on of the most important lesion in face is Solitary radiolucencies that could be a sign of malignancy in oral cavity...here is more about it...

1. Solitary radiolucencies
with ragged & poorly
defined borders
Seyed mohammad reza masoumi
Student Research Committee, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran

2. Mostcommonlesionsinclude
thefollowing:
• CHRONIC OSTEITIS
• CHRONIC OSTEOMYELITIS
• HEMATOPOIETIC BONE MARROW DEFECT
• FIBROUS DYSPLASIA-EARLY LESION
• OSTEOSARCOMA
• CHONDROSARCOMA
• METASTATIC TUMORS TO THE JAWS
• SQUAMOUS CELL CARCINOMA

3. Chronic osteitis
(chronic alveolar abscess)

4. Chronic osteitis
(chronic alveolar abscess)
• Inflammation or infection usually occurs around the roots of a
tooth
• inciting tooth is pulpless and usually tender to percussion.
• A sinus may be present and may pass through the alveolar
bone to open onto the mucosa generally near the level of the
apex.

5. Differential diagnosis
• The presence of an
intraalveolar draining
sinus is not conclusive
evidence that a
radiolucent area is a
chronic osteitis, an
abscess, or
osteomyelitis.
Management
• Extraction
• RCT
• Curettage and
microscopic evaluation
for rejection of
malignancies.

6. OSTEOMYELITIS
• The most common location is the posterior body of the mandible
Is an inflammation of the bone caused by pathogenic
microorganisms
• The disease process is empirically considered osteitis when just the
alveolar bone is affected.
• If the basal bone of the jaws is involved, the process is considered
osteomyelitis
• This infectious process creates an effective barrier to viable bone
and vascularization.
.

7. Radiographic features
• The hallmark of osteomyelitis is the development of
sequestra.
• periosteal reaction is a characteristic but not pathognomonic
• Osteomyelitis of the mandible most frequently occurs in the
body radiographically an early acute osteomyelitis does not
show bony changes because of the rapid onset.
• lesion often appears as a somewhat linear radiolucency with
ragged borders possibly varying in width as it follows the
fracture line through the bone
• Often the surrounding bony borders are denser than the
adjacent normal bone.

8. The types of osteomyelitis are
listed below
I. Acute osteomyelitis
2. Chronic osteomyelitis
3. Proliferative periostitis
4. Sclerosing osteomyelitis

9. OSTEOMYELITIS

11. Chronic osteomyelitis
• Recurrent chronic supportive osteomyelitis of the mandible

12. Chronic osteomyelitis
• spotty areas of osteolysis and reactive sclerosis, which are
rendered even more visible along the course of the
mandibular canal.

13. Differential diagnosis
• Very sclerotic, radiopaque chronic lesions of osteomyelitis may
be difficult to differentiate from fibrous dysplasia, Paget's
disease, and osteosarcoma.

14. HEMATOPOIETIC BONE
MARROW DEFECT
• It can appear as a radiolucent lesion with ragged, poorly
defined border
• Usually the suspicion index is so low with these lesions that
the clinician chooses to radiograph the lesion in 3 to 6 months‘
time to ensure that it is not enlarging.

15. FIBROUS DYSPLASIA
• a hamartomatous fibroosseous lesion not of periodontal
ligament origin
• in its early stage
• The solitary (monostotic) form of fibrous dysplasia, which
accounts for 70% of all cases
• Fibrous dysplasia involves the maxilla almost twice as often as
the mandible and occurs more frequently in the posterior
aspect
• Radiolucent to radiopaque
• Trabecular, wispy and finger print pattern when progression of
lesion is seen.

16. FIBROUS DYSPLASIA

17. Differential diagnosis
• Metabolic bone diseases such as hyperparathyroidism
• Paget's disease
• Osteomyelitis
• cementoossifying fibroma
• Osteosarcoma

18. Osteosarcoma
• „Malignant neoplasm of bone
• „New bone is produced by the lesion (not by reactive bone
formation of surrounding osteoclasts)
• „Three major types
1. Chondroblastic
2. Osteoblastic
3. Fibroblastic

19. Clinical Features
• Rare. Jaws account for only 7% of all osteosarcomas
• „2:1 Male: Female ratio
• „Peak in 4th decade
• „Initially reported due to swelling or bleeding

20. Osteosarcoma

21. Radiographic Features
Location
• Location
– More common in the
mandible
– Usually arises in the
posterior mandible. the
molar areas and ramus are
most commonly affected
– In maxilla, usually arises in
the posterior.
• The ridge, sinus, and palate
are most commonly
affected
Borders and shape
• – Ill-defined
– Radiolucent without
capsule or surrounding
osteosclerosis
– If the periosteum is
involved, sunray spicules
(aka: “hair-on-end”
trabeculae, or orthoradial
striations) may be present

22. Radiographic Features
• Effects on adjacent structures
– Widening of the PDL
– Destruction of cortices
– May destroy or widen the cortex of the inferior alveolar canal

23. Differential diagnosis
• Chondrosarcoma
• Metastatic tumors
• Fibrooseuss lesions

24. Chondrosarcoma
• „Malignancy of cartilaginous origin
• „Firm to hard bony mass of long duration
• „Four subtypes
1. Clear cell
2. Dedifferentiated
3. Myxoid
4. Mesenchymal
• „Occurs within the bone, peripheral to the bone, or, less
commonly, in soft tissue
• „Mean age: 47 yrs Affects males and females equally

25. Radiographic Features
Location
• „Location
– Unusual in the facial bones.
Accounts for only 10% of all
cases
– Occurs equally in maxilla
and mandible nearcartilage
– Maxillary lesions tend
toward the anterior, while
mandibular lesions occur in
the coronoid process, head
of the condyle and neck, and
sometimes in the mandibular
symphysis
Borders and shape
• „Borders and Shape
– Round, ovoid, or lobulated
– Borders can range from
smooth and well corticated
to indistinct
– If the periosteum is
involved, sunray spicules
(aka: “hair-on-end”
trabeculae, or orthoradial
• striations)

26. Chondrosarcoma

27. Radiographic Features
• Internal architecture
– May appear as multilocular lucencies to highly
calcified lesions. Usual appearance is mixed
density
– Radiographic appearance – may be
“flocculent” (snow-like)
– “Moth eaten appearance” may be seen, amid
islands of unaffected bone

28. Differential Diagnosis
• „Osteosarcoma
• „Benign fibro osseous lesions
• „Odontogenic myxoma
• „Fibroma
• „Osteoma
• „Ameloblastoma
• „Central bone malignancies

29. Metastatic Lesions
• „Metastatic tumors are foci of malignant disease that
originated in a distant primary tumor
• „Usual pathway is through the bloodstream metastases
located in the jaws generally arise from primary tumors
located below the clavicles
• „Usually, the primary has been discovered prior to the
discovery of jaw metastases

30. Clinical Features
• „Most common in 5th to 7th decade of life
„Complaints may include:
– Pain
– Numbness
– Paresthesia
– Bleeding
– Pathologic fracture of the mandible

31. Radiographic Features
• „Location
– Posterior regions of the jaws
– More common in:
ƒmandible > maxilla >maxillary sinus > anterior
hard palate> mandibular condyle
– Metastases may be bilateral
– Lesions may be located in the periodontal
ligament space. They may be confused with
periodontal or apical inflammatory lesions

32. Radiographic Features
Borders and Shape
– Moderately well-
demarcated
– Non-corticated borders
– May also have ill-
defined, invasive borders
– Polymorphous in shape
(i.e.: irregular)
Effects on adjacent
structures
• – Effacement of the lamina
dura
– Widening of the PDL
space
– Periosteal reaction. May
perforate cortices
and form a soft tissue mass
extraorally or
intraorally
– Teeth may “float” in a
soft tissue mass and
may be displaced

33. Metastatic Lesions

34. Squamous Cell Carcinoma
• Since SCC is the most common malignant lesion in
the oral cavity, it is also the most common malignancy to
produce radiolucent lesions in the jawbones

35. Clinical Appearance
• „Red, white, or mixed lesion
• „Ulcerated
• „Indurated or rolled borders
• „Can be painful or painless
• „Rubbery or hard lymph nodes that are “fixed” to underlying
structures.
• „Usually occurs in patients >50 years
• „More common in males

36. Radiographic features
• „Location
– Often on lateral border of the tongue
Therefore, it is seen radiographically in the
posterior mandible
– Lesions in lip and floor of the mouth may
invade anterior mandible
– Ginigival lesions may initially mimic
periodontal disease

37. Radiographic features
• „Shape and Borders
– Commonly irregular and ill-defined borders
– Finger-like projections demonstrating invasion
– Occasionally, the lesion may have smooth
borders, indicating erosion
– Pathologic fractures may occur. Sharp, thin
edges may be evident

38. Radiographic features
• „Effects on adjacent structures
– Periodontal ligament space will initially appear
to widen. Eventually, teeth will appear to
“float” in the lesion, and may be displaced as
lesion expands
– Tumor may spread along the mandibular
canal, giving a widened appearance
– Adjacent cortical borders may be effaced
(destroyed)

39. Squamous Cell Carcinoma