Mixed radiolucent radiopaque lesions

Question 1

Ossifying fibroma
Benign odontogenic tumor
o Consists of (2) that contains varying amounts of —
o speed, symptoms, etc
o
o Age
o Gender

Answer 1

highly cellular, fibrous tissue; mineralized tissue (abnormal bone and/or cementum)
Slow growing, asymptomatic (at the time of discovery) and expansile.
Facial asymmetry (occasionally)
Young adults (20-30 years of age)
Females> males

Question 2

Ossifying fibroma
Juvenile ossifying fibroma is a

Answer 2

very aggressive form of ossifying fibroma that
occurs in the first 2 decades of life (more expansile and rapid growth)

Question 3

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

Answer 3

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

Question 4

Ossifying fibroma
oEffects on the surrounding tissues:
(4)

Answer 4

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 5

Ossifying fibroma
The internal pattern may be very similar to

Answer 5

fibrous dysplasia. One
distinguishing feature that may be present is a soft tissue capsule
at the periphery not seen in fibrous dysplasi

Question 6

Ossifying fibroma
oInternal structure:

Answer 6

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

Question 7

Ossifying fibroma
Treatment
(2)

Answer 7

oEnucleation or resection
oUnlikely recurrence

Question 8

Garre’s osteomyelitis
o What?
o Hypothesis:

Answer 8

Atypical chronic osteomyelitis with prominent periosteal reaction

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)

Question 9

Garre’s osteomyelitis
o Affects
oMost common site in the head and neck is the
oMay cause — and — is uncommon. (3) may be present

Answer 9

children, mean age of 12 years (below 30). Slight male predominance
mandible
facial asymmetry; pain; Fever, lymphadenopathy, and leukocytosis

Question 10

Garre’s osteomyelitis
Management:
(2)

Answer 10

o Root canal treatment or extraction
o Surgical

Question 11

Osteosarcoma
oMalignant neoplasm of — in which — is produced by the malignant cells. Rare
on the jaws (–% of all osteosarcomas)

Answer 11

osteoblasts
osteoid
7

Question 12

Osteosarcoma
o gender and age
o symptoms
o where
o reaction

Answer 12

Male : female 2:1. Peak in the fourth decade.
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.
Mandible more affected than maxilla, mostly posterior areas.
Sunray periosteal

Question 13

Osteosarcoma
o borders
We may see irregular
oInternal structure:

Answer 13

Poorly defined borders and no cortication. Cortical destruction may be seen (soft tissue
invasion).
widening of the PDL.
radiolucent, radiopaque, mixed. Will depend on the ability to produce bone.

Question 14

Osteosarcoma
Management:

Answer 14

o Surgery, radiation therapy, and
chemotherapy alone or in
combination.

Question 15

Chondrosarcoma
oChondrosarcoma is a malignant tumor of — origin that produces —. Rare on the jaws (–% of all chondrosarcomas)

Answer 15

mesenchymal
cartilage
10

Question 16

Chondrosarcoma
o age gender
o where
oThe tumors are covered with normal overlying skin or mucosa unless

Answer 16

Occur in any age (mean age, 47 years). Males and females affected equally.
Affects maxilla and mandible equally (in areas where cartilage may be present)
secondarily ulcerated.

Question 17

Chondrosarcoma
oPatient may have a
May be

Answer 17

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

Question 18

Chondrosarcoma
oIf occurring in the TMJ: (3)

Answer 18

pain, trismus and/or abnormal joint function

Question 19

Chondrosarcoma
Internal Structure:

o Internal calcifications:

Answer 19

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

Question 20

Chondrosarcoma
Management:
(1)

Answer 20

o Surgical resection.

Question 21

Calcifying Epithelial Odontogenic
Tumor (CEOT)
o AKA:
o %
o gender, race
o age
o Produce a — substance.
o usually the only sign…
o where
o periphery

Answer 21

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

Question 22

Calcifying Epithelial Odontogenic
Tumor (CEOT)
(3)

Answer 22

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

Question 23

Calcifying Epithelial Odontogenic
Tumor (CEOT)
Treatment

Answer 23

o Local resection

Question 24

Calcifying Odontogenic Cyst (COC)
Clinical/Radiographic Features:
o AKA: Gorlin cyst.
o %
o periphery
o RO, RL, mixed?
o symptoms (4)
oCan

Answer 24

Rare (<1% of jaw lesions)
Well defined, corticated and can be uni or multilocular.
Can be totally radiolucent or present internal calcifications (50%)
Asymptomatic swelling, loosening of teeth or incidental finding.
Slow growing.
resorb roots and displace teeth.

Question 25

Calcifying Odontogenic Cyst (COC)
o —% is pericoronal to an unerupted
or impacted tooth (mostly when in the
anterior area)

Answer 25

20-50

Question 26

Calcifying Odontogenic Cyst (COC)
where
age

Answer 26

oAnterior>Posterior
o 75% anterior to 1st molar
oWide age range (average teens and
young adults)

Question 27

Calcifying
Odontogenic Cyst (COC)
Treatment:
o

Answer 27

Enucleation