Radiolucency

Question 1

Give diff dx of unilocular radiolucency associated with crown of teeth

Answer 1

Hyperplastic follicle (<5mm)
Dentigerous cyst
OKC
Orthokeratinized odontogenic cyst
Unicystic ameloblastoma
AOT
Ameloblastic fibroma
COC

Question 2

Gove diff dx of unilocular radiolucency at periapical of tooth

Answer 2

Periapical granuloma
Periapical cyst
Cementoosseous dysplasia (early)

Question 3

Give diff dx of unilocular radiolucency

Answer 3

Odontogenic in origin:
Radicular cyst
Okc
Orthokeratinized odontogenic cyst
Unicystic ameloblastoma

Nonodontogenic in origin:
Central giant cell lesion
Langerhans cell histiocytosis
Florid COD (early lesions)
Schwannoma
Neurofibroma
Aneurysmal bone cyst

Question 4

Multilocular radiolucency differentials

Answer 4

Benign odontogenic cyst/tumor
OKC
SMA
Odontogenic myxoma
Ameloblastic fibroma
Calcifying odontogenic cyst

benign nonodontogenic lesions
Central giant cell lesions
Browns tumor
Langherhans cell histiocytosis
Cherubism
Schwannoma
Neurofibroma
Central hemangioma

Malignancy

• PIOC
• ameloblastic ca
• ccoc
• gcoc
• odontogenic carcinosarcoma
• central MEC

Question 5

Multilocular radiolucency with central giant cells on histopath

Answer 5

Central giant cell lesion
Brown tumor
Cherubism
Aneurysmal bone cyst
Langerhans cell histiocytosis

Question 6

Differentials for multifocal radiolucent lesions or generalized radiolucent lesions

Answer 6

Florid COD (Early lesions)
Gorlin goltz syndrome (multiple OKC)
Multiple myeloma
Cherubism
Langerhans cell histiocytosis
Hyperparathyroidism (browns tumor)

Question 7

Differentials for mixed radiolucency radiopacity

Answer 7

Odontogenic:
Odontoma (complex and compound)
COC
odontogenic fibroma
Cementoblastoma
Cementoossifying fibroma
CEOT

Nonodontogenic

• COD (intermediate stage)
• osteoid osteoma
• osteoblastoma
• ossifying fibroma (intermediate stage)
• pagets disease
• osteomyelitis
• osteonecrosis (mronj/orn)

Question 8

What further history do u wanna ask regarding the radiolucent swelling

Answer 8

Duration of swelling
Slow progression or rapid growth
Any previous hx of dental treatments done associated with teeth in the radiolucent lesions
Associated symptoms - pain? Numbness? Loose teeth?

Question 9

What do u expect to reveal during examination

Answer 9

Facial asymmetry due to bony expansion
Egg-shell cracking on palpation (esp for multiloculated lesions - amelo, okc, odonto myxoma, CGCG)
Buccolingual expansion? (Prominent in amelo)
Any perforation?
loose teeth? (amelo causes root resoprtion and displacement; okc scallops around apices)

Question 10

Further investigations of radiolucent lesions

Answer 10

After OPG

• teeth vitality
• CBCT
• Incisonal biopsy (prior to biopsy- aspiration)
• cystic content analysis (protein? Keratin?)
• nerve assessment for involvement

Question 11

Describe the content and its differential dx

Answer 11

Clear, pale, straw colored fluid - dentigerous,

Brownish - unicystic amelo, brown tumor

Creamy white cheesy viscoid - OKC

Pus - infected cyst, abscess

Blood - traumatic bone cyst, aneurysmal bone cyst, central hemangioma

Empty cavity - solitary bone cyst

Question 12

What ix can you send for the cystic content aspiration?

Answer 12

Protein analysis
Okc - reduce protein content (<5g/dL)
Dentigerous and radicular cyst - 8-12g/dL

Question 13

What is Langerhans cells histiocytosis

Answer 13

Proliferation of Langerhans cells (dendritic cells - accompanied by eosinophils, lymphocytes, plasma cells, multinucleated cells)

3 clinicopathologic presentation

• unifocal unisystem (eosinophilic granuloma)
• multifocal unisystem (Hand-Schuller-Christian) classic triad involves lesions in jaw, exophthalmos, diabetes insipidus related to pituitary gland
• multifocal multisystem (Letterer- Siwe disease)

Clinical presentation on jaws:
Punched-out non corticated lesions
Scooped out lesions (if involve superficial alveolus)
Floating teeth in the air

Gold standard diagnosis (histopath and IHC)

• Birbeck granules
• giant cells
• IHC (CD1a, S100)

Tx:

1. Observation
2. Enucleation and curettage
3. Radiation (for inaccessible lesions - 550-600Gy)
4. Excision + chemoradiation in high risk organs

Question 14

Adjunctive therapy for CGCG

Answer 14

Intralesional steroids (weekly x 6/52)
Calcitonin 50-100IU monthly x 6-9/12
Interferon-alpha 2a 3MU/m2 (depending on the size)

Question 15

What is a surgicial ciliated cyst?

Answer 15

True cyst that occur from a sinus lining that was separated and transferred during surgery to another surgical site

Forming a non corticated well defined radiolucency

Dx thru histopath revealed ciliated pseustratified columnar epithelium

Tx requires surgical enucleation