Mixed radiolucent-radiopaque lesions

Question 1

oBenign odontogenic tumor
oConsists of highly cellular, fibrous tissue that contains varying amounts of
mineralized tissue (abnormal bone and/or cementum)
oSlow growing, asymptomatic (at the time of discovery) and expansile.
oFacial asymmetry (occasionally)
oYoung adults (20-30 years of age)
oFemales> 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)

Answer 1

Cemento-ossifying fibroma

AKA: Ossifying fibroma, cementifying fibroma.

Question 2

Imaging features:
oMost commonly in the mandible.
oIf in the mandible: Inferior to the premolars and molars
and superior to the inferior alveolar canal.
oIf 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.

Answer 2

Cemento-ossifiying fibroma

Question 3

oEffects on the surrounding tissues:
oConcentric growth (equal in all directions)
oThinning and displacement of the bone cortices (remaining
intact)
oDisplacement of the IAC and teeth. Root resorption may occur.
oThe 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

Answer 3

Cemento-ossifying fibroma

Question 4

oInternal structure: Mixed radiopaque-radiolucent. Could be totally radiolucent.
The amount of mineralized tissue will determine the amount of radiopacities.
oCortical expansion but does not perforate
oCan grow into and occupy the entire maxillary sinus
Treatment
oEnucleation or resection
oUnlikely recurrence

Answer 4

Cemento-ossifying fibroma

Question 5

oAtypical 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)
oAffects 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
Management:
oRoot canal treatment or extraction
oSurgical

Answer 5

Garre’s osteomyelitis

Question 6

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
oRapid enlarging swelling, painless*, tenderness, erythema of the overlying mucosa, ulceration,
loose teeth, non healing extraction site, epistaxis, hemorrhage, nasal obstruction,
exophthalmos, trismus, parethesia and blindness.
oMandible more affected than maxilla, mostly posterior areas.
oPoorly defined borders and no cortication. Cortical destruction may be seen (soft tissue
invasion). We may see irregular widening of the PDL.
oInternal structure: radiolucent, radiopaque, mixed. Will depend on the ability to produce bone.
oSunray periosteal reaction

Management:
oSurgery, radiation therapy, and
chemotherapy alone or in
combination.

Answer 6

Osteosarcoma

Question 7

o________ is a malignant tumor of mesenchymal origin that produces
cartilage. Rare on the jaws (10% of all chondrosarcomas)
oOccur 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)
oIf occurring in the TMJ: pain, trismus and/or abnormal joint function

Answer 7

Chondrosarcoma

Question 8

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

Answer 8

Chondrosarcoma

Question 9

oRare (1% of benign odontogenic tumors)
oMen > women, African Americans
o8-92 years of age. Mean 42 years of age
oProduce a mineralized substance.
oJaw expansion, hard on palpation (usually the only sign)
oMandible > maxilla (2:1). Premolar-molar area (52% association with the
crown of an unerupted/impacted tooth)
oWell-defined and corticated periphery. Cortical displacement.

oMay be unilocular or multilocular 
oTooth displacement
oPrevention of eruption
Treatment
oLocal resection

Answer 9

Calcifying Epithelial Odontogenic

Tumor (CEOT)

Question 10

Clinical/Radiographic Features:

oRare (<1% of jaw lesions)
oWell 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.

o20-50% is pericoronal to an unerupted or 
impacted tooth (mostly when in the 
anterior area).
oMaxilla = Mandible
oAnterior>Posterior
o75% anterior to 1st molar
oWide age range (average teens and young 
adults)

Treatment:
oEnucleation and curettage

Answer 10

Calcifying Odontogenic Cyst (COC)

oAKA: Gorlin cyst.