Cystic lesions of the mandible and maxilla

Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification

Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies. These lesions can arise from various tissues, including bone, cartilage, and soft tissue, each presenting distinct challenges in diagnosis and treatment. While some pathologies exhibit characteristic imaging features that aid in diagnosis, many others are nonspecific. This overlap often necessitates a multimodal imaging approach, combining techniques such as radiographs, computed tomography, and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations. This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors, including updates on the 2022 World Health Organization classification of these tumors. The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.

Solitary intraosseous neurofibroma in the mandible mimicking a cystic lesion: A case report and review of literature

BACKGROUND

Neurofibromas are benign tumors of a neurogenic origin. If these tumors occur without any other signs of neurofibromatosis, they are classified as isolated neurofibromas. Neurofibromas in the oral cavity mostly occur within soft tissues, indicating that solitary intraosseous neurofibromas in the mandible are rare. Due to the absence of specific clinical manifestations, early diagnosis and treatment of these tumors are difficult to achieve.

CASE SUMMARY

A 37-year-old female patient visited our hospital due to numbness and swelling of the gums in the right lower molar area that had persisted for half a month. The patient's overall condition and intraoral examination revealed no significant abnormalities. She was initially diagnosed with a cystic lesion in the right mandible. However, after a more thorough examination, the final pathological diagnosis was confirmed to be neurofibroma. Complete tumor resection and partial removal of the right inferior alveolar nerve were performed. As of writing this report, there have been no signs of tumor recurrence for nine months following the surgery.

CONCLUSION

This case report discusses the key features that are useful for differentiating solitary intraosseous neurofibromas from other cystic lesions.

World Health Organization Classification of Odontogenic Tumors and Imaging Approach of Jaw Lesions

Tumors of the jaws represent a heterogeneous group of lesions that are classified histologically in the World Health Organization Classification of Odontogenic Tumors (2017). This article provides an update of the current nomenclature. The main role of imaging is to describe the precise location and extent of these lesions. Although characterization of imaging is often difficult due to overlapping characteristics, imaging is helpful to define which lesions should be referred for histologic examination and subsequent treatment planning. Location and density are the cardinal criteria for potential characterization on imaging. Radiologically, lesions may be radiolucent, radiopaque, or of mixed density. Additional criteria include lesion demarcation, morphology, cortical breakthrough, periosteal reaction, and adjacent soft tissue changes. Final lesion characterization is only definitive after interdisciplinary discussion and radiopathologic correlation. Correct diagnosis is obtained by a combination of the patient's age, lesion location, and clinical and radiologic presentation. It is important that all physicians use a uniform nomenclature.

Detection of Dental Pathologies in Routine Paranasal CT Scans: A Retrospective Study

INTRODUCTION

Multidetector Computed Tomography (MDCT) is a widespread method for evaluating paranasal sinuses and nasal cavity in daily practice. The maxillary teeth are in field of view in a paranasal sinus CT scan and it is possible to detect dental pathologies with CT.

AIM

To determine the incidence of maxillary teeth pathologies in routine paranasal sinus CT scans.

MATERIALS AND METHODS

A retrospective study was conducted. Consecutive 395 paranasal sinus CT scans were evaluated. All CT images were obtained with a 64 detector-CT. Patients with previous facial trauma, operation, invasive tumors and repeated exams were excluded. Detected findings were classified as "tooth loss, dental restorations or procedures and dental pathologies (carious lesions, dental developmental anomalies, periapical lesions and periodontal diseases). The proportion of findings was reported as simple percentiles.

RESULTS

Three hundred and eighty-four CT scans were included in the study. Dental restorations or procedures were determined in 129 (33.5%) patients. A total of 34 (8.8%) patients had normal teeth count and morphology. A total of 264 (64.3%) patients had at least one tooth loss. A total of 195 (51%) patients had at least one or more dental pathology. Number of dental carious lesions, dental developmental anomalies, periapical lesions and periodontal disease were 104 (27.0%), 78 (14.3%), 46 (11.9%), 44 (11.4%), respectively.

CONCLUSION

Dental pathologies were encountered in more than half of the patients. Detecting dental pathologies may prevent tooth loss and improve oral health. The radiologist should keep in mind dental pathologies while evaluating paranasal sinus CT in daily practice.

Periapical lucency around the tooth: radiologic evaluation and differential diagnosis

Periapical lucencies are often seen incidentally at head and neck imaging studies performed for indications not related to the teeth. These lesions are, however, occasionally manifestations of diseases that have a wide range of effects and may at times represent the source of symptoms that prompted the study. The vast majority of periapical lucencies are the result of apical periodontal or pulpal disease. If found in an advanced state or left untreated, disease related to the tooth may spread to adjacent tissues, including the sinuses, orbits, deep fascial spaces of the neck, and intracranial structures, and result in a significant increase in patient morbidity and mortality. Although the majority of periapical lucencies seen on radiographs and computed tomographic images occur secondary to apical periodontal or pulpal disease, not all lucencies near the tooth root are due to infection. Lucency near the tooth root may be seen in the setting of other diseases of odontogenic and non-odontogenic origin, including neoplasms. Although imaging findings for these lesions can include periapical lucent components, awareness of the varied secondary imaging features can aid the radiologist in developing an accurate differential diagnosis. Familiarity with the imaging features and differential diagnoses of diseases or conditions that cause lucency around the tooth root results in appropriate referral and prompt diagnosis, management, and treatment, and can prevent unnecessary additional imaging or intervention. In addition, early recognition and appropriate treatment of infectious processes will result in improved clinical outcomes and a decrease in morbidity and mortality.

Differential diagnosis of apical periodontitis and nasopalatine duct cyst

INTRODUCTION

An accurate differential diagnosis of apical periodontitis (AP) and nasopalatine duct cyst (NPDC) should be established to define the best treatment for endodontically treated maxillary anterior teeth with apical periodontitis. Three-dimensional cone beam computed tomography (CBCT) images help to plan treatment and to define an initial diagnostic hypothesis. However, endodontic treatment or retreatment may be unnecessarily prescribed when radiographs show a superimposition of the incisor foramen over the apex of maxillary central incisors, mimicking AP. Diseases of nonendodontic origin that affect the tooth apex, such as NPDC, should be included in the differential diagnosis.

METHODS AND RESULTS

Four clinical cases of patients with large periapical radiolucencies and similar radiographic features are described. AP is usually a consequence of endodontic infection; in cases of NPDC, however, spontaneous epithelial proliferation, in addition to bacterial infection and trauma, may also contribute to cyst formation. The frequency and recurrence rates of NPDC are low, and its behavior is less aggressive. Surgical enucleation of the periapical lesion is recommended after nonsurgical treatment does not heal AP.

CONCLUSIONS

The use of new diagnostic tools, such as CBCT imaging, may provide detailed high-resolution images of oral structures, which help to make an initial diagnostic hypothesis and to plan surgery. Histopathology is mandatory for the differential diagnosis.

[Dental-radical cysts, a rare aetiology of maxillary sinus opacity]

OBJECTIVE

To specify CT scan roll in diagnosis of radicullar cyst invading maxillary sinus.

METHODS

Two cases of 23 and 34-year-old men presented with facial injury and sinusitis was explored by CT scan.

RESULTS

CT scan showed in both patients a cystic lesion, developing into the maxillary sinus around a tooth apex and limits by a double dense thin rim.

CONCLUSION

CT scan permits diagnosis of radicular cyst invading maxillary sinus, in the event of obscured maxillary sinus, when double dense thin rim corresponding to the repulsed wall of the sinus is looking.

Radiologic and pathologic characteristics of benign and malignant lesions of the mandible

Mandibular lesions develop from both odontogenic and nonodontogenic origins and have varying degrees of destructive potential. Common benign cystic lesions include periapical (radicular) cysts, follicular (dentigerous) cysts, and odontogenic keratocysts. Benign solid tumors represent a broad spectrum of lesions such as ameloblastomas, odontomas, ossifying fibromas, and periapical cemental dysplasia. Malignant tumors that often involve the mandible include squamous cell carcinomas, osteosarcomas, and metastatic tumors. In addition, vascular lesions such as hemangiomas and arteriovenous malformations may develop, further expanding the differential diagnosis. Because mandibular lesions have a wide range of pathologic features but similar imaging appearances, familiarity with embryologic characteristics and secondary findings is crucial. Patient age at manifestation, prevalence, location within the mandible, cystic or solid appearance, border contour, and effect of the lesion on adjacent structures are all considerations in making the diagnosis. Despite this information, however, many lesions are impossible to differentiate without biopsy. In such cases, defining the degree of malignant potential is very helpful. Although imaging will not always provide a specific diagnosis, it should help narrow the differential diagnosis, thereby helping to guide patient treatment.

Periorbital Cyst with Bone Defect in a Dog

A 4-year-old female Miniature Dachshund was referred with a chief complaint of right periorbital swelling that had not responded to antibiotic therapy. Ultrasonography and fine-needle aspiration revealed that the periorbital lesion had a cystic structure without any inflammatory or neoplastic cells. Computed tomography (CT) showed that the cyst occupied a defect in the periorbital maxillary, lacrimal, and frontal bones and had invaded the nasal cavity. The lesion was histologically suspected by incisional biopsy as an epithelial cyst.