Multiloc Radio Flashcards
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Multilocular Radiolucencies
(7)
- Ameloblastoma
- Odontogenic Keratocyst
- Central Giant Cell Granuloma
- Odontogenic Myxoma
- Vascular Lesions - Hemangioma
. A-V aneurysm - Familial Fibrous Dysplasia
Ameloblastoma
(2)
Benign odontogenic neoplasm; one of very few true odontogenic neoplasms
Capable of uncontrolled, unlimited
growth potential
Ameloblastoma
Classified into:
(2)
- Conventional (Multicystic)
Ameloblastoma - Unicystic Ameloblastoma
Conventional (Multicystic)
Ameloblastoma
* Account for —% of all ameloblastomas
* — histologic sub-types;
85 – 90
Five
Five histologic sub-types;
- follicular - most common
- also have plexiform, acanthomatous,
granular, desmoplastic and basaloid
Ameloblastoma
Conventional
(3)
- Usually slow painless swellings
- Small lesions only detected by
radiographs - Larger lesions detected clinically
Ameloblastoma
Conventional
Radiographic
(4)
- Small lesions are
unilocular with
corticated borders - Large, aggressive
lesions develop
multilocular patterns - Displace and resorb
teeth - expansive
Ameloblastoma
Conventional
Age
Site
Gender Predilection
Mainly adults – equal prevalence in 3’rd to 7’th decade
Uncommon in 2’nd decade
Rare in 1’st decade
mandible (85%); maxilla (15%)
none
Ameloblastoma
Management
Other
Large lesions are aggressive requiring bone
resection
Higher likelihood for recurrence.
Ameloblastoma
Management
Other
Block or marginal resection; ie resect >1.0cm
past radiographic limits of tumor
15% recurrence
50-90% recurrence if not resected
Rare to be malignant
Unicystic Ameloblastoma
(3)
- arise within a cyst lining; either luminal,
intraluminal or mural - less aggressive form of ameloblastoma
- Recurrence rates of 10-20%
Ameloblastoma
Radiographic
(1)
- expansive
Ameloblastoma
unicystic
Age
Site
Mandible (–%)
Maxilla (–%)
Mean age 23 years
90, 10
Odontogenic Keratocyst
Pathophysiology
(3)
- 10-12% of all odontogenic cysts; 3’rd
highest oral cyst frequency - aggressive cysts; behave more like
benign neoplasms - thought to arise from cell rests of dental
lamina
OKC
Clinical
(2)
- Normally asymptomatic
- With increasing size, pain, swelling and
exudate may oocur
OKC
Radiographic
(5)
- Well-defined, smooth,
corticated borders - Thinning and mild
expansion with
occasional perforation
of cortical plates - Displacement of teeth
- *only occasional
root resorption
(< dentigerous and
< radicular cysts) - *mild B-Li
expansion; but
extensive antero-
posterior extension
Odontogenic Keratocyst
Age
Site
Gender
Majority (i.e., 60%) in 2nd and 4th decade
Majority (60-80%) affect mandible posterior to the
canines
Male predilection
Odontogenic Keratocyst
Management
Other
Enucleation with curettage
- High recurrence rate; some rates
reported @ 47 and 62% (probably
parakeratinized variants)
Odontogenic Keratocyst
Other
* When multiple OKCs are found they
may constitute part of the
basal cell
nevus syndrome (a.k.a. nevoid basal
cell carcinoma syndrome)
Nevoid basal cell carcinoma syndrome
(6)
- multiple basal CA’s of skin
- Palmar and plantar pitting (60%)
- > 1 OKC (KOT) of jaws (75%)
- Bifid or splayed ribs (60-75%)
- Kyphoscoliosis (50%)
- Skull anomalies:
Skull anomalies:
(4)
- frontal and parietal bossing
- hypertelorism
- intracranial calcifications;
- majority are of falx cerebri
Central Giant Cell
Granuloma
Clinical
(2)
- Asymptomatic swelling
- Can be aggressive
Central Giant Cell
Granuloma
Radiographic
(4)
- Well-defined
borders - Can be multilocular
- Thinning and
expansion of cortical
plates - Displacement of
teeth and occasional
root resorption
Central Giant Cell
Granuloma
Age
Site
Gender
Usually < 30 years (60%)
mandible (70%) & frequently between the
molars
Female > male (2:1)
Central Giant Cell
Granuloma
Management
Other
Enucleation with aggressive curretage
- Lesion is histologically similar to the Brown
tumor of primary hyperparathyroidism
Central Giant Cell
Granuloma
Other
- Patients with the CGCG should be evaluated to
rule out hyperparathyroidism
Screening test in the appropriate blood studies:
– serum calcium
– alkaline phosphatase
– serum phosphorus
increase
increase
decrease
Odontogenic Myxoma
Clinical
(2)
- Primarily a lesion of alveolar bone
- Basically a fibrous lesion
Odontogenic Myxoma
Radiographic
Scalloped and
multilocular
Odontogenic Myxoma
Age
Site
Young to adults (25 – 30 years)
Greater prevalence in mandible
Odontogenic Myxoma
Management
Other
Excision
Recurrence up to 25% because the lesions are
not encapsulated.
Central Hemangioma
Clinical
* — are next most common site after skull and
vertebrae
* Firm, slow-growing — expansion
* Overlying mucosa is more
* Spontaneous
* — on diascopy and — sensation may be
detected
* Many require — to assist diagnosis
Jaws
asymmetric
erythematous and warm to touch
gingival bleeding
Bruit, pulsatile
needle aspiration
Central Hemangioma
Radiographic
(2)
- Variable pattern
ranging from cyst-
like radiolucencies - May have
multilocular “soap-
bubble” or spoke-
like appearance
Central Hemangioma
Age
Site
Sex
Teens and young adults
Posterior mandible
Female:male 2:1
Central Hemangioma
Management
(2)
Other
- Sclerosing agents, radiation,
enucleation - Embolization of major arteries
necessary prior to surgery as
hemorrhage is a significant and life-
threatening complication
Etiology is either traumatic/developmental
or benign neoplasm
Cherubism
Clinical
(3)
- Cherubic looking face by 5 years of age due
to bilateral bony expansion - Asymptomatic
- Bone lesions are more active in younger
patients. After age 12, activity usually
diminishes and finally lesions become
inactive with residual deformity by age 30
Cherubism
Radiographic
(2)
- Bilateral multilocular
cyst-like, expansile
lesion, usually
affecting the
mandible and
sometimes the
maxilla - Pathologic fracture
is not a feature
Cherubism
Age
Site
Sex
Usually detected by age 5
Bilateral mandible, may affect maxilla
Male:female 2:1
Cherubism
Management
Other
Cosmetic osseous contouring at age 12 and
later
Benign self-limiting condition
