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Radiology > Radiolucent Lesions 1 > Flashcards

Radiolucent Lesions 1 Flashcards

1
Q

T/F Cycts are well defined?

A

True

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2
Q

are cysts radioluscent?

A

Yes - and well defined

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3
Q

definition of a cyst

A

fluid filled cavity lined by epithelium and surrounded by a connective tissue wall

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4
Q

where do cyts occur most and why

A

in the jaw because they can develop from remnants of odontogenic epithelium

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5
Q

clinical features of cysts

A

swelling, lack of pain (unless secondarily infected or related to non-vital tooth) and can be associated with unerupted teeth, especially third molars

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6
Q

general shape of cyst

A

rounded or oval – follow shape of surrounding structure so can loo scalloped

think of a balloon

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7
Q

location of cysts

A

generally located within the boe – anywhere in maxilla or mandible (rare in coronoid process)

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8
Q

odontogenic cyst where?

A

TOOTH0BEARING regions in the mandible usually ABOVE the inferior alveolar canal

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9
Q

where is non-odontogenic cyst usually? catrgory?

A

can grow into sinus (non-odontogenic) or arise from soft tissue

  • may be below the inferior alveolar canal
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10
Q

what does the periphery of a cyst look like?

A

well-defined CORTICATED (fairly uniform) thin RADIO-OPAQUE line

*but a secondary infected, or chronically present cyst can change to a thicker, more sclerotic boundary, or make the cortex less apparent

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11
Q

internal features of a cyst

A

RADIOLUSCENT – long standing cyst may develop more dystrophic calcification

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12
Q

cyst general effect on other structures

A

slow-growing but can displace other structure – teeth, inferior alveolar canal, expands

can thin coritcal plates and resorb roots of teeth

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13
Q

two examples of odontogenic epithelial tumors

A
  1. ameloblastoma

2. Calcifying epithelial odontogenic tuor

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14
Q

4 examples of odontogenic tumors

A
  1. odontoma
  2. ameoloblastic fibroma
  3. ameloblastic fibro-odontoma
  4. adenomatoid odontogenic tumor
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15
Q

odontoma is an example of? growth rate?

A

example of a hamartoma – it stops growing at the same tie as dental tissues

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16
Q

three main breakdowns of Odontogenic Tumors? these are all what?

A
  1. Odontogenic epithelial
  2. mixed odontogenic tumors
  3. mesenchymal tumors (odontogenic ectomesenchyme)
    * THESE ARE ALL BENIGN
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17
Q

three examples of mesenchymal tumors (odontogenic ectomesenchyme)

A
  1. odontogenic myxoma
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18
Q

breakdown of non-odontogenic benign tumors

A
  1. benign tumors of neural origin

2. mesodermal tumors

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19
Q

benign tumors of neural origin examples

A
  1. neurolemoma

2. neurofibroma

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20
Q

general properties of benign tumors

A
  1. slow growing
  2. spread by DIRECT extension, NOT metastisis
  3. histologically resemble the tissue of origin
  4. thought to have unlimited growth potential
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21
Q

location of cartilaginous benign tumor

A

regions where cartilage resides

- condyle, and syphysis

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22
Q

most likely location of benign tumor

A

posterior mandible

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23
Q

peripheray and shape of benign tumor

A

smooth, well defined, sometimes but not always corticated round or oval

*more mature art of tumor is in the center – calcification surrounded by soft tissue cpsule

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24
Q

root resoprtion in bengin vs metastic tumor

A

benign - smooth borders continous with WD lesion

malignant - from the outside , resulting in thinning ‘SPIKED’ roots

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25
Q

root resoprtion more common in malignant or benign?

A

BENIGN – ameloblstoma, ossifying fibroma, central giant cell granuloma

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26
Q

effect on surrounding structure in benging tumors

A

exerts pressure on structures – DISPLACEMENT OF TEETH OR CORTICES – faster growin tumors may outpace the ability of the periosteum to lay down more bone –perforation of the cortex or root resorption

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27
Q

what happens to the periosteum as a lesion grows?

A

as the lesion grows slowly (in benign) it resorbs the endosteal bone surface and the PERIOSTEUM lays down new bone along the outer cortex, thinning but maintaining the integrity of the cortex

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28
Q

4 examples of well-defined, unilocular radiolucencies in a Pericoronal Location

A
  1. Dentigerous Cyst
  2. Odontogenic Keratocyst
  3. Ameloblatoma
  4. Ameloblastic Fibroma
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29
Q

synonym for dentigerous cyst

A

follicular cyst

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30
Q

definition of dentigerous cyst

A

a cyst that forms around the crown of an unerupted tooth; fluid accumulates between the epithelium and crown of the tooth; an eruption cyst is the soft tissue counterpart of a dentigerous cyst

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31
Q

clinical features of dentigerous cyst

A

swelling and facial symetry; missing tooth; no pain or discomfort

5% are supernumerary teeth, mostly mesiodens

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32
Q

where does a dentigerous cyst attach

A

attaches at CEJ

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33
Q

Effect of entigerous cyst on surrounding structures

A

propensity to resorb adjacent teeth; displaces associated teeth apically

*resorbing adjacent teeth and can displace teeth into the ramus areas and extend into the sinuses - displacing and expanding the walls of maxilla

cysts in the sinus may rain and collapse as with radicular cysts

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34
Q

location of a dentigerous cyst

A

ABOVE AND AROUND THE CROWN OF AN UNERUPTED TOOTH but can be eccentric ; commonly third molar or canine ATTACHES AT CEJ can grow into maxillary sinus and can extend into the ramus

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35
Q

differential diagnosis for dentigerous cyst

A

histopathologic appearance is not specific, raiographic and surgical observation of attachment of cyst is important

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36
Q

managment of dentigerous cyst

A

surgical removal, may include the tooth as well

large cyst may be marsupialized

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37
Q

odontogenic keratocyst disease mechanism and describe

A

epithelial lining of OKC has INNATE growth potential–(feature of a tumor) but the radiographic and gross appearance of the lesions are cystic in nature, the epithelial lining is keratinized (hence the name) the inside often contains a viscous or cheesy material derived from the epithelial lining

38
Q

odontogenic keratocyst synonym

A

OKC

KOT- keratocystic odontogenic tumor and primordial cyst

39
Q

clinical features of a odontogenic keratocyst

A

occur in wide age range but typically 2nd and 3rd decades; slight male predominance, can form around unerupted teeth, aspiration may reveal thick yellow cheesy material

high propensity for recurrence

40
Q

location of odontogenic keratocyst

A

90% occur posterior to the canines)

posterior body of mandible, posterior maxilla and ramus)

41
Q

periphery and shape of odontogenic keratocyst

A

similar to other cysts or may have scalloped outline

42
Q

internal structure of odontogenic keratocyst

A

radiolucent - in some cases curve internal SEPTA, multilocular

43
Q

effect on surrounding structures in terms of odontogenic keratocyst

A

grows mesiodistally with relatively little B-L expansion
(excet in upper ramus and coronoid process)

can displace and resorb teeth like pushing the mandibular canal inferior as an example - but to a less extent than dentigerous cysts

44
Q

clinical feature of exapnsion of odontogenic keratocyst in the mandible

A

little B-L expansion so significant expansion in the upper ramus but little expansion in the body

  • despite the large size the lingual and buccal cortical plates of the mandible only slightly expanded
  • lack of expansion in b-l direction and cyst scalloping between the roots of the teeth
45
Q

odontogenic keratocyst may expand where

A

into the ramus – so potential to perforate into the medial cortex and contact with the medial pterygoid muscle

46
Q

odontogenic keratocyst differential diagnosis

A

most likely a odontogenic keratocyst if attaches APICAL TO CEJ or no expansion of the cortical plates or if follicles are IN TACT

47
Q

management of odontogenic keratocyst

A

variable surgical treatment, resection, curettage, marsupialization to reduce the size of the large lesions, close attention to remove cyst walls due to recurrence rate

through radiological assessment and follow-up

48
Q

ameloblastoma - general

A

BENIGN but LOCALLY AGGRESSIVE

49
Q

ameloblastomamost common when?

A

between 20 and 50

average is 50

50
Q

location of ameloblastoma

A

molar-ramus of mandible or posterior maxilla

51
Q

potential of growth for ameloblastoma? implications

A

may grow very large – posterior maxilla can be problomatic due to orbit an skull location

52
Q

describe appearance of ameloblastoma

A

mixed with CURVED, COARSE SEPTATION (CAN BE STRAIGHT)
“HONEY COMBED”
“SOAP BUBBLE”

53
Q

do ameloblastoma resorb roots?

A

Yes - they have a strong potential to do this

54
Q

management of ameloblastoma

A

surgical resection
- tends to invade bone beyond radiologic appearance ; and high recurrence if not adequately removed

can be treated with radiation if in-operable

55
Q

ameloblastoma is what type

A

odontogenic epithelial tumor

56
Q

ameloblastic fibroma is what type?

A

mixed odontogenic tumor

57
Q

ameloblastic fibroma proliferation of?

A

proliferation of odontogenic epithelium as well as dental papilla

58
Q

are ameloblastic fibroma a stage of an odontoma

A

NO — has more growth potential and is a legitimate benign neoplasm

59
Q

age of ameloblastic fibroma

A

age 5-20

*think tooth formation but average is 15

60
Q

ameloblastic fibroma associated with?

A

crown of unerupted tooth

61
Q

brief description of ameloblastic fibroma

A

may be multilocular with indistinct or curved septa

  • assocaited with crown of unerupted tooth
62
Q

what should we think of when we see a younger patient with radiolucent associated with crowns of unerupted teeth

A

ameloblastic fibroma

63
Q

differential diagnosis of ameloblastic fibroma?

A

may not be bale to differentiate between this and dentigerous cyst or hyperplastic follicle

64
Q

ameloblastoma vs ameloblastic fibroma

A

ameloblastoma – older age and septa more defined and coarse

65
Q

what type is a ameloblastic fibro-odontoma?

A

benign mixed odontogenic tumor

66
Q

ameloblastic fibro-odontoma differnce to ameloblastic fibroma?

A

it is just like an ameloblastic fibroma but with SCATTERED COLLECTIONS OF ENAMEL AND DENTIN, varying from small discrete to round pebbles, doughnut or tooth like

67
Q

age range for ameloblastic fibro-odontoma?

A

same as ameloblastic fibroma (5-20)

68
Q

ameloblastic fibro-odontoma associated with?

A

crown of unerupted tooth

69
Q

which has scattered small pieces?

A

odontoma

70
Q

examples of well defines, unilocular radiolucencies in a periapical location

A
  1. periapical inflammatory lesion/ cyst
  2. osseous dysplasia
  3. lateral periodontal cyst
71
Q

radicular cyst is what type

A

unilocular radiolucencies in a periapical location

  • benign
72
Q

radicular cyst synonyms and disease mechanism

A

peri-apical cyst, apical periodontal cyst , dental cyst

  • epithelial rest cells of malassez are stimulated by a necrotic pulp and inflammatory roducts and undergo cystic degeneration
  • thought to grow by osmotic pressure
73
Q

clinical features of radicular cyst

A

most comon type in the jaw

ARISES FROM NON-VITAL ASYMPTOMATIC - unless secondary infection occurs

74
Q

location of a radicular cyst

A

APEX OF NON-VITAL TOOTH
- cna appear on the mesial or distal surface of a tooth root
60% in maxilla - especially in incisors or canines

75
Q

periphery and shape of radicular cyst

A

well-defined corticated border
secondary infection may lead to loss of cortex or more sclerotic border
round, curved

internal and effect on surrounding structure is typical for a cyst

76
Q

differential diagnosis between radicular cyst and apical granuloma?

A

may be impossible - but bigger than 2 cm all indicate a cyst

77
Q

management of radicular cyst

A

eliminate source of infection , RCT, apical surgery or extraction

78
Q

bone grows in what dimension around a cyst? implication?

A

from the outside in

  • so from the periphery
  • leading to a wheel spoke pattern
79
Q

Periapical osseous dysplasia general description and occurs in who?

A

resorption of normal bone, replaced by fibrous tissue and amorphous bone

occurs in MIDDLE AGE - 39 years

  • females > males
  • blacks> asains>whites

VITAL TEETH
NO PAIN

80
Q

where are periapical osseous dysplasia located?

A

peri-apical region and mandibular anterior more

mand ant > mand post > max teeth

81
Q

what does periapical osseous dysplasia look like?

A

usually multiple and bilateral RL border of varying width, often surrounded by sclerotic boe and typically round

note the sclerotic bone at the periphery of the lesions in some cases

82
Q

stages of periapical osseous dysplasia

A

RL-> mixe-> RO

can grow and cause expansion, thinning and erosion of cortical borders

83
Q

periapical osseous dysplasia compared to a cementoblastoma

A

cementoblastoma are completely round

84
Q

lateral periodontal cyst disease mechanism

A

arise from epithelial rests in the periodontium lateral to tooth roots

unicystic or small and grapelick cluster

  • botryoid odontotgenic cyst
  • intra bony counterpart of gingival cyst in adult
85
Q

clinical features of lateral periodontal cyst

A

most are small, less than 2 cm in diameter

- if larger the age range increases

86
Q

location of lateral periodontal cyst

A

over half occur in the mandible

in mandible usually from incisor to second pre-molar

in maxilla usually from insicor to cuspid

87
Q

periphery and shape of lateral periodontal cyst

A

very circular - well defined cortical borders

rare large cysts will be more irregular in shape

88
Q

internal structure of lateral periodontal cyst

A

radiolucent, botryoid variety may have multilocular apearance

89
Q

effect on surrounding structure with lateral periodontal cyst

A

may efface the lamina dura of the adjacent root and may displace teeth, may have growth pattern similar to KOT

90
Q

management of lateral periodontal cyst

A

biopsy or simple enucleation - do not tend to recur

Radiology (26 decks)

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