Mixed Radiolucent Radiopaque Lesions

Question 1

describe ossifying fibroma and its predilection

Answer 1

• benign odontogenic tumor
  -consists of highly cellular fibrous tissue that contains varying amounts of mineralized tissue
• slow growing, asymptomatic and expansile
• facial asymmetry
• young adults 20-30 years of age
• females > males
• juvenile ossifying fibroma

Question 2

describe juvenile ossifying fibroma

Answer 2

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

Question 3

what are the imaging features of ossifying fibroma

Answer 3

• most common in mandible
• if in mandible: inferior to the premolars and molars and superior to the inferior alveolar canal
• if in the maxilla: occurs most often in the canine fossa and zygomatic process of the maxilla area
• periphery: well defined and the cortical borders may appear thickened

Question 4

what are the effects of ossifying fibroma on surrounding tissues

Answer 4

• concentric growth (equal in all directions)
• thinning and displacement of the bone cortices- intact
• teeth displacement - missing lamina dura
• displacement of the IAC and teeth, root reosprtion may occur

Question 5

describe the internal structure of ossifying fibroma

Answer 5

mixed RO- RL. could be totally RL
- the amount of mineralized tissue determine the amount of RO

Question 6

what is the difference between fibrous dysplasia and ossifying fibroma

Answer 6

• a soft tissue capsule at periphery seen in ossifying fibroma
• ossifying fibroma does not keep shape of surrounding tissues but fibrous dysplasia does

Question 7

what is the tx for ossifying fibroma

Answer 7

• enucleation or resection
• unlikely to recur

Question 8

what is Garre’s osteomyelitis

Answer 8

-atypical chronic osteomyelitis with prominent periosteal reaction

Question 9

what is the hypothesis of Garre’s osteomyelitis cause

Answer 9

initiated by bacterial infection but after time the infection resolves but the bone inflammation persists
- bacteria are not detected usually at the time of culture

Question 10

what are the features of Garre’s osteomyelitis and what is the predilection

Answer 10

• affects children, mean age of 12 years, slight male predominance
• most common site in the head and neck is the mandible
• may cause facial asymmetry and pain is uncommon, fever, lymphadenopathy, and leukocytosis may be present
• sequestrum

Question 11

what is the management for Garre’s osteomyelitis

Answer 11

root canal treatment or extraction
- surgical

Question 12

describe osteosarcomas

Answer 12

• malignant neoplasm of osteoblasts in which osteoid is produced by the malignant cells
• rare on the jaws - 7% of osteosarcomas

Question 13

what features are seen in osteosarcoma

Answer 13

• rapid enlarging, swelling, pain, tenderness, erythema of overlying mucosa, ulceration, loose teeth, non healing extraction site, epistaxis, hemorrhage, nasal obstruction, exopthalmos, trismus, paresthesia and blindness
• poorly defined borders and no cortication. cortical destruction may be seen. irregular widening of the PDL
• sunray periosteal reaction

Question 14

what is the predilection for osteosarcoma

Answer 14

• male: female 2:1 peak in fourth decade
• mandible >maxilla
• mostly posterior areas

Question 15

what is the internal structural of osteosarcoma

Answer 15

RL, RO, mixed. will depend on ability to produce bone

Question 16

what is the mangement for osteosarcoma

Answer 16

• surgery , radiation therapy, and chemotherapy alone or in combination

Question 17

what is a chondrosarcoma

Answer 17

a malignant tumor of mesenchymal origin that produce cartilage
- rare on the jaws - 10%of all chondrosarcomas

Question 18

what is the predilection for chondrosarcoma

Answer 18

• occur in any age - mean age: 47 years
• males = females
• affects maxilla and mandible equally

Question 19

what are the features of chondrosarcoma

Answer 19

• tumors are covered with normal overlying skin or mucosa unless secondarily ulcerated
• patient may have a painless hard mass of relatively long duration (Slow growing)
• may be well defined and corticated at times
• if occuring in the TMJ: pain, trismus and/or abnormal joint function

Question 20

what is the internal structure of chondrosarcoma

Answer 20

• usually some form of internal calcification, giving them a mixed RL and RO appearance. the internal pattern may be variable
• internal calcifications: areas of unaffected bone or produced by the malignant cells

Question 21

what is the management of chondrosarcoma

Answer 21

surgical resection

Question 22

what is another name for the calcifying epithelial odontogenic tumor (CEOT)

Answer 22

Pindborg tumor

Question 23

what is the predilection for the CEOT and features

Answer 23

• men >women, african americans
• 8-92 years of age. mean = 42 years
• produce a mineralized substance
• jaw expansion, hard on palpation
• mandible > maxilla 2:1
• premolar- molar ares - 52% association with the crown of an unerupted/impacted toth
• well defined and corticated periphery. cortical displacement

Question 24

what is the radiographic presentation of CEOT

Answer 24

• unilocular or multilocular
• tooth dispalcement
• prevention of eruption

Question 25

what is the tx for CEOT

Answer 25

local resection

Question 26

what are the clinical/radiographic features of calcifying odontogenic cyst and its other name

Answer 26

• gorlin cyst
• rare
• well defined, corticated and can be uni or multilocular
• can be totally RL or present internal calcifications (50%)
• asymptomatic swelling, loosening of teeth or incidental finding, slow growing
• can resorb and displace teeth

Question 27

where is COC found

Answer 27

anterior > posterior
75% anterior to 1st molar

Question 28

what is the age range for COC

Answer 28

wide age range- average teens and young adults

Question 29

_____ is pericoronal to an unerupted or impacted tooth in COC

Answer 29

20-50%

Question 30

what is the treatment for COC

Answer 30

enucleation