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Radiology Quiz Case 1: Diagnosis

Radiology Quiz Case 1: Diagnosis Diagnosis: Dentigerous mandibular cyst Cystic and cystlike lesions of the mandible are primarily ellipsoid, radiolucent, and clearly demarcated and may be odontogenic or nonodontogenic. Odontogenic cysts are found in the jaws arising from epithelium involved in tooth formation. They include dentigerous (also known as follicular), lateral periodontal, and radicular cysts. A follicular cyst is a unilocular, osteolytic lesion that classically incorporates the crown of an unerupted tooth; also, it may give rise to ameloblastomas and, in rare cases, undergo malignant transformation. Careful consideration of the patient's history and the location of the lesion within the mandible, as well as the lesion's borders, its internal architecture and structures, and its effects on adjacent structures, generally make it possible to narrow the differential diagnosis.1 Odontogenic cysts develop during and after the formation of teeth. Nonmineralized odontogenic lesions fail to demonstrate internal mineralization and are classically described as radiolucent. Such lesions may partially or completely surround a normal mineralized structure, such as a tooth, as in the present case. Mineralization produces lesions with varying degrees of opacity. Most odontogenic mandibular lesions are benign, but some may exhibit aggressive and destructive behavior locally. Many of these processes are asymptomatic, particularly in their early stages, and are discovered incidentally on routine dental radiography. The most common symptom is pain, which may or may not be accompanied by swelling. Other reported symptoms and signs include paresthesias and tooth displacement or mobility. The presence or absence of signs and symptoms does not always aid in differentiating benign from malignant processes.2 It is sometimes difficult to distinguish cystic-appearing mandibular lesions with conventional or panoramic radiography.3 Based on imaging alone, the dentigerous cyst is difficult to differentiate from the less common odontogenic keratocyst, and final diagnosis often depends on pathologic appearance. However, ameloblastomas are often multilocular, less commonly incorporate an unerupted tooth, and may have a soft tissue component in addition to the cyst. Computed tomography, with or without 3-dimensional reconstruction, helps in the differential diagnosis and surgical planning. Recently, it was demonstrated that stromal myofibroblasts have the potential to facilitate progression of benign neoplastic epithelial lesions and have a role in their biological behavior.4 In this case, surgical treatment included a transoral approach with curettage, marsupialization, and the extraction of teeth 30 though 32 (included in the cyst).5 References 1. Scholl RJKellett HMNeumann DPLurie AG Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics19991911071124PubMedGoogle Scholar 2. Aboul-hosn Centenero SMari-Roig APiulachs-Clapera P et al Primary intraosseous carcinoma and odontogenic cyst: three new cases and review of the literature. Med Oral Patol Oral Cir Bucal200611E61E65PubMedGoogle Scholar 3. Ferreira Junior ODamante JHLauris JR Simple bone cyst versus odontogenic keratocyst: differential diagnosis by digitized panoramic radiography. Dentomaxillofac Radiol200433373378PubMedGoogle Scholar 4. Vered MShohat IBuchner ADayan D Myofibroblasts in stroma of odontogenic cysts and tumors can contribute to variations in the biological behavior of lesions. Oral Oncol20054110281033PubMedGoogle Scholar 5. Shah JPPatel SG Tumores óseos. In: Shah J, ed. Cirugía y Oncología de Cabeza y Cuello.3rd ed. Madrid, Spain: Elsevier España; 2004:549-588Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Radiology Quiz Case 1: Diagnosis

Archives of Otolaryngology - Head & Neck Surgery , Volume 132 (7) – Jul 1, 2006

Radiology Quiz Case 1: Diagnosis

Abstract

Diagnosis: Dentigerous mandibular cyst Cystic and cystlike lesions of the mandible are primarily ellipsoid, radiolucent, and clearly demarcated and may be odontogenic or nonodontogenic. Odontogenic cysts are found in the jaws arising from epithelium involved in tooth formation. They include dentigerous (also known as follicular), lateral periodontal, and radicular cysts. A follicular cyst is a unilocular, osteolytic lesion that classically incorporates the crown of an unerupted tooth; also,...
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.132.7.804-a
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Dentigerous mandibular cyst Cystic and cystlike lesions of the mandible are primarily ellipsoid, radiolucent, and clearly demarcated and may be odontogenic or nonodontogenic. Odontogenic cysts are found in the jaws arising from epithelium involved in tooth formation. They include dentigerous (also known as follicular), lateral periodontal, and radicular cysts. A follicular cyst is a unilocular, osteolytic lesion that classically incorporates the crown of an unerupted tooth; also, it may give rise to ameloblastomas and, in rare cases, undergo malignant transformation. Careful consideration of the patient's history and the location of the lesion within the mandible, as well as the lesion's borders, its internal architecture and structures, and its effects on adjacent structures, generally make it possible to narrow the differential diagnosis.1 Odontogenic cysts develop during and after the formation of teeth. Nonmineralized odontogenic lesions fail to demonstrate internal mineralization and are classically described as radiolucent. Such lesions may partially or completely surround a normal mineralized structure, such as a tooth, as in the present case. Mineralization produces lesions with varying degrees of opacity. Most odontogenic mandibular lesions are benign, but some may exhibit aggressive and destructive behavior locally. Many of these processes are asymptomatic, particularly in their early stages, and are discovered incidentally on routine dental radiography. The most common symptom is pain, which may or may not be accompanied by swelling. Other reported symptoms and signs include paresthesias and tooth displacement or mobility. The presence or absence of signs and symptoms does not always aid in differentiating benign from malignant processes.2 It is sometimes difficult to distinguish cystic-appearing mandibular lesions with conventional or panoramic radiography.3 Based on imaging alone, the dentigerous cyst is difficult to differentiate from the less common odontogenic keratocyst, and final diagnosis often depends on pathologic appearance. However, ameloblastomas are often multilocular, less commonly incorporate an unerupted tooth, and may have a soft tissue component in addition to the cyst. Computed tomography, with or without 3-dimensional reconstruction, helps in the differential diagnosis and surgical planning. Recently, it was demonstrated that stromal myofibroblasts have the potential to facilitate progression of benign neoplastic epithelial lesions and have a role in their biological behavior.4 In this case, surgical treatment included a transoral approach with curettage, marsupialization, and the extraction of teeth 30 though 32 (included in the cyst).5 References 1. Scholl RJKellett HMNeumann DPLurie AG Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics19991911071124PubMedGoogle Scholar 2. Aboul-hosn Centenero SMari-Roig APiulachs-Clapera P et al Primary intraosseous carcinoma and odontogenic cyst: three new cases and review of the literature. Med Oral Patol Oral Cir Bucal200611E61E65PubMedGoogle Scholar 3. Ferreira Junior ODamante JHLauris JR Simple bone cyst versus odontogenic keratocyst: differential diagnosis by digitized panoramic radiography. Dentomaxillofac Radiol200433373378PubMedGoogle Scholar 4. Vered MShohat IBuchner ADayan D Myofibroblasts in stroma of odontogenic cysts and tumors can contribute to variations in the biological behavior of lesions. Oral Oncol20054110281033PubMedGoogle Scholar 5. Shah JPPatel SG Tumores óseos. In: Shah J, ed. Cirugía y Oncología de Cabeza y Cuello.3rd ed. Madrid, Spain: Elsevier España; 2004:549-588Google Scholar

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Jul 1, 2006

Keywords: radiology specialty,cysts,mandible

References