1

CONTENTS

 Introduction
 Types of multilocular radiolucencies
 Anatomic patterns
 Odontogenic keratocyst
 Dentigerous cyst
 Ameloblastoma
 Calcifying epithelial odontogenic tumor
 Odontogenic myxoma
 Ameloblastic fibroma
 Cherubism
 Aneurysmal bone cyst
 Osteosarcoma
 Metastatic tumors to the jaws
 Central haemangioma
 References
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INTRODUCTION
Multilocular radiolucencies are produced by multiple, adjacent, frequently coalescing and
overlapping pathologic compartments in bone.
May sometimes occur in maxilla but found more common in mandible.
May occur single cyst like radiolucencies or even as poorly-defined radiolucencies.
True multilocular lesions contains two or more pathologic chambers partially separated by
septa of bone. Occasionally septa may be thin, & their images so indistinct as to cause
multilocular lesion to appear unilocular on radiographic examination.

Unilocular ameloblastoma appearing as multilocular radiolucencies.

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CLASSIFICATION

Classification of the main cysts and tumours and other bone-related conditions that can
present as a cyst-like radiolucency-
I)CYSTS-
a) Odontogenic-
Radicular
Residual
Lateral periodontal
Dentigerous
b) Non-odontogenic-
Nasopalatine duct cyst
II) TUMOURS & OTHER TUMOUR LIKE LESIONS-
a) Benign odontogenic-
i)Epithelial with mature fibrous stroma without odontogenic ectomesenchyme-
Ameloblastoma
CEOT
AOT
KCOT
ii)Epithelial with odontogenic ectomesenchyme with or without dental hard tissue formation-
Ameloblastic fibroma
Ameloblastic fibro-odontoma
iii) Mesenchymal odontogenic ectomesenchyme with/without odontogenic epithelium-
Odontogenic myxoma
Odontogenic fibroma
b) Non odontogenic intrinsic primary bone tumors-
i)Benign-
Fibroma
Chondroma
Central haemangioma
ii)Malignant-
Osteosarcoma
Fibrosarcoma
III) BONE RELATED DISORDERS-
a)Giant cell lesions-
Central giant cell granuloma
Brown tumor in hyperparathyroidism
Cherubism
Aneurysmal bone cyst
b) Osseus dysplasia-
Periapical osseus dysplasia
Focal osseus dysplasia
c)Other lesions-
Ossifying fibroma
Fibrous dysplasia
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TYPES OF MULTILOCULAR RADIOLUCENCIES

HONEYCOMB APPEARANCE-
Lesions whose compartments are small and tends to be uniform in size.
e.g- Ameloblastoma
Odontogenic keratocyst
Odontogenic myxoma
Central giant cell granuloma
Central haemangioma
Aneurysmal bone cyst

SOAP BUBBLE APPEARANCE-

Comprises of lesions consisting of several circular compartments that vary in size and appear
to overlap.
e.g- Ameloblastoma
Odontogenic myxoma
Odontogenic keratocyst
Central giant cell granuloma
Central haemangioma
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TENNIS RACKET APPEARANCE-

Lesions results from angular rather than rounded compartments which results from
development of more or less straight septa.
e.g- Odontogenic myxoma
Ameloblastoma
Central haemangioma

ANATOMIC PATTERNS

Anatomic patterns showing multilocular appearances-

1)Maxillary sinus
2)Bone marrow spaces
1) Maxillary sinus-
Has several compartments giving radiographic appearance of septa dividing sinus into lobes.
Soap bubble appearance.
2)Bone marrow spaces –
Appear frequently as multilocular radiolucencies, especially in mandible.

ODONTOGENIC KERTOCYST

SYNONYMS-
Keratocystic odontogenic tumor
Primordial cyst
Keratinising cysts
Often asymptomatic misdiagnosed as -
Peri-apical cysts,
Follicular cysts,
Lateral periodontal cyst
Ameloblastoma.

WHO DEFINED it as “a benign uni- or multicystic, intraosseous tumour of odontogenic

origin, with a characteristic lining of parakeratinized stratified squamous epithelium and
potential for aggressive, infiltrative behaviour.”
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Philipsen in 1956 ,but in 1963 Pindborg & Hansen described the essential features of cyst.
Odontogenic keratocyst (OKC) is so named because keratin is produced by the cystic lining
fills the cystic lumen.

ETIOLOGY-
OKC (60%) arise from dental lamina rests or from the basal cells of oral epithelium.
Mutation of the PTCH gene is partly responsible.

CLINICAL FEATURES-

AGE- 2nd and 3rd decade

GENDER- Men (Caucasian populations of Northern European decent).
SITE- Posterior body or in the ascending ramus of the mandible.
rd
Maxillary -3 molar region followed by cuspid region.
Smaller lesions tend to be unilocular, while larger lesions tend to be multilocular.
Show well-delineated, sclerotic or scalloped borders, soft-tissue extension and daughter
cysts.
SYMPTOMS-

Most keratocysts are asymptomatic.

Swelling with or without pain
Facial asymmetry, Fluid discharge
Displacement of teeth
Occasionaly peresthesia of lower lip.
Aspiration may reveal a thick, yellow cheesy material
Maxillary OKC tend to be secondarily infected than mandibular ones, coz of close
persistence of maxillary sinus.

RADIOLOGICAL FEATURES-

Radiolucent area, with scalloped borders.

Little or no expansion of cortical bones (secondarily infected) A-P direction.
Palpation may reveal firm fluctuance than usual bony cyst & has a doughy consistency.
Internal structure is radiolucent with septa giving multilocular appearance.
Displacement/ resorption of teeth (The inferior alveolar canal ).
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SYNDROMES ASSOCIATED-

Gorlin goltz syndrome,

Marfans syndrome,
Ehlers danlos syndrome,
Noonans syndrome,
Orofacial digital syndrome,
Simpsongolabi-behmel syndrome

DIFFERENTIAL DIAGNOSIS

CLINICAL

Residual cyst
Dentigerous cyst
Ameloblastoma
Aneurysmal bone cyst
Central haemangioma

RADIOLOGICAL

Ameloblastoma
Central giant cell granuloma
Central hemangioma of bone
Odontogenic myxoma
Aneurysmal bone cyst
TREATMENT-

Surgical excision is the treatment of choice.

Extraordinary recurrence rate .(13-60%) , almost 37-40 years after surgery.
Retained satellite cysts/daughter cysts.
Cyst wall is thin & friable.
Incomplete removal of cyst because of corrugated surface

DENTIGEROUS CYST

„DENTIGEROUS‟- means tooth bearing.

Described by Paget in 1863
Also c/d as follicular cyst.
Dentigerous cyst is the most common developmental odontogenic cyst
Defined as an odontogenic cyst that surrounds the crown of an impacted tooth, caused by
fluid accumulation between the REE & enamel surface, resulting in a cyst in which the
crown is located within the lumen.
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Always associated with crown of a normal permanent tooth. Deciduous tooth is sheldom
involved.

CLINICAL FEATURES-
nd th
AGE- 2 -4 decades
rd rd
SITE- Mandibular posterier region (mandibular 3 molar> maxillary canine> maxillary 3
molars
GENDER- Male> female
Always associated with the crown of an
 impacted,
 embedded,
 unerupted tooth.
Asypmtomatic , diagnosed incidentally during routine radiological examination.
Occasionally they can become extremely large and cause-
Cortical expansion(Egg shell crackling)
Facial asymmetry,
Teeth displacement,
Resorption of teeth
On erosion of cortical plates, palpation feels a rubbery, fluctuant non-emptiable mass.
rd
Cystic involvement of unerupted mandibular 3 molar results in “HOLLOWING OUT”of
entire ramus extending to condyle and coronoid process as well as expansion of cortical
plates.
Obliteration of the maxillary antrum and nasal cavities.

Paraesthesia of IAN
Straw colored fluid is aspirated.

RADIOLOGICAL FEATURES-

When Follicular space is more than 5mm, dentigerous cyst is suspected.

3 radiological variants-
 Central
 Lateral
 Circumferential.
A large dentigerous cyst may appear multilocular radiographically owing to the persistence of
bone trabeculae within the radiolucency.
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SYNDROMES-
Maroteaux-Lamy Syndrome.
Cleidocranial dysplasia associated with bilateral & multiple dentigerous cysts.

TREATMENT-

Small lesions- complete enucleation

Large lesions- insertion of surgical drain or marsupialization.

COMPLICATIONS-

Ameloblastoma
Epidermoid carcinoma
Muco-epidermoid carcinoma

DIFFERENTIAL DIAGNOSIS

CLINICAL

 Radicular cyst
 Odontogenic keratocyst
 Adenomatoid odontogenic tumor
 Unicystic ameloblastoma
 Ameloblastic fibroma
 CEOT

RADIOLOGICAL

 Aneurysmal bone cyst

 Odontogenic keratocyst
 Unicystic Ameloblastoma

AMELOBLASTOMA
Synonyms:
 Adamantinoma
 Adamantoblastoma
 Epithelial odontoma
 Multilocular cyst
nd
2 most common odontogenic neoplasm.
Term Ameloblastoma was suggested by Churchill in 1934 to replace the term
Adamantinoma , coined by Malassez in 1885.

PATHOGENESIS-

Cell rests of enamel organ, either remnants of cell rests of malassez & rests of serre
Disturbances in developing enamel organ.
Epithelium of odontogenic cysts (dentigerous).
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Basal cells of surface epithelium of the jaws.

Heterotopic epithelium of other parts of the body.

CLASSIFICATION- (WALDRON 2002)

 Unicystic ameloblastoma
 Solid/multicystic ameloblastoma
 Peripheral ameloblastoma

CLINICAL FEATURES-

AGE: Between 20 and 60 years.

GENDER: No significant gender predilection (increased incidence of ameloblastoma in
black individuals.)
SITE: Mandible (ramus & posterier body)
Slow enlarging, painless ovoid or fusiform bony hard swelling of the jaw.
Large tumors may infiltrate adjacent soft tissues, usually secondary to perforation of the
lingual cortex producing jaw asymmetry.
Later causes migration, tipping, mobility of tooth and parasthesia of lip.

RADIOLOGICAL FEATURES-

LOCATION: Molar ramus region of the mandible, but they may extend to the symphyseal
area.
PERIPHERY: Well defined and frequently delineated by a cortical border.
unilocular/ multilocular radiolucency.
Multilocular cyst exhibiting a compartmented appearance with septa extending to radiolucent
tumor mass.
Honeycomb appearance
Soap-bubble appearance
Tennis racket appearance
Ameloblastomas are typically expansile with an osseous shell that represents the involved
bone.
Can perforate the lingual cortex of the mandible and extend into the adjacent soft tissues.
Root resorption (knife edge)
Displacement of adjacent tooth.
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DIFFERENTIAL DIAGNOSIS

CLINICAL
 Odontogenic keratocyst
 Central giant cell granuloma
 Calcifying epithelial odontogenic tumor
 Odontogenic myxoma

RADIOLOGICAL
 Odontogenic keratocyst
 Central giant cell granuloma
 Odontogenic myxoma
 Central haemangioma
 Aneurysmal bone cyst

TREATMENT-

 Depends on the extent of tumor infiltration through the cyst wall.

 Localized removal with wide margins
 Curettage , Segmental resection
 En bloc resection (highly infiltrative & extensive).
 Electrocautery
 Radiation therapy

CALCIFYING EPITHELIAL ODONTOGENIC TUMOR

J.J Pindborg in 1956 , first described calcifying epithelial odontogenic tumor.

CEOT, is a benign neoplasm of odontogenic origin. occasionally locally invasive, slow
growing neoplasm.

Rare tumor accounting for less than 1% of all odontogenic tumors.

PATHOGENESIS-

Reduced enamel organ of unerupted tooth.

Rests of dental lamina or basal cells of oral epithelium.
Epithelial remnants of dental lamina complex.

CLINICAL FEATURES-

 AGE- Middle aged(40 years)

 GENDER- Occurs in both men & women.
 SITE- Mandible> maxilla(2:1), prevalence in molar region is 3 times than in bicuspid
region.
 Slow enlarging painless bony hard swelling of the jaws with expansion and distortion
of cortical plates.
 Occur as (central) intraosseous (87.8%) tumours or as peripheral(extraosseous)
tumours (6.1 %)
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 Nasal stuffiness, epistaxis, proptosis and headache are the symptoms when the
maxilla is involved.

 Displacement of teeth
 Facial asymmetry
 It associated with unerupted or impacted teeth

RADIOLOGICAL FEATURES-

LOCATION- Molar –pm region

PERIPHERY- Ill defined borders.
Diffuse , Unilocular or multilocular radiolucent area
Multilocular lesions occur due to combined pattern of radiolucency & radiopacity with small
irregular bony trabeculae traversing the radiolucent area .
“Driven snow appearance”
Honeycomb pattern
CT demonstrates expansion & thinning of buccal & lingual cortical plates by a well defined
mass containing scattered radiopaque areas of varying size and signal intensity.
CLINICAL DD
Dentigerous cyst
Unicystic Ameloblastoma
RADIOLOGICAL DD
Calcifying odontogenic cyst
Adenomatoid odontogenic tumor
Ameloblastic fibro-odontoma
Central haemangioma

TREATMENT-
Small intrabony lesions- Enucleation or curettage .
Large lesions- Segmental resection such as partial or hemimandibulectomy or
hemimaxillectomy.
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ODONTOGENIC MYXOMA

SYNONYMS-
 Odontogenic fibromyxoma
 Myxofibroma
 Account for 3- 6% of odontogenic tumors
 These are benign, intraosseous neoplasm, non encapsulated & tend to infiltrate the
surrounding bone.

PATHOGENESIS-

Arises from mesenchymal portions of tooth germ.

 Dental papilla,
 Dental follicle
 Periodontal ligament

CLINICAL FEATURES-
nd rd
 AGE- 2 -3 decade of life
 (23-30 yrs)
 GENDER- Females=males
 SITE- Mandible> maxilla. Usually in tooth bearing area.
 Non tooth bearing area- condyle/neck of condyle.
 Slowly enlarging, painless expansion of jaw with possible spreading, loosening &
migration of teeth.
 Numbness of lip seen, pain may or may not be a feature.
 Central lesion of bone which causes bony expansion & destruction of cortex.
 Congenitally missing or unerupted teeth may be associated.

RADIOLOGICAL FEATURES-

LOCATION- Mandibular pm-molar region

PERIPHERY-well defined corticated, poorly defined, diffuse margins.
Radiographically seen as-
 Unicystic
 Multilocular
 Pericoronal (less often)
 Radiolucent-radiopaque(rare)
Unilocular & multilocular occur with equal frequency.(unilocular –anterior),(multilocular-
posterior).
Displacement of tooth(common)
Root resorption (uncommon)
Invasion of antrum occur in cases of maxilla.
Expansion & perforation of cortical plates produces a bosselated surface.
Expanding tumor soft on palpation & gives an impression of fluctuance.
Aspiration is non- productive.
Tennis racket/ step ladder pattern.
Barros et al. described two internal structural patterns.
In the first stage, an osteoporotic appearance is manifested as multilocular radiolucency
14

The second stage is destructive ,marked with loss of internal locules, perforation of cortex
and invasion
Fish bone/hair brush pattern.

DIFFERENTIAL DIAGNOSIS

CLINICAL

 Ameloblastoma
 Aneurysmal bone cyst
 CEOT

RADIOLOGICAL

 Aneurysmal bone cyst

 Ameloblastoma
 Central giant cell granuloma
 OKC
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TREATMENT-

Surgical resection with a wide margin of bone, followed by cautery, because of the tendency
of the tumor to infiltrate and re-occur.

AMELOBLASTIC FIBROMA

SYNONYMS-

 Soft mixed odontogenic tumor

 Soft mixed odontoma
 Fibro-adamantoblastoma
 Granular cell ameloblastic fibroma
 First described by Kruse in 1891.
 Characterized by simultaneous proliferation of both epithelial & mesenchymal tissue
without formation of enamel and dentin.
 Rare accounting to only 2.5% of all tumors .

CLINICAL FEATURES-

 AGE- Occurs in the first two decades of life(younger population).

 SITE-Posterior region of mandible, premolar–molar area, often associated with an
unerupted tooth.(3:1).
 GENDER- Male predilection(1.4:1)
 Accidentally discovered on routine examination.
 Slower clinical growth than simple ameloblastoma & doesn‟t infilterate between
trabeculae of bone, making the periphery smooth.
 Delay in tooth eruption or alteration of eruption sequence.
 Small lesions are asymptomatic, larger lesions are associated with pain, swelling.

RADIOLOGICAL FEATURES-

Unilocular/multilocular radiolucency with a sclerotic border.

Associated with unerupted teeth
Expansion of cortical plates
May or may not produce evident bulging of bone.
Displacement of teeth with divergence of roots of adjacent teeth
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DIFFERENTIAL DIAGNOSIS

CLINICAL

 Dentigerous cyst
 Ameloblastoma
 Odontogenic keratocyst

RADIOLOGICAL

 Odontogenic myxoma
 Aneurysmal bone cyst
 Ameloblastoma

TREATMENT-

Conservative surgical removal of lesion is preferred than since it doesn‟t involve bone
actively & widely.

CHERUBISM

SYNONYMS-

 Familial fibrous dysplasia of the jaws

 Disseminated juvenile fibrous dysplasia
 Familial multilocular cyst disease of jaws
 Familial fibrous swelling of jaws
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Cherubism, first described by Jones, in 1933 is an autosomal dominant fibro-osseus lesions

of the jaws involving more than 1 quadrant that stabilizes after the growth period, usually
leaving facial deformity & maloclussion.

CLINICAL FEATURES –

 Boys > girls (2 : 1).

 Affected children normal at birth .
 No clinically/radiographically evident disease till 14 months-3 years of age.
 At this time, symmetric enlargement of jaw begins.
 Self limited bone growth begins to slow down when pt reaches 5 years of age & stops
a the age of 12-15 yrs.
 Lesions are usually hereditary, symmetrical and non-tender, involve molar-coronoid
regions, condyles always being spared.
 Respiratory obstruction
 Impairement of vision and hearing.
 Cervical & submandibular lymphadenopathy.
 Intra-oral swelling of alveolar ridges.
 CHUBBY FACE” & “EYE TO HEAVEN APPEARANCE”-in case of
involvement of maxillary ridges.
 Alkaline phosphatase levels
 Serum calcium & phosphorus, TSH, FSH, LH, T4 and T3 -normal .

DENTAL ANOMALIES-
 Early exfoliation of deciduous teeth.
 Delayed eruption of permanent teeth.
 Displacement of teeth
 Ectopic tooth eruption & impacted tooth.
nd
 Agenesis of permanent teeth(2 & 3rd molars).

RADIOLOGICAL FEATURES-
Characterized by bilateral, multilocular cystic expansion of jaws.
SITE- Post. body of mandible & ascending ramus.
Maxillary lesions escape due to overlapping of sinus & nasal cavities.
“FLOATING TOOTH SYNDROME”.
GROUND GLASS APPEARANCE.
Involvement of IAN.
The sinuses frequently appear to be obliterated leading to problems in phonation
Infiltration of the orbital cavities may cause exacerbated exophthalmia and limiting ocular
movements.
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GRADING- Arnott (1978)

Grade I- Bilateral involvement of the ascending ramus of mandible.

Grade II-Bilateral involvement of the ascending ramus of mandible and maxillary tuberosity.
Grade III-Complete involvement of the maxilla and mandible except the coronoid processes
and condyles.

DIFFERENTIAL DIAGNOSIS

CLINICAL

Fibrous dysplasia
Pagets disease
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RADIOLOGICAL
Ameloblastoma
Giant cell lesion of hyperparathyroidism
Central haemangioma
Aneurysmal bone cyst

TREATMENT-
Surgery to correct jaw deformities, usually done after puberty when the remission phase of
lesions have been reached.

ANEURYSMAL BONE CYST

Pseudo cyst/false cyst.

(ABC) as defined by WHO is an expansile osteolytic lesion consisting of blood filled spaces
separated by connective tissue septae that contain osteoid material and multinucleated giant
cells.
Jaffe and Lichtenstein were the first to recognize ABC chiefly affecting the metaphyseal
region of long bones and vertebrae.
The term “aneurysmatic” refers to the “blow-out” effect or expansion of the affected bone

PATHOGENESIS-

Levy et al. had proposed that a history of trauma and subperiosteal hematoma formation-an
essential factor in the development of ABC.
Jaffe and Lichentenstein refer to –
Alterations in local hemodynamics
Increased venous pressures
Engorgement of vascular bed in transformed bone
`
Bone resorption
Connective tissue replacement and osteoid formation.
TYPES-
Hernandez et al. classified ABC as primary and secondary.
Primary Congenital – with history of trauma
In children, adults
Acquired- pre-existing AV malformations
Seen in adults with history of trauma
Secondary type is associated with degeneration of preexisting lesions such as a cyst, tumor
or fibrosseous lesion.

PHASES OF PATHOGENESIS-

Osteolytic initial phase

Active growth phase
Mature stage(stage of stabilization)- A distinct peripheral bony shell and internal bony septa
& trabeculae produces a classic soap-bubble appearance.
Healing phase –Progressive calcification & ossification of the cyst and its eventual
transformation into dense bony mass into an irregular structure.
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CLINICAL FEATURES-

 AGE- young persons under 20 years of age.

 GENDER- No gender predilection.
 SITE- Mandible > maxilla(molar-ramus region)(11:9-2:1)
 Varies from a small, asymptomatic lesion to rapidly growing, expansile, and
destructive lesion causing pain, swelling, deformity, neurologic symptoms, pathologic
fracture, and cortical perforation.
 On aspiration frank blood is aspirated.

 “WELLING UP” from the tissue.

“Blood soaked sponge”.

RADIOLOGICAL FEATURES-

Appear radiolucent, radiopaque, or mixed.

Expansion & perforation of the cortical plates.
Periosteal reaction may be evident.
Displacement of teeth
Resorption of roots
Expanded bone resembles a honeycomb/soap bubble/cartwheel appearance.
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DIFFERENTIAL DIAGNOSIS

CLINICAL

Central haemangioma of bone.

Central giant cell granuloma

RADIOLOGICAL

Odontogenic myxoma
Central haemangioma of bone
Keratocystic odontogenic tumor
Central giant cell granuloma

TREATMENT-
Surgical curettment /excision is the treatment of choice, low doses of radiation are also used.
Large lesions require surgical resection & immediate reconstruction.

OSTEOSARCOMA

SYNONYMS-

 Osteogenic sarcoma
 Gnathic osteosarcomas
 Refers to a heterogeneous group of primary malignant neoplasms affecting bone
forming or mesenchymal tissues that have histopathologic evidence of osteogenic
differentiation.
 Accounts for 4–6% occur in the maxillofacial region.
 Mandibular and maxillary osteosarcomas account for 6–9% of all the osteosarcomas.

ETIOLOGY-

The exact cause of OS is unknown, but thought to arise from primitive mesenchymal bone
forming cells & ch. by production of osteoid.

Other causes include-

Genetic predisposition-13q14(RB) gene.
Paget‟s disease
Fibrous dysplasia
Li-fraumeni syndrome
Rothmund- thomson syndrome

CLINICAL FEATURES-
 AGE- 10-25 yrs with decrease incidence as age advances.
 GENDER- Males > females (1.25:1)
 SITE- Maxilla = mandible
 Facial deformity and pain.
 Dislocation of tooth
22

 Unhealed extraction site.

 Trismus and paresthaesia (mandibular tumors)
 Nasal obstruction(maxillary tumors).

RADIOLOGICAL FEATURES-
Appear as osteolytic, osteoblastic type or can have a mixed pattern.
„Cumulus cloud densities‟- formed within intramedullary and soft tissue caused by
mineralizing tumor osteoid.
3 features of osteosarcoma-
Typical “sunray” appearance is observed at the periphery of the tumor.
“Garrington sign”
“Codman‟s triangle”

DIFFERENTIAL DIAGNOSIS

CLINICAL

Osteomyelitis with proliferative periostitis,

Suppurative osteomyelitis,
Osteoblastoma
Fibrous dysplasia

RADIOLOGICAL

Fibrous dysplasia

TREATMENT-
Therapy of choice is radical surgical excision because it provides a 5-year survival rate of
over 80%.
Local recurrence of the lesion was still the leading cause of death.
23

METASTATIC TUMORS TO THE JAWS

Uncommon, 1-3% of all malignant oral neoplasms.

Occur in both osseous and soft tissues.
Metastatic lesions in the jaws usually arise from sites that are anatomically inferior to the
clavicle. Common primary sources include breast, lung and kidney.
Lung is the most common source of metastases to the oral soft tissues, whereas the breast is
the most common source for metastatic tumors to the jawbones.
Attached gingiva is the most frequently involved site preceded by the tongue, in soft tissues.

CLINICAL FEATURES-

 AGE- 40-70 years

 GENDER- Equal distribution in jaw bone metastases, 2:1( M:F) in oral soft tissue
metastases.
 SITE- Mandible (molar)
 Pain, bleeding, ulceration, interference with mastication, presence of intraoral mass,
extruded teeth, cortical expansion, regional lymphadenopathy.
 Tooth mobility, trismus & pathological fracture is seen in some cases.
 “Numb chin syndrome”/ “Mental nerve neuropathy”

RADIOLOGICAL FEATURES-
Solitary well defined cyst like radiolucency
Solitary poorly defined radiolucency-„„moth-eaten‟‟ appearance.
Multiple, separate poorly defined radiolucency
Multiple, punched out radiolucency
An irregular Salt &pepper appearance
Dense solitary radiopaque area
Radiopaque patterns with any radiolucent appearances.
24

TREATMENT-
Involve surgical resection, radiation, chemotherapy or a combination of these techniques.

DIFFERENTIAL DIAGNOSIS

CLINICAL

Squamous cell carcinoma

Periapical inflammatory lesion
Multiple myeloma

RADIOLOGICAL

Multiple myeloma
Osteomyelitis
Ewing sarcoma
25

CENTRAL HAEMANGIOMA OF BONE

Vascular neoplasm of endothelial origin and rarely develops in the jaws.

Accounts for approximately 1% of all primary bone tumors. Frequently found in the
vertebrae and the skull.

CLINICAL FEATURES-
nd th
 AGE- 2 -5 decades of life
 GENDER- Female>male(2:1)
 SITE- Body of mandible
 Can be either asymptomatic/ symptomatic.
 Firm, non-painful, bony swelling associated with-
 Local hemorrhage around cervices of teeth
 Associated tooth demonstrate pumping action.
 Bluish discoloration of gingiva and mobile teeth.
 Audible bruits on extension into the soft tissue.
 Aspiration yields copious amt. of blood

Other dental findings include-
(1) Derangement of occlusion;
(2) Displacement of teeth
(3) Supraeruption
(4) Premature exfoliation of primary teeth
(5) Early eruption of permanent teeth as a result of the pressure of expanding lesion.

RADIOLOGICAL FINDINGS-

“The great mimicker”

Unilocularity, multilocularity, and heterogeneous degree of radiolucency are commonly
reported radiographic variations that are associated with a:
Honeycomb
Sunburst
Soap bubble
Tennis racket appearance
Parallel/tube-like arrangement of radio-opaque striae is an indicator of hemangioma-
Langland et al.
Spokes of a wheel by Worth
Due to marked variability of central haemangiomas radiologically, other than plain
radiographs CT,MRI, ultrasonography and thermography are also used.
„„Polka-dot‟‟ appearance with cortical expansion

Intra-arterial angiography remains the gold standard for evaluating vascular lesions.
26

DIFFERENTIAL DIAGNOSIS

CLINICAL

A-V aneurysm
A-V fistula

RADIOLOGICAL

Osteosarcoma
Central giant cell granuloma
Ameloblastoma
Multiple myeloma
Dentigerous cyst
Odontogenic keratocyst
Aneurysmal bone cyst

TREATMENT-
(1) Noninvasive radiotherapy;
(2) Injection of sclerosing and embolizing agents
(3) Surgical intervention by curettage
27

(4) Radical resection with immediate osseous reconstruction.

(5) Incisional biopsy is contraindicated.
28

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