Discussion Author: William R Graf
Looking at the radiographic appearance of lesions within the jaw can provide a simple and accurate means of reaching a diagnosis. Lesions may broken down into those, which appear predominately radiolucent, radiopacified, and those, which are both radiolucent and radio opaque. Radiolucent or cystic lesions can be further divided into those at are solitary and those that are multiple. Theses lesions will have well defined border; however, their expansible nature may cause local boney destruction. There is usually very little associated soft tissue reaction. Solitary pericornal (arising from the crown) lesions with well-defined round/elliptical border include calcifying odontogenic (adolescent patients and lesions often contain solitary tooth), and ameloblastic fibroma-odontoma. More aggressive unilocular lesions include amelobastoma (patients usually adults > 40 yrs old). Multilocular cystic lesions include osteomyelitis, fibrous dysplasia, aneurysmal bone cysts (< 20 yrs old), hemangioma (typically 35-55 yrs. old), ameloblastoma, and giant cell granuloma. Periapical lesions, which are opacified, include focal condensing ostetis, hypercementosis, benign cementoma, and cemento-ossifying fibroma (typically occurring in young adults). More ill defined areas of osteolysis may include. osteomyelitis, skeletal metastasis (rare), histiocytosis, plasma cell myeloma, radiation necrosis, lymphoma, primary bone sarcoma, and adjacent squamous cell carcinoma.
This case has the typical appearance of odontogenic cyst. The most common odontogenic cyst are dentigerous cysts. They are formed by an excessive accumulation of fluid between enamel and the dental capsule. Most frequently seen in the mandible (80%) associated with unerupted third molars. Complications associated with dentigerous cysts include infection and pathologic fracture.
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