Monday, March 25, 2013

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS OF COMMON LESIONS IN ORO MAXILLO FACIAL REGION




1. PERIAPICAL RADIOLUCENCIES
·           Granuloma
·           Radicular cyst
·           Abscess
·           Apical scar
·           Surgical defect
·           Periodontal disease
·           Chronic suppurative osteomyelitis
·           Periapical cemental dysplasia (osteolytic stage)
·           Cementoblastoma (osteolytic stage)
·           Cementifying and ossifying fibromas (osteolytic stage)
·           Odontogenic and nonodontogenic cysts
·           Odontogenic and nonodontogenic benign tumors
·           Malignant tumors

2. PERIAPICAL RADIOPACITIES
·         Periapical cemental dysplasia (calcified stage)
·         Cementoblastoma (calcified stage)
·         Cementifying and ossifying fibromas (calcified stage)
·         Condensing osteitis
·         Osteosclerosis
·         Socket sclerosis
·         Florid osseous dysplasia (diffuse cementosis)
·         Tori
·         Hypercementosis


3. PERICORONAL RADIOLUCENCIES

Do NOT contain radiopacities:
·         Follicular space
·         Dentigerous cyst
·         Unicystic (mural) ameloblastoma
·         Odontogenic keratocyst
·         Ameloblastoma
·         Ameloblastic fibroma

MAY contain radiopacities:
·         Ameloblastic fibro-odontoma
·         Adenomatoid odontogenic tumor
·         Calcifying epithelial odontogenic tumor (Pindborg tumor)
·         Calcifying odontogenic cyst (Gorlin cyst)

4. SOLITARY CYSTLIKE RADIOLUCENCIES

Normal anatomy and Variations
·         Tooth follicle (early stage)
·         Large marrow space (wide inter-trabecular space)
·         Post extraction socket
·         Surgical defect

Odontogenic cysts:
·         Primordial
·         Lateral periodontal
·         Residual
·         Odontogenic keratocyst

Fissural cysts:
·         Incisive canal (nasopalatine)
·         Globulomaxillary
·         Median palatine
·         Median mandibular

False cysts:
·         Traumatic bone cyst
·         Stafne bone cavity

Odontogenic tumors:
·         Ameloblastoma
·         Odontogenic adenomatoid tumor
·         Calcified epithelial odontogenic tumor(Pindborg tumor)
·         Ameloblastic fibroma
·         Cementifying and ossifying fibromas (osteolytic stage)

Giant cell and nonodontogenic tumors:
·         Central giant cell granuloma
·         Giant cell lesion of hyperparathyroidism
·         Non-odontogenic benign tumors

5. SOLITARY RADIOLUCENCIES WITH DIFFUSE IRREGULAR BORDERS
·         Chronic alveolar abscess
·         Chronic osteomyelitis
·         Osteoradionecrosis
·         Squamous cell carcinoma
·         Metastatic tumors to the jaws
·         Fibrous dysplasia (early stage)
·         Histiocytosis X
·         Osteosarcoma and chondrosarcoma
·         Ewing's sarcoma
·         Burkitt's lymphoma

6. MULTILOCULAR RADIOLUCENCIES

Cysts:
·         Odontogenic keratocyst (basal cell nevus syndrome)
·         Aneurysmal bone cyst


Tumors:
·         Ameloblastoma
·         Odontogenic myxoma
·         Central hemangioma of bone
·         Metastatic tumors to the jaws

Others:
·         Cherubism
·         Central giant cell granuloma
·         Giant cell lesion of hyperparathyroidism

7. SOLITARY RADIOPACITIES
·         Exostoses and tori
·         Osteoma
·         Retained root
·         Osteosclerosis
·         Socket sclerosis
·         Mature cementoma
·         Complex composite odontoma
·         Compound composite odontoma
·         Calcifications in soft tissue
·         Foreign objects in the jaws
·         Fibrous dysplasia
·         Garré's osteomyelitis

8. MIXED RADIOLUCENT - RADIOPAQUE LESIONS

Inflammatory:
·         Condensing osteitis

Osteomyelitis:
·         Chronic suppurative osteomyelitis
·         Tuberculous osteomyelitis
·         Syphilitic osteomyelitis
·         Actinomycotic osteomyelitis
·         Osteoradionecrosis

Cementomas (intermediate and calcified stages):
·         Periapical cemental dysplasia
·         Cementifying and ossifying fibroma
·         Cementoblastoma
·         Florid osseous dysplasia (diffuse cementosis)

Others:
·         Fibrous dysplasia
·         Paget's disease
·         Osteosarcoma
·         Chondrosarcoma
·         Osteoblastic metastatic carcinoma

Pericoronal mixed lesions:
·         Ameloblastic fibro-odontoma
·         Odontogenic adenomatoid tumor
·         Calcifying epithelial odontogenic tumor (Pindborg tumor)
·         Calcifying odontogenic cyst (Gorlin cyst)

9. GENERALIZED RADIOPACITIES
·         Florid osseous dysplasia (diffuse cementosis, sclerotic cemental masses)
·         Paget's disease
·         Osteopetrosis
·         Gardner's syndrome
·         Infantile cortical hyperostosis
·         Albright’s syndrome

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