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Radiographic Pathology: Differential Diagnosis of Jaw Lesions, Exams of Radiography

Stanford UniversityRadiography

A concise overview of radiographic pathology, focusing on the differential diagnosis of various radiolucent and radiopaque lesions in the jaws. It categorizes lesions based on their radiographic appearance (unilocular, multilocular, poorly defined borders, etc.) and location (periapical, pericoronal, etc.), offering potential diagnoses for each category. A useful tool for dental students and practitioners seeking to improve their diagnostic skills in oral and maxillofacial radiology. It covers a range of conditions, from common entities like periapical granulomas and cysts to less frequent lesions such as ameloblastomas and osteosarcomas. The document also includes specific radiographic features associated with certain diseases, such as the 'ground glass' appearance in fibrous dysplasia and the 'cotton wool' appearance in paget's disease.

Typology: Exams

2024/2025

Available from 06/21/2025

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RADIOGRAPHIC PATHOLOGY
UNILOCULAR RADIOLUCENCIES: PERICORONAL LOCATION (FCOA) correct
answers HYPERPLASTIC DENTAL FOLLICLE: < 5 mm in thickness
DENTIGEROUS CYST: > 5 mm in thickness
ODONTOGENIC KERATOCYST
AMELOBLASTOMA: Usually unicystic type
OTHER ODONTOGENIC LESIONS: Examples: calcifying epithelial odontogenic tumor,
odontogenic myxoma, central odontogenic fibroma.
UNILOCULAR RADIOLUCENCIES: PERIAPICAL LOCATION (GCCA) correct answers
PERIAPICAL GRANULOMA: Nonvital tooth.
PERIAPICAL CYST: Nonvital tooth.
PERIAPICAL CEMENTO-OSSEOUS DYSPLASIA (early): Especially in black females;
usually with apical to mandibular anteriors; teeth are vital.
AMELOBLASTOMA: Especially unicystic type.
MULTILOCULAR RADIOLUCENCIES (MACCHO) correct answers MYXOMA
AMELOBLASTOMA: Especially in posterior mandible; often associated with impacted
tooth.
CENTRAL GIANT CELL GRANULOMA: Especially in anterior mandible.
CHERUBISM: Hereditary; onset in childhood; multiple quadrants involved.
HEMANGIOMA
ODONTOGENIC KERATOCYST (OKC)
RADIOLUCENCIES: POORLY DEFINED OR RAGGED BORDERS correct answers
PERIAPICAL GRANULOMA OR CYST: Nonvital tooth.
HEMATOPOIETIC BONE MARROW DEFECT: Especially edentulous areas in posterior
mandible; more common in females.
OSTEOMYELITIS: Usually painful or tender
TRAUMATIC BONE CYST: Mandibular lesion that scallops up between roots of teeth;
usually in younger patients.
METASTATIC TUMORS: Painful; parasthesia; usually in older adults.
RADIOLUCENCIES: MULTIFOCAL OR GENERALIZED correct answers CEMENTO-
OSSEOUS DYSPLASIA: Teeth still Vital.
Unilocular radiolucencies - other locations correct answers Lateral radicular cyst
Nonvital pulp; lateral canal
Residual (periapical) cyst
Odontogenic keratocyst
Central giant cell lesion--Esp. anterior mandible
Stafne bone defect--Angle of mandible below mandibular canal
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RADIOGRAPHIC PATHOLOGY

UNILOCULAR RADIOLUCENCIES: PERICORONAL LOCATION (FCOA) correct answers HYPERPLASTIC DENTAL FOLLICLE: < 5 mm in thickness DENTIGEROUS CYST: > 5 mm in thickness ODONTOGENIC KERATOCYST AMELOBLASTOMA: Usually unicystic type OTHER ODONTOGENIC LESIONS: Examples: calcifying epithelial odontogenic tumor, odontogenic myxoma, central odontogenic fibroma. UNILOCULAR RADIOLUCENCIES: PERIAPICAL LOCATION (GCCA) correct answers PERIAPICAL GRANULOMA: Nonvital tooth. PERIAPICAL CYST: Nonvital tooth. PERIAPICAL CEMENTO-OSSEOUS DYSPLASIA (early): Especially in black females; usually with apical to mandibular anteriors; teeth are vital. AMELOBLASTOMA: Especially unicystic type. MULTILOCULAR RADIOLUCENCIES (MACCHO) correct answers MYXOMA AMELOBLASTOMA: Especially in posterior mandible; often associated with impacted tooth. CENTRAL GIANT CELL GRANULOMA: Especially in anterior mandible. CHERUBISM: Hereditary; onset in childhood; multiple quadrants involved. HEMANGIOMA ODONTOGENIC KERATOCYST (OKC) RADIOLUCENCIES: POORLY DEFINED OR RAGGED BORDERS correct answers PERIAPICAL GRANULOMA OR CYST: Nonvital tooth. HEMATOPOIETIC BONE MARROW DEFECT: Especially edentulous areas in posterior mandible; more common in females. OSTEOMYELITIS: Usually painful or tender TRAUMATIC BONE CYST: Mandibular lesion that scallops up between roots of teeth; usually in younger patients. METASTATIC TUMORS: Painful; parasthesia; usually in older adults. RADIOLUCENCIES: MULTIFOCAL OR GENERALIZED correct answers CEMENTO- OSSEOUS DYSPLASIA: Teeth still Vital. Unilocular radiolucencies - other locations correct answers Lateral radicular cyst Nonvital pulp; lateral canal Residual (periapical) cyst Odontogenic keratocyst Central giant cell lesion--Esp. anterior mandible Stafne bone defect--Angle of mandible below mandibular canal

Cemento-osseous dysplasia--Early stage; usually in young adult & middle-aged black women; usually in mandible Central ossifying fibroma Ameloblastoma Langerhans cell disease Radiopacities - well-demarcated borders correct answers Torus or exostosis-- Associated with bony surface mass Condensing osteitis--Usually at apex of tooth with nonvital pulp Idiopathic osteosclerosis--Most commonly associated with roots of posterior teeth; no apparent inflammatory etiology Pseudocyst of the maxillary sinus--Homogeneous, dome-shaped relative opacity rising above bony floor of maxillary sinus Radiolucencies - multifocal or generalized correct answers Cemento-osseous dysplasia--Early-stage lesion; usually in black females; usually mandible Nevoid basal cell carcinoma syndrome Odontogenic keratocysts Multiple myeloma--Painful; older adults; "punched-out" lesions Cherubism--Usually multilocular; onset in childhood; hereditary Hyperparathyroidism--Multiple brown tumors Langerhans cell disease--Histiocytosis X; children & young adults; teeth "floating in air" Radiolucencies - poorly defined or ragged borders correct answers Metastatic tumors-- Painful; parasthesia; usually in older adults Osteo-radionecrosis--H/O radiation therapy; painful Multiple myeloma--May be painful; older adults Primary intraosseous carcinomas--Odontogenic or salivary gland origin Osteosarcoma--Often painful; young adults Chondrosarcoma Ewing sarcoma--Almost always children Radiopacities - poorly-demarcated borders correct answers Cemento-osseous dysplasia--Late-stage lesions; esp. in middle-aged & older black women; usually in mandible Condensing osteitis--Usually at apex of tooth with nonvital pulp Sclerosing osteomyelitis--May be painful Fibrous dysplasia--"Ground glass" appearance; usually in younger patients Paget's disease of bone--"Cotton wool" appearance; late-stage lesions; in older patients Osteosarcoma--May have "sunburst" cortical change; frequently Mixed radiolucent/radiopaque lesions - well-demarcated borders correct answers Cemento-osseous dysplasia--Intermediate-stage lesions; esp. in middle-aged black women; usually in mandible Odontoma--Compound or complex type; younger patients; may prevent eruption of teeth Complex-posterior more often

PADGET'S DISEASE OF BONE: "Cotton Wool" appearance; late-stage lesions; in older patients; more common in maxilla. GARDNER SYNDROME: Multiple osteomasl epidermoid cysts; gastrointestinal polyps witih high tendency toward malignant transformation; hereditary. MIXED RADIOLUCENT/RADIOPAQUE LESIONS: WELL-DEMARCATED BORDERES correct answers CEMENTO-OSSEOUS DYSPLASIA: Intermediate-stage lesions; especially in middle-aged black women; usually in mandible. ODONTOMA: Compound or complex type; in younger patients; may prevent eruption of teeth. AMELOBLASTIC FIBRO-ODONTOMA: Usually in Children. MIXED RADIOLUCENT/RADIOPAQUE LESIONS: POORLY DEMARCATED BORDERS correct answers OSTEOMYELITIS: With sequestrum formation or with sclerosing type; often painful. METASTATIC: Especiallty prostate and breast carcinomas; may be painful. MIXED RADIOLUCENT/RADIOPAQUE LESIONS: MULTIFOCAL OR GENERALIZED correct answers PADGET'S DISEASE OF BONE: In older patientws; more common in maxilla. UNNIQUE RADIOGRAPHIC APPEARANCES: "GROUND GLASS" (FROSTED GLASS) RADIOPACITIES correct answers FIBROUS DYSPLASIA: Onset usually in younger patients. HYPERPARATHYROIDISM: May cause loss of lamina dura UNIQUE RADIOGRAPHIC APPEARANCES "COTTON WOOL" RADIOPACITIES correct answers CEMENTO-OSSEOUS DYSPLASIA: Especially in middle-aged black women; usually in madible. PADGET'S DISEASE OF BONE: in older patients; more common in maxilla. GARDNER SYNDROME: Multiple osteomasl epidermoid cysts; gaastrointestinal polyps with high tendency toward malignant transformation; hereditary. GIGANTIFORM CEMENTOMA: Hereditary; facial enlargement may be present. UNIQUE RADIOGRAPHIC APPEARANCES: "SUNBURST" RADIOPACITIES correct answers OSTEOSARCOMA: Often painful; usually in young adults. INTRAOSSEOUS HEMANGIOMA: Especially in younger patients. SOFT TISSUE RADIOPACITIES correct answers AMALGAM TATTOO: Markedly radiopaque; associated with surface discoloration. SIALOLITH: Glandular pain may be present while parient is eating. CALCIFIED LYMPH NODES: Example : Tuberculosis