Multilocular Radiolucencies Flashcards by Pickle Rick

What are the multilocular radiolucencies?

Ameloblastoma
Odontogenic Keratocyst
Central Giant Cell Granuloma
Odontogenic Myxoma
Vascular Lesions
— Hemangioma
— A-V aneurysm
Familial Fibrous Dysplasia

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What is an ameloblastoma?

Benign odontogenic neoplasm (one of very few true odontogenic neoplasms)
Capable of uncontrolled, unlimited growth potential

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What are the classifications of ameloblastoma?

Conventional (Multicystic) Ameloblastoma
Unicystic Ameloblastoma

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What are the characteristics of the conventional (multicycstic) ameloblastoma?

Account for 85 – 90% of all ameloblastomas
Five histologic sub-types
— follicular (most common)
— plexiform
— acanthomatous
— granular
— desmoplastic and basaloid

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What are the symptoms of the conventional (multicystic) ameloblastoma?

Usually slow painless swellings
Small lesions only detected by radiographs
Larger lesions detected clinically

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What do conventional ameloblastoma look like radiographically?

Small lesions are unilocular with corticated borders
Large, aggressive lesions develop multilocular patterns
Displace and resorb teeth
expansive

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What age and gender is most prevelant for a conventional ameloblastoma?

AGE:
- Mainly adults – equal prevalence in 3’rd to 7’th decade
- Uncommon in 2’nd decade
- Rare in 1’st decade

GENDER:
none

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What site is most common for a conventional ameloblastoma?

mandible (85%)
maxilla (15%)

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What is the managment of conventional ameloblastoma?

Large lesions are aggressive requiring bone resection (higher likelihood for recurrence)
Block or marginal resection; ie resect > 1.0 cm past radiographic limits of tumor 15% recurrence (50-90% recurrence if not resected)

Rare to be malignant

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What are the characteristics of the unicystic ameloblastoma?

arise within a cyst lining; either luminal, intraluminal or mural
less aggressive form of ameloblastoma
Recurrence rates of 10-20%

comes from another cyst (ex: dentigerous cyst, periapical cyst, etc.)

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What does unicystic ameloblastoma look like radiographically?

expansive

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What age is most prevelant for a unicystic ameloblastoma?

Mean age 23 years

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What site is most common for a unicystic ameloblastoma?

Mandible (90%)
Maxilla (10%)

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What is the managment of unicystic ameloblastoma?

Enucleation: less aggressive than multicystic

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What is a odontogenic keratocyst (OKC)?

aggressive cysts; behave more like benign neoplasms
thought to arise from cell rests of dental lamina
Normally asymptomatic
With increasing size, pain, swelling and exudate may oocur

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The OKC (odontogenic keratocyst) _______% of all odontogenic cysts;

10-12%

3rd highest oral cyst frequency

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What are the clinical signs of a OKC?

Normally asymptomatic
With increasing size, pain, swelling and exudate may oocur

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What does an OKC look like radiographically?

Well-defined, smooth, corticated borders
Thinning and mild expansion with occasional perforation of cortical plates
Displacement of teeth

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Does OKC have root resorption?

only occasional root resorption

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What type of expansion does an OKC follow?

mild B-Li expansion; but extensive anteroposterior extension

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What age and gender is most prevelant for an OKC?

Age: Majority (i.e., 60%) in 2nd and 4th decade
Gender: Male predilection

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What site is most common for an OKC?

Majority (60-80%) affect mandible posterior to the canines

What is the management for an OKC?

Enucleation with curettage

What are the chances of recurrence fo OKC?

High recurrence rate; 47 and 62% (probably parakeratinized variants)
recurrence within 5 years; but can be up to 10

When multiple OKCs are found they may constitute part of the...

basal cell nevus syndrome (a.k.a. nevoid basal cell carcinoma syndrome)

What are the findings in nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome)?

* 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: --- frontal and parietal bossing --- hypertelorism --- intracranial calcifications --- majority are of falx cerebri

Nevoid basal cell carcinoma syndrome

What are palmar pitting associated with?

Nevoid basal cell carcinoma syndrome

What can Nevoid basal cell carcinoma syndrome turn into?

Multiple basal cell carcinomas

Nevoid basal cell carcinoma syndrome is inherited in what fasion?

autosomal dominant

What are the clinical signs of central giant cell granuloma (CGCG)?

* Asymptomatic swelling * Can be aggressive

How do central giant cell granulomas look radiographically?

* Well-defined borders * Can be multilocular * Thinning and expansion of cortical plates * Displacement of teeth and occasional root resorption

What age and gender is most prevelant for a central giant cell granuloma?

Age: usually < 30 years (60%) Gender: female > male (2:1)

What site is most common for a central gianr cell granuloma?

mandible (70%) & frequently between the molars

What is the management of central giant cell granulomas?

Enucleation with aggressive curretage

Patients with the CGCG should be evaluated to rule out __________________

hyperparathyroidism - Lesion is histologically similar to the Brown tumor of primary hyperparathyroidism ## Footnote Screening test in the appropriate blood studies: – serum calcium (increased) – alkaline phosphatase (increased) – serum phosphorus (decreased)

What are the clinical signs of odontogenic myxoma?

* Primarily a lesion of alveolar bone * Basically a fibrous lesion

What does a odontogenic myxoma look like radiographically?

Scalloped and multilocular

What age is most prevelant for an odontogenic myxoma?

Young to adults (25 – 30 years)

What site is most common for an odontogenic myxoma?

Greater prevalence in mandible

What is the management for odontogenic myxoma?

Excision | Recurrence up to 25% because the lesions are not encapsulated.

What are the differen types of vascular lesions?

Hemangioma Aneurysmal Bone Cyst Atrio-Venous Malformation

What are the clinical signs of central hemangioma?

* Jaws are next most common site after skull and vertebrae * Firm, slow-growing asymmetric expansion * Overlying mucosa is more erythematous and warm to touch * Spontaneous gingival bleeding * Bruit on diascopy and pulsatile sensation may be detected * Many require needle aspiration to assist diagnosis

What does a central hemangioma look like radiographically?

* Variable pattern ranging from cyst like radiolucencies * May have multilocular “soap bubble” or spokelike appearance

What age and gender is a central hemagioma common in?

Age: Teens and young adults Sex: Female:male 2:1

What site is the central hemangioma common in?

Posterior mandible

What is the managment of a central hemangioma?

* Sclerosing agents, radiation, enucleation * Embolization of major arteries necessary prior to surgery as hemorrhage is a significant and lifethreatening complication

What is the etiology of a central hemangioma?

Etiology is either traumatic/developmental or benign neoplasm

What is familial fibrous dysplasia (cherubism)?

* 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

What does cherubism (familial fibrous dysplasia) look like radiographically?

* multilocular cyst-like * expansile lesion * usually bilateral * mostly mandibular, but sometimes the maxilla * pathologic fracture is not a feature

What age and gender is cherubism common?

Age: Usually detected by age 5 Sex: Male:female 2:1

What site is most common for cherubism?

Bilateral mandible, may affect maxilla

What is the managment for cherubism?

Cosmetic osseous contouring at age 12 and later | Benign self-limiting condition (lesions regress once full-grown)