Multilocular Radiolucencies Flashcards
What are the multilocular radiolucencies?
- Ameloblastoma
- Odontogenic Keratocyst
- Central Giant Cell Granuloma
- Odontogenic Myxoma
- Vascular Lesions
— Hemangioma
— A-V aneurysm - Familial Fibrous Dysplasia
What is an ameloblastoma?
- Benign odontogenic neoplasm (one of very few true odontogenic neoplasms)
- Capable of uncontrolled, unlimited growth potential
What are the classifications of ameloblastoma?
- Conventional (Multicystic) Ameloblastoma
- Unicystic Ameloblastoma
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
What are the symptoms of the conventional (multicystic) ameloblastoma?
- Usually slow painless swellings
- Small lesions only detected by radiographs
- Larger lesions detected clinically
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
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
What site is most common for a conventional ameloblastoma?
mandible (85%)
maxilla (15%)
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
What are the characteristics of the conventional (multicycstic) 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.)
What age is most prevelant for a unicystic ameloblastoma?
- Mean age 23 years
What site is most common for a unicystic ameloblastoma?
Mandible (90%)
Maxilla (10%)
What is the managment of unicystic ameloblastoma?
Enucleation: less aggressive than multicystic
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
The OKC (odontogenic keratocyst) _______% of all odontogenic cysts;
10-12%
3rd highest oral cyst frequency
What are the clinical signs of a OKC?
- Normally asymptomatic
- With increasing size, pain, swelling and exudate may oocur
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
Does OKC have root resorption?
only occasional root resorption
What type of expansion does an OKC follow?
mild B-Li expansion; but extensive anteroposterior extension
What age and gender is most prevelant for an OKC?
Age: Majority (i.e., 60%) in 2nd and 4th decade
Gender: Male predilection
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 cerebr
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
Screening test in the appropriate blood studies:
– serum calcium (increased)
– alkaline phosphatase (increased)
– serum phosphorus (decreased)
What are the clinical signs of odontogenix 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
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
