Radiographic Diagnosis Of Pathology Affecting The Jaws Question And Answers

Radiographic Diagnosis Of Pathology Affecting The Jaws

Describe radiological differential diagnosis for ameloblastoma, central giant cell granuloma, odontogenic myxoma and central hemangioma.
Answer.

Radiological Aifferential Diagnosis for Ameloblastoma

Small and Unilocular ameloblastoma

• Small unilocular ameloblastomas that are located around the crown of an unerupted tooth often cannot be differentiated from a dentigerous cyst.
• Residual cyst: History of extraction of tooth is present.
• Lateral periodontal cyst: Seen in incisor, canine and premolar area in the maxilla, ameloblastoma occurs more in the mandibular molar area.
• Giant cell granuloma: Seen more often in areas anterior to the molars, younger age group and have more granular and ill-defied septae.
• Traumatic bone cyst: This occurs in the mid twenties, whereas ameloblastoma is more common in the 3rd and 4th decades.

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Multilocular Ameloblastoma

• Odontogenic keratocyst: It contains curved septae but tends to grow along the bone without marked expansion.
• Odontogenic myxoma: There is history of missing tooth and has a presence of septa that divide the image into muchfier coarse than those in ameloblastoma. Myxoma has one or two thin sharp, straight septa which are characteristic of it. Myxomas are not expansile and tend to grow along the bone.
• Ossifying firoma: The septa are usually wide, granular and ill-defied. Small irregular trabeculae are seen.
• Radiological Differential Diagnosis for central Giant cell Granuloma
• Early stage (Radiolucent appearance)
• Giant cell lesions of hyperparathyroidism: Here there is overall radiolucency, the serum alkaline phosphatase and serum calcium levels are raised, with a decrease in serum phosphate levels.

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• Osteoporosis: It may be confused with Paget’s disease in the early stage, but if the area is pathologically enlarged with straight linear trabeculae seen aligned parallel to the long axis of the affcted bone, osteoporosis is ruled out.
• Osteomalacia: Pseudofractures are common in this case. The serum calcium and serum phosphorous levels are decreased in this case, whereas they are normal in Paget‘s disease.
• Multiple myeloma: There is a painful enlargement of the jaws and shows typical radiolucent punched out lesions on the skull radiograph.

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Second Stage (Mixed Radiolucent Radiopaque Appearance)

• Osteogenic sarcoma: This occurs in the younger age group, and shows a variety of radiographic appearances such as, sunburst and Codman’s triangle.
• Cementifying and ossifying firoma: This is also seen in the younger age group, and shows well-defied margins in contrast to the diffuse border of the lesions of Paget’s disease.
• Fibrous dysplasia: Seen in younger patients, Paget’s disease spreads more diffusely, seen bilaterally and has linear trabeculae and a cotton-wool appearance which is distinctive. In fibrous dysplasia, the size of maxillary sinus is reduced, whereas in Paget’s disease the air space is not reduced.

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• Osteoblastic metastatic carcinoma: There will be history of a primary tumor.
• Ossifying subperiosteal hematoma: It is seen in patients younger than 15 years of age, and the patient usually gives history of recent trauma.
• Chondroma and chondrosarcoma: There is complaint of intense pain which is usually not there in the case of Paget’s disease.

Advanced Stage (Purely Radiopaque appearance)

• Florid osseous dysplasia: Hypercementosis is present, but it is only confined to the jaw bones, in localized area only. In case of Paget’s disease when the jaw bones are involved, it affects all of the jaw. This may have a cotton-wool pattern, but these lesions are centered above the inferior alveolar canal and commonly have a radiolucent capsule.
• Osteosclerosis: The lesion is usually small and confined to the jaw bones.
• Tori: The lesion is usually small and confined to the jaw bones.
• Osteoma: The lesion is usually small and confined to the jaw bones.

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Radiological Differential Diagnosis for Odontogenic Myxoma

• Central giant cell granuloma: It has a preferred anterior location in the mandible.
• Ameloblastoma: This occurs in older patients.
• Cherubism: This occurs in the younger age group and has a bilateral involvement.
• Metastatic carcinoma: In the older age group and there wil be presence of the primary tumor.

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• Aneurysmal bone cyst: This is tender and painful.
• Osteogenic sarcoma: This also has a speculated appearance but the outer cortex is lost in osteogenic sarcoma which is not so in odontogenic myxoma.

Radiological Differential Diagnosis for Central Hemangioma

• Central giant cell granuloma: This crosses the midline.
• Giant cell lesions of hyperparathyroidism: Maybe differentiated by biochemical investigations.
• Aneurysmal bone cyst: Hemangioma will show profuse hemorrhage, if aspirated.

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• Ameloblastic firoma: No local gingival bleeding or pumping action of the involved tooth seen.
• Odontogenic myxoma: Shows a typical tennis racket appearance.
• Cherubism: Usually seen in children, with a typical facial appearance and is bilateral.