Mixed Radiolucent Radiopaque Lesions Of Oral Cavity

Mixed Radiolucent Radiopaque Lesions Of Oral Cavity

Give differential diagnosis of mixed radiopaque and radiolucent lesions of jaws.
Answer.

Mixed Radiopaque and Radiolucent Lesions of Jaws

• Intermediate stage of Paget’s disease
• Fibrous dysplasia
• Osteoid osteoma
• Chronic osteomyelitis
• Osteoradionecrosis
• Cemento-ssifying firoma
• Calcified epithelial odontogenic tumor (CEOT)
• Osteogenic sarcoma
• Chondroma
• Chondrosarcoma
• Central hemangioma
• Ossifying subperiosteal hematoma

Mixed Radio-paque and Radiolucent Lesions Associated with teeth

cemento-ossifying Fibroma

• Osteoblastoma: Histology helps in establishing diagnosis.
• Osteosarcoma: Osteosarcoma is a malignant tumor which shows malignant characteristics such as invasion of tumor cells in sof tissue, destruction of cortices while cemento ossifying firoma is benign in nature.
• Osteoid osteoma: More common in men at 3rd to 4th decade while cemento-ossifying firoma is common in women of same age group. Osteoid osteoma leads to pain during night while cemento-ossifying firoma is asymptomatic.
• Calcifying epithelial odontogenic tumor (CEOT): Most common site of occurrence is posterior body and ramus of mandible while most common site of occurrence for cemento-ssifying firoma is mandibular premolar-molar region.
• Chondrosarcoma: In chondrosarcoma borders are ill defied with formation of periosteal bone while in cemento ossifying firoma borders are well defied.
• Periapical cemental dysplasia: In periapical cemental dysplasia occurance is in older age group as compared to periapical cemental dysplasia. Periapical cemental dysplasia occur in mandibular incisor lesion while cemento ossifying firoma occur in premolar-molar region.
• Fibrous dysplasia: It has equal sex predilection while cemento ossifying firoma is more common in females. Border of lesion in firous dysplasia is ill-defied while in Paget’s disease borders are well defied.
• Paget’s disease: Paget’s disease show cottn-wool appearance while no such appearance is seen in cemento-ossifying firoma.
• Benign cementoblastoma: In benign cementoblastoma tumor is attched to the root and shows root resorption while in cemento-ossifying firoma, tumor is not attched to root. Benign cemento blastoma is associated with pain while cemento-ossifying firoma is asymptomatic.
• Juvenile ossifying firoma: Juvenile ossifying firoma is seen in 1st to 2nd decades while cemento-ossifying firoma is seen in 3rd to 4th decades. In juvenile-ossifying firoma maxilla is commonly affected while in cemento-ossifying firoma mandible is commonly affected. Radiographic appearance of both lesions is similar, diagnosis is made histologically.

Fibrous dysplasia

• Osteoblastic metastatic carcinoma: Osteoblastic carcinoma does not reveal monotonous pattern while fibrous dysplasia show monotonous pattrn.
• Osteosarcoma: Osteosarcoma shows Codman’s triangle, sunburst pattrn while firous dysplasia shows granular pattern.
• Chondrosarcoma: Chondrosarcoma is painful while in firous dysplasia, frank pain is there. Fibrous dysplasia is seen in younger age group while chondrosarcoma is seen in older age group.
• Cemento-ossifying fibroma:
  • Cemento-ossifying fibroma has predilection for mandible while fibrous dysplasia has predilection for maxilla.
  • Shape of cemento-ossifying fibroma is rounded while of fibrous dysplasia is rectangular.
  • Margins in cemento-ossifying fibroma are sharply defied while in fibrous dysplasia, they are indistinct.
  • Cemento-ossifying fibroma is seen in young people while fibrous dysplasia is seen in older persons.
• Paget’s disease: Serum alkaline levels are raised in paget’s disease, while they are within normal range in fibrous dysplasia.

Paget’s disease

• Osteoblastic metastatic carcinoma: Osteoblastic metastatic carcinoma shows history of primary tumor while Paget’s disease does not had such history.
• Osteosarcoma: Osteosarcoma occurs in younger age group while Paget’s disease occur in middle age group. Osteosarcoma shows radiographic appearance such as sun ray appearance and codman’s triangle.
• Chondrosarcoma: One of the common symptom of chondrosarcoma is pain while pain is absent in Paget’s disease.
• Cemento-ossifying-fibroma: Cemento-ossifying fibroma occurs in younger age group while paget’s disease occur in 40 years of age. Cemento-ossifying firoma show well defined margins while Paget’s disease shows diffuse margins.
• Fibrous dysplasia: Fibrous dysplasia occurs in younger age group while Paget’s disease is seen during 40 years of age. Paget’s disease resemble cottn wool-appearance while firous dysplasia shows motted appearance. In firous dysplasia, maxillary sinus is reduced while in paget’s disease air space is not reduced.
• Ossifying subperiosteal hematoma: Ossifying subperiosteal hematoma is seen in younger age, i.e. 15 years and there is also history of recent trauma.

Osteosarcoma

• Metastatic carcinoma: In metastatic carcinoma, history of primary tumor is evident while no such history is seen in osteosarcoma.
• Chondrosarcoma: Chondrosarcoma occurs in older age group and there is predilection for maxilla while osteosarcoma occur in middle age group and predilection for maxilla and mandible is equal.
• Ossifying firoma: Internal structure is uniform in ossifying firoma, while it is non-uniform in osteosarcoma.
• Fibrous dysplasia: Lesions are more demarcated and have uniform appearance as compared to osteosarcoma.
• Ossifying subperiosteal hematoma: Patient will give history of recent trauma in ossifying subperiosteal hematoma, while it is not so in osteosarcoma.

Chondrosarcoma

• Osteosarcoma: Chondrosarcomareveals typicalcalcifiations in radiograph which are absent in osteosarcoma.
• Fibrous dysplasia: In radiograph, periphery of fibrous dysplasia is well defied as compared to chondrosarcoma. In chondrosarcoma, widening of PDL space is seen while in firous dysplasia thinning of PDL is seen.

Osteoid osteoma

• Osteoblastoma: Osteoid osteoma is more painful as compared to osteoblastoma.
• Ossifying firoma: In ossifying firoma, root resorption is present while in ossifying firoma root resorption is absent.
• Fibrous dysplasia: In firous dysplasia, predilected site is maxilla while in osteoid osteoma slight predilection of mandible is present.