Multilocular Radiolucencies Flashcards
1
Q
what are the multilocular radiolucencies
A
- ameloblastoma
- odontogenic keratocyst
- central giant cell granuloma
- odontogenic myxoma
- vascular lesions- hemangioma and A-V aneurysm
- familial fibrous dysplasia
2
Q
what are the ways that multilocular radiolucencies can be described
A
- soap bubble
- honeycomb
- tennis racket
3
Q
describe ameloblastomas
A
- benign odontogenic neoplasms- one of the very few true odontogenic neoplasms
- capable of uncontrolled, unlimited growth potential
4
Q
what can ameloblastomas be classified into
A
- conventional (multicystic) ameloblastoma
- unicystic ameloblastoma
5
Q
conventional ameloblastomas account for _____ of all ameloblastomas
A
85-90%
6
Q
what are the histologic subtypes for conventional ameloblastomas and what is the most common ones
A
- plexiform
- acanthomatous
- granular
- desmoplastic
- basaloid
- follicular is the most common
7
Q
describe the conventional ameloblastoma
A
- usually slow painless swellings
- small lesions only detected by radiographs
- larger lesions detected clinically
8
Q
what is the radiographic appearance of a conventional ameloblastoma
A
- small lesions are unilocular with corticated borders
- large, aggresive lesions develop multilocular patterns
- displace and resorb teeth
- expansive
9
Q
what is the predilction for a conventional ameloblastoma
A
- age: mainly adults - equal prevalence in 3rd to 7th decade. uncommon in 2nd decade. rare in 1st
- site: mandible (85%) and maxilla (15%)
- gender predilection: none
10
Q
what is the management and likelihood of recurrence for ameloblastoma
A
- large lesions are aggressive requiring bone resection
- block or marginal resection- resect at least 1cm past radiographic limits of tumor
- higher likelihood for recurrence
- 15% recurrence if resected correctly
- 50-90% recurrence if not resected
- rare to be malignant
11
Q
borders of ameloblastomas are greater than what they appear to be:
A
microscopically and radiologically
12
Q
what does unicystic mean
A
growing within the wall of the cyst
13
Q
describe unicystic ameloblastomas
A
- arise within a cyst lining; either luminal, intraluminal or mural
- less aggressive form of ameloblastoma
- recurrence rates of 10-20%
14
Q
what is the predilection for unicystic ameloblastoma
A
- age: mean age 23 years
- site: mandible (90%) maxilla 10%
15
Q
what is the management for unicystic ameloblastoma
A
enucleation because it is less aggressive than multicystic
16
Q
what is the prevalence of the OKC
A
-10-12% of all odontogenic cysts
- 3rd highest oral cyst frequency
17
Q
describe OKC
A
- aggresive cysts; behave more like benign neoplasms
- though to arise from cell rests of dental lamina
18
Q
what does the histo for OKC look like
A
a cyst with epithelium sloughing off into lumen
19
Q
what is the clinical presentation of OKC
A
- normally asymptomatic
- with increasing size, pain, swelling and exudate may occur
20
Q
what is the radiographic presentation for OKC
A
- well defined, smooth, corticated borders
- thinning and mild expansion with occasional perforation of cortical plates
- displacement of teeth and resorbs teeth
- only occasional root resoprtion- less than dentigerous cysts and radicular cysts
- mild BL expansion but extensive antero posterior extension following the long axis of the mandible
21
Q
what is the predilection for OKC
A
- age: majority in 2nd and 4th decade - 60%
- site: majority (60-80%) affect mandible posterior to the canines
- gender: male predilection
22
Q
what is the management of OKCs
A
- enucleation with curettage
- lacks autonomy of a neoplasm- therefore reamins a current nomenclature dilemma
23
Q
what is used after enucleated of OKC with curettage
A
cytotoxins such as carnitine is painted on the walls of the cyst after it has been removed. it kills daughter cells that would increase the recurrence of the cyst. it delays healing time
24
Q
what is the recurrence of OKCs
A
- high recurrence rate between 47-62%
- recurrence within 5 years but can be up to 10
25
when multiple OKCs are found they may constitute part of the:
basal cell nevus syndrome AKA nevoid basal cell carcinoma syndrome
26
describe nevoid basal cell carcinoma syndrome
- multiple basal CAs of skin
- palmar and plantar pitting (60%)
- greater than 1 OKC of jaws (75%)
- bifid or splayed ribs (60-75%)
- kyphoscoliosis (50%)
- skull anomalies:
- frontal bossing and parietal bossing
- hypertelorism
- intracranial calcifications
- majority are of flax cerebri
27
what is the inheritance pattern of nevoid basal cell carcinoma syndrome
autosomal dominant
28
what is the clinical presentation for central giant cell granuloma
- asymptomatic swelling
- can be aggressive
29
what is the radiographic presentation of central giant cell granulomas
- well-defined borders
- can be multilocular
- thinning and expansion of cortical plates
- displacement of teeth and occasional root resorption
30
what is the predeliction for central giant cell granuloma
- age: usually less than 30 years old (60%)
- mandible (70%) and frequently between the molars
- gender: female > male (2:1)
31
what is the management of a central giant cell granuloma
- enucleation with aggressive curretage
32
central giant cell granulomas are histologically similar to:
brown tumor of hyperparathyroidism
33
what should be evaluated in patients with CGCG to rule our hyperparathyroidism
- increased serum calcium
- increased alkaline phosphatase
- decreased serum phosphorus
34
what is the clinical presentation of an odontogenic myxoma
- primarily a lesion of alveolar bone
- basically a fibrous lesion
35
what is the radiographic appearance of an odontogenic myxoma
- scalloped and multilocular
36
what is the predilection for odontogenic myxoma
- age: young to adults (25-30 years)
- site: greater prevalence in the mandible
37
what is the management and recurrence of odontogenic myxoma
- excision
- recurrence up to 25% because the lesions are not encapsulated
38
what are the 3 types of vascular lesions and what is the most aggressive one
- central hemangioma- most aggressive one
- aneurysmal bone cyst
- A-V malformation
39
what are the clinical signs of the central hemangioma
- jaws are next most common site after skull and vertebrae
- firm, slow growing asymmetric expansion
- overlying mucosa is more erythematous and warm to touch
- spontaneous gingival bleeding
- bruit on diascopy and pulsatile sensation may be detected
- many require needle aspiration to assist diagnosis
40
what is the radiographic presentation for central hemangioma
- variable pattern ranging from cyst like radiolucencies
- may have multilocular soap bubble or spoke like appearance
41
in central hemangiomas tissue will be:
red, expanded, compressible
42
what is the predilection for central hemangioma
- age: teens and young adults
- site: posterior mandible
- sex: female: male 2:1
43
what is the management for central hemangiomas
- sclerosing agents, radiation, enucleated
- embolization of major arteries necessary prior to surgery as hemorrhage is a significant and life threatening complication
44
what is the etiology for central hemangioma
- either traumatic/developmental or benign neoplasm
45
what is another name for cherubism and what is the inheritance
familial fibrous dysplasia
- autosomal dominant
46
what is the clinical presentation for cherubsim
- cherubic looking face by 5 years of age due to bilateral bony expansion
- asymptomatic
- bone lesions are more active in younger patients. after age 12 activity usually diminishes and finally lesions become inactive with residual deformity by age 30
47
what is the radiographic presentation for cherubism
- multilocular cyst like
- expansile lesion
- usually bilateral
- mostly mandibular but sometimes the maxilla
- pathologic fracture is not a feature
48
are the lesions in cherubism solid or cystic
solid
49
what is the predilection for cherubsim
- age: usually detected by age 5
- site: bilateral mandible, may affect maxilla
- sex:male: female 2:1
50
what is the management of cherubism
cosmetic osseous contouring at age 12 and later
51
cherubism is a _____ condition
benign, self limiting
52
