mixed radiolucent/opaque lesions

Question 1

Ossifying fibroma
B/M?
o Consists of?
o growth? symptoms? expansion?
o Facial app?
o ages?
o gender?
oJuvenile ossifying fibroma?

Answer 1

Benign odontogenic tumor
o Consists of highly cellular, fibrous tissue that contains varying amounts of mineralized tissue (abnormal bone and/or cementum)
o Slow growing, asymptomatic (at the time of discovery) and expansile.
o Facial asymmetry (occasionally)
o Young adults (20-30 years of age)
o Females> males
oJuvenile ossifying fibroma is a very aggressive form of ossifying fibroma that occurs in the first 2 decades of life (more expansile and rapid growth)

Question 2

Answer 2

ossifying fibroma

Question 3

Ossifying fibroma Imaging features:
oMost commonly in the?
o If in the mandible:
o If in the maxilla:
oPeriphery:

Answer 3

oMost commonly in the mandible.
o If in the mandible: Inferior to the premolars and molars
and superior to the inferior alveolar canal.
o If in the maxilla: it occurs most often in the canine
fossa and zygomatic process of the maxilla area.
oPeriphery: Well-defined and the cortical borders may
appear thickened.

Question 4

Answer 4

ossifying fibroma

Question 5

Ossifying fibroma Effects on the surrounding tissues:

Answer 5

o Concentric growth (equal in all directions)
o Thinning and displacement of the bone cortices (remaining intact)
o Teeth displacement (missing lamina dura)
o Displacement of the IAC and teeth. Root resorption may occur

Question 6

oss fibroma internal pattern

Answer 6

The internal pattern may be very similar to fibrous dysplasia. One distinguishing feature that may be present is a soft tissue capsule at the periphery not seen in fibrous dysplasia

Question 7

Answer 7

oss fibroma

Question 8

Ossifying fibroma
oInternal structure:

Answer 8

oInternal structure: Mixed radiopaque-radiolucent. Could be totally radiolucent. The amount of mineralized tissue will determine the amount of radiopacities

Question 9

oss fibroma tx

Answer 9

oEnucleation or resection
oUnlikely recurrence

Question 10

Answer 10

juvenile oss fibroma

Question 11

Answer 11

oss fibroma

Question 12

Garre’s osteomyelitis
o def?
o demo?
oMost common site in the head and neck?
oMay cause?

Answer 12

o Atypical chronic osteomyelitis with prominent periosteal reaction. Hypothesis: Initiated by bacterial infection but after time the infection resolves but the bone inflammation persists (usually no bacteria detected at the time of the culture)
o Affects children, mean age of 12 years (below 30). Slight male predominance
oMost common site in the head and neck is the mandible
oMay cause facial asymmetry and pain is uncommon. Fever, lymphadenopathy, and leukocytosis may be present

Question 13

Answer 13

garres osteomyelitis

Question 14

Answer 14

garres osteomyelitis

Question 15

Answer 15

garres osteomyelitis

Question 16

in a teenager, likely dx?

Answer 16

garres

Question 17

Osteosarcoma
o def?
o demo?
o s/s?
o more cmmon arch/area?
o broders/cortex? pdl?
oInternal structure:

Answer 17

oMalignant neoplasm of osteoblasts in which osteoid is produced by the malignant cells. Rare on the jaws (7% of all osteosarcomas)

oMale : female 2:1. Peak in the fourth decade.

o Rapid enlarging swelling, pain, tenderness, erythema of the overlying mucosa, ulceration,
loose teeth, non healing extraction site, epistaxis, hemorrhage, nasal obstruction, exophthalmos, trismus, parethesia and blindness.

o Mandible more affected than maxilla, mostly posterior areas.
o Poorly defined borders and no cortication. Cortical destruction may be seen (soft tissue
invasion). We may see irregular widening of the PDL.

o Internal structure: radiolucent, radiopaque, mixed. Will depend on the ability to produce bone.

Question 18

unique radio finding of osteosarcomas?

Answer 18

sunray periosteal reaction

Question 19

Answer 19

osteosarcoma

Question 20

osteosarcoma management

Answer 20

Surgery, radiation therapy, and chemotherapy alone or in combination

Question 21

Answer 21

osteosarcoma

Question 22

Chondrosarcoma
o def?
o age/sex?
o mnan/max?
oThe tumors are covered with?
oPatient may have a?
o If occurring in the TMJ:

Answer 22

o Chondrosarcoma is a malignant tumor of mesenchymal origin that produces cartilage. Rare on the jaws (10% of all chondrosarcomas)

o Occur in any age (mean age, 47 years). Males and females affected equally.

oAffects maxilla and mandible equally (in areas where cartilage may be present)

oThe tumors are covered with normal overlying skin or mucosa unless secondarily ulcerated.

oPatient may have a painless hard mass of relatively long duration (slow growing)= May be well defined and corticated at times (this may be misleading to think it may be a benign entity)

o If occurring in the TMJ: pain, trismus and/or abnormal joint function

Question 23

Answer 23

chondrosarcoma

Question 24

Answer 24

chondrosarcoma

Question 25

Chondrosarcoma Internal Structure:
o Usually exhibit some form of?
o Internal calcifications:

Answer 25

o Usually exhibit some form of internal calcification, giving them a mixed radiolucent and radiopaque appearance. The internal pattern may be quite variable.
o Internal calcifications: areas of unaffected bone or produced by the malignant cells

Question 26

chondrsarcoma management

Answer 26

surgical resection

Question 27

Calcifying Epithelial Odontogenic Tumor (CEOT)
o AKA:
o Rare?
o sex/race?
o ages?
o Produce a?
o Jaw expansion? palpation?
o arches/teeth?
o periphery/cotex?

Answer 27

o AKA: Pindborg Tumor
o Rare (1% of benign odontogenic tumors)
o Men > women, African Americans
o 8-92 years of age. Mean 42 years of age
o Produce a mineralized substance.
o Jaw expansion, hard on palpation (usually the only sign)
o Mandible > maxilla (2:1). Premolar-molar area (52% association with the crown of an unerupted/impacted tooth)
o Well-defined and corticated periphery. Cortical displacement

Question 28

Answer 28

CEOT

Question 29

Answer 29

CEOT (lucent type)

Question 30

Answer 30

CEOT

Question 31

Answer 31

CEOT

Question 32

Calcifying Epithelial Odontogenic
Tumor (CEOT) appearences/ radio

Answer 32

o May be unilocular or multilocular
o Tooth displacement
o Prevention of eruption

Question 33

Answer 33

CEOT

Question 34

Calcifying Odontogenic Cyst (COC)
Clinical/Radiographic Features:
o AKA:
oRare?
o radio app?
oCan be? or?
o symptoms/growth?
o roots/teeth?

Answer 34

o AKA: Gorlin cyst.
oRare (<1% of jaw lesions)
o Well defined, corticated and can be uni or multilocular.
oCan be totally radiolucent or present internal calcifications (50%)
oAsymptomatic swelling, loosening of teeth or incidental finding. Slow growing.
oCan resorb roots and displace teeth.

Question 35

Answer 35

COC

Question 36

Calcifying Odontogenic Cyst (COC)
o20-50% is?
o where in arches is more common? %?
o ages?

Answer 36

o20-50% is pericoronal to an unerupted or impacted tooth (mostly when in the anterior area).
o Anterior>Posterior
o 75% anterior to 1st molar
o Wide age range (average teens and young adults)

Question 37

Answer 37

COC

Question 38

Answer 38

COC

Question 39

Answer 39

COC

Question 40

COC tx

Answer 40

enucleation