IMAGING CONTRIBUTION IN THE DIAGNOSIS OF MAXILLOMANDIBULAR LESIONS A NEFFATI, K BOUZAÏDI, I KECHAOU, K AYACHI*, F JABNOUN, M MAAMOURI * Radiology service, MT Maamouri Hospital, Nabeul, Tunisia *ORL service, MT Maamouri Hospital, Nabeul, Tunisia HEAD AND NECK : HN 6
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IMAGING CONTRIBUTION IN THE DIAGNOSIS OF MAXILLOMANDIBULAR LESIONS A NEFFATI, K BOUZAÏDI, I KECHAOU, K AYACHI*, F JABNOUN, M MAAMOURI * Radiology service,
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IMAGING CONTRIBUTION IN THE DIAGNOSIS OF MAXILLOMANDIBULAR LESIONS
A NEFFATI, K BOUZAÏDI, I KECHAOU, K AYACHI*, F JABNOUN, M MAAMOURI *
lesion of the mandible. Biopsy: Bone localization of
Langerhans cell histiocytosis.
Radicular (Periapical) Cyst
The most common odontogenic cyst (65%) It is thought to arise from the epithelial cell rests
of Malassez in response to inflammation. In fact, practically all radicular cysts originate in
preexisting periapical granulomas. Clinic: The cyst is painless when sterile and
painful when infected. Microscopically, the cyst is described with a
connective tissue wall that may vary in thickness, a stratified squamous epithelium lining, and foci of chronic inflammatory cells within the lumen.
Radicular (Periapical) Cyst
Radiographic findings consist of a pulpless, nonvital tooth that has a small well-defined periapical radiolucency at its apex.
Large cysts may involve a complete quadrant with some of the teeth occasionally mobile and some of the pulps nonvital.
Root resorption may be seen.
Treatment is extraction of the affected tooth and its periapical soft tissue or root canal if the tooth can be preserved.
Ameloblastoma
The most common odontogenic tumor.
Young adults without sex predilection.
Originates from epithelial remnants of dental
embryogenesis, without the participation of
the odontogenic ectomesenchyme.
It is a benign but locally invasive neoplasm.
Ameloblastoma
Three different clinicopathologic subtypes: multicystic (86%), unicystic (13%) and peripheral (extraosseus – 1%).
It is characterized by a progressive growth rate and, when untreated, may reach enormous proportions.
Early symptoms are often absent, but late symptoms may include a painless swelling, loose teeth, malocclusion, or nasal obstruction.
Ameloblastoma
Any location in the mandible or maxilla, but the regions of the inferior molars and mandibular ramus are the most prevalent anatomical locations (80%).
The most common radiographic findings are unilocular and multilocular masses, septation, association with unerupted teeth, loss of lamina dura and root resorption.
In solid or multicystic ameloblastomas, a multilocular radiolucent lesion with undefined borders is the most characteristic radiographic aspect (soap bubble or honeycomb appearance).
Ameloblastoma
In the unicystic type, the lesions usually appear as radiolucent areas with relatively well-defined borders that surround the crown of an impacted inferior third molar, resembling a dentigerous cyst.
In addition to these osteolytic lesions, CT scan shows the loco-regional extension and their content: Cystic type with liquid content, often voluminous, thick
walled, enhanced after contrast injection. Furthermore, it can be associated to a tissue formation.
Langerhan’s cell histiocytosis
Langerhan’s cell histiocytosis is defined as an abnormal proliferation of Langerhans cells in various organs and tissues (bone, skin, lymph nodes…)
Maxillo-mandibular localisation is the most commun, it represents 20,8% of non odontogenic tumors.
Among facial locations, mandibular involvement is the most frequent and occurs in young people less than 20 years.
Langerhan’s cell histiocytosis
It is characterized by multiple radiolucent lesions, well defined, circular or oval without bone condensation reaction giving the appearance of floating teeth.
CT confirms these informations and may shows a cortical rupture in places without invasion of the soft tissues.
However, only the pathological examinationcan confirm the diagnosis.
Others
Beside these lesions there other many lesions.
In fact, tumoral and pseudotumoral (odentogenic) pathology of the maxilla forms a large diverse group with three types of tumors:
Those derived from odontogenic device
Tumors and pseudotumors of bone origin
Epithelial cysts of the maxilla
They can be devided also in:
Others
Odontogenic Cysts:
Inflammatory Cysts:
Radicular (periapical) Cyst, paradental Cyst
Developmental Cysts:
Dentigerous (follicular) Cyst, developmental
Lateral Periodontal Cyst, odontogenic Keratocyst,
glandular Odontogenic Cyst (GOC).
Others
Nonodontogenic cysts
Incisive Canal Cyst, stafne Bone Cyst, traumatic Bone Cyst, surgical Ciliated Cyst (of Maxilla)