Differential diagnosis of cystic lesions
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1. The document discusses the differential diagnosis and treatment of various cystic lesions of the jaw, including periapical granulomas, cysts such as radicular and follicular cysts, giant cell lesions, fibrous dysplasia, and odontogenic tumors. 2. It provides details on the etiology, clinical and radiographic features, and treatment approaches for each condition, such as non-surgical versus surgical treatment depending on factors like lesion size and tooth involvement. 3. The diagnostic workup is also summarized, including aspiration of cystic lesions to determine fluid characteristics, and biochemical tests and biopsy to differentiate between solid lesions.
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Differential diagnosis of cystic lesions
- 2. 1-Periapical granuloma 2-Cysts 3-Giant cell Lesions 4-Fibrous dysplasia 5-Neoplasia 6-Structural anomalies
- 3. Periapical Granuloma Widening of the periodontal space Periphery less sharply demarcated Less than a Cm in diameter
- 4. Periapical Granuloma-Etiology Trauma/caries Tooth infection Pulp Necrosis Toxins exit apical foramen Periapical inflammation stimulates epithelial rests of Malassez Periapical granuloma
- 6. Treatment planning for 31,41 RCT Apisectomy RRF In one Sitting
- 7. Treatment planning RCT Apisectomy RRF In one Sitting
- 8. Immediate postop 1 year postop
- 10. 3/12 post Re RCT Treatment planning Apisectomy RRF
- 13. Anterior teeth <1/3rd of the root involved >1/3rd of the root involved
- 14. <1/3rd of the root involved Non surgical endodontic Periodic follow up Regressing Persisting No active treatment Surgical endodontic
- 15. >1/3rd of the root involved Non surgical endodontic Periodic follow up Regressing Persisting No active treatment Ext + Curettage
- 18. Posterior teeth Non surgical endodontic Periodic follow up Regressing Persisting No active treatment Ext + Curettage
- 23. Pre op 1½ year Post op
- 24. CYSTS Odontogenic Inflammatory Radicular cyst Developmental Follicular cyst Kerato cyst Non Odontogenic Non Epitheliated Aneurismal bone cyst Solitary bone cyst
- 25. Radicular Cyst-Etiology Periapical granuloma lack of blood supply Epithelium Necrosis Radicular Cyst
- 35. Follicular Cyst Develops within dental follicle Decreasing order of frequency around unerupted teeth: Mandibular third molars, Maxillary third molars Maxillary canines
- 51. Pre op 03-03-05
- 66. TREATMENT OF CYSTS Anterior teeth Posterior teeth
- 67. Anterior teeth <1/3rd of the root involved >1/3rd of the root involved
- 68. <1/3rd of the root(s) involved RCT+API+RRF of the involved teeth Enucleation Primary closure Follow up
- 69. >1/3rd of the root(s) involved Extraction of the involved teeth Enucleation Primary closure or packing Follow up
- 72. Pre op 2/12 post op
- 73. 6/12 post op 1 year post op
- 74. Pre-op
- 75. Post-op 3/12
- 76. Post op 9/12
- 77. Post op 1½ year
- 79. MARSUPILIZTION Follicular cyst in young patient when the tooth can be properly accommodated in the arch Size of the cyst is not the issue
- 80. GIANT CELL LESIONS 1-Giant cell granuloma 2-Giant cell tumor 3-Brown node of hyperparathyroidism
- 81. 1-Giant cell granuloma Common in maxillofacial region Expansion of both cortical plates Firm in consistency Internal trabeculation Very vascular
- 98. 2-Giant cell tumor Rare in maxillofacial region Common at the end of long bones Tumor markers are present
- 100. 3-Brown node of Hyperparathyroidism Clinical + cytological presentation similar to giant cell granuloma Decrease definition of bone trabeculae Partial or complete loss of lamina dura
- 103. FIBROUS DYSPLASIA General Features Cellular fibrous tissue replaces normal bone Gradually increasing ossification Lesions form rounded swellings Self limiting disease No specific changes in blood chemistry 70-80% are monostotic 20-30% are polystotic
- 104. POLYSTOTIC FIBROUS DYSPLASIA--sites Femur 91% Tibia 81% Pelvis 78% Ribs, skull, facial bones 50% Decreasing order of frequency Upper extremities Lumber spine Clavicle and Cervical spine
- 105. POLYSTOTIC FIBROUS DYSPLASIA Multiple lesions, sometimes painful Jaw lesions in 30% cases Often multilocular cystic appearance Mainly girls Precocious puberty, skin pigmentation Albright’s Syndrome Rare
- 106. McCune-Albright Syndrome Describe 50 years ago Is named after two physicians 10% of polystotic fibrous dysplasia Endocrine disorders Early puberty Skin pigmentation with irregular borders Café-au-Lait
- 107. MONOSTOTIC FIBROUS DYSPLASIA--sites Ribs 28% Femur 23% Tibia 10-25% Craniofacial bones 10-25%
- 108. MONOSTOTIC FIBROUS DYSPLASIA Usually Maxilla Painless rounded swelling Rounded radiolucency Margins ill-defined Ground glass appearance Gradually increasing opacity Cosmetic surgical correction
- 123. Epithelial Ameloblastoma Adenomatoid odontogenic Tumor Calcifying Epithelial odontogenic Tumor
- 124. Ameloblastoma Most common Locally invasive Represent 11% of odontogenic tumors Represent 1% of all oral tumors Even Sex distribution Mandible more often affected than maxilla All features of a solid lesions present Unilocular but often multilocular
- 129. Pre op
- 130. 4/12 post op
- 131. 8/12 post op
- 141. 1 year post op
- 147. Post op 2/12
- 155. Unilocular Curettage Bone skimming Primary closure or packing Follow up with check X-ray
- 156. Multilocular But Intact lower border Marginal resection Primary closure or Packing Follow up with check X-ray
- 157. Multilocular But Treated previously and recurred Involved lower border Total resection Immediate reconstruction IMF for 6-8/52
- 158. Adenomatoid odontogenic Tumor More common in incisor / premolar region Associated with unerupted tooth Clearly demarcated periphery Scattered calcific bodies in radiolucent area Can be confused with follicular cyst Capsulated
- 162. Connective Tissue Cementomas and cemental dysplasias Odontogenic Fibroma Myxoma
- 163. CEMENTOMA Early stage Well demarcated radiolucency If develop at apex lamina dura is lost If develop at distance lamina dura persists Involved teeth vital Later stage Calcified mass of cementum
- 164. TYPES OF CEMENTOMA Benign cementoblastoma Cementifying fibroma Periapical cemental dysplasia Gigantiform cementoma
- 172. WHO CLASSIFICATION 1- Complex odontome 2- Compound odontome
- 173. COMPLEX ODONTOME All dental tissues are represented, individual tissues being well formed but occur in a more or less disorderly pattern
- 174. COMPOUND ODONTOME All the dental tissues are represented in more orderly pattern than in the complex odontome so that the lesion consists of many tooth like structure
- 175. CLINICAL FEATURES--I * Slow growing * Asymptomatic * Retention of deciduous teeth * Swelling extra oral intra oral both
- 176. CLINICAL FEATURES--II * Impacted teeth * Displacement of erupted teeth * Secondary infection Pain Fever Suppuration
- 177. X-RAY - APPEARANCE Radiopaque solid masses OR Radiopaque multiple tooth lets
- 192. HEMANGIOMA Pulsation Soap bubble appearance Medullary spaces and vascular canals widened
- 195. Primary Bone Tumors Benign Fibroma Chondroma Osteoma Malignant Osteogenic Sarcoma Fibrosarcoma Chondrosarcoma
- 197. Suggestion Two separate tumors identical in nature, except for the cell undergoing proliferation OR Two facets of the same tumor
- 198. INCIDENCE Any age but common in adults Both sexes equally affected 70% occur in Mandible
- 199. CLINICAL FEATURES Extra oral Intra oral
- 200. Extra oral features Swelling Deformity Facial asymmetry
- 201. Intra oral features Displacement of teeth Expansion of cortical plates Intact mucosa
- 202. Radiological features Radiolucent stage Mixed stage Radiopaque stage
- 226. 3/12 post op
- 236. 1/52 post op
- 240. STRUCTURAL ANOMALIES Thin labiolingual bone in symphysis region Canine fossa in pre-maxillary region
- 243. CLINICAL EXAMINATION Dead tooth or residual root Expansion of outer cortical plate Expansion of both cortical plates Egg shell crackling sound Fluctuation Loosening of adjacent teeth Missing tooth without history of extraction Dull or hallow sound
- 244. RADIOGRAPHS Intra oral Periapical view Occlusal view Extra oral Lateral oblique view Posterio anterior view Para nasal sinus view Pnorex view Orthopantomogram
- 245. ASPIRATION Light straw colored fluid Follicular cyst Radicular cyst Residual cyst
- 246. ASPIRATION Dirty white fluid Kerato cyst
- 247. ASPIRATION Bright red blood Arterial Haemangioma
- 248. ASPIRATION Dark blood Venous Haemangioma Giant Cell Granuloma Aneurysmal Bone Cyst
- 249. BIOCHEMICAL TESTS Protein estimation Radicular Follicular 5 gm/100ml Residual Kerato cyst <4gm/100ml Serum Ca Serum P Serum Alkaline Phosphatase Urine Ca (24 hours)
- 250. BIOPSY To differentiate between different solid lesions