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Radiolucent Lesions - Coggle Diagram
Radiolucent Lesions
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Developmental Cysts
Lateral Periodontal Cyst (Botryoid Odontogenic Cyst):
- Etiology: Odontogenic, nonkeratinized developmental cysts, believed to develop from the dental lamina remnants (rests of Malassez) from within bone.
- Method of Transmission: Not applicable
- Characteristics: Asymptomatic in most cases and is not usually noticed until seen on a radiograph. usually unilocular, is round or oval, and is well delineated. Teeth are vital.
- Dental Implications: It is necessary to rule out an inflammatory-type lesion or a more serious type of cyst or tumor, such as the odontogenic keratocyst discussed below in this chapter.
- Treatment and Prognosis: Surgical excision and pathologic review are treatments of choice. Vitality testing is important in order to avoid unnecessary endodontic treatment. There may be a higher rate of recurrence when the cyst is a botryoid odontogenic cyst. Periodic radiographic follow-up is needed. the prognosis is excellent.
- Citation: Delong, Burkhart textbook, pg. 472-473
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Gingival Cyst of the Newborn (Bohn Nodules, Epstein Pearls, or Dental Lamina Cysts of the Newborn)
Odontogenic Keratocyst (Also Known as Keratocystic Odontogenic Tumor):
- Etiology: Develops from the dental lamina or its remnants. Very aggressive.
- Method of Transmission: Not applicable.
- Characteristics: Often develops in the posterior mandibular region and can occupy most of the ramus in some cases. Jaw becomes weak and fracture may occur. Radiographically, multilocular or unilocular, well circumscribed on the radiograph, and radiolucent with a scalloped appearance. Very aggressive features.
- Dental Implications: The association with nevoid BCC syndrome is especially important in a diagnosis, and the cysts have very aggressive behavior. Prompt treatment is required.
- Treatment and Prognosis: Careful removal of entire cyst. Decompression is used, allowing the cyst to shrink before definitive surgical removal. The thin wall is often difficult to separate from bone and remove in one piece, often allowing daughter cells to remain and increase in occurrence.
- Citation: Delong, Burkhart textbook, pg. 476-477
Nevoid Basal Cell Carcinoma Syndrome (Gorlin-Goltz Syndrome):
- Prime concern for patients diagnosed with OKC due to a close association between the two disorders. This syndrome is an inherited autosomal dominant disorder with a male predilection of 3 to 1. The syndrome has 5 main components: basal cell carcinoma, jaw cysts, congenital skeletal anomalies, calcifications, and palmar and plantar pits. The face is affected most often. Since the entity is an inherited autosomal dominant disorder, careful questioning of the patient is needed such as: Has anyone else in your family had the same type of lesions? Do you have more lesions anywhere else? Has anyone in your family been diagnosed with any autoimmune diseases? Do any of your relatives have any type of inherited diseases?
Primordial Cysts
Calcifying Odontogenic Cyst: COC (Gorlin Cyst):
- Etiology: Reduced enamel epithelium or odontogenic epithelium.
- Method of Transmission: Not applicable
- Characteristics: Found as masses within the oral tissues, almost always within the gingiva. May resemble gingival cyst or a peripheral giant cell granuloma. Unilocular or Multilocular radiolucencies that exhibit clearly defined margins.
- Dental Implications: Definitive diagnosis is important to rule out more aggressive lesions, and complete removal is necessary.
- Treatment and Prognosis: Surgical excision is recommended. Prognosis is good, although recurrence is sometimes seen.
- Citation: Delong, Burkhart textbook, pg. 479
Globulomaxillary Cyst:
- Etiology: Believed to represent a fissural cyst that arose from the epithelium that was thought to be trapped when the globular portion of the median nasal process fused with the maxillary process, but has essentially been deemed by some oral pathologists as unlikely.
- Method of Transmission: Not applicable.
- Characteristics: inverted pear-shaped lesion because of its location, causing divergence of the tooth roots. It is circumscribed and radiolucent. Vitality of the pulp provides some evidence about the type of cyst.
- Dental Implications: Vitality of the teeth involved, such as the lateral and the cuspid, must be evaluated. Endodontic therapy should be administered when necessary.
- Treatment and Prognosis: Surgical removal is the treatment of choice, and prognosis is good, depending on the type of cyst.
- Citation: Delong, Burkhart textbook, pg. 479-480
Glandular Odontogenic Cyst (Originally Called Sialoodontogenic Cyst):
- Etiology: Derived from odontogenic origins. Locally aggressive.
- Method of Transmission: Not applicable.
- Characteristic: Some clinical swelling. Some reports of pain/discomfort, infection, and paresthesia.
- Dental Implications: Follow-up is important since the recurrence rate is very high. Radiographic examinations are important in an early diagnosis of recurrence.
- Treatment and Prognosis: Enucleation, Curettage, cystectomy, and excision. Recurrence rate is 50%.
- Citation: Delong, Burkhart textbook, pg. 480-481
Nasopalatine Duct Cyst (Incisive Canal Cyst, Nasopalatine Duct Cyst):
- Etiology: Developmental Cyst. This cyst arises from epithelial remnants of the embryologic structure of the nasopalatine ducts, and the structure connects the oral and nasal cavities in the area of the incisive canal, probably because of infection or some stimulation.
- Method of Transmission: Not applicable.
- Characteristics: Swelling and elevation of the external surfaces around the nose and lip areas. Pt. may complain of pain, tenderness, and swelling, and drainage may be noted in the maxillary incisor region.
- Dental Implications: Not radiographically diagnostic and must be removed and biopsied for definitive microscopic evaluation.
- Treatment and Prognosis: Complete surgical removal is needed. The prognosis is good, and the recurrence rate is low with complete removal.
- Citation: Delong, Burkhart textbook, pg. 481
Median Palatine Cyst
Static Bone Cyst (Stafne Bone Defect, Static Defect, Lingual Mandibular Bone Concavity):
- Etiology: Not a true cyst. It's a defect in the mandible that surrounds salivary gland tissue. Believed to entrap salivary gland tissue and is not lined by epithelium.
- Method of Transmission: Not applicable
- Characteristics: Asymptomatic and usually discovered in a Panorex. Sharply circumscribed, oval, radiolucent lesion with sclerotic border. Usually found at the angle of the mandible.
- Dental Implications: When location is superior to the mandibular canal, a biopsy may be needed to rule out pathology.
- Treatment and Prognosis: Static bone cyst is noted and followed long term, and if any changes occur, they are noted in the patients record. Other cysts should be considered if the cyst is occurring above the mandibular canal.
- Citation: Delong, Burkhart textbook , pg. 483
Neoplasms
Ameloblastic Fibroma:
- Etiology: Mixed odontogenic tumor that is believed to originate from odontogenic ectomesenchyme and odontogenic epithelium.
- Method of Transmission: Not applicable.
- Characteristics: No pain, Unilocular or multilocular. Normally well-defined and usually associated with an unerupted tooth.
- Dental Implications: Generally, the ameloblastic fibroma is asymptomatic.
- Treatment and Prognosis: Conservative excision is the treatment of choice. Recurrence is seen in approximately 20% of cases.
- Citation: Delong, Burkhart textbook, pg. 495-486
Odontogenic Myxoma:
- Etiology: Derived from odontogenic ectomesenchyme.
- Method of Transmission: Not applicable
- Characteristics: Swelling in isolated areas. Unilocular or multilocular radiographically and may have scalloped appearance. Step-ladder or honeycomb appearance.
- Dental Implications: Enlarged dental follicles or the dental papilla of a developing tooth may be mistaken for the myxomas upon microscopic examination. Can cause tooth displacement.
- Treatment and Prognosis: Surgical removal. Fairly difficult to remove via curettage due to gelatinous material. Recurrence rate as high as 25% because tumor is non-encapsulated. Fragments are difficult to remove.
- Citation: Delong, Burkhart textbook, pg. 485
Langerhans Cell Disease: Langerhans Cell Histiocytosis (Formerly Called Histiocytosis X):
- Etiology: Unknown
- Method of Transmission: Not applicable
- Characteristics: Poor healing. Radiographically, the bone lesions resemble a "punched-out" appearance with sharply demarcated lesions. Lesions commonly present as a "floating tooth/teeth". Tenderness, pain, swelling are common complaints. Premature loosening and exfoliation of teeth in children.
- Dental Implications: Lesions that occur periapically can be confused with periapical cyst or granulomas. Tooth vitality would still be present.
- Treatment and Prognosis: Depends on involvement of the disease and the age of the patient. Conservative surgical treatment is sometimes the only treatment. The prognosis is more favorable when the disease states develop in older young adults.
- Citation: Delong, Burkhart textbook, pg. 486-488
Adenomatoid Odontogenic Tumor:
- Etiology: Encapsulated benign epithelial odontogenic tumor.
- Method of Transmission: Not applicable.
- Characteristics: Swelling in the facial area. Root displacement and a bony hard expansion with an eggshell cracking appearance over the protrusion. The glandular or duct-like features forming a rosette pattern clearly differentiates.
- Dental Implications: Facial asymmetry occurs as the tumor grows.
- Treatment and Prognosis: Complete removal of the tumor is necessary, and the prognosis is excellent without any recurrence.
- Citation: Delong, Burkhart textbook, pg. 483-485
Infections
Osteomyelitis: Acute and Chronic Forms:
- Etiology: Inflammation of the bone. There may be specific bacteria involved in the occurrence, such as staphylococci, actinomyces, and streptococcus. Fractures, trauma, and surgery including extractions can also allow bacteria to enter the bone.
- Method of Transmission: the acute form of osteomyelitis may have several infectious organisms involved in the disease process.
- Characteristics: Lymphadenopathy, fever, and pain are often symptoms and are especially noted in the acute form. Chronically there are more patches of necrotic bone and diffuse radiolucent lesions are seen, and the lesions appear more mottled, with a sclerotic appearance on the radiograph.
- Dental Implications: Addressing the cause is paramount. Pain and lymphadenopathy are most likely felt by the patient. The correct antibiotics are needed to treat the infection; therefore, identification of the specific organism through laboratory tests is crucial.
- Treatment and Prognosis: Drainage and antibiotics are needed to treat the acute form of osteomyelitis. Chronic is more difficult to manage because of necrosis. Surgery is indicated, with antibiotic coverage. In acute osteomyelitis, antibiotics are very effective, but chronic usually requires surgery, antibiotics, and drainage.
- Citation: Delong, Burkhart textbook, pg. 471