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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.

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Presentation on theme: "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."— Presentation transcript:

1 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; 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

2 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), 5 th ed., 1997. 2. Neville and Damm et al: Oral & maxillofacial patholgy, 3 rd ed. 3. 口腔病理科門診臨床記錄

3 WenChen Wang Bony Lesions Radiolucent Contacting toothNot contacting tooth Periapical Pericoronal Inter-radicular Solitary cystlike Multilocular Multiple, separate Solitary-ragged Generalized rarefaction Radiolucent mixed with radiopaque Radiopaque ★ ★

4 WenChen Wang Cystlike lesion  Dark radiographic image, circular in outline and usually smoothly contoured with well-defined borders Ref. 1

5 WenChen Wang Marrow spaces Ref. 1

6 WenChen Wang Maxillary sinus Ref. 1

7 WenChen Wang Ref. 1

8 WenChen Wang Early stage of tooth crypt Postextraction socket Ref. 1

9 WenChen Wang Residual cyst -Cyst remained after its associated tooth has been lost -Age >20 y/o -Surgical intervention Ref. 1

10 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

11 WenChen Wang Q: A 40y/o male, a tooth removed due to hypermobility, what were the possible diagnosis ? Ref. 1

12 WenChen Wang Multilocular RL, bony expansion Ref. 2

13 WenChen Wang Stafne cyst; static bone cyst Lingual mandibular bone defect - A well-defined RL in the post. Region under mandibular canal Ref. 1

14 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

15 WenChen Wang Ameloblastoma-unicystic  Mean age:23 y/o  90% in mandible, posterior region Ref. 1

16 WenChen Wang practice  21 y/o male  2x1.5 cm cystlike RL lesion over an edentulous 3 rd 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 Ref. 3

17 WenChen Wang Surgical defect Ref. 1

18 WenChen Wang  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

19 WenChen Wang  R ange 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 expanded border Multilocular RL, bony expansion Central giant cell granuloma Ref. 2

20 WenChen Wang Giant cell lesion Hyperparathyroidism  Diagnosis based on history and laboratory findings Ref. 2

21 WenChen Wang Secondary Hyperparathyroidism Chronic Renal Failure Phosphate active VitD3 calcium Retention ↑ production↓ resorption ↓ Hypocalcemia PTH↑

22 WenChen Wang Fibroosseous lesion  Early : Unilocular RL  Later : Mixed RL with RO or RO Early stage of a COF

23 WenChen Wang Incisive canal cyst  Enlargement of the Incisive foramen & canal, > 1cm Ref. 2 Ref. 1

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

25 WenChen Wang Benign nonodontogenic tumors as radiolucencies in the jaws  Lipoma  Salivary gland tumors  Amputation neuroma  Neurofibroma, schwannoma  Leiomyoma  Fibroma Ref. 1

26 WenChen Wang Metastatic bronchogenic carcinoma Ref. 1

27 WenChen Wang Aneurysmal bone cyst Multilocular RL, bony expansion Unilocular RL  90% Max.  Proliferative response of vascular tissue  R-L, expansile osteolytic process Ref. 2 Ref. 1 Ref. 2

28 WenChen Wang Typical locations of odontogenic and nonodontogenic cysts Summary Ref: Essentials of Dental Radiography and Radiology, 4th edition, 2007

29 WenChen Wang Multilocular radiolucencies Soap bubble HoneycombTennis racket Ref. 1, 3

30 WenChen Wang Maxillary sinus Ref. 1

31 WenChen Wang Marrow spaces Ref. 1

32 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

33 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

34 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

35 WenChen Wang 32 y/o male, ameloblastoma Ref. 3

36 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

37 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

38 WenChen Wang Odontogenic myxoma, tennis racket appearance Ref. 2

39 WenChen Wang Cherubism  Inherited developmental abnormality, only affects the jaws, cherubic appearance  Age: 2-20 y/o  Multiple multilocular RL Ref. 2

40 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

41 WenChen Wang Central Odontogenic Fibroma large lesion: multilocular radiolucencies. Many lesions have sclerotic border, root resorption or root divergence Ref. 2

42 WenChen Wang 16 y/o boy, severe hemophilia 23 y/o, hemophilia, condyle, ramus, coronoid process Ref. 1

43 WenChen Wang Intrabony neurilemoma Ref. 1

44 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

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