WenChen Wang

1. Solitary cystlike Radiolucencies not necessarily contacting teeth

2. Multilocular radiolucencies

王文岑 助理教授 高雄醫學大學 牙醫學系 高醫大附設醫院 S 棟 2 樓 口腔病理影像診斷科

07-3208284; wcwang@kmu.edu.tw

Differential Diagnosis of Oral and Maxillofacial lesions

1.顎骨中未必接觸牙齒之單一囊狀放射線透射性病灶2.多房性放射線透射性病灶

WenChen Wang

學習目標 複習顎骨中的單囊狀及多房性放射線透射病灶之疾病與成因，並學習其相關之鑑別診斷。

學習資源及主要圖片引用 :1. Differential diagnosis of oral lesion. Wood, Gooz(Mosby), 5th ed., 1997.2. Neville and Damm et al: Oral & maxillofacial patholgy, 3rd ed.

3.口腔病理科門診臨床記錄

WenChen Wang

Bony Lesions

Radiolucent

Contacting tooth Not contacting tooth

Periapical

Pericoronal

Inter-radicular

Solitary cystlike

Multilocular

Multiple, separate

Solitary-ragged

Generalized rarefaction

Radiolucent mixed with radiopaque

Radiopaque

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WenChen Wang

Cystlike lesion

Dark radiographic image , circular in outline and usually smoothly contoured with well-defined borders

Ref. 1

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Marrow spaces

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Maxillary sinus

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Early stage of tooth crypt

Postextraction socket Ref. 1

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Residual cyst

-Cyst remained after its associated tooth has been lost -Age >20 y/o -Surgical intervention

Ref. 1

WenChen Wang

Traumatic bone cyst

Classically: Above the mandibular canal Vital tooth, scallpoed appearance Solitary (majority) or multiple

(bilateral) post. Mandible, ramus <30 y/o 95% containing fluid or empty Surgical curettage May coexist with fibro-osseous

lesion

Ref. 1

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Q: A 40y/o male, a tooth removed due to hypermobility, what were the possible diagnosis ?

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Multilocular RL, Multilocular RL, bony expansion bony expansion

Ref. 2

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Stafne cyst; static bone cyst

Lingual mandibular bone defect

- A well-defined RL in the post. Region under mandibular canal

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Odontogenic keratocyst

A well-defined multilocular (or unilocular) radiolucency

Most common in post. mandible Resorb and /or move teeth, vital Multiple lesions in Gorlin

syndrome

Ref. 2Ref. 2

Ref. 2

WenChen Wang

Ameloblastoma-unicystic

Mean age:23 y/o 90% in mandible,

posterior region

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WenChen Wang

practice 21 y/o male 2x1.5 cm cystlike RL lesion

over an edentulous 3rd molar region of the mandible

asymptomatic, masndibular canal inferiorly displaced

More likely diagnosis:• Residual cyst• Traumatic bone cyst• Primordial cyst • OKC (Primordial type)• unicystic ameloblastoma • Odontogenic myxoma

Less likely diagnosis:• Benign nonodontogenic

tumor• Cemento-ossifying

fibroma • Giant cell granuloma• Fissure cysts• 3rd molar tooth crypt

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Surgical defect

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Unilocular or multicular R-L Cortical bone expansion Well defined, corticated or not ; some are poorly

defined Displace tooth follicle & roots, root resorption, lamina

dura of adjacent teeth resorbed.

Central giant cell granuloma

Ref. 1

Ref. 2

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WenChen Wang

Range 2-80 y/o; 70% < 30y/o Mandible : maxilla = 2:1 More in mand. ant. to 1st molar, 21%

cross midline Painless swelling Vital mobile teeth

right angles to the outer right angles to the outer expanded borderexpanded border

Multilocular RL, bony expansion

Central giant cell granulomaRef. 2

WenChen Wang

Giant cell lesion Hyperparathyroidism

Diagnosis based on history and laboratory findings

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WenChen Wang

Secondary Hyperparathyroidism

Chronic Renal Failure

Phosphate active VitD3 calcium Retention ↑ production↓ resorption ↓ Hypocalcemia PTH↑

WenChen Wang

Fibroosseous lesion Early : Unilocular RL Later : Mixed RL with RO or RO

Early stage of a COFEarly stage of a COF

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Incisive canal cyst

Enlargement of the Incisive foramen & canal , > 1cm

Ref. 2Ref. 1

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Midpalatine cyst; median palatal cyst

Ref. 1

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Benign nonodontogenic tumors as radiolucencies in the jaws

LipomaSalivary gland tumorsAmputation neuromaNeurofibroma, schwannomaLeiomyomaFibroma

Ref. 1

WenChen WangMetastatic bronchogenic carcinoma

Ref. 1

WenChen Wang

Aneurysmal bone cyst

Multilocular RL, bony expansion

Unilocular RL

90% < 30 y/o; Md. > Max. Proliferative response of

vascular tissue R-L, expansile osteolytic

process

Ref. 2Ref. 1

Ref. 2

WenChen Wang

Typical locations of odontogenic and nonodontogenic cysts

Summary

Ref: Essentials of Dental Radiography and Radiology, 4th edition, 2007

WenChen Wang

Multilocular radiolucencies

Soap bubble Honeycomb Tennis racket

Ref. 1, 3

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Maxillary sinus

Ref. 1

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Marrow spaces

Ref. 1

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Multilocular cysts Odontogenic cyst:

Dentigerous cyst

Odontogenic keratocyst

Lateral periodontal cyst

Primordial cyst

Glandular odontogenic cyst

Nonodontogenic cyst(pseudocyst): Aneurysmal bone cyst Traumatic bone cyst

WenChen Wang

Glandular odontogenic cyst

middle-aged adults, mean=49 y/o ； rarely before the age of 20

–85 ％ in mandible.

–strong predilection for the anterior region, cross midline

Ref. 2

WenChen Wang

Ameloblastoma-conventional type

Wide age range, mean=39 y/o, rare in young children > 80% in mandible, molar-ramus Painless swelling or expansion the bone, benign but

local invasive non-encapsulated and destructive seldom causes paresthesia may cause loosening of teeth or resorption

Ref. 1

Ref. 2

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32 y/o male, ameloblastoma

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Ameloblastic fibroma younger age gr., not commonly over 21 y/o painless, asymptomatic, slow expansion of the cortical plates of

the premolar and molar areas, more frequently in mandible Smooth, well-outlined cyst-like or radiolucency, cannot be

differentiated from unilocular ameloblastoma,or multilocular

Ref. 3

WenChen Wang

Odontogenic myxoma

10-50 y/o, without any sex predilection and slight preference for the mandible (3/4)

Multilocur radiolucency of varying sizes separated by straight (tennis racket) or curved bony trabeculae (soap bubble appearance)

May be unilocular RL or an iII-defined RL

Ref. 2

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Odontogenic myxoma, tennis racket appearance

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Cherubism

Inherited developmental abnormality, only affects the jaws, cherubic appearance

Age: 2-20 y/o Multiple multilocular RL

Ref. 2

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Vascular malformations(VM) and central hemangioma(CH) of bone

35% VM occur in bone, CH rare 10-20 y/o 50% multilocular, some are unilocular; well- or poor defined border Resorption of roots, some phleboliths may present Pulsation, occasionally parthesia; local hemorrhage

Ref. 1

WenChen Wang

Central Odontogenic Fibroma

large lesion: multilocular radiolucencies.

Many lesions have sclerotic border, root resorption or root divergence

Ref. 2

WenChen Wang

16 y/o boy, severe hemophilia

23 y/o, hemophilia, condyle, ramus, coronoid process

Ref. 1

WenChen Wang

Intrabony neurilemoma

Ref. 1

WenChen Wang

Multilocular radiolucencies Anatomic patterns Odontogenic cysts Odontogenic tumors

Ameloblastoma Odontogenic myxoma

Central giant cell grnuloma Giant cell lesion of hyperparathyroidism Cherubism Simple bone cyst Aneurysmal bone cyst Metastatic tumors to the jaws Vascular malformations and central hemangioma

of bone Rarities

Summary