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solitary _ multilocular RL

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					Differential Diagnosis of Oral and Maxillofacial lesions



    1. Solitary cystlike Radiolucencies
        not necessarily contacting teeth
    2. Multilocular radiolucencies

 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


        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
                                              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
                               Radiopaque
 Bony
Lesions                Radiolucent mixed with radiopaque

                Radiolucent

 Contacting tooth             Not contacting tooth


                                            Inter-radicular
Periapical                                  ★
                                                Solitary cystlike
                                                ★
             Pericoronal                            Multilocular

                                                Solitary-ragged
                                         Multiple, separate

                                     Generalized rarefaction
                                               WenChen Wang
          Cystlike lesion


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

                              Ref. 1
                            WenChen Wang
Marrow spaces




                  Ref. 1
                WenChen Wang
Maxillary sinus



                    Ref. 1
                  WenChen Wang
  Ref. 1
WenChen Wang
        Early stage of tooth crypt




                                Ref. 1
Postextraction socket        WenChen Wang
                            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




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




                                                Ref. 1
                                             WenChen Wang
          Ref. 2
Multilocular RL,
      expansion
bony WenChen Wang
    Lingual mandibular bone defect
Stafne cyst; static bone cyst


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

 Ref. 1




                                     WenChen Wang
                          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. 2




    Ref. 2                              Ref. 2   WenChen Wang
                       Ameloblastoma-unicystic




                            Ref. 1

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


                                      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
                                                       Ref. 3
    Less likely diagnosis:
    • Benign nonodontogenic        More likely diagnosis:
      tumor                        • Residual cyst
    • Cemento-ossifying            • Traumatic bone cyst
      fibroma                      • Primordial cyst
    • Giant cell granuloma         • OKC (Primordial type)
    • Fissure cysts                • unicystic ameloblastoma
    • 3rd molar tooth crypt        • Odontogenic myxoma
                                                 WenChen Wang
         Surgical defect



Ref. 1




                 WenChen Wang
Central giant cell granuloma
   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.
                                                                     Ref. 2
                       Ref. 2




                                                                Ref. 1
                                                               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           Multilocular RL,
                                                 bony expansion




     right angles to the outer
     expanded border

Ref. 2                           Central giant cell granulomaWang
                                                       WenChen
          Giant cell lesion
         Hyperparathyroidism
   Diagnosis based on history and laboratory
    findings




             Ref. 2                     WenChen Wang
       Chronic Renal Failure


Phosphate       active VitD3  calcium
Retention ↑    production↓ resorption ↓


              Hypocalcemia

                     PTH↑

Secondary Hyperparathyroidism
                                   WenChen Wang
         Fibroosseous lesion
   Early : Unilocular RL
   Later : Mixed RL with RO or RO


       Early stage of a COF




                                     WenChen Wang
                        Incisive canal cyst

   Enlargement of the
    Incisive foramen & canal ,
    > 1cm




Ref. 1                           Ref. 2   WenChen Wang
Midpalatine cyst; median palatal cyst




                                 Ref. 1
                                 WenChen Wang
    Benign nonodontogenic tumors as
       radiolucencies in the jaws


Lipoma
Salivary gland tumors

Amputation neuroma

Neurofibroma,

schwannoma
Leiomyoma

Fibroma




                         Ref. 1   WenChen Wang
                            Ref. 1


Metastatic bronchogenic carcinoma    WenChen Wang
Aneurysmal bone cyst

      Unilocular RL

                                                Ref. 2
                                Multilocular RL,
                                bony expansion
                                                  Ref. 2
      Ref. 1

   90% < 30 y/o; Md. > Max.
   Proliferative response of
    vascular tissue
   R-L, expansile osteolytic
    process
                                             WenChen Wang
Typical locations of odontogenic and                   Summary
       nonodontogenic cysts




Ref: Essentials of Dental Radiography and Radiology,
4th edition, 2007                                       WenChen Wang
Multilocular radiolucencies




 Soap bubble   Honeycomb   Tennis racket

Ref. 1, 3                          WenChen Wang
Maxillary sinus
                  Ref. 1




                           WenChen Wang
Marrow spaces




   Ref. 1
                WenChen Wang
     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




                                      Ref. 2
middle-aged adults, mean=49 y/o;rarely
 before the age of 20
–85% in mandible.
–strong predilection for the anterior region,
 cross midline
                                          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   Ref. 2
    local invasive
   non-encapsulated and destructive
   seldom causes paresthesia
   may cause loosening of teeth or resorption




                                           Ref. 1   WenChen Wang
                                 Ref. 3

32 y/o male, ameloblastoma
                             WenChen Wang
             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


                                                            Ref. 2




   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
                                                    WenChen Wang
Ref. 2

   Odontogenic myxoma, tennis racket appearance
                                           WenChen Wang
Cherubism

               Inherited developmental
                abnormality, only affects
                the jaws, cherubic
                appearance
               Age: 2-20 y/o
               Multiple multilocular RL

                                     Ref. 2




                              WenChen Wang
       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
                                        Ref. 1
16 y/o boy, severe hemophilia



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



                                                 WenChen Wang
Ref. 1
         Intrabony neurilemoma
                                 WenChen Wang
                                         Summary

     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
                                            WenChen Wang

				
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