CT of cystic jaw lesions

Evaluation of Spontaneous Bone Regeneration after Enucleation of Large Cysts of the Jaws using Radiographic Computed Software

Introduction

Spontaneous regeneration of bone is commonly seen in the small surgical defects caused by enucleation of cysts. However, in case of large surgical defects caused by the enucleation, spontaneous regeneration of bone is a rare phenomenon and it depends on factors, such as age of the patient, intact periosteum, and proper stabilization.

Materials and methods

The study included 16 patients, who reported to the department of oral and maxillofacial surgery with the complaint of pain and swelling in the jaws diagnosed as cyst. The sample included equal numbers of male and female subjects aged between 15 and 40 years. Panoramic radiographs were taken pre- and postoperatively on day 2 of the enucleation.

The dimensions of the cyst were evaluated on the radiograph according to the proforma.

Subsequent radiographs were taken at regular intervals of 1.5, 3, and 6 months using standard parameters and were analyzed using MCID™ analysis software of imaging research.

Results

Mean reduction was seen in up to 39 and 60% in the cystic cavity size and increase in the mean density up to 59 and 90.2% at 3 and 6 months intervals respectively.

Conclusion

Spontaneous bone regeneration was seen even after primary closure of the large cystic defect without the need for placement of foreign substances or grafts and it also eliminated the complications resulting from placement of foreign substance. Further studies are required in a larger sample with longer follow-up durations to confirm the outcome of the present work for the benefit of patients.

Clinical significance

The present study depicted that spontaneous bone regeneration can occur with accepted results after simple enucleation of jaw cyst without the aid of any graft material. Hence, simple enucleation may be considered as a first line of treatment modality for cystic lesion of the jaws. This simplifies the surgical procedure, decreases the economic and biologic costs, and reduces the risk of postoperative complications. Follow-up is necessary along with patient's compliance for the success of treatment.

How to cite this article

Wagdargi SS, Rai KK, Arunkumar KV, Katkol B, Arakeri G. Evaluation of Spontaneous Bone Regeneration after Enucleation of Large Cysts of the Jaws using Radiographic Computed Software. J Contemp Dent Pract 2016;17(6):489-495.

Diagnostic imaging: Morphological and eruptive disturbances in the permanent teeth

This paper reviewed the literature on newer three-dimensional imaging techniques and their applications in diagnosis and treatment planning of various dental anomalies. Developmental anomalies can occur during any of the developmental stages and are manifested clinically after the tooth is fully formed. These dental anomalies may involve a single tooth, a group of teeth, or the entire dentition. Two-dimensional diagnostic imaging, including periapical, occlusal, panoramic, or cephalometric radiographs are essential in localization and management of morphological and eruptive disorders. However, due to their inherent limitations such as insufficient precision because of unusual projection errors and lack of information about spatial relationships, these methods are considered unreliable. Thus, the use of newer image acquisition techniques that allow comprehensive three dimensional imaging and visualization of dental abnormalities is highly recommended for making a confirmatory diagnosis. The significance of accurate endodontic, surgical and orthodontic treatment planning in dental abnormalities cannot be overstated as it pertains to critical anatomic landmarks such as proximity to adjacent teeth or the mandibular canal. The precise information on spatial relationships provided by multiplanar imaging helps the dental surgeon to establish more accurate diagnosis, management strategies and also increases the patient safety. This review highlights the use of high-end diagnostic imaging modalities in diagnosis of the various morphologic and eruptive dental abnormalities.

Peripheral osteoma of maxilla: A case report

Osteoma is a benign osteogenic lesion with a very slow growth, characterized by proliferation of either compact or cancellous bone. Most cases of peripheral osteomas are asymptomatic and produce swelling and asymmetry. Its pathogenesis is unclear but commonly accepted theories propose embryologic, traumatic, or infectious causes. The osteoma may appear in the form of a limited peripheral lesion involving the alveoli or cheek or as a tumoral growth developing inward toward the sinus. Recurrences of osteomas have not been reported in the literature. We report a rare case of maxillary peripheral osteoma with impacted right canine in a 32-year-old female patient.

Peripheral osteoma of the palate: report of a case and review of literature

Osteomas are benign osteogenic lesions with very slow growth, which may arise from proliferation of either cancellous or compact bone. Peripheral osteomas of maxilla are relatively rare. Excluding the maxillary sinus, there are few cases of maxillary osteoma reported in the English-language literature. This paper reports an additional case of osteoma in the palatal region in a 34-year-old female patient. The aim of this paper is to present an unusual case along with an analysis of the literature in order to contribute to the knowledge concerning the pathogenesis, differential diagnosis, and management of these lesions.

Contrast-enhanced multidetector computerized tomography for odontogenic cysts and cystic-appearing tumors of the jaws: is it useful?

OBJECTIVE

The purpose of this study was to investigate the usefulness of computerized tomography (CT), particularly contrast-enhanced CT, in differentiation of jaw cysts and cystic-appearing tumors.

STUDY DESIGN

We retrospectively analyzed contrast-enhanced CT images of 90 patients with odontogenic jaw cysts or cystic-appearing tumors. The lesion size and CT values were measured and the short axis to long axis (S/L) ratio, contrast enhancement (CE) ratio, and standard deviation ratio were calculated.

RESULTS

The lesion size and the S/L ratio of keratocystic odontogenic tumors were significantly different from those of radicular cysts and follicular cysts. There were no significant differences in the CE ratio among the lesions.

CONCLUSIONS

Multidetector CT provided diagnostic information about the size of odontogenic cysts and cystic-appearing tumors of the jaws that was related to the lesion type, but showed no relation between CE ratio and the type of these lesions.

An unusual case of tooth in the floor of the orbit: the libyan experience

Maxillary dentigerous cysts although uncommon need to be considered in the differential diagnosis in children with painless facial swelling. We present a case of dentigerous cyst associated with maxillary deciduous canine and maxillary premolars manifesting as a unilateral swelling in canine region of the face. A ten-year-old boy came to oral and maxillofacial surgery unit with a painless left facial swelling. The local dentist had prescribed antibiotics for treatment for the facial swelling, but the swelling did not subside, and the parents brought the child to our unit in Zliten Dental College. After clinical examination and imaging, the diagnosis of dentigerous cyst was made. Caldwell-Luc approach was done, the cyst was enucleated, and primary closure was done. The patient was followed up for a period of two years and there was no evidence of any recurrence.

Cystic lesions of the jaws - a clinicopathological study of 322 cases and review of the literature

Three hundred and twenty-two patients (192 male and 130 female) with cystic lesions of the jaw were successfully diagnosed and treated. One hundred and fifty-five (48%) were radicular cysts, 80 (25%) were dentigerous cysts, 23 (7%) were odontogenic keratocyst (=keratocystic odontogenic tumor), 19 (6%) were eruption cysts, 16 (5%) were traumatic bone cysts, and 29 (9%) were non-odontogenic cysts. There were 95 in the pediatric age group (1 month to 16 years) and 227 in the adult age group (17 years and older). Male to female ratio was 1 in the pediatric age group and 1.7 in the adult age group. The treatment modalities were: marsupialization, enucleation, enucleation with bone grafting, or resection. The distribution and characteristics of jaw cysts in children are different from those in adults. In children there is a relatively high rate of developmental cysts, whereas in adults the inflammatory cysts are more common. Following enucleation of a cystic jaw lesion, the entire surgical specimen and not only a biopsy specimen, should be examined histopathologically to prevent any possibility of an intramural squamous cell carcinoma that may be overlooked. The differences in prevalence of each type of jaw cyst during a lifetime may point toward a multifactorial polygenic pattern rather than a monogenic pattern.

Mandibular traumatic peripheral osteoma: a case report

An osteoma is a slow-growing, benign lesion comprising mature bone tissue. Osteomas rarely occur in maxillary bones, with the exception of the maxillary sinuses. Various possible etiologies have been proposed, including congenital anomalies, chronic inflammation, muscular activity, embryogenetic changes, and trauma. Here we present a case of an osteoma of the buccal plate of the mandible at the site where a sports-related traumatic injury occurred 15 years earlier. Both conventional and 3-dimensional x-ray examinations were used for diagnosis and preoperative evaluation of the possible involvement of the adjacent anatomic structures. The lesion was treated surgically without complications and the patient made a complete recovery. Histologic tests confirmed the preoperative diagnosis. A review of the international literature is also presented.

Computed tomography appearance of mandibular para-radicular third molar radiolucencies

OBJECTIVES

Mandibular para-radicular third molar radiolucencies (MPRs) were first described in 2004 by Bohay et al (Bohay RN, Mara TW, Sawula KW, Lapointe HJ. A preliminary radiographic study of mandibular para-radicular third molar radiolucencies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 97-101) as a well-defined oval radiolucency surrounded by a thin sclerotic border located immediately distal to the mandibular third molar roots. Bohay et al's analysis was undertaken using panoramic radiographs. The purpose of this study was to confirm Bohay et al's findings on panoramic radiographs and to identify and document the appearance of MPRs on cross-sectional CT.

METHODS

Panoramic films and CT images of the lower third molar regions from 143 patients were reviewed.

RESULTS

MPR was identified on panoramic film in 12 patients with a total of 14 MPRs. A number of factors were recorded from panoramic films and CT.

CONCLUSIONS

This study confirmed the findings of Bohay et al and concluded that the relative lucent appearance on panoramic radiographs can be explained by the presence of one or a combination of factors: (i) an area of decreased density in trabecular bone, (ii) thinning of the inner surface of the buccal cortex, (iii) thinning of the inner surface of the lingual cortex or (iv) a depression in the external surface of the lingual cortex.

Cystic lesions of the jaws in edentulous patients: analysis of 27 cases

In this retrospective study we reviewed the distribution, characteristics, and treatment of 27 cystic jaw lesions in edentulous patients, and compared these with 242 cysts in dentate patients. The mean age was 60 years (range 46-74), and the male:female ratio 4.4:1. The maxilla was more affected than the mandible, with radicular/residual cysts being the most common. Patients were treated by marsupialisation, enucleation, or enucleation with bone grafting. Edentulous men were at higher risk than women of developing cystic lesions in the maxilla. Patients who are edentulous alert us to the possibility that their general health may be compromised, and this should be kept in mind when planning treatment.

Multidetector computed tomography of jaw lesions in children and adolescents

Jaw lesions in paediatric and adolescent population are uncommon and can arise in odontogenic or non-odontogenic tissues. With the advent of multidetector computed tomography (MDCT), algorithm for imaging jaw lesions has changed dramatically. This pictorial essay describes the imaging appearance of commonly encountered jaw lesions in children and adolescents with emphasis on MDCT findings.

Computed tomography-assisted management of a mandibular dentigerous cyst in a dog with a nasal carcinoma

CASE DESCRIPTION

A 6-year-old neutered male Boston Terrier was examined to determine the cause of sneezing, bilateral nasal discharge, nasal congestion, lethargy, and coughing of 2 months' duration.

CLINICAL FINDINGS

An undifferentiated nasal carcinoma was diagnosed. During computed tomography (CT) evaluation of response to tomotherapy radiation treatment, a mandibular dentigerous cyst, associated with an unerupted left mandibular first premolar, was monitored for expansion.

TREATMENT AND OUTCOME

The dog had a profound response to radiation treatment, and the nasal carcinoma totally resolved. It was determined on the basis of CT that the rate of expansion of the dentigerous cyst was placing the dog at risk for mandibular fracture and loss of vitality to the surrounding teeth. The unerupted left mandibular first premolar and associated dentigerous cyst were surgically removed and submitted for histologic evaluation.

CLINICAL RELEVANCE

Images obtained during sequential CT evaluations performed after radiation treatment of nasal carcinoma should be examined for evidence of the primary neoplasm as well as to detect unrelated lesions of the orofacial region that can compromise the quality of life. Findings of CT evaluations can be used to determine when and how to initiate treatment for dentigerous cysts in regard to the patient's response to radiation treatment.

Validation of computed tomography protocols for simulated mandibular lesions: a comparison study

Computed tomography is the choice technique to assess oral and maxillofacial osseous lesions because it provides hard and soft tissues visualization in one examination without superimposition of surrounding structures. This examination offers a significant advance in maxillofacial lesions detection with an excellent anatomic resolution. The aim of this research was to evaluate the validity of two protocols, in axial sections, in simulated mandibular lesions. Two CT protocols were obtained in dry mandibles in which perforations were done simulating lesions. Two observers, previously calibrated, evaluated the images according to different parameters. The results indicated that the sensitivity and specificity in lesion detection were 100% for both protocols, but the detection of loci number of multilocular lesions and the location and detection of medullar invasion obtained reduced validity values, which were influenced by the acquisition protocol. We concluded that thinner axial slices and reconstructions were more effective in detecting early medullar invasion and loci number. Thicker protocols were not considered appropriate to detect multilocular lesions and early stages of medullar invasion.

Pindborg tumor in children

Pindborg tumor or calcifying epithelial odontogenic tumor is a rare benign neoplasm. The average age at diagnosis is 40 years without a significant prevalence for one sex. The most frequent localization is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla, while other localizations like the maxillary sinus are extremely rare. Ethiology of this lesion is not clear. The complete surgical removal of the lesion is usually considered the most common type of treatment. The authors report a peculiar case of Pindborg tumor characterized by a rare localization of the lesion (maxillary incisal area) and by the young age of the patient (nine years old). The correct treatment in the case of a small mass is the surgical enucleation of the lesion. The purpose of the surgical treatment is the radical resection of the neoplasm with clean margins in order to reduce the risk of recurrence of disease. Recurrence of disease many years after surgical therapy has been reported that is why a clinical and instrumental long-term follow-up of the patient are suggested.

Eruption cyst in the adult--a case report

A case of eruption cyst in the right maxilla of a 40-year-old female is reported.

Cystic lesions of the jaws in children

Sixty nine pediatric patients with cystic lesions of the jaws were successfully diagnosed and treated. Thirty one (45%) were dentigerous cysts (D.C.), 15 (22%) were eruption cysts (E.C.), 12 (17.3%) were traumatic bone cysts (T.B.C.), nine (13.3%) were radicular cysts (R.C.), one (1.5%) was primordial cyst (P.C.) and one (1.5%) globulomaxillary cyst (G.M.C.). The mean age for E.C., R.C., D.C., T.B.C. was 4.7, 9.2, 11.5, and 13.3 years, respectively. The mean age of E.C. is significantly (P<0.05) younger than D.C. and T.B.C. but not from R.C. No significant age differences were found between R.C., D.C. and T.B.C. The differences in mean cyst diameter were not significant. Male to female ratio was 1. The treatment modalities were: marsupialization, enucleation or enucleation with bone grafting. The findings demonstrate that the distribution and characteristics of jaw cysts in children is unique and is different from the distribution in adults. The relatively high rate of developmental cyst and the fact that they occur in an area with rapid developmental changes, suggest the need for more conservative surgical management in this selected patient population.

Image accuracy of plain film radiography and computerized tomography in assessing morphological abnormality of impacted teeth

This study compares the image accuracy of computerized tomography (CT) with that of plain film radiography (PFR) in analyzing the 3-dimensional shape of impacted teeth suspected of being malformed. Eighteen patients with 22 malformed teeth were studied by PFR and CT. Crown shape, root shape, crown/root relationship, and tooth inclination and structure were assessed by PFR and CT. CT was found to be superior to PFR in showing the multiplanar shape of tooth crown and root, crown/root relationship, and tooth inclination (P <.001). No difference was found in the representation of tooth structures. The findings demonstrate that CT imaging is useful to diagnose and plan treatment for patients with unerupted and malformed teeth.

3D-CT vascular setting protocol using computer graphics for the evaluation of maxillofacial lesions

In this paper we present the aspect of a mandibular giant cell granuloma in spiral computed tomography-based three-dimensional (3D-CT) reconstructed images using computer graphics, and demonstrate the importance of the vascular protocol in permitting better diagnosis, visualization and determination of the dimensions of the lesion. We analyzed 21 patients with maxillofacial lesions of neoplastic and proliferative origins. Two oral and maxillofacial radiologists analyzed the images. The usefulness of interactive 3D images reconstructed by means of computer graphics, especially using a vascular setting protocol for qualitative and quantitative analyses for the diagnosis, determination of the extent of lesions, treatment planning and follow-up, was demonstrated. The technique is an important adjunct to the evaluation of lesions in relation to axial CT slices and 3D-CT bone images.

The validation of 3D spiral CT-based measurements of simulated maxillofacial neoplasms

OBJECTIVE

The purpose of this study was to determine the precision and accuracy of 3-dimensional spiral computed tomography-based linear measurements of neoplasms associated with the mandible.

STUDY DESIGN

Four cadaver heads, each with 2 simulated tumors made of clay, containing contrast medium, and positioned medial to the mandible, were examined by means of a subsecond spiral computed tomography unit. The computed tomography data were transferred to a computer workstation and analyzed through use of 3-dimensional reconstructed images. Linear measurements of the length, width, and depth of the simulated tumors were made by 2 observers, twice each. The soft tissues were then removed and the same measurements made by means of calipers.

RESULTS

There were no statistically significant differences between the 3-dimensional computed tomography and physical measurements (P >.05). The mean difference was found to be less than 0.4 mm.

CONCLUSIONS

Spiral computed tomography imaging allows for precise and accurate 3-dimensional computed tomography-based measurements for neoplastic lesions in the mandible.

Value of computed tomography and magnetic resonance imaging in the treatment of a calcifying epithelial odontogenic (Pindborg) tumour

The calcifying epithelial odontogenic (Pindborg) tumour is a rare primary tumour of the jaw with a characteristic histological appearance. We describe here its appearance on computed tomography (an expanding, multilocular lesion that is thinning both plates of the mandible, is well-defined and contains scattered radio-opaque areas) and magnetic resonance imaging (predominantly hypointense on T1-weighted images and of mixed hyperintensity on T2-weighted images; the extent of the tumour including involvement of the mandibular canal was clear).

Accuracy and precision of spiral CT in the assessment of neoplastic lesions associated with the mandible

RATIONALE AND OBJECTIVES

The purpose of this study was to determine the accuracy (validity) and precision (reliability) of spiral computed tomographic (CT) images by using film- and computer graphics-based measurements of simulated neoplastic lesions associated with the mandible.

MATERIALS AND METHODS

Four cadaver heads, each with two simulated tumors containing contrast medium positioned medial to the mandibles, were examined by using a subsecond spiral CT scanner. Data were transferred to film and to a computer workstation. With computer graphics, data were analyzed by using multiplanar reconstructed images. Linear measurements of the length, width, and depth of simulated tumors were made by two observers, twice each, on the film scans by using manual calipers and on the multiplanar reconstructed images by using computerized measurements. The soft tissues were then removed from the cadavers and the same measurements made by using the same calipers.

RESULTS

No statistically significant differences between computer graphics- or film-based measurements and physical measurements (P > .05) or between inter- and intraobserver measurements (P > .05) were found.

CONCLUSION

The authors found high reproducibility of measurements for all dimensions. Spiral CT allows accurate computer graphics- and film-based measurements of neoplastic lesions associated with the mandible.

Trigeminal neuropathy: improved imaging with a dental computed tomography software program

PURPOSE

This study evaluated the use of images obtained by a dental computed tomography (CT) software program in the diagnosis and treatment of trigeminal neuropathy associated with jaw abnormality.

PATIENTS AND METHODS

Twelve patients with jaw abnormality associated with trigeminal neuropathy as the presenting symptom were studied by plain film radiography (PFR) and by a dental CT software program (DS) that displays multiple panoramic and cross-sectional views of the mandible and maxilla. The two modalities were compared for delineation of the integrity of mandibular foramen, mandibular canal, mental foramen, incisive foramen, and incisive canal. Also, displacement of the neurovascular bundle was evaluated and scored.

RESULTS

The DS was superior to PFR in showing the bony integrity of the foramina and canals in the jaws, as well as the degree of displacement of the neurovascular bundle.

CONCLUSION

DS should be the study of choice for evaluating trigeminal neuropathy associated with abnormalities of the jaws.

Osseous regeneration in the jaws using demineralized allogenic bone implants

Osseous defects of the jaws following trauma, congenital deformity or pathology may show poor osteogenesis and the affected area may never be completely replaced by bone or will show alveolar height loss. The purpose of the present study was to evaluate the effect of allogenic bone implants (ABI) on the osteogenesis of jaw defects. Fifty-two patients (27 males, 25 females) with cystic lesions of the jaws were randomly divided into two groups: Group A underwent enucleation and packing with adsorbable gelatine sponge. Group B underwent enucleation and grafting with ABI. Both groups were evaluated radiographically. The height of the alveolar process was measured directly on the radiography. The density was measured with a digital densitometer. In Group A, the mandibular height at 6, 12 and 24 months postoperatively was 88%, 80% and 78% of the preoperative heights, respectively. In Group B, the heights were 95%, 93% and 90%, respectively. These differences were significant (P < 0.05-0.01). The density in Group B was significantly greater (P < 0.05-0.01) than in Group A at 6 and 12 months postoperatively. The difference at 24 months was not significant. On the basis of these findings, it can be concluded that ABI grafting of jaw defects enhances osteogenesis and prevents alveolar height loss in the mandible. ABI represent an encouraging alternative to autogenous bone grafting.

Teeth in the maxillary sinus--imaging and management

PURPOSE

To evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus.

METHODS

Twelve patients with teeth in the maxillary sinus were studied by plain film radiography (PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored.

RESULTS

The radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation.

CONCLUSION

CT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.

Temporomandibular joint dysfunction in children

Sixteen pediatric patients with temporomandibular joint (TMJ) dysfunction were successfully diagnosed following appropriately selected imaging methods. The role of radiography in diagnosis of TMJ dysfunction is essential in distinguishing between the osteogenic and non-osteogenic etiologies. Computed tomography (CT) was found to be a valuable imaging method, with advantages over plain film radiography. The treatment modalities considered were: non-invasive therapy, occlusal therapy and surgical treatment. The treatment of choice was dependent on the osteogenic or non-osteogenic etiology. Surgery was considered only when the non-invasive or occlusal therapies were ineffective.

Effect of decalcified freeze-dried bone allograft on the healing of jaw defects after cyst enucleation

PURPOSE

This study radiographically evaluated the changes that occur in jaw defects after enucleation of cysts and either grafting with demineralized freeze-dried bone allograft (DFDBA) or packing with absorbable gelatine sponge (Gelfoam).

PATIENTS AND METHODS

Thirty-two patients (14 males, 18 females) with cystic lesions of the jaws were divided into two groups. Group A underwent enucleation and bone grafting with DFDBA. Group B underwent enucleation and packing with Gelfoam. Both groups were evaluated radiographically before surgery, immediately postoperatively, and 6, 12, 24, and 36 months postoperatively. The density of the area was measured with a digital densitometer.

RESULTS

The density in group A was significantly (P < .05 to .01) greater than in group B at 6 and 12 months postoperatively. The difference at 24 months was not significant. Group A reached density levels at 6 months that were reached by group B at 12 months.

CONCLUSION

The findings demonstrate that decalcified freeze-dried bone allograft enhances bone healing in jaw defects after cyst removal.

DentaCT for evaluating mandibular and maxillary invasion in cancer of the oral cavity

We used a retrospective analysis of charts, imaging studies, and histologic findings when available in 17 patients with cancer of the oral cavity to define the value of DentaCT or multiplanar reformation software in assessing bony involvement by malignant tumors of the oral cavity. From two academic tertiary-referral medical centers, the 17 patients had a mean age of 63 years and suspected maxillary (2) or mandibular (15) invasion. All patients had conventional computed tomography scanning and multiplanar reformation scans with several additional imaging studies obtained. Two patients demonstrated no bony involvement by imaging and histologic studies. Twelve of the remaining 15 patients had surgically documented bony involvement also correctly detected by DentaCT. DentaCT was found to be a valuable tool in defining extent of bony invasion by tumor. Although not compared to other imaging modalities, our experience supports the use of DentaCT where available for this purpose.

Radiographic features of central giant cell granuloma of the jaws in children

The radiographic features of ten pediatric cases of central giant cell granuloma of the jaws were studied, using plain film radiography (PFR), computed tomography (CT), and a dental CT software program (DS). The radiologic features varied from ill-defined destructive lesions to a well-defined, multilocular appearance. Teeth or root displacement was found as the most consistent feature. Root resorption was rare. The features seen on CT were clearer than those seen on PFR. DS, by its visualization of the jaw in three plans - axial, panoramic, and buccolingual - provided useful information for determining the topography of the lesion in its structure (uni- or multilocular) and proximity to adjacent anatomic structures, such as teeth, nerves, or maxillary sinus. CT and, ideally, CT with DS should be used for diagnosis and surgical management of central giant cell granuloma of the jaws in children.