Radiolucent Non-Odontogenic Lesions Flashcards
Nasolabial Cyst
RL Non-Odontogenic Cyst
- Developmental cyst
- Develops from remnants of nasolacrimal duct
- Upper lip, lateral to midline
- Nasal/MX processes
- More common in females 2:1
- Elevation of ala of the nose
- Swelling of lip lateral to mimdline
- Characteristically lined by pseudostratified columnar epithelium, often w/ Goblet cells & cilia
Nasolabial Cyst: Tx
RL Non-Odontogenic Cyst
Surgical excision
Recurrence is rare
Another name for Nasopalatine Duct Cyst
RL Non-Odontogenic Cyst
Incisive canal cyst
What is the most common non-odontogenic cyst?
RL Non-Odontogenic Cyst
Nasopalatine Duct Cyst
Nasopalatine Duct Cyst
RL Non-Odontogenic Cyst
- Most common non-odontogenic cyst
- Connects oral and nasal cavities in the incisive canal area
- Swelling of anterior palate, w/ drainage and pain
- Most common in 4th-6th decades of life
Nasopalatine Duct Cyst: Rad
RL Non-Odontogenic Cyst
- RL
- Well-circumscribed
- Round/oval
- Inverted pear
- Heart shape
- Lined by highly variable epithelium (75% stratified squamous)
Nasopalatine Duct Cyst: Tx
RL Non-Odontogenic Cyst
- Surgical excision
- Biopsy req’d
- Lesions not dx radiographically
- Other lesions can mimic this one
- Recurrence is rare
Globulomaxillary Cyst
RL Non-Odontogenic Cyst
- Fusion of globular and MX processes
- B/w incisor & K9
- THIS CYST DOESN’T EXIST
Median MN Cyst
RL Non-Odontogenic Cyst
- Fusion of halves of MN during embryonic life
- Most of these midline cysts are odontogenic in origin
- THIS CYST DOESN’T EXIST
Idiopathic Bone Cavity
RL Non-Odontogenic Pseudocyst
- AKA Simple Bone Cyst
- Cavity usually filled w/ blood but not a real cyst b/c no epithelial lining; thinly corticated
- Cause & pathogenesis are uncertain
- In younger people (10-20yo) and not always from trauma
- 90% in posterior MN
-
MOST OF THE TIME cavity has some mixture of blood and other fluids; otherwise filled w/ air
- 65%: Sero-sanguinolent fluid
- 35%: Empty bone cavity
- Key: NO EPITHELIAL LINING = NOT A CYST
Idiopathic Bone Cavity: Rad
RL Non-Odontogenic Pseudocyst
- Well-defined RL, thinly corticated superior border and non-corticated inferior border
- Interdental scalloping: Classic feature of SBC/IBC
Idiopathic Bone Cavity: Tx
RL Non-Odontogenic Pseudocyst
- Dx based on clinical, rad, surgical features
- After surgical exploration, heals in 6mo
- Open up and find it’s just filled w/ blood so close up and it will heal
- Good px
Stafne Bone Cyst
RL Non-Odontogenic Pseudocyst
-
Focal concavity of bone on lingual surface of MN; associated w/ subMN gland
- Defect from extra subMN gland tissue
- Rarely found in upper MN ramus and anterior MN
- Striking male predilection: 90% of cases in males
- RL below MN canal; b/w molar teeth and angle of MN
Another name for Idiopathic Bone Cavity
Simple Bone Cyst
Another name for Stafne Bone Cyst
Stafne Bone Defect
Static Bone Cyst
Stafne Bone Cyst: Rad
RL Non-Odontogenic Pseudocyst
- Usually has thick corticated borders
- RL below MN canal; b/w molars and angle of MN
Stafne Bone Cyst: Tx
RL Non-Odontogenic Pseudocyst
- No tx needed
- Excellent px
- Lesions in anterior jaws may be difficult to recognize
- Biopsy may be needed to r/o other pathologic lesions
Central Giant Cell Granuloma
RL Non-Odontogenic Lesions: Other
- More common in children & young adults but can occur in all ages
- More common in MN, but can also occur in MX
- Benign, but aggressive lesions can grow rapidly
- More in women; <30yo
- Classically found in anterior MN
Aggressive CGCG vs. Non-Aggressive CGCG
RL Non-Odontogenic Lesions: Other
-
Most CGCG lesions are NON-AGGRESSIVE
- Asymptomatic, slowly growing, no root resorption, no perforation of cortical bone
- Tend not to recur after curettage
-
AGGRESSIVE CGCG
- Pain or paresthesia, root resorption, cortical perforation
- Higher recurrence rate after curettage
- Still benign looking even though it’s aggressive
CGCG: Rad
RL Non-Odontogenic Lesions: Other
- RL lesions w/ well-defined borders, similar to odontogenic tumors & cysts
- May or may not have corticated border
- Unilocular or multilocular, depending on size
- Can cause expansion and/or perforation of cortical plate
- Tends to resorb roots horizontally
CGCG: Microscopic features
RL Non-Odontogenic Lesions: Other
- Fibrous tissue, numerous multinucleated giant cells, hemorrhage, hemosiderin
- Resembles hyperparathyroidism & cherubism
What pathogolies does CGCG resemble?
RL Non-Odontogenic Lesions: Other
-
Hyperparathyroidism
- Increased serume PTH levels
-
Cherubism
- <10yo, bilateral
CGCG: Tx
RL Non-Odontogenic Lesions: Other
- Usually curettage is used (15-20% recurrence rate)
- Aggressive lesions: Intralesional corticosteroids, calcitonin, interferon
Hemangioma/Vascular malformation
RL Non-Odontogenic Lesions: Other
- Hemangioma: Benign proliferation of small BVs
-
Vascular malformation: AKA arteriovenous malformation and high flow angioma
- Proliferation of small BVs and larger arterial vessels associated w/ more blood flow and can result in excessive bleeding during surgery
- Part of Sturge-Weber Syndrome
- Usually detected during first 3 decades of life
- Vaslcular malformations may have thrill (pulsatile to palpation) or bruit (heard upon auscultation)
Hemangioma/Vascular malformation: Rad
RL Non-Odontogenic Lesions: Other
- RL lesions w/ well-defined, corticated borders
- Usually RL, but may have RO areas and/or multilocular “honeycombed” or “soap bubble” appearance
- May have coarse internal trabeculae
- Aspiration of all bony lesions is done before biopsy or tooth extraction to r/o vascular malformations
Hemangioma/Vascular malformations: Tx
RL Non-Odontogenic Lesions: Other
- Angiography
- Surgical resection
- Thromboembolization of vascular malformations may be req’d before surgery
Focal Osteoporotic Bone Marrow Defect
RL Non-Odontogenic Lesions: Other
- Area of hematopoietic marrow that produces RL
- May be confused w/ an intraosseous neoplasm
- Variation of normal
- Typically asymptomatic
- No jaw expansion
- Not completely RL so can’t be a cyst
- 75% in women; typically posterior MN
Focal Osteoporotic Bone Marrow Defect: Rad
RL Non-Odontogenic Lesions: Other
-
Key: Differentiate from other lesions
- Irregular shape
- Trabecular pattern still seen inside the lesion
- No jaw expansion
- Not completely RL so can’t be a cyst
- Just widened trabecular spaces, not multilocular
What are Radiolucent Non-Odontogenic Lesions?
- Nasolabial Cyst
- Nasopalatine Duct Cyst
- Globulomaxillary Cyst ***
- Median MN Cyst ***
What are RL Non-Odontogenic Pseudocysts?
- Idiopathic Bone Cavity
- Stafne Bone Cyst
What are Other RL Non-Odontogenic Lesions?
- Central Giant Cell Granuloma
- Hemangioma/Vascular Malformation
- Focal Osteoporotic Bone Marrow Defect
