Describing dental radiographic lesions can be quite a challenge. This post will look at ways to describe lesions identified on radiographs.
Why is describing important?
There are many reasons for why describing dental radiographic lesions is important.
- Help differentials and referrals – A precise description can narrow your differentials significantly. This is important when referring patients. A simple glance at the description can be help triage urgent cases. Knowing that something has ill-defined borders can help bump up the urgency.
- Determine nature of lesion – It can help determine the tissue of origin and the processes happening within the lesion. Does it have a bony structure? Is it radiopaque and likely to contain fluid or is it solid bone/calcified structure?
- Effective record-keeping – This is vital to provide evidence ensuring you have assessed and appropriately managed a patient.
How to describe a lesion
The best way to imagine describing is to paint a picture with your words. If you were to describe the lesion to someone, they should be able to draw what it looks like without any other reference. There are many components to this, but an acronym that is useful is LESION.
L – Location
E – Edge
S – Shape/Size
I – Internal
O – Other structures
N – Number
Location
There are a few things to consider location wise:
- Mandible or maxilla – which jaw is the lesion present in? This may even include a specific location of the jaw e.g. angle of the mandible or ramus.
- Anterior/posterior and inferior/superior – the position relative to normal anatomy.
- Localised or generalised – if the lesion is localised to a side/jaw or generalised to both e.g. multiple keratocysts.
- Unilateral or bilateral – this ties in with localised/generalised.
Edge
This is looking at the border of the lesion(s) and includes:
- Well-defined – this describes a sharp boundary that separates the lesion from surrounding structures and is easily identified. Surrounding structures beyond this lesion appear normal.
- Ill-defined – unlike a well-defined lesion, the borders of this cannot be traced and followed. Normal tissues and abnormal tissues merge together and cannot be separated easily. An ill-defined lesion usually is more concerning.
- Corticated – this is usually seen with a well-defined lesion, where there is a thin, radio-opaque outline surrounding the lesion. This is often seen with cysts.
Shape/Size
Estimate the size of the lesion – use nearby anatomy as a reference if needed. For example, a description combining the location may be helpful such as ‘a lesion extending from the left angle of mandible to the left mental foramen’.
There are many ways to describe the shape. Examples include ovoid, round, scalloped between roots of teeth or other structures.
Internal
This looks at the internal appearance of the lesion and is usually one of 3 things:
- Radiopaque – the inside of the lesion is likely white or grey. Compare the density to other structures, such as enamel or bone. Radiopaque lesions may be discernible, such as teeth in an odontome.
- Radiolucent – this can be further divided in to unilocular and multilocular. Multilocular lesions may have internal septa which will appear radiopaque.
- Mixed density – this shows a mixture of both radiolucent and radiopaque areas. It is quite common in fibro-osseous lesions. Terms like cotton wool, or orange peel can be useful terms to describe these lesions.
Other Structures
Assess the lesion in relation to surrounding structures and anatomy including:
- Teeth – are teeth being resorbed/displaced/scalloped around?
- Inferior alveolar nerve – has the nerve been displaced/destroyed?
- Maxillary sinus – is there loss/displacement of sinus walls?
Other features to consider include any change in the density of surrounding bone and any pathological fractures or loss of lower border of the mandible.
Number
Simply put – is there a single lesions or are there multiple lesions (common in Gorlin-Goltz syndrome).
Summary
- Effective description of dental radiographic lesions is important to communicate information as well as diagnose
- An easy acronym to describe lesions is LESION
- LESION allows for systematic and complete description
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