1. 1. Solitary cystlike Radiolucencies not necessarily contacting teeth
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 ;

2. 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。 3.口腔病理科門診臨床記錄
學習資源及主要圖片引用: 1. Differential diagnosis of oral lesion. Wood, Gooz(Mosby), 5th ed., Neville and Damm et al: Oral & maxillofacial patholgy, 3rd ed.
3.口腔病理科門診臨床記錄

3. Radiolucent mixed with radiopaque Generalized rarefaction
Bony Lesions
Radiopaque
Radiolucent mixed with radiopaque
Radiolucent
Contacting tooth
Not contacting tooth
Inter-radicular
Periapical ★
Solitary cystlike ★
Pericoronal
Multilocular
Solitary-ragged
Multiple, separate
Generalized rarefaction

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

5. Marrow spaces
Ref. 1

6. Maxillary sinus
Ref. 1

7. Ref. 1

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

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

10. Traumatic bone cyst Ref. 1 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. Q: A 40y/o male, a tooth removed due to hypermobility,
what were the possible diagnosis ?
Ref. 1

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

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

14. 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

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

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

17. Surgical defect
Ref. 1

18. 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

19. Central giant cell granuloma
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 granuloma

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

21. Secondary Hyperparathyroidism
Chronic Renal Failure
Phosphate active VitD calcium
Retention ↑ production↓ resorption ↓
Hypocalcemia
PTH↑
Secondary Hyperparathyroidism

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

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

24. Midpalatine cyst; median palatal cyst
Ref. 1

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

26. Metastatic bronchogenic carcinoma
Ref. 1
Metastatic bronchogenic carcinoma

27. Multilocular RL, bony expansion
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

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

29. Multilocular radiolucencies
Soap bubble
Honeycomb
Tennis racket
Ref. 1, 3

30. Maxillary sinus
Ref. 1

31. Marrow spaces
Ref. 1

32. Nonodontogenic cyst(pseudocyst):
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. 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

34. 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. 2
Ref. 1

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

36. Ameloblastic fibroma Ref. 3 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. 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

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

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

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

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

43. Intrabony neurilemoma
Ref. 1
Intrabony neurilemoma

44. Multilocular radiolucencies
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