4. What is radiolucency ?
It express that the region/area/object didn’t absorb
the radiation but is transparent/translucent thus
more radiation reaches the sensor/film leading to
a darker area.
5. What is unilocular radiolucency?
From the word uni: means one and lucular
means lobes, it means the lesion appears
as one mass.
6. Multilocular radiolucency is produced by multiple adjacent,
frequently coalescing & overlapping pathologic compartments
in bone.
True multilocular lesion contains two or more pathologic
chambers partially separated by septa of bone.
Soap bubble appearance-
Lesions consists of several circular compartments that vary
in size & usually appear to overlap
7. Honeycomb-
Lesions whose compartments are small & tend to be
uniform in size
Tennis racket-
Lesions that are composed of angular rather than rounded
compartments that result in formation of more or less septae.
These compartments tend to be triangular rather, rectangular
or square
12. o Structures relatedto Maxilla
• Intermaxillary Suture
• Incisive Foramen
• Nasal Cavity
• Nasolacrimal duct/canal
• Maxillary sinus
o Structures common to bothJaws
• Periodontal ligament space
• Marrow Space
• Nutrient Canal
• Follicular Space
13. MANDIBULAR FORAMEN
Usually situated just above the mid point in the
medial surface of the ramus & just posterior to the
mid point between the anterior & posterior borders.
Seen on panographic & lateral oblique films
Outline of foramen varies from triangular to oval to
funnel shaped
Radiographic image is usually upto 1 cm in
diameter
It is associated with relatively radiolucent
mandibular canal that passes from it in an
anteroinferior direction
STRUCTURES RELATED TO MANDIBLE
14. MANDIBULAR FORAMEN
Lingula may be detected as a triangular radiopacity of variable density
at the foramen’s anterior border
These associated structures, with mandibular canal & lingula, can be
mistaken for pathology
15. MANDIBULAR CANAL/ INFERIOR DENTAL CANAL:
Largest of the nutrient canals
Seen on panoramic or periapical radiographs of molar region
Appears as relatively radiolucent channel bounded by definite, thin
radiopaque lines (cortical bones) through out its length
Its course can be followed anteroinferiorly to a point where it
frequently appears to sweep upward to meet the mental foramen
16. MENTAL FORAMEN
Anterior limit of mandibular canal
Mandibular canal send off the mental
canal in the premolar region
This smaller, short canal runs in superior
buccal direction, terminating with the
mental foramen
It is usually located on the radiograph in
the vicinity of premolar apices.
It may be mistaken for periapical pathosis
when it occurs at the apex of premolars
17. LINGUAL FORAMEN
Seen in relation to lower central
incisors often on periapical views
Located well below the apices of
these teeth in the midline
Seen as radiolucency measuring
usually 1-2mm in diameter surrounded
by prominent radiopaque ring of cortical
bone
Occasionally 2 or more foramina are
seen.
18. SUBMANDIBULAR GLAND FOSSA
Submandibular fossa is concave area on the
lingual side of the mandible below the molar area
which accommodates the Submandibular salivary
gland
Lies between inferior alveolar canal & lower
cortical margin of mandible
This is seen as relatively radiolucent area with
sparse trabecular pattern which is sharply limited
superiorly by the lower border of mylohyoid ridge
and inferiorly by lower border of mandible
Shape is round, ovoid or triangular (rarely)
Rarely occurs bilaterally
19. MENTAL FOSSA
Depression on the labial aspect of
midline of mandible just above the
mental tubercle
Due to relative thinness of bone
over in this area, it may be seen as
radiolucency over the incisor roots
which may be mistaken for
periapical pathology
20. MIDLINE SYMPHYSIS
Seen on the midline of the
mandible of infants
Seen as radiolucent line
which may be misinterpreted
for fracture line
Symphysis usually ossifies
by age of 1 year & then is no
longer apparent
21. MEDIAL SIGMOID DEPRESSION
It is a radiolucency that appears below & just anterior to greatest
depth of sigmoid notch of ramus
Seen on approximately 10% of panoramic radiographs
It is defined by temporal crest & crest of mandibular neck
Its degree of expression is variable depending upon prominence of
these two crests.
22. SUBLINGUAL GLAND DEPRESSION
First reported by Richard & Ziskind (1957)
It may develop to accommodate sublingual
salivary gland tissue that lies in close proximity
to the lingual cortex of mandible in canine region
Most often associated with canines, followed
by incisors & 2nd premolars (rare), in apical 1/3rd
of root
Average size-1.2 cm
Trabeculation may be present within
radiolucency
Have punched out appearance or corticated
margin
24. AIRWAY SHADOW
Bilateral, relatively radiolucent
Seen on panoramic, lat oblique & cephalomatric radiographs
Results from lack of soft tissue between he posterolateral surface of
tongue & region of soft palate & posterior pharynx
25. INTERMAXILLARY SUTURE
Intermaxillary/ median suture
between right & left maxillary bones,
can be identified as thin vertical
radiolucency in midline between central
incisors
Usually delineated by two thin,
vertical radiopaque lines (cortical
bone).
Generally fuses later in life & then no
longer seen on radiograph.
26. INCISIVE FORAMEN,
Incisive foramen (anterior palatine
foramen) frequently shows as a round,
oval, diamond shaped or heart shaped
radiolucency that is well defined on
occlusal & periapical radiographs
The position of foramen on radiograph
ranges from between the roots of central
incisors, close to alveolar ridge to the
level of apices.
Variability in position of foramen on
radiograph is due to the angulation of the
rays & position of foramen
27. SUPERIOR FORAMINA OF
INCISIVE CANALS
On radiograph they are seen as two
round or oval radiolucent areas above
the apices of central incisors in the
floor of nasal cavity near its anterior
border & both sides of nasal septum
In IOPA their image be
superimposed over apices incisors,
which may be misinterpreted as
periapical pathosis
28. NASOLACRIMAL DUCT/ CANAL
Nasal & maxillary bones form The nasolacrimal canal
Seen on maxillary occlusal radiograph , projected onto the posterior
hard palate near the 1st or 2nd molar as well defined radiolucency
bilaterally well defined by sharp radiopaque borders.
On periapical radiographs it may be seen in the region above the
apex of canine, especially if steep angulation is used.
29. MAXILLARY SINUS
Appear as well defined radiolucency with
thin, sharp radiopaque borders
It shows considerable variation in size
They enlarge in childhood, achieving
mature size by age of 15 to 18 years
Floors of maxillary sinus & nasal cavity are
seen at approximately same level at age of
puberty in radiograph
In adults sinuses are usually seen to
extend from the distal aspect of canine to
the posterior wall of maxilla above tuberosity
30. In older individuals it may extend farther
into the alveolar process & may extend
upto the alveolar ridge in absence of
teeth
32. MARROW SPACE
Marrow spaces between trabeculae of
bone appear as radiolucent region
Varies greatly in shape, size &
distribution
Radiographically, in maxilla, they are
generally relatively uniform in size
In mandible marrow spaces are smaller
& more numerous in the anterior portion &
larger in the posterior portion
33. In some persons trabecular
spaces just above & below the
roots of molars are so large &
trabeculae so sparse that the
combined appearance may
resemble & be misinterpreted as
cysts & other pathosis
These are referred as focal
osteoporotic bone marrow
defects
34. NUTRIENT CANAL
Appear as ribbonlike
radiolucencies of fairly uniform width
Carry neurovascular bundles
Seen more often on periapical
mandibular radiographs
Canals become more marked
when teeth are missing
35. PERICORONAL/ FOLLICULAR SPACE
The crowns of unerupted teeth are
surrounded by dental follicle- remnant of
reduced enamel epithelium
It is composed of soft myxomatous to
dense collagenous fibrous connective
tissue or cords of odontogenic epithelium
On radiograph it appears as
homogeneous radiolucent halo
36. Surrounded by thin outer
radiopaque border representing
compact bone continuous with
lamina dura
Radiolucent halo merges with
periodontal ligament space
Width of halo varies because of
varying thickness of the follicles &
accumulation of fluid between the
capsule of reduced enamel
epithelium & tooth crown
Normal follicular space – 1.5 to 2 mm
37.
38. PERIAPICAL ABSCESS
The primary abscess develops in a periapical region that is normal
on radiographic examination.
The infection is usually acute and exudative, involving the
periodontal tissues at the apex of the tooth with necrotic pulp.
The infection and inflammation in the apical area forces the tooth
slightly from its socket, creating an increased periodontal ligament
space around the entire root that is usually apparent on the
radiograph.
The secondary abscess may be of the chronic or the acute type
39. Related tooth shows features such as deep restorations, caries,
narrowed pulp chamber, or canals which suggest that the pulp is non-
vital.
The roots of these teeth may show resorption at the apex.
The tooth is painful on percussion and the patient complains that it
seems ‘high’ to bite on.
Tooth doesnot respond to electric pulp test.
The tooth may demonstrate increased mobility.
In untreated cases the abscess may penetrate the cortical plate at
the thinnest and closest point to the apex and form a space infection
in the adjacent soft tissue.
40. Periapical radiolucency is a feature of
the secondary abscess.
The radiolucency may vary from small to
quite large to involve much of the jaw.
The initial periapical lesion may cause
expansion of cortical plate.
In case of acute lesion the margins of
the radiolucency may be well defined with
possibly a hyperostotic border.
The borders are poorly defined in case
of chronic conditions. Sometimes the
radiolucency is represented as a blurred
area of somewhat lessened density than
that of surrounding bone.
Radiographic
Features
41. Represents between 69.7% & 94% of all pulpoperiapical lesions
It is a result of successful attempt by the periapical tissue to
neutralize & confine the irritating toxic products that are escaping
from the root canal
Continual discharge of chronic irritating products from the canal
into the periapical tissue is sufficient to maintain a low grade
inflammation in the tissues which results in formation of periapical
granuloma
PERIAPICAL GRANULOMA
42. Well circumscribed radiolucency somewhat
rounded & surrounding apex of tooth
May be surrounded by thin radiopaque
(hyperostoic ) border
Cannot be differentiated from radicular cyst
radiographically alone
Cysts tend to be larger than granulomas but
differentiation on basis of size is not possible as
some cysts are small & granulomas large
Granulomas are rarely larger than 2.5cm in
diameter
Involved tooth is non vital & asymptomatic
Radiographic
Features
43. Synonyms-
Periapical cyst
Apical periodontal cyst
Dental cyst
Most common type of cyst in jaw
It results when cell rests of Malassez in the PDL are stimulated to
proliferate & undergo cystic degeneration by inflammatory products
by non vital tooth
Usually asymptomatic unless secondary infection occurs
Incidence is greater in 3rd to 6th decade with slight male predilection
RADICULAR CYST
44. Most radicular cysts involve apices of permanent teeth
58% involve lateral incisors
History & clinical features are similar to those of periapical
granuloma
Studies by Lalonde show that such a lesion is more likely to be a
radicular cyst if the periapical radiolucency tends to be atleast 1.6cm
in diameter
45. An untreated cyst may enlarge slowly & cause expansion of
cortical plates.
In these cases a domelike swelling is seen on the alveolus over the
periapical region of alveolus of involved tooth
Swelling is initially bony hard on palpation but later it may
demonstrate crackling sound (crepitus) as cortical plate is thinned
In these cases swelling is rubbery & fluctuant because of cystic
fluid
46. Radiographic
Features LOCATION
Most common site- maxilla (60%)
especially incisors (58%) & canines
In deciduous teeth most commonly molars
are involved
Epicenter is located at the apex of
nonvital tooth
Occasionally it appears on the mesial or
distal surface of root, at the opening of
accessory canal, or infrequently in a deep
periodontal pocket
47. PERIPHERY & SHAPE
Usually has well defined cortical border
When cyst becomes secondarily infected due to inflammatory
reaction of surrounding bone, cortex may be lost or become more
sclerotic
Outline is usually curved or circular
48. EFFECT ON SURROUNDING STRUCTURES
If cyst is large, displacement & resorption of roots of adjacent teeth
may occur
Outer cortical plate of maxilla or mandible my expand in curved or
circular shape
Cyst may displace the inferior alveolar canal in an inferior direction.
49. Periapical granuloma & radicular cyst cannot be
distinguished radiographically alone, although
radiolucency with well defined corticated border more
than 2cm diameter, it is more likely to be cyst.
Differential
Diagnosis
50. Periapical cementoosseous
dysplasia:
Difficult to distinguish
radiographically from periapical
granuloma & radicular cyst in its
early lytic stage. Tooth is vital in
PCOD
Lower teeth especially incisors more
commonly involved
51. Traumatic bone cyst: Teeth associated
with lesion are vital
Most commonly seen in mandibular region
in molar, premolar & incisor region
Periapical granuloma does not have
predilection for lower jaw & more
common in anterior region
Lamina dura is intact in traumatic bone
cyst
52. Synonym- Follicular cyst
Most common type of cyst that is formed around
crown of an unerupted tooth
Begins with accumulation of fluid in the layers of
reduced enamel epithelium or between the epithelium
and the crowns of unerupted or supernumerary tooth
Typically patient has no pain or discomfort
53. Location
Mandibular 3rd molar or maxillary
canines are most commonly involved
Epicenter is found just above the
crown of involved tooth
Cyst is attached to the CEJ
Some cyst are eccentric
developing from the lateral aspect
of crown so that they occupy an
area besides the crown instead of
above the crown
Radiographic Features
54. Periphery and Shape
It has well defined cortex
with a curved or circular
outline
Cortex may be missing if
infection is present
Internal Structure
Completely radiolucent
except the crown of involved
tooth
55. Effects on Surrounding Structure
Displaces tooth involved usually in apical direction
It may also resorb the adjacent teeth
The floor of maxillary antrum may be displaced as the cyst
invaginates the antrum & displace inferior alveolar canal in inferior
direction
It tends to expand outer cortex of involved jaw
56. Hyperplastic follicle
Size of normal follicular space is 1.5-2mm
If follicular space exceeds 5mm, it is more likely
to be dentigerous cyst.
Tooth displacement & expansion is associated with
dentigerous cyst
DIFFERENTIAL DIAGNOSIS
57. Odontogenic cyst
Sometimes associated with
unerupted tooth with lesion
present at pericoronal position
Does not cause expansion of
bone
Less likely to resorb teeth
May attach further apically on
root than at CEJ
58. Ameloblastic fibroma
May be present around the
crown of an unerupted tooth
Difficult to differentiate
radiographically
61. Synonyms
Mural Ameloblastoma
Cytogenic Ameloblastoma
Cystic variant of Ameloblastoma
Cystic Ameloblastoma
Intracystic Ameloblastoma
Arises from the wall of cyst
2nd most frequently occurring pathologic pericoronal
radiolucency
Represents approximately 5% of all ameloblastomas
62. It is associated with following cysts
Dentigerous cysts (85%)
Residual cysts
Radicular cysts
Globulomaxillary cysts
Primordial cysts
Shortly after induction, the tumour begins as mural (within
wall)
When it infiltrates the connective tissue wall of cyst it invades
between the medullary spaces of bone. It than behaves like
conventional ameloblastoma.
63. Approximately 20% are associated with the crown of
mandibular 3rd molar.
Seen in younger age (average age- 21 years)
Associated with impacted, displaced tooth showing
incomplete root formation
Present as painless swelling
64. Mandible is more commonly involved
77% were in molar ramus region, 10% in premolar area, 13%
in symphysis
There is pericoronal radiolucency associated with an
unerupted mandibular 3rd molar
Associated teeth is displaced
RADIOGRAPHIC FEATURES
65. Adjacent erupted 2nd or 3rd molar may show knife edge
pattern of root resorption
Expansion is often present, which tends to be greatest on
buccal aspect
There may be perforation of anterior margins of ramus or at
retromolar pad area
67. Age- 2nd decade
Female predilection (2:1)
Follicular type is associated with unerupted
tooth
Unerupted teeth frequently associated with
tumour in order of frequency are maxillary
canine, lateral incisor & mandibular premolar
Presents as slow growing painless swelling
68. Location
75% occurs in maxilla especially in incisor-
canine- premolar region
Has follicular relationship with impacted
tooth but doesnot attach at CEJ, most often
canine is involved or sclerotic border
RADIOGRAPHIC FEATURES
69. Periphery
Lesion is well defined with
corticated or sclerotic border
Internal structure
1/3rd of cases show completely
radiolucent lesions
In rest radiopacities are
present within the lesion
70. Effect on surrounding structures
Causes displacement of teeth
Root resorption rare
May inhibit eruption of tooth
Expansion of jaw may occur
71. Dentigerous cyst
Associated with impacted teeth but
radiolucent lesion is more apical than CEJ
DIFFERENTIAL DIAGNOSIS
Odontogenic keratocyst
Difficult to differentiate pericoronal OKC
from AOT radiographically
73. These are benign, true mixed odontogenic tumours
, containing nests & strands of odontogenic &
ameloblastic epithelium in primitive dental papilla
Calcified odontogenic structures are not present
Age – below 20 years
Manifests as painless, slow growing expansion &
displacement of involved tooth
May be associated with missing tooth
74. Location
Mandibular premolar- molar
region most common site
Tumour may involve ramus in
some cases
Common location is crest of
alveolar process or in follicular
relationship with an unerupted
tooth
RADIOGRAPHIC FEATURES
75. Periphery
Borders are well defined
& corticated
Internal Structure
More commonly present
as unilocular radiolucency
but may be multilocular
with indistinct curved
septa
76. Effects on Surrounding Structure
Large lesion can cause expansion of cortical
plates without bone destruction
Associated tooth may fail to erupt or
displaced apically
81. Represents about 1% of all odontogenic epithelial tumours & 11%
of all odontogenic tumours
Slight male predilection
More common in blacks
Age- 20 to 50 years
Slow growing
Frequently discovered on routine radiographs
Teeth in involved region may be displaced or become mobile
82. Location
About 80% develop in mandibular
molar– ramus region & may extend
into the symphyseal region
In maxilla 3rd molar area is involved
& extends in the maxillary sinus &
nasal floor
RADIOGRAPHIC FEATURES
83. Periphery
Well defined & delineated with
a cortical border
Border is often curved & in
small lesions it may be
indistinguishable from a cyst
Maxillary lesion are more ill
defined
84. Internal Structure
Varies from totally radiolucent to
mixed with bony septae creating
internal compartments
These septae are usually coarse &
curved & originate from the normal
bone that has been trapped within
the tumour
85. Internal Structure
Since ameloblastoma
frequently has internal cystic
components, these septae are
often remodeled into curved
shape giving a honeycomb or
soap bubble appearance
Generally loculations are larger
in posterior mandible than in
anterior part
86. Effects On Surrounding
Structures
Causes extensive root resorption & tooth
displacement
Common point of origin is occlusal to
tooth; teeth may be displaced apically
Occlusal radiograph may show cyst like
expansion & thinning of adjacent cortical
plate, leaving a thin eggshell of bone
87. In late stages perforation of bone into
surrounding soft tissues or anatomic spaces
occurs
Unicystic types may cause extreme
expansion of mandibular ramus
90. ODONTOGENIC MYXOMA
Both more common in mandible
Ameloblastoma is common in molar- ramus region
Odontogenic myxoma in premolar & molar region & rare in ramus
Straight thin septa seen in odontogenic myxoma whereas curved coarse in
ameloblastoma
Ameloblastoma causes extensive root
resorption
Odontogenic myxoma tends to grow in
length of bone
92. SYNONYM
Familial fibrous dysplasia
Cherubism is rare, inherited developmental abnormality that
causes bilateral enlargement of jaws, giving child a cherubic facial
appearance
It is inherited as autosomal dominant trait
It is composed of giant cell like granuloma- like tissue & does
not form bone matrix
Lesion regress with age
93. Age- 2- 6 years
Presents as painless, firm, bilateral enlargement of lower face.
Occasionally whole mandible is involved
Maxillary sinus, orbital floor & tuberosity region may be involved
causing stretching of skin of cheeks, which depresses the lower
eyelids, exposing thin line of sclera (eyes in heaven appearance)
94. Lesions grow slowly, expanding but not perforating cortex
Enlargement of submandibular lymph nodes may occur
By age of 8-9 years of age , growth of pathologic lesion may stop
At puberty lesion may begin to regress
Usually bony architecture returns to normal by age of 30 years
95. Location
Lesion is bilateral
Often both the jaws are affected
When present in only one jaw, mandible is
more commonly affected
Epicenter is always in posterior part of
jaws, in ramus of mandible, or tuberosity of
maxilla
Lesion grows in anterior direction
In severe cases may extend upto midline
RADIOGRAPHICFEATURES
96. Periphery
Well defined & in some instances corticated
Internal Structure
Fine granular bony & wispy trabeculae present giving a soap bubble appearance
97. Effects On Surrounding Structure
Expansion of maxillary & mandibular cortex occurs resulting in
severe enlargement of jaws
Maxillary lesion enlarges into maxillary sinus
Teeth are displaced in anterior direction as epicenter is placed in
posterior part of jaw
Degree of expansion can be severe resulting in destruction of
tooth buds & incipient follicles
98. GIANT CELL GRANULOMA
Internal structure has fine, wispy
trabeculae as in cherubism
Cherubism is bilateral with epicenter in
ramus
DIFFERENTIAL DIAGNOSIS
100. SYNONYM
Myxoma
Myxofibroma
Firbomyxoma
Account for 3- 6% of odontogenic tumours
These are benign, intraosseous neoplasm that arises from
odontogenic ectomesenchyme & resemble mesenchymal portion of
dental papilla
Non encapsulated & tend to infiltrate the surrounding cancellous
bone
101. Age- 10 – 30 years
Slight female predilection
Slow growing painless lesion
If left untreated it grows large & may invade maxillary sinus
Recurrence rate – 25% (noncapsulated, poorly defined
boundaries, extension of nests or pockets of myxoid tumour into
trabecular spaces)
102. LOCATION
Most commonly affects mandible (3:1)
Occurs in premolar & molar areas & rarely in ramus & condylar
area
In maxilla, alveolar process in premolar & molar regions &
zygomatic process is involved
PERIPHERY
May be well defined & corticated or poorly defined (in maxilla)
RADiographicfeatures
103. INTERNAL SRTUCTURE
It may produce several pattern
Unicystic
Multilocular
Pericoronal
Radiolucent – radiopaque
Residual bone trapped within the bone remodels into curved or
straight, coarse or fine septae giving multilocular appearance
104. INTERNAL SRTUCTURE
Characteristically septae are
straight & thin (tennis racket or
step ladder appearance)
but this pattern is rarely seen
Majority of septae are curved &
coarse, but finding one or two of
these straight septa helps in
identification
105. EFFECTS ON SURROUNDING
STUCTURE
Causes displacement & loosening of
teeth but rarely resorption
Lesion frequently scallops between
the roots of adjacent structure
Tendency to grow along the bone
without causing much expansion
106. AMELOBLATOMA
Both more common in mandible
Ameloblastoma is common in molar- ramus region
Odontogenic myxoma in premolar & molar region
& rare in ramus
Straight thin septa seen in odontogenic myxoma
whereas curved coarse in ameloblastoma
Ameloblastoma causes expansion of bone but
odontogenic myxoma grows along the length of
bone
Differential DIAGNOSIS
107. CENTRAL GIANT CELL GRANULOMA
Both occur in mandible but CGCG occurs
anterior to 1st molar
septae are ill- defined & wispy & some are
at right angles to the periphery
CGCG causes expansion of jaws
108. CENTRAL HEMANGIOMA
Mandible common site but posterior body ,
ramus & inferior alveolar canal is involved
Shows coarse trabecular pattern
109. OSTEOGENIC SARCOMAS
In odontogenic myxoma a small area of expansion with straight septae may be
projected over an intact bony cortex & give spiculated appearance resembling
osteogenic sarcoma
But outer cortex is destroyed in odontogenic sarcoma
110. Hemangioma is a proliferation of blood vessels
Most frequently noticed in skin & subcutaneous tissues
Central hemangioma is more commonly seen in vertebrae & skull
Rarely develops in jaws
Lesion may be developmental or traumatic in origin
More prevalent in females (2:1)
Age- 1st decade
111. Presents as slow, non tender expansion of jaws
It is bony hard in consistency
Pain, if present is probably throbbing type
Some tumours are compressible or pulsate & bruit may be detected
on auscultation
Anesthesia of skin supplied by mental nerve occurs
Bleeding may occur around gingiva around the neck of teeth
112. LOCATION
Mandible twice more affected than maxilla
Posterior body & ramus & within the inferior alveolar canal
Gives a cart wheel apperaence.
113. PERIPHERY
Periphery is well defined & corticated or
ill defined
Variation is related to the amount of
residual bone around the blood vessels
Formation of linear spicules of bone
emanating from the surface of the bone in
sunray- like appearance can occur when
hemangioma breaks through the outer
cortex & displace the periosteum
114. INTERNAL STRUCTURE
Multilocular appearance is due to
entrapment of residual bone trapped
around the blood vessels
Small radiolucent locules may
resemble marrow spaces surrounded by
coarse, dense & well defined trabeculae
These trabeculae produces honeycomb
pattern composed of small circular
radiolucent spaces that represent blood
vessels oriented in the same direction of
x- ray beams
115. Width of inferior alveolar canal, if involved, is increased & shape becomes
serpiginous
Phleboliths are formed when soft tissue is involved
They develop from thrombi that become organized & mineralized & consists of
calcium phosphate & calcium carbonate
116. EFFECTS ON SURROUNDING STRUCTURES
Roots of teeth are resorbed or displaced
Width of inferior alveolar canal, if involved, is increased & shape changes to serpiginous path
Mandibular & mental foramen may be enlarged
Involved bone may be enlarged & have coarse internal trabeculae
Developing teeth in contact with hemangioma may be larger & erupt earlier
117. •Characterized as false cyst as it does not have epithelial
lining
•Age- below 30 years
•Female predilection
•Usually presents as rapid bony swelling
•Pain is occasionally present
•Involved area may be tender on palpation
118. LOCATION
•Mandible is more commonly involved than maxilla (3:2) in molar
& ramus region
PERIPHERY & SHAPE
•Periphery is usually well defined & shape is circular.
Radiographic features
119. INTERNAL SRTUCURE
•Small initial lesion may show no evidence of an internal structure
•Often internal structure is multilocular
•Septa is wispy & ill- defined & perpendicular to outer expanded border
EFFECTS ON SURROUNDING STRUCTURES
•Causes expansion of outer cortical plates
•Displaces & resorbs teeth
120. CENTRAL GIANT CELL
GRANULOMA
Both have wispy, ill- defined trabeculae
Expansion of cortex is more in ABC than
CGCG
ABC is found in molar & ramus area whereas
CGCG in anterior to 1st molar region
DIFFERENTIALDIAGNOSIS
121. AMELOBLASTOMA
ABC causes cortical expansion &
displaces & resorbs tooth as in
ameloblastoma
Molar – ramus region common site
in both
Septae are curved, coarse & well
defined in ameloblastoma
Occurs in older age
DIFFERENTIALDIAGNOSIS
122. CHERUBISM
Both have ill defined, wispy trabeculae & causes expansion of jaws
But cherubism is multifocal & bilateral
DIFFERENTIALDIAGNOSIS
123. SYNONYM
Giant cell reparative granuloma
Giant cell lesion, giant cell tumour
Slow growing lesion
Affects mostly adolescents & young adults, usually below the age
of 20 years
Presents as painless swelling
Area is tender on palpation
Overlying mucosa is purple in colour
124. LOCATION
More common in mandible (2:1)
Epicenter of lesion is usually anterior to 1st molar, although large lesion can
extend posterior to ist molar
Most maxillary lesion arise anterior to canines
Lesions can cross midline
PERIPHERY
Well defined margin in mandible
Lesions in maxilla have ill defined borders
Radiographic features
125. INTERNAL STRUCTURE
Small lesions are completely
radiolucent
Larger lesion show subtle granular
pattern of calcification
Occasionally these calcifications
are organized into ill- defined wispy
septa which are at right angles to the
periphery of the lesion
Sometimes these septa are well
defined & divide the internal aspect
into compartments, creating a
multilocular appearance
126. EFFECTS ON SURROUNDING
STRUCTURES
Often displace & resorb teeth
Resorption of roots not common but
when it occurs, it may be profound &
irregular in outline
Lamina dura of involved teeth is absent
Inferior alveolar canal may be displaced
in an inferior direction
127. EFFECTS ON SURROUNDING STRUCTURES
Causes expansion of cortical boundaries of jaw
Expansion is uneven or undulating in nature, which may give
appearance of a double boundary when seen in occlusal radiograph
Outer cortical plate is destroyed in some cases & is seen more
often in maxilla
129. CHERUBISM
Internal structure has fine, wispy trabeculae as in cherubism
Cherubism is bilateral with epicenter in posterior part of jaw
130. ODONTOGENIC MYXOMA
Both occur in mandible but CGCG occurs
anterior to 1st molar
septae are sharper & straighter in OM
CGCG causes expansion of jaws
131. ABC
Both have wispy, ill- defined trabeculae
Expansion of cortex is more in ABC than CGCG
ABC is found in molar & ramus area whereas CGCG is anterior to
1st molar region
132. *OKC is a noninflammatory odontogenic cyst that arises from
dental lamina
*Accounts for about 1/10th of all cysts in the jaws
*Age- 2nd & 3rd decade
*Male predominance
*Usually asymptomatic
*Pain may occur with secondary infection
*Aspiration may reveal thick, yellow cheesy material (keratin)
133. LOCATION
*Site- posterior body of mandible (90% occur posterior to canine) &
ramus (> 50%)
*Epicenter is located superior to inferior alveolar canal
RADIOGRAPHIC FEATURES
134. PERIPHERY & SHAPE
*Cortical border is intact unless they have become secondarily
affected
*Has smooth round or oval shape
136. EFFECTS ON SURROUNDING
STRUCURES
*Grows along the internal aspect of jaws,
causing minimal expansion
*This occurs throughout the mandible except
for the upper ramus & coronoid process, where
considerable expansion may occur
*Can displace & resorb teeth
*Inferior alveolar canal may be displaced
inferiorly
*In maxilla, it may invaginate & occupy
maxillary antrum
139. It is endocrine abnormality in which there is an excess of
circulating Parathyroid hormone (PTH)
It causes increase in serum calcium by two processes
An excess of serum PTH increases bone remodeling by
osteoclastic resorption, which mobilizes calcium from
skeleton
PTH also increases renal tubular resorption of calcium &
renal products of active vitamin D metabolite
141. SECONDARY TYPE
Results from compensatory increase in output of PTH in
response to hypocalcemia
Hypocalcemia may be due to
Poor dietary intake
Poor absorption of Vitamin D
Deficient metabolism of Vitamin D in liver or kidney
142. RADIOGRAPHIC FEATURES OF JAWS
Demineralization & thinning of cortical boundaries often occur in the jaws in
cortical boundaries such as inferior borders, mandibular canal & the cortical
outlines of maxillary sinuses
The densities of the jaws is decreased, resulting in a radiolucent appearance
that contrasts with density of teeth
143. The teeth stand out in contrast to the radiolucent
jaws
A change in normal trabeculae pattern may occur,
resulting in ground- glass appearance of numerous
small, randomly oriented trabeculae
144. Brown tumour appear more frequently in facial bones
& jaws, particularly in long standing cases
Lesions may be multiple within a single bone
Have variably defined margins
May produce cortical expansion
145. RADIOGRAPHIC FEATURES OF
TEETH & ASSOCIATED
STRUCTURES
Lamina dura is lost (10%) giving
tooth a tapered appearance because of
decreased image contrast
It may occur around one tooth or all
teeth
It may be either partial or complete
146. REFERENCES
Differential diagnosis of Oral & Maxillofacial lesions- 5th
Ed,Wood & Goaz
Oral Radiology -5th Ed White & Pharoah-
Diagnostic Imaging of Jaws- Langland, Langlais, Nortje
Clinical Outline of Oral Pathology,Eversole
Essentials of Dental Radiology & radiography,Eric
Whaites
Textbook of Oral Pathology- 4th Ed ,Shafer, Hine, Levy
Editor's Notes
According to site
phleboliths (small areas of calcification
or concretions found in a vein with slow blood
flow) may occur within surrounding soft tissue