lesions radioclaires des maxillaires

1. Radiolucent Lesions

2. Classification according to diagnostic point of view
:
Lesions at apex of tooth
*Radiolucency at apex of nonvital tooth
Dental granuloma
Radicular cyst
Abscess
*Radiolucency in extraction site
Residual cyst
*Radiolucency at apex of vital tooth
Cementoma(stage 1)
*Radiolucency at apex of endodontically treated tooth
Radicular cyst
Dental granuloma, abscess
*Radiolucency associated with R.C.filling & apical surgery
Apical
scar

3. Lesions in midline of maxilla :
*Nasoalveolar cyst(nasolabial cyst)
*Globulomaxillary cyst
*Median alveolar cyst
*Nasopalatine cyst
Lesions in place of missing tooth
*Odontogenic keratocyst
*Ameloblastoma
Lesions around crown of impacted tooth
*Dentigerous cyst
*Odontogenic fibroma and odontogenic myxoma
*Eruption cyst
*Ameloblastoma
*Odontogenic adenomatoid tumor

4. Soap bubble-like radiolucencies
*Central giant cell granuloma
*Aneurysmal bone cyst
*Ameloblastoma
Multiple but separated radiolucent lesions
*Cementoma(stage 1)
*Histiocytosis X
*Hyperparathyroidism
*Multiple myeloma
*Metastatic tumors

5. Lesions that destroy the cortical plate
*Primary malignant tumors of the jaws
*Metastatic tumors to the jaw
*Osteomylitis
Miscellaneous & rare lesions
*Traumatic cyst
*Gingival cyst
*Lateral periodontal cyst
*Physiologic osteoporosis
*Periodontal disease
*Median mandibular cyst
*Fractures

6. Radiolucency at apex of nonvital tooth
P. A. abscess P. A. Cyst

7. Is a cyst that remains after incomplete removal of the original cyst.
The term residual is used most often for a radicular cyst that may
be left behind, most commonly after extraction of a tooth.
*Persistent radiolucency in an area where a tooth has previously
extracted.
Residual cyst

8. Radiolucency at apex of vital tooth:
*Cementoma (stage 1)
Is a localized change in normal bone metabolism
in the replacement of the
that result
components of normal cancellous bone with
fibrous tissue and Cementum -like material,
(abnormal bone)or a mixture of the two.
The involved tooth is vital and often painful.
The pain seems to vary from patient to patient and can
be relieved by anti-inflammatory drugs.
Treatment. It is self-limiting and rarely recur after enucleation. Simple
excision and extraction of the associated tooth are sufficient treatment.
In some cases the tumor may be amputated from the tooth, which is then
treated endodontically.

9. Radiolucency at apex of endodontically treated tooth
A: Radiolucent apical scar
left after successful
endodontic treatment..
B:New bone forming from
the periphery of the
Lesion.
If the R.L.enlarged,
pain,sinus,or no regression
in the size of lesion after
6months (P. A. Cyst).
A B
Apical scar

10. Lesions in midline of maxilla
Nasoalveolar cyst (nasolabial cyst)
Located in the vestibule of upper lateral & cuspid area , its soft tissue
lesion may not produce any radiolucency ,in such case aspiration &/or
radiograph with radiopaque contrast media is used to establish the
diagnosis. Teeth are vital , clinically involve the lip & the floor of the
nose .
The radiograph shows erosion of the
alveolar bone (o) and elevation
of the floor of the nasal fossa (arrows).

11. Globulomaxillary Cyst
Located between the lateral
incisor & cuspid teeth, the teeth
are vital .
Radiographically;an inverted
pear shape radiolucency
between the roots of lateral &
cuspid teeth, the roots of teeth
pushed apart.
Treatment by excision.

12. Median Alveolar Cyst
It is located between the maxillary central
incisors (which are vital). This lesion dose not
exist as an entity but it represents an incisive canal
cyst.

13. Nasopalatine Cyst
Also called nasopalatine canal cyst, incisive canal
cyst, median palatine cyst , or median
anterior maxillary cyst.
*It is located in the midline between the upper central
incisors. Note the superimposed shadow of nasal
spine causing the cyst to appear heart shaped.
The teeth are vital.
This cyst causes the roots of the central incisors to
diverge, and occasionally root resorption occur.
*Treatment by excision.

14. Lesions in place of missing tooth:
Odontogenic keratocyst:
*This cyst develops from the epithelium of the dental lamina instead
of the normal tooth which is therefore typically missing from the series.
*The regional teeth are vital.
*Shape: Oval, extending along the body of the mandible with little
mediolateral expansion.
*Minimal displacement of the adjacent teeth , rarely resorbed
Extensive expansion within the cancellous bone.
*Treatment by surgical excision.

15. A 11-year-old female with
swelling on the right side.
impacted canine

16. Ameloblasoma
*Non-metastasizing tumor originating from remnants of the
odontogenic epithelium of the enamel organ or dental lamina.
*Associated with the crown of impacted teeth.
*80% located in the bicuspid & molar regions.
*Shape: is either unicystic or soap bubble-like lesion, Expansile,
*Tooth migration is common,teeth in the area are vital.
*Adjacent teeth displaced, loosened , often resorbed
Extensive expansion in all dimensions
Maxillary lesions can extend into the paranasal sinuses, orbit or base of
the skull.
Male > female.
Age; > 30 years

18. Lesions around crown of impacted tooth
Dentigerous Cyst
It forms around the crown of an unerupted or supernumerary tooth
at CEJ.
Some dentigerous cysts are eccentric, developing from the lateral
aspect of the follicle so that they occupy an area beside the crown
instead of above the crown.
It displace and resorb adjacent teeth.
It commonly displaces the associated tooth
in an apical direction.

21. Eruption Cyst
The term eruption cyst is used to describe a
dentigerous cyst when it is in the soft
tissues overlying the unerupted tooth.

22. Odontogenic Fibroma
Benign tumor appear as a solid mass,
around the crown of impacted teeth.
Odontogenic Myxoma
*They are benign, intraosseous neoplasms
that arise from the mesenchymal portion of
the dental papilla.
*Monolucular or multiloculor radiolucency
associated with missing or unerupted tooth.
*Can be distinguished from the Fibroma
by histological examination(excessive
ground substance myxoid tissue).

23. *A 13 year old boy presents with a
recurrent friable granular lesion of the
anterior maxilla. This is a recurrent lesion
after excision.
Differential Diagnosis:
 Pyogenic Granuloma
 Peripheral Odontogenic (Ossifying)
Fibroma
 Peripheral Giant Cell Granuloma
 Squamous Cell Carcinoma other soft
tissue malignancies

24. Differential Diagnosis:
 Ameloblastoma
 Odontogenic Keratocyst
 Odontogenic Myxoma
 Giant Cell Granuloma
*A 55 year old man with an
expansile multilocular radiolucency
of the left mandible. The swelling
had been noticed by the patient for
approximately one year.

25. A: Odontogenic fibroma
B,C,D:Odontogenic myxoma.

26. Odontogenic Adenomatoid Tumor (OAT)
*Uncommon, nonaggressive tumor of odontogenic epithelium.
*Age <20 years.
*Location; cuspid area of the maxilla.
*As the tumor enlarged the adjacent teeth are displaced. Root
resorption is rare.
*This lesion also may inhibit eruption of an involved tooth.
*Although some expansion of the jaw may occur, the outer cortex is
maintained.

27. The maxillary left canine and premolar have
been displaced superiorly by the tumor.
The canine and lateral incisor
have been displaced by the
lesion.

28. Soap bubble-like radiolucencies
Central giant cell granuloma
*A relatively uncommon, non- neoplastic mass in the jaws
(intraosseous) producing an expansile radiolucent soap bubble
appearance.
*Age; <20 years. Female > Male.
*Teeth are vital, with some root resorption & migration of teeth.
Multilocular appearance, expansion
(arrowed) and considerable
displacement of the adjacent teeth.
Buccal and lingual expansion
(arrowed) and the undulating cortical
border.

29. Aneurysmal Bone Cyst
Large multilocular aneurysmal bone cyst
in the ramus with marked expansion and
the displacement of/8.
It is non-neoplastic ,exaggerated , localized, proliferative lesion of
vascular tissue, containing giant cells.
It’s a variation of the central giant cell granuloma , can be diagnosed
only by histological examination

30. Multiple but separated radiolucent lesions
Histiocytosis-X (Langerhans cell disease):
They are three manifestations produce tumour-like lesions in bone,
caused by proliferation of Langerhans cells and eosinophilic leucocytes.
Radiographically :
•Multiple radiolucent areas in the interdental & interradicular bone.
• teeth seem to hang in air. Exfoliation of teeth & teeth germ are
common, ulceration of overlaying mucosa.
• Multiple radiolucent foci seen in the skull & long bone of the skeleton,
lesion in the skull give appearance of geographic map , with skull
enlargement .

31. Histiocytosis-X
•Eosinophilic Granuloma (2nd-3rd decade of life).
•Hand-Schüller-Christian disease (1stdecade of life).
•Letterer-Siwe disease (before 2 years of age).

32. Hyperparathyroidism
Increased secretion of parathormone, causes generalized skeletal bone resorption
leading to osteopenia (generalized decrease in bone density).
Single or multiple radiolucency in the maxilla & mandible.
Loss of normal bone trabeculation & replaced by fine poorly calcified bone spicules
that give ground glass appearance.
Missing of lamina dura.
D.D.by elevation of serum calicum & alkaline phosphatase levels.
Loss of the lamina dura
and the granular texture
of the bone pattern.

33. Multiple Myeloma
*Is a malignant tumor of the bone marrow.
Age; > 40 years, male > female.
Radiographically; multiple punched-out in the jaw & skull, the
peripheral border is smooth & irregular in comparison with the
Histiocytosis-x.

34. Miscellaneous & rare lesions
Traumatic cyst
*Mandible > Maxilla. <20 years of
age.
*Asymptomatic, expansile,
associated with history of trauma.
*Extend between the roots of teeth
with scalloped border .
*Aspiration is not productive,
empty cavity.

35. Gingival Cyst
* Arises from attached
gingiva & with growth
cupping the cortical
plate.
*The teeth are vital.

36. Lateral Periodontal Cyst
*It is a developmental cyst and not an inflammatory cyst ,developed
from the cell rests of the dental lamina.
*Occur at the lateral surface of the roots of vital teeth in the lower
canine/premolar region or upper lateral incisor region.
*It is the intrabony counterpart of the gingival cyst in the adult .

37. Median Mandibular Cyst
*Located in the midline of the mandible.
*Teeth are vital. Arise from the fissural epithelia.

38. FRACTURES