radiolucent lesions Flashcards
what to consider when coming up with differential dx
Patient demographics
* Sex, race, age
Clinical signs and symptoms
* Type, duration, etc.
Radiographic features
* Number, location, contents, size, borders, loculation, origin, relationship to adjacent structures, root resorption, displacement of adjacent structures
Midline radiolucency
Presentation:
* Male
* Aged 41
* Painless swelling palatal to 11 and 21
* 11 and 21 both restored and previous apicectomy 21
How would you describe the radiolucency? What is your differential diagnosis?
a circular, well defined radiolucency with radiopaque margin
typical cystic appearance
differential dx: radicular cyst (common) or nasopalatine cyst (less common)
how does the lesion relate to central incisors
apply horizontal and vertical parallax shift
radiolucency is slightly higher up in the occlusal indicating it is palatal
any normal anatomical features which can help sway suspected dx?
Even though these teeth are root treated and 21 has a retrograde root canal filling, it does not automatically mean that they are the cause of a problem: specifically look for the periodontal ligament space – it is clear around 11 on the occlusal.
This was a nasopalatine cyst
MUTLIPLE RADIOLUCECNIES
Male with no symptoms
Panoramic radiograph taken
Based on the dentition, what age do you think this patient is?
1st molar roots complete so not younger than 9
37 erupted so not younger than 12
* 37 roots not complete - so approx 14year
There are two radiolucencies in the posterior right mandible
Do you think these are 2 different things or are they related to each other?
What is your differential diagnosis/diagnoses?
appear to be seperate entities
- circular, well defined approx 1cm in diameter, in position of possible 48 - all other 3rd molars developing so likely a normal tooth crypt
- surrounds crown of unerupted 47 and too large to be a normal dental follicle - typical for dentigerous cyst
Male aged 57
Referred to investigate radiolucency related to 38
Incidental finding on left bitewing radiograph by GDP (asymptomatic)
37 is vital & there is no notable expansion
What are your radiographic findings for the 38 region? What is your differential diagnosis for the radiolucency?
unerupted 38 - mesio-angular deep inpaction
well defined corticated radiolucency summetrtically surrounds crown and extends to mesial apex 37 - up to alveolar crest, co-incidence with the upper bornder of the IDC posteriorly and overlaps the canal anteriorly
differential dx: odontogenic keratocyst (esp as no expansion clinically), dentingerous cyst
any other radiolucenies in mandible (not around 38)
Small, well-defined, oval radiolucency below the right inferior alveolar canal, below 48. Maximum diameter of approximately 8mm.
The site (below the inferior alveolar canal) means that this cannot be odontogenic in origin.
Second radiolucency at the inferior border of the right mandible
What is the most likely diagnosis for this radiolucency?
Its location (close to the angle of the mandible) and its “cystic” appearance are typical of a Stafne cavity.
The cross-sections and 3D reconstruction show the lingual position of the cavity very clearly
Male, 33y
Presented to GDP with painful swelling in left maxilla
* present for weeks
* Clinically there is an intra-oral swelling which is predominantly palatal
GDP extracted 24 & 25 but there was no resolution of the swelling
There is also a radiolucency in the mandible which is more obvious on the radiographs taken
How would you describe this mandibular lesion and what would be in your differential diagnosis?
46 is grossly carious and the radiolucent lesion encompassing the roots and causing resorption of the distal apex is likely to be inflammatory in origin.
Differential dx: periapical granuloma and radicular cyst
What clinical and radiographic features raise concern?
Clinically the swelling was mainly palatal – this should raise concern as most odontogenic pathology related to upper teeth typically causes buccal swelling.
lesion in the L maxilla has caused a lot of alveolar bone destruction and we see a floating tooth (23) – this is a serious sign.
compare L sinus outline of the R maxillary sinus (know which bony margins/walls you are seeing)
* L cannot see the floor or medial wall –margins destroyed by either a malignancy or, less commonly, an inflammatory process.
how to get defintive dx of this lesion
histology - high grade carcinoma of salivary gland origin
Male, 38y
Regular patient in Periodontology who had full mouth periapicals taken
Describe any radiolucencies you can see
periapical radiolucency related to 25.
* endodontically treated.
* radiolucency is a few millimetres in diameter, and well-defined with a radiopaque margin.
Probable diagnosis a periapical granuloma.
One month later, at his second visit, the patient c/o tenderness in his upper left buccal sulcus
* A panoramic radiograph was taken and reported
* An occipitomental skull view was taken subsequent to this
Q2: What are your findings on these 2 radiographs ?
What needs to be done now?
floor of the L maxillary sinus posteriorly and the posterior wall inferiorly no longer exist; the L sinus is also a bit cloudy.
OM view shows the lesion within the L sinus and destruction of the lateral border.
Only a malignant lesion growing out from within the sinus, or, less commonly, an aggressive inflammatory lesion, would cause the bony destruction.
* The lesion needs to be biopsied
it was found to be a malignancy (adenoid cystic carcinoma).
type of CT slice shown here
which is higher up
Both axial.
left is higher – the ramus is dividing into the coronoid and condylar processes at this level. The lesion occupies most of the left maxillary sinus and has caused destruction of the postero-lateral bony wal
Male, 15, Chinese
* Friend noticed swelling of lower right face
* Asymptomatic
* Firm but not hard swelling, buccal to teeth 45-47
* No previous treatment in this part of the mouth
Describe the radiolucency.
Large oval radiolucency in right mandible extending from 44 to distal of 47;
* well-defined margin, corticated in places;
* scalloped lower margin (a significant finding);
* root resorption and tipping of 46;
* lingual expansion;
* difficult to see what has happened buccally but no bone evident so probable destruction (as there is a clinical swelling).
* Although it is almost impossible to see on this particular panoramic image there is destruction of the ID canal.
46 is unrestored and non-carious, so there is no reason why there should be an associated inflammatory lesion
any particularly significant findings - what would be differential dx?
scalloping and root resorption, and significant buccal expansion with bone destruction suggest an aggressive lesion.
Odontogenic tumours would be top of the list – this was found to be an ameloblastoma (based on the histopathology).
50 year old male
c/o swelling in the anterior palate and a salty taste.
generally fit and well
examination shows a fluctuant swelling of premaxilla and that all teeth are vital
probable dx
nasopalatine duct cyst
histology of nasopalatine duct cyst
epithelial remains of the embryonic nasopalatine canal .
Respiratory type of epithelium originates from the nasal cavity; squamous epithelium from the oral cavity (non-keratinised)
55 year old female
lower denture not fitting well
medical history is complicated
obvious swelling of left mandible intraorally, not fluctuant or painful
differntial dx
residual cyst
odontogenic keratocyst
ameloblastoma
55 year old female
lower denture not fitting well
medical history is complicated
obvious swelling of left mandible intraorally, not fluctuant or painful
describe the histolopathology of this lesion
surface epithelium - has nests of epithelium
histologically like the developing tooth bud
mandibular odontogenic cyst - likely Residual cyst
20 year old female
Small swelling buccal to tooth 35
The tooth 35 is vital
describe radiolucency
Well defined corticated radiolenecy on the mesial apical aspect of the 35
describe histology features of this lesion
Cellular fibrous background
Red blood cells
Multinucleated giant cells
central giant cell granuloma.
* differnetials: hyperparathyroidism, cherubism, aneurysmal bone cyst
what is this
radicular cyst or granuloma
what is this
ameloblastoma
what is this
giant cell granuloma
what is this
ossifying fibroma
what is this
periapical cemento-osseous dysplasia
what is this
cementoblastoma
what is this
dentingerous cyst
what is this
keratocyst (OKC)
what is this
ameloblastoma
3 imp radiolucent lesion seen at apex of tooth
radicular cyst/granuloma
ameloblastoma
giant cell granuloma
3 important radiopaque/mixed lesions
ossifying fibroma
periapical cemento-osseous dysplasia
cementoblastoma
3 important lesions at angle of mandible
dentigerous cyst
odontogenic keratocyst
ameloblastoma
radicular cysts formed from
hertwigs epithelial root sheath
dentingerous cysts formed from
reduced enamel epithelium
(also eruption cysts)
ameloblastoma, odontogenic keratocyst, gingival cysts all form from
dental lamina
15yo F
* LR quad
* 15yo
* Slight expansion
* Asymp
OPT
* Between 44 and 45
* Collection radiopacities
differential dx
tests needed
impact of dx
Differential dx
* Compound odontoma
Tests needed
* CBCT
Impact – on Fixed appliance, root resorption,
55y F, radiograph taken to aid implant planning in mandible
Asym no clinical signs on exam
radiographic findings
differential dx
special tests needed
- radiopaque lesion between 44 and 45
- homogenous
- well defined
- no corticated or radiolucent border
- no communication with PDL 44 or 45
differential dx - idiopathic osteosclerosis; sclerosising osteitis -* reaction to inflammation*
tests needed - sensibility 44 and 45
40y M investigate fullness of left cheek
Asymp no other clinical signs on exam
Radiographic findings
differnetial dx
other tests needed
- Left mandible
- Radiolucent large lesion in the body extending up the ramus to the sigmoid notch/base of coronoid
- Doesn’t appear to be displacing or resorping the teeth
- Thinning of lower corticated border of mandible (compared to RHS)
- Pseudolocular
- Slight scalloping of margin (hard to see on OPT)
differential dx
* Odontogenic keratocyst – due to not affecting teeth greatly and pattern of expansion (mandible shape still mainly intact)
* Ameloblastoma
* Solitary bone cyst – unlikely to be this size, few cms usually
* fibrous dysplasia (due to swelling but unlikely to be this radiolucent and have margin)
other tests needed - biopsy
33y M pericoronitis of 48 and absent 37-38
Otherwise asymp and no clinical signs on examination
radiographic findings
differential dx
other tests needed
- 37 distoangular deep impaction
- 38 aberrant /ectopic
- Unilocular Radiolucent corticated lesion extending from ACJ of 37 up to root of 38
- IDC has been displaced inferiorly – still corticated and not compressed
- 48 superficial horizontal impacted
differential dx
* dentingerous cyst
* adenomatoid odontogenic tumour - rare
* odontogenic keratocyst
other tests needed - biopsy before tx (risks of daughter cysts and recurrece - so want to know before surgical plan)
