma
Hanging (often suicide)
Homicide (strangulation)

Radiolucency in Condylar Head

Elys cyst of degenerative joint disease
Projection artifact (e.g. pterygoid pit; air cells
extending into zygomatic arch)
Bifid condyle
Previous trauma
Villonodular synovitis
/continued
Benign tumor (e.g. myxoma)
Primary malignancy (e.g. osteogenic
sarcoma; chondrosarcoma; synovial
sarcoma; multiple myeloma; adjacent
rhabdomyosarcoma; adjacent glandular
carcinomas; lymphoma)
Metastatic malignancy (e.g.
hypernephroma; carcinoma from lower
gastrointestinal tract)
True TMJ Ankylosis

True TMJ Ankylosis (Common)
Osteomyelitis
Tonsillitis
Otitis media or externa
Mastoiditis
Adjacent soft tissue
infection
Dental abscess
Tuberculosis
(Stills disease)
Ankylosing spondylitis
(infection) (traumatic)
(other)
Mandibular fracture
Forceps delivery
True TMJ Ankylosis (Uncommon)
Syphilic gumma
Cancrum oris (noma)
Typhoid
Masseter cellulitis
Rheumatic fever
Measles
Secondary to burn
Congenital fusion of
gums
(infection) (traumatic)
(other)
Iatrogenic
Temporal muscle fibrosis
Chronic dislocation of
mandible
(neoplasia)
Invasive malignancy
Osteochondroma
False TMJ
Ankylosis

False TMJ Ankylosis
(common) (uncommon)
Splinting due to TMJ pain
Malar fracture (fibrous or
bony union subsequent to)
Coronoid hyperplasia
Coronoid hyperplasia with
campylodactyly
Osteochondroma

sclerosis)
Hysterical trismus
Temporal muscle fibrosis
Myositis ossificans progressiva
Torticollis
Congenital elevation of scapula

Increased TMJ Space

Increased TMJ Space
(common) (uncommon)
Normal variant
Non-uniform patient
positioning
Projection effect (beam
angulation)
Posturing of jaw by patient
Displaced articular disk
Effusion into joint

Hemorrhage into joint
Loose body in joint
Acute suppurative arthritis
Displacement due to fracture of
condyle or glenoid fossa
Mandibular partial agenesis
Increased Anterior TMJ Space

Normal variant
Beam angulation or patient position artifact
Internal derangement of TMJ
Retracted position of condyle due to dental
occlusion
Deep overbite
Overclosure of mandible (especially in
edentulous)
Absent middle ear
Decreased TMJ Space

Decreased TMJ Space
(common) (uncommon)
Excessive vertical
angulation of beam
during transcranial
projection
Arthritis (any kind)
Gross disk
displacement

Previous surgical
removal of disk
Bony or other true
ankylosis
Limited TMJ Movement
(common)
Normal variant
Pain reaction
Internal derangement of
joint
True or false ankylosis

Limited TMJ Movement
(uncommon)

Scar tissue
Fractured zygomatic arch
Coronoid hyperplasia
Malignancy in joint area
Facial Paralysis
Torticollis
Myositis osificans progressiva
Submucous fibrosis
Secondary to high dose radiation

Excessive Translation of TMJ

Excessive Translation of TMJ
(common) (uncommon)
Normal variant
Lax TMJ capsule

Recurrent dislocations
Neurosis
Ehlers-Danlos
syndrome
Small Antrum (Normal in Shape)

Small Antrum (Normal in Shape)
(uncommon)
Hemifacial hypoplasia (congenital)
Craniometaphyseal dysplasia (Pyles disease)
Craniofacial dysostosis (Crouzons Sx)
Other craniostenoses
Thalassemia and other congenital anemias
Hemifacial atrophy (Rombergs disease)
Oculomandibulodyscephaly (Hallerman-Streiff
syndrome)

Suspected Antral Foreign Bodies

Suspected Antral Foreign Bodies
(common) (uncommon)
Tooth root, or restoration
fragment (superimposed
or real)
Panoramic ghost shadow
Antrolith
Bony excrescence/septum
Overlying soft tissue
calcification
Pellets; bullets; shrapnel;
auto glass

Displaced tooth
Broken dental instrument
Drainage tubes
Heavy cosmetics or
eyeglass shadow
Aspergillosis

Antral Opacification (Normal Walls)

(common) (uncommon)
Infectious antritis
Allergic antritis
Mucous retention
phenomenon
Mucositis secondary to
dental apical pathosis or
periodontitis
Hemorrhage following
trauma

Antral Opacification (Normal Walls)

Antral polyp
Blocked ostia
Antral polyposis
Cystic fibrosis
Mucocele (blocked ostia
and antral expansion)
Apical dental cyst (rare)
Aspergillosis

Antral Opacification (Abnormal Walls)

(common) (uncommon)
Radicular cyst
Other benign cyst or
tumor
Fibrous dysplasia
(thicker)
Antral hypoplasia
(thicker)
Antral malignancy (e.g.
carcinoma; lymphoma)

Antral Opacification (Abnormal Walls)

Inverted papilloma
Osteomyelitis
Thalassemia
Agenesis of antrum
Mucormycosis

Antral Opacification (Breached Walls)

(common) (uncommon)
Oral-antral fistula
Dental abscess
Antral carcinoma
Oral squamous cell
carcinoma
Salivary gland
malignancy

Antral Opacification (Breached Walls)

Infectious antritis
True mucocele
Benign odontogenic
tumor (ameloblastoma;
myxoma, etc.)
Lymphoma or sarcoma
Absent Nasal Bones

Severe trauma
Prior surgery
Facial cleft syndromes
Arhinencephaly

(common) (uncommon)
Facial cleft syndromes
Previous surgery
Previous trauma
Achondroplasia
Congenital syphilis

Depressed/Absent Nasal Bones

Craniometaphyseal
dysplasia (Pyles disease)
Arhinencephaly
Acrodysostosis

Hypoplasia of Maxillary and
Malar Bones (common)

Mandibulofacial dysostosis (Treacher-
Collins syndrome
Achondroplasia
Craniofacial dysostosis (Crouzons
syndrome)
Acrocephalysyndactyly (Aperts
syndrome)

Hypoplasia of Maxillary and Malar
Bones (uncommon)

Bird-headed dwarfism
Congenital telangiectatic erythema with
growth retardation (Blooms syndrome)
Cochaynes syndrome
De Lange syndrome
Oculoauriculovertebral dysplasia
(Goldenhars syndrome
Leprechaunism (Donohues syndrome)

/continued

Bones (uncommon)

Marshall syndrome
Mietens-Weber syndrome
Oculomandibulodyscephaly (Hallerman-
Streiff syndrome)
Oropalatal digital syndrome

/continued
Bones (uncommon)
Pyknodysostosis
Rubenstein-Taybi syndrome
Russel-Silver syndrome
Trisomy 13
Trisomy 18
Weill-Marchesani syndrome

Enlarged Maxilla

(common) (uncommon)
Normal variant
Relative to mandible
(see retrognathia)
Influence of adjacent or
contiguous vascular
tumor
Fibrous dysplasia
Osteopetrosis

Enlarged Maxilla

Juvenile hypothyroidism
(cretinism)
Thalassemia
Influence of adjacent or
contiguous neural tumor
Craniopharyngioma

(common) (uncommon)
Cleft lip and palate
Isolated cleft palate
(unilateral vs bilateral;
anterior vs posterior;
complete vs incomplete)

Cleft Palate

Arhinencephaly
Cleft palate,
micrognathia and
glossoptosis (Pierre-
Robin syndrome)
Miscellaneous other
craniofacial syndromes

Soft Tissue Signs
Copyright of Allan G. Farman
Facial Soft Tissues
Calcifications of facial soft tissues
Calcifications in muscle and subcutaneous
tissues
Widespread soft tissue calcification
Solitary large calcified mass adjacent bone
Lymph node calcifications
Calcifications in submandibular gland region
/continued
Facial Soft Tissues
Calcification in parotid duct region
Sialolithiasis
Air in soft tissue
Nasopharyngeal mass
Macroglossia
Salivary gland enlargement
Ductal stricture on sialography
/continued

Facial Soft Tissues
Increased retropharyngeal space (child)
Increased retropharyngeal space (adult)
Soft tissue mass with underlying bone
involvement
Suspected soft tissue tumor shadow

Calcification
in Facial Soft
Tissues

(common) (uncommon)

Calcified acne
(often post tuberculosis)
Phleboliths
Calcified hematoma
Calcified adipose tisssue
Non-calcification (e.g.
tooth displaced into soft
tissues)

Calcification in Facial Soft Tissues

Myositis ossificans
(traumatic)
Myositis ossificans
progressiva
Ehlers-Danlos
syndrome
sclerosis)
Calcinosis universalis
Cysticercosis
Hypervitaminosid D
Calcifications in
Muscles and
Subcutaneous
Tissues

Calcifications in Muscles and
Subcutaneous Tissues (common)
Dermatolysis and calcinosis
Gout
Vascular calcifications
Healing abscess
Subcutaneous Tissues
(uncommon)
Hyperparathyroidism
Hypoparathyroidism
Multiple nevoid basal cell carcinoma syndrome
(Gorlin and Goltz syndrome)
Idiopathic hypercalcuria
Myositis ossificans (traumatic and progressiva)
/continued

Subcutaneous Tissues
(uncommon)
Paraplegia
Calcified parasites (e.g. cysticercosis)
Carbon monoxide poisoning
Fracture segment
Tumoral calcinosis
Secondary to thermal burn or frostbite
Benign or malignant soft tissue tumor
Lupus erythrematosus

Widespread Calcification
in Soft Tissues

(uncommon)
Hypoparathyroidism
sclerosis)
Multiple vascular
calcifications

Widespread Calcification
in Soft Tissues
Gout
Hyperparathyroidism
Immobilization
Lupus erythematosus
Cysticercosis
Tumoral calcinosis
Idiopathic
hypercalcemia
Gross metabolic bone
breakdown/metastatic
calcification
(common)

Vascular
Calcification

(uncommon)
Carotid atherosclerosis
Hemangioma
Ranine varices
Phleboliths
Familial arteriosclerosis
Vascular Calcification

Monkbergs sclerosis
Enchondromatosis-
hemangiomata Sx
(Maffucis syndrome)
Aneurysm
Progeria (Hutchinson-
Gilford syndrome)
Lipodystrophy
Renal transplantation
Werners syndrome
Generalized
calcification of infancy
(common)
Secondary
arteriosclerosis (e.g.
diabetes; Cushings Sx;
nephrotic Sx)
(rare)

Solitary Large Calcified Mass
Adjacent to Bone

(uncommon)
Sialolithiasis in
Whartons duct
(superimposition)
Calcified fat
Calcified hematoma
Solitary Large Calcified Mass
Adjacent to Bone
Scleroderma
(systemic sclerosis)
Osteochondroma
Gout
Hyperparathyroidism
Soft tissue osteo- or
chondrosarcoma
Tumoral calcinosis
Myositis ossificans
Foreign body
(common)

Calcification in Lymph Nodes
of Face

(uncommon)
Tuberculosis
(active or scar)
Sarcoidosis
Idiopathic
Calcification in Lymph Nodes
of Face
Histoplasmosis
BCG vaccination
Coccidiomycosis
Filiaris
Lymphoma
Osteoblastic
metastases
(common)

Calcification in
Submandibular
Area

(uncommon)
Sialolithiasis (in duct
or gland)
Root or tooth displaced
in soft tissues
Foreign body
Calcification in Submandibular Area

Chondrodystrophica
calcificans congenita
Myossitis ossificans
(common)
Phlebolith
Scleroderma
Radiographic artifact
(rare)

Calcification in
Parotid Area

(uncommon)
Sialolithiasis (in duct
or gland)
Artifact
Phlebolith
Foreign body
Calcification in Parotid Area
(common)
Myossitis ossificans
Other soft tissue
calcifications including
metastatic calcification
related to metabolic
disease

Sialolith Appearance

(uncommon)
True sialolith
Film artifact
Superimposition of
tooth in soft tissue or
in bone
Superimposed tori,
exostoses or
osteosclerosis
Foreign body

Sialolith Appearance
Gout
Hyperparathyroidism
Immobilization
Lupus erythematosus
Cysticercosis
Tumoral calcinosis
Idiopathic
hypercalcemia
Gross metabolic bone
breakdown/metastatic
calcification
(common)

(uncommon)
Gas producing
odontogenic infection
Surgical emphysema
from air rotor or
during endodontics
Projection of air in
sulci in occlusal view
Air/Gas in Soft Tissue
Craters of ulcerative
malignancy
Crushing injury to
thorax
Persistent severe
coughing
Lipomatous
accumulation
projected over muscle
(common)
Nasopharyngeal Mass
(common)
Adenoids/tonsillar tissue
(especially in adolescence)
Infections
Projection of posterior aspect of
inferior turbinates
Nasopharyngeal Mass
(uncommon)
Hematoma
Malignant nasopharyngeal neoplasm
(carcinoma; lymphoma; lymphoepithelioma;
multiple myeloma; chordoma)
Benign nasopharyngeal neoplasm (juvenile
angiofibroma; neurilemmoma, angioma)
Dermoid cyst
/continued

Nasopharyngeal Mass
(uncommon)
Extension of neoplasm from sphenoid sinus
Extension of neoplasm from nasal passage
Antral-choanal polyp
(rare)
Sarcoidosis or tuberculosis
Meningioma extending from base of skull
Encephalocoele

Macroglossia
(common)
Normal variant or spread following loss of teeth
Acromegaly
Hamartoma (lymphangioma or hemangioma)
Neurofibroma
Edema following trauma or allergic reaction
Primary or secondary amyloidosis
Lingual thyroid
Macroglossia
(uncommon)
Glycogen storage disease
Angioneurotic edema
Infant of diabetic mother
Muscular dystrophy
Happy-puppet syndrome
Beckwith-Wiedemann syndrome
Salivary Gland Enlargement
(common)
Paramyxovirus parotitis (mumps)
Sialolithiasis
Idiopathic
Sjgrens syndrome
Suppurative sialadenitis
Pleomorphic adenoma
Salivary Gland Enlargement
(uncommon)
Chronic alcoholism
Hormonal imbalance
Malnutrition (e.g. protein deficiency)
Mikuliczs syndrome
Hashimotos disease
Tuberculosis or sarcoidosis
Benign or malignant tumors
Oncocytosis
Mucoviscoidoses

(uncommon)
Inflammation
Sialolithiasis
Stricture of Salivary Duct
Normal variant
Carcinoma
Trauma including
factitial injury and
surgery
Radiation therapy
(common)

(uncommon)
Enlarged adenoids
and tonsils
Artifact
Retropharyngeal
extension of upper
respiratory tract
disease or
odontogenic infection
Increased Retropharyngeal Space
(childhood)
Juvenile nasopharyngeal
angiofibroma
Severe chest trauma
Cretinism
Cystic hygroma or
hemangioma
Foreign body impaction
Retropharyngeal goiter
Spinal lesion
(common)

(uncommon)
Infections extending
from upper
respiratory tract
Infections extending
from odontogenic
causes
Increased Retropharyngeal Space
(adulthood)
Chordoma
Carcinoma
Retropharyngeal goiter
Zenkers diverticulum
Rheumatoid arthritis of
spine
(common)
Soft Tissue Mass with
Underlying Bone Erosion


Oral squamous cell carcinoma
Kaposis sarcoma (often in AIDS)
Nasolabial cyst
Pyogenic granuloma including pregnancy epulis
Other gingival epulides and denture-induced
gingival hyperplasia
Neurofibromatosis (blister region)
Salivary gland malignancy
Metastatic malignancy (in extraction site)
(common)

Lymphoma in soft tissues
Malignant lymph node
Amyloidosis
Angioma
Fungal diseases
Hemophilia
Sarcoma in soft tissues
(uncommon)
Suspected Soft Tissue Tumor
Shadow in Facial Region

Primary soft tissue tumors casting
their own radiographic shadows are
all uncommon in the oral cavity

Key to relative frequency in next 5
charts: * = relatively common; **
= uncommon; *** = rare
(Muscle)
Rhabdomyosarcoma**
Leiomyoma***
Leiomyosarcoma***
(Fat)
Lipoma*
Liposarcoma***

Fibromatosis*
Fibrosarcoma**
Fibrous histiocytoma **
Other aggressive fibrous lesions**
(Connective tissue)

Neurofibroma *
Neurilemmoma**
Neurosarcoma***
Neuroblastoma**
(Neural tissue) (Vascular)
Hemangioma*
Hemangiopericytoma**
Angiosarcoma***
Kaposis sarcoma*

Oral squamous cell carcinoma*
Salivary gland tumors*
Metastatic malignancy** (male =
lung; prostate; kidney; colon;
rectum; liver/female = breast; lung;
thyroid; kidney; colon; rectum)
(Epithelial)

Acute (e.g. cellulitis)*
Chronic (e.g. fibro-
epithelial polyp)*
Condylomata/warts*
Other epulides*
(I nflammatory)
Hematoma*
Aneurysms***
Mesenchymoma***
Soft tissue sarcoma***
Accessory muscle
mass***
Dermatologic lesions*

(Miscellaneous)
Part 6: Skull Signs
Copyright of Allan G. Farman
Radiologic Signs Concerning the
Skull
Craniostenoses
Microcephaly and macrocephaly
Frontal bossing
Basilar invagination
Hypoplasia of skull base
Localized increase in calvarial density
Generalized increase in calvarial density
/continued

Skull
Localized increased density of skull base
Generalized increased density of skull base
Localized thinning of calvaria
Generalized thinning of calvaria
Granular bone in skull
Erosion of inner diploe
Button sequestra
/continued
Skull
Solitary calvarial radiolucency
Radiolucent skull defect in childhood
Multiple calvarial radiolucencies
Enlargement or destruction of sella
Small sella and J-shaped sella
Multiple wormian bones
Presence of fontanelle shadows
/continued

Skull
Defective cranial ossification
Hair-on-end calvarial density
Solitary intracranial opacity
Multiple intracranial opacities
Basal ganglia calcification
Hypertelorism
Hypotelorism
/continued

Skull
Brachycephaly
Dolichocephaly
Trigonocephaly
Turricephaly and acrocephaly
Copper-beaten appearance

Craniostenosis
Craniofacial dysostosis (Crouzons disease)
Acrocephalosyndactyly (Aperts syndrome)
Acrocephalopolysyndactyly (Carpenters Sx)
Chotzens syndrome
Pfeiffers syndrome
/continued
Craniostenosis
Diaphyseal dysplasia (Engelmanns Sx)
Idiopathic microcephaly
Hypophosphatasia
Hyperthyroidism
Hypervitaminosis D
/continued
Craniostenosis
Mandibulofacial dysostosis (Treacher-Collins
syndrome)
Van Buchems disease
Head binding/papoose board

Microcephaly
(Small Skull)

Microcephaly (Small Skull)
Craniosynostosis syndromes
Arhinencephaly
Cockaynes syndrome
Cri du chat syndrome
De Lange syndrome
Dysautonomia (Riley-Day syndrome)
Focal dermal hypoplasia (Goltz syndrome)

/continued
Hypospadias-dysphagia (G syndrome)
Homocystinuria
Idiopathic small brain and anencephaly
Incontinentia pigmentii (Bloch-Sulzberger
syndrome)
Myotonic dystrophy (Steinerts syndrome)
Nanocephalic dwarfism (Seckels syndrome)

/continued
Pancytopenia-dysmelia (Fanconis Sx)
Phenylketonuria
Prenatal and neonatal irradiation or infection
(e.g. toxoplasmosis)
Smith-Lemli-Opitz syndrome
Trisomy 13, trisomy 18 or trisomy 21
Tuberous sclerosis (Bourneville-Pringle Sx)
Normal variant

Macrocephaly (Large Skull)

Hydrocephalus (including Dandy-Walker Sx)
Achondroplasia or achondrogenesis
Congenital anemias
Diaphyseal dysplasia (Engelmanns disease)
Cerebral giantism (Sotos syndrome)

/continued
Familial macroencephaly
Intracranial tumor or subdural hematoma in
childhood
Beckwith-Wiedmann syndrome
Pituitary dwarfism
Apparent with certain craniostenoses

Frontal Bossing

Frontal Bossing
Achondroplasia
Oculomandibulodyscephaly (Hallerman-
Streiff syndrome)

/continued
Frontal Bossing
Osteopetrosis
Otopalatodigital syndrome
Hemolytic anemias
Healed rickets
Congenital syphilis


Achondroplasia
Ankylosing spondylitis
Klippel-Feil anomalad
Osteomalacia

/continued
Osteopetrosis
Osteoporosis
Pyknodysostosis
Syphilis or tuberculosis
Trauma-induced

Hypoplasia
of Skull Base

Hypoplasia of Skull Base
Achodroplasia
Chondroectodermal dysplasia

Localized Increase in Calvarial
Density

Localized Increase in Calvarial
Density
Fibrous dysplasia
Hyperostosis frontalis interna
Calcifying epithelioma of Malherbe
Dense bone island as normal variant
Osteoblastic metastasis
(scalp or brain)
Late sequel after electrical burn

Generalized Increase in Calvarial
Density

Density
Acromegaly
Anemias (sickle cell anemia; thalassemia;
congenital spherocytosis; elliptocytosis)
Childhood cerebral atrophy
Congenital cyanotic heart disease
Chronic increased intracranial pressure
Cranial hemiatrophy

/continued
Density
Craniostenoses (all causes)
Dilantin medication
Fibrous dysplasia
Hyperostosis frontalis interna

/continued
Density
Hyperparathyroidism
Hyperphosphatasia
Hypervitaminosis D
Hypo/ pseudohypoparathyroidism
Idiopathic
Melorrheostosis

/continued
Density
Meningioma
Microcephaly
Myelosclerosis
Osteopetrosis

/continued
Density
Otopalataldigital syndrome
Sclerosteosis
Secondary polycythemia
Syphilitic osteitis
Treated hydrocephalus
Treated rickets

/continued
Density
Tuberous sclerosis (Bourneville-
Pringle syndrome)
Van Buchems disease

Generalized Increase
Opacification of Skull Base

Fibrous dysplasia
Fluorosis
Healed vitamin D resistant rickets
Hyperparathyroidism (following treatment)
Hypervitaminosis D

/continued
Melorrheostosis
Meningioma
Neurofibromatosis
Osteodysplasia
Severe anemia

Localized Increase Opacification
of Skull Base

Localized Increase Opacification
of Skull Base
Acromegaly
Chondrosarcoma
Chordoma with
calcification
Chronic periostitis
Fibrous dysplasia
Lymphoma
Mastoiditis

Meningioma
Nasopharyngeal
carcinoma
Osteoblastic
metastases
Osteochondroma
Osteogenic sarcoma
Sclerosteitis
Sphenoid sinusitis
Generalized Thinning of
Calvarium

Generalized Thinning of
Calvarium
Normal variant (parietal thinning)
Chronic subdural hematoma
Congenital arachnoid cyst
Leptomeningeal cyst
Localized temporal lobe hydrocephalus
Neurofibromatosis
Porencephalic cyst
Slow-growing intracranial tumor

Localized Thinning of Calvarium

Localized Thinning of Calvarium
Craniolacuna
Hydrocephalus
Hypophosphatasia
Progeria (Hutchinson-Gilford Sx)

Granular Bone in Skull

Granular Bone in Skull
Electrical burn
Hereditary anemia
Hyperparathyroidism
(primary or secondary)
Idiopathic
Leukemia
Long term steroids
or neuroblastoma

Multiple myeloma
Osteomalacia
Osteomyelitis
Osteoporosis
Pagets disease
Meningioma
Osteoradionecrosis
Syphilis

Erosion of Inner Diploe

Erosion of Inner Diploe
Arteriovenous
malformation
Chronic subdural
hematoma
Cisterna magna anomaly
Epidermoid cyst
Glioma
Hemangioma of skull
Meningioma

Metastasis
Neoplasm of dura
Pacchionian
granulation
Porencephaly
Sinus pericranii

So-called Button Sequestra

So-called Button Sequestra
Hemangioma
Osteomyelitis
Surgical defect
Radiation necrosis
Syphilis
Tuberculosis

Solitary Radiolucency in
Calvarium

Calvarium
Arachnoid cyst
Arteriovenous malformation
Benign tumor of scalp
Carcinoma of scalp
Cholesteatoma
Dermal sinus
Fibrous dysplasia

/continued
Calvarium
Fracture
Hemangioma
Hyperparathyroidism
Idiopathic
Lymphoma
Langerhans cell
disease
Meningocele
Metastasis

Multiple myeloma
Neurofibromatosis
Normal variant (venous
lake)
Osteogenic sarcoma
Osteomyelitis
Sarcoidosis, syphilis or
tuberculosis
Radiolucent Defect in Skull of
Child

Child
Arteriovenous malformation
Central or peripheral hemangioma
Epidermoid cyst
Fibrous dysplasia
Hemophilic pseudotumor
Neurofibromatosis (blister lesion)

/continued
Child
Normal fontanelle
Normal variant (venous lake)
Osteomyelitis
Metastatic neuroblastoma
Osteogenic sarcoma
Surgical defect

Multiple Calvarial Radiolucent
Defects

Defects
Craniolacuna
Hyperparathyroidism
Leukemia or lymphoma
Lipid reticuloendothelioses (Niemann-Pick
disease)

/continued
Defects
Multiple myeloma
Osteoradionecrosis
Osteomyelitis
Pacchionian granulations
Normal variant (parietal foramina)
Sarcoidosis, syphilis or tuberculosis
Surgical defects

Enlarged or Eroded Sellae

Benign tumor of base of skull
Chordoma
Craniopharyngioma
Empty sella syndrome
Enlargement of internal carotid artery
Hyperparathyroidism
Hypogonadism
Increased intracranial pressure

/continued
Juxtasellar or suprasellar tumors
Mucopolysaccharoidoses I-H (Hurlers
syndrome)
Nasopharyngeal or sphenoid sinus neoplasm
Optic sheath tumor
Osteomyelitis

/continued
Pituitary tumor
Rathkes cleft cyst
Tumor of frontal lobe of brain

Small Sella

Small Sella
Cushings syndrome
Genetic dwarfism
Hypopituitarism
Normal variant

/continued
Small Sella
Post-partum pituitary necrosis (Sheehans
syndrome)
Prader-Willi syndrome
Radiation therapy in childhood
Trisomy 21

J-Shaped Sella

J-Shaped Sella
Hydrocephalus
Mucopolysaccharoidosis I-H
(Hurlers syndrome)
Neurofibroma
Normal variant
Pituitary tumor
Suprasellar tumor

Multiple Calvarial Wormian
Bones

Bones
Hypophosphatasia
Normal variant
Oculomandibuldyscephaly (Hallermann-
Streiff syndrome)

/continued
Bones
Pachydermoperiostitis
Prader-Willi syndrome
Pyknodysostosis
Trisomy 21

Presence of Fontanelle Shadows

Normal in early infancy
Cerebrohepatorenal syndrome
Cutis laxa
Dysplasia epiphysealis punctata
(Conradis disease)
Frontonasal dysplasias
Hypophosphatasia

/continues
Intracranial tumors
Oculomandibulodyscephaly
(Hallermann-Streiff syndrome)
Osteodysplasia

/continues
Pediatric rubella infection
Pyknodysostosis
Trigonocephaly causes
Trisomy 13, trisomy 18 or trisomy 21

Defective Cranial Ossification

Hydrocephalus
Langerhans cell disease (Letterer-
Siewe variety)
Neurofibromatosis

/continued
Prematurity
Progeria (Hutchinson-Gilford Sx)
Pyknodysostosis

Hair on End Calvarium

Hereditary anemias (thalassemia;
sickle cell anemia; spherocytosis;
elliptocytosis)
Congenital heart disease
Ewings sarcoma
Hemangioma
Iron deficiency anemia
Meningioma

/continued
Metastatic thyroid carcinoma
Multiple myeloma
Osteogenic sarcoma
Chondrosarcoma
Polycythemia vera

Solitary Intracranial Opacity

Arachnoid granulation
Arteiovenous malformation
Atherosclerosis
Calcified choroid plexus
Calcified cerebral infarct
Calcified diaphragma sella
Calcified dura (falx; tentorium;
sagittal sinus)

/continued
Calcified hematoma
Calcified petroclonoid or
interclinoid ligament
Chondrosarcoma of skull base
Craniopharyngioma
Cysticercosis
Encephalofacial angiomatosis
(Strurge-Weber syndrome)

/continues
Ependyoma
Epidermoid or dermoid cyst
Foreign body (e.g. artery clip)
Healed granuloma or abscess
Hemangioma (sclerosing)
Idiopathic
Meningioma
Metastatic neoplasm

/continued
Osteochondroma
Osteoradionecrosis
Pineal gland
Pituitary adenoma
Rubella
Syphilitic gumma
Tuberous sclerosis
(Bourneville-Pringle Sx)

Multiple Intracranial Opacities

Aneurysm
Atherosclerosis
Basal ganglia calcifications
Idiopathic
Encephalofacial angiomatosis
(Sturge-Weber syndrome)
Healed brain abscesses
Carbon monoxide intoxication

/continued
Cockaynes syndrome
Cytomegalo virus inclusion disease
Encephalitis
Hematomas
Hepatolenticular degeneration
(Wilsons disease)
Hyperparathyroidism
Hypervitaminosis D

/continued
Lipoid proteinosis
Multiple tumors (e.g. meningiomas)
Neurofibromatosis
Parasitic disease
Toxoplasmosis
Tuberous sclerois

Basal Ganglia Calcifications

Birth anoxia
Carbon monoxide poisoning
Cockaynes syndrome
Encephalitis
Hemorrhage
Hypoparathyroidism
Idiopathic
Lead intoxication
Parkinsonism

/continued
Pseudohyperparathyroidism
Toxoplasmosis
Tuberous sclerosis

Hypertelorism
(increased
interorbital
width)

Hypertelorism
Acrocephalysyndactyly (Aperts Sx)
Anterior meningocoele
Central facial hypoplasia
Cerebral giantism (Sotos syndrome)
Craniostenosis causes
Cri du chat syndrome
De Langes syndrome
Dysplasia epiphysealis punctata
(Conradis syndrome)

/continued
Hypertelorism
Facial duplication
Fibrous dysplasia
Hypertelorism-hypospadias syndrome
Idiopathic
Larsens syndrome
Metaphyseal chondrodysplasia
Metaphyseal dysplasia
Midline dermoid or teratoma
Mulopolysaccharidoses I-H (Hurlers Sx)

/continued
Hypertelorism
Noonans syndrome
Orofacial digital syndrome
Thalassemia
Mandibulofacial dysplasia (Treacher-
Collins syndrome)
Turners syndrome

Hypotelorism
(decreased
interorbital
width)

Hypotelorism
Arhinencephaly
Glycogen storage disease
Phenylketinuria
Trigonocephaly
Trisomy 13
Trisomy 21

Unilateral Exophthalmos

Craniostenosis causes
Dermoid cyst
Epidermoid
Fibrous dysplasia
Fracture with retro-orbital blood or air
Hemangioma
Hyperthyroidism
Lacrimal gland tumor
Meningioma

/continued
Metastatic disease
Mucocele
Mucormycosis
Neurofibromatosis
Orbital meningocoele
Benign tumor (e.g. ossifying fibroma)
Osteoma of paranasal sinus
Osteomyelitis

/continued
Primary orbital soft tissue disease
Pseudotumor of orbit
Retro-orbital abscess or cellulitis
Sinusitis

Destructive Lesions with
Exophthalmos

Destructive Lesions with
Exophthalmos
Chloroma
Langerhanss cell disease
Lymphoma
Primary carcinoma
Burkitts lymphoma

Enlargement of Superior Orbital
Fissure

Fissure
Aneurysm of internal carotid artery
Chordoma
Craniopharyngioma
Extension of orbital malignancy
Meningioma
Metastatic carcinoma to sphenoid bone
Middle cranial fossa mass

/continued
Fissure
Neurofibroma
Neurofibromatosis
Normal variant
Pituitary tumor
Posterior orbital encephalocele

Prominent Muscle Attachment

Prominent Muscle Attachment
Acromegaly
Normal variant
Ankylosis
Pseudo-ankylosis
Masseteric hypertrophy

Radiologic Signs For Maxillofacial Diag

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