Lesions of the Jaw

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Imaging of lesions within the maxilla and mandible is often fraught with difficulty owing to the similarity in the imaging appearance of a diverse array of pathological processes. Principally, lesions arise from either odontogenic sources or from primary bone lesions. The response of the cancellous and cortical bone to pathologic insult can be expressed either through an osteolytic or an osteoblastic response; thus the majority of lesions within the jaws can be classified as cystic or lytic appearing, sclerotic, or a mixture of the two. This article will review the imaging features of the most common cysts, fibro-osseous lesions, benign and malignant neoplasms, and highlight those features key to the differential diagnosis.

Introduction

Imaging of lesions within the maxilla and mandible is often fraught with difficulty owing to the similarity in the imaging appearance of a diverse array of pathologic processes. Principally, lesions arise from either odontogenic sources (lesions arising from tooth forming epithelium) or primarily from bone. The response of the cancellous and cortical bone to pathologic insult can be expressed either through an osteolytic or an osteoblastic response; thus, most lesions within the jaws can be classified as cystic or lytic appearing, sclerotic, or a mixture of the two. This article will review the imaging features of the most common cysts, fibro-osseous lesions, benign and malignant neoplasms, and highlight those features key to the differential diagnosis.

Section snippets

Cystic Lesions: Cysts and Benign Tumors

Most lesions arising within the jaws present with some form of osseous demineralization, rarefaction, or remodeling rendering them lytic or cystic appearing on imaging. The degree of osseous rarefaction and remodeling will differ among inflammatory, benign, and malignant lesions, and it is this feature, along with location of the lesion, which allows for differentiation.

The most common odontogenic cyst is the radicular cyst, which arises secondary to pulpal necrosis of a tooth following

Mixed Cystic and Sclerotic Lesions: Benign Fibro-Osseous Lesions

Bony expansion and septation of the alveolus represents the osteolysis, replacement and or remodeling of the cancellous trabeculation by a neoplastic mass and as such these findings are relatively nonspecific to the odontogenic neoplasms. Nonodontogenic neoplasms will similarly expand bone and may be septated. Ossifying fibromas (Cemento-ossifying fibromas) are among the most common nonodontogenic neoplasms to arise within the alveolus, but as their tissue of origin is not odontogenic, they are

Mixed Cystic and Sclerotic or Sclerotic Lesions: Benign and Malignant Tumors

The mixture of soft tissue neoplastic elements and cartilaginous or ossified neoplastic elements, or the osseous destruction of bone, will generate the appearance of lesions having a mixed cystic and sclerotic composition. Although the most common benign odontogenic neoplasms are typically cystic in appearance, more uncommon or rare lesions including the odontogenic myxoma, and the calcifying epithelial odontogenic cyst and calcifying epithelial odontogenic tumor will appear mildly dense or

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