Analytic/Systemic Strategy Flashcards
What may you use to describe features?
- Location
- Shape and Size
- Internal Structure
- Effect on Surrounding Structures
Definition: Generalized
Abnormal portion affects all (most) of the osseous structures of the maxillofacial region
Definition: Localized
- Unilateral
- Bilateral
How does position of lesion in jaws aid diagnostic process?
- Determining the center of the location
- Some lesions tend to be found in specific locations
Where are the different origin centers of lesions and what origin are they?
- Coronal to tooth: Odontogenic origin
- Above IAC: Odontogenic origin
- Below IAC: Not odontogenic origin
- W/in IAC: Probably neural or vascular
- Condylar areas: Cartilaginous lesions
- MX sinus: Epithelial origin
- Lined w/ pseudostratified ciliated columnar epithelium
How may lesion size aid in forming a differential dx?
- Lesions can grow to any size
- Odontomas: Stop growing so they don’t reach any size
- Dentigerous cysts vs. Hyperplastic follicle
Different lesion shapes?
- Hydraulic: Somewhat circular; appears to be fluid-filled or inflated balloon
-
Scalloped: Series of contiguous arcs or semicircles
- Do not confuse for multilocular; multilocular lesions are often scalloped
Poorly defined borders
Difficult to draw exact delineation around most of an ill-defined periphery
Various types of well-defined borders
- Corticated
- Non-corticated or punched out
- ST capsule
Definition: Well-defined borders
- Imaginary pencil can draw the limits of the lesion
- Don’t confuse well-defined for corticated; corticated lesions are not often well-defined, but well-defined are corticated
Definition: Corticated
Uniform RO line at the periphery of lesion
- Displayed w/ thin RO border
- All of the outside of the MN is corticated
- B & L plates are corticated
Definition: Non-corticated
Sharp boundary w/ narrow transition; no bone rxn seen
- No RO border
Definition: ST capsule
RL line at periphery; may be seen in conjunction w/ corticated periphery
Definition: Blending borders
-
Sclerotic: Wider zone of transition w/ thick RO border of reactive bone
- RL border at the apex, but it isn’t well-defined and looks like a paint brush and not a sharpie
What type of lesions are totally RL?
Usually cysts
What type of lesioons are totally RO?
Certain bone lesions
What lesions are mixed RL/RO?
Tumor or cyst that produces calcified material
Increasing RO
Air, fat, gas < Fluid < ST < Bone marrow < Trabecular bone < Cortical bone & dentin < Enamel < Metal
Abnormal trabecular patterns
Variation of number, length, width, and orientation of trabeculae
Internal septation
- Long strands of bone or walls w/in a lesion
- Well-defined, corticated, but internally, it still has all these RO lines that look like bubbles (septations), walls of bone
Multilocular
Internal structure divided into different compartments/cavities
Unilocular
Singular compartment
At what point would a mixed lesion be considered RO (radiographically)?
- Mixed <1-90% - RO
- RO >90% RO material
What lesions are space-occupying lesions?
Cysts & tumors
- Tumors: Solid mass
- Cysts: Lining and center is often filled w/ fluid or debris
Because they are space occupying, they can have effects on surrounding structures.
Lesions can displace, resorb, expand, or destroy these structures
In which direction do odontogenic lesions displace teeth? In which direction do bone lesions & hematopoietic lesions displace teeth?
- Odontogenic: Displace tooth apically
- Bone lesions, hematopoietic lesions: Displace tooth coronally
What type(s) of lesions may cause directional resorption?
Benign tumors/cysts
What types of lesions may cause non-directional resorption?
Malignant tumors
Orthodontic movement vs. Malignant lesions
- Orthodontic movement: Uniform widening w/ lamina dura intact
- Malignant lesions: Irregular widening & destruction of lamina dura
What types of lesions cause expansion? What types of lesions cause perforation?
- Expansion: Slowly growing lesions; cysts & tumors
- Perforation: Rapidly growing lesions; malignancies
Reactive lesions
- Life periosteium off of the cortical bone and stimulate osteoblasts to lay down new bone
- Inflammatory lesions but also tumors
Growth characteristics of slowly growing lesions
- Sharply demarcated borders
- Corticated borders (sometimes)
- Displaces normal anatomical structures
- Expands rather than perforates cortical plate
- Overlying mucosa is normal
- Pain or paresthesia is uncommon
Growth characteristics of rapidly/aggressively growing lesions
- Poorly demarcated borders
- Destroys normal anatomical structures
- Perforation of cortical plate more common
- Crepitus during palpation more common
- Ulceration of overlying mucosa more common
- Pain or paresthesia more common
Odontogenic
- Lesions (cysts, tumors) derived from cells that produced teeth
- Lesions originate and are centered in teeth bearing areas
- Lesions may extend to non-odontogenic regions
- Above IA canal
- IAC displaced inferiorly
- Originate where teeth normally are
- The RL is from salivary glands
- Ghost images from overlap
Non-Odontogenic
- Lesions derived from bone, vasculature, nerve, or sinus
- Lesions may in non-tooth bearing areas, however often may arise in teeth bearing areas
- Bone origin
- Sinus origin
- IA canal origin
- Neural/vascular
Inflammatory lesion characteristics
- Focal
- Poorly defined borders
- Pain is variable
- Often, not always, surrounded by sclerotic bone
- Systemic manifestation: Fever, malaise, leukocytosis, tender lymphadenopathy
- Widespread
- Poorly defined borders
- Pain is variable
- Often, not always, surrounded by sclerotic bone
- May appear “moth-eaten”
- Irregulalr patches of osteolysis surrounded by denser sclerotic bone
Cyst features
- Slow growth
- Features
- Usually well-defined
- Corticated borders common
- Hydraulic appearance on rads
- Can cause expansion
- May arise from odontogenic or non-odontogenic epithelium
- May resemble tumor radiographically
- All cysts are RL, except for ONE **COC**
Features of benign tumors
- Slow growth
- Features
- Well-defined
- Usually corticated
- Displace structures
- Can cause expansion
- Malignant odontogenic tumors are RARE
Features of malignant tumors
- Poorly defined; destroys anatomical structures
- Most common malignant neoplasm of jaw: metastatic carcinoma
- Lymph nodes are nontender, hard, fixed
- May present as toothache
- Rad
- Poorly defined
- Widens PDL space irregularly
- Irregular (vertical or non-directional) resorption of roots
- May cause expanion but will perforate cortex
Rationale to submit biopsy
All biopsies should be sent for pathologic dx
- Establish a definitive dx
- Confirm provisional clinical dx
- Establish the adequacy of surgical margins
- Obtain information to help in disease management
- Acquire knowledge on clinical behavior & px
- Substantiate pt records in medico-legal context
Enucleation
Removal of lesion only
Curettage
Removal of lesions and some surrounding bone w/ hand instrument
Peripheral ostectomy
Removal of lesion and some surrounding bone w/ rotary instrument
En bloc resection/segmental resection
Resection of lesion & bone w/ clear margin
Decompression/Marsupialization
Used to decrease size of cysts
- Decompression: Making small opening in the cyst and keeping it open w/ a drain
- Marsupialization: Converts cyst into pouch
