Radiopaque Jaw Lesions: An Approach to the Differential Diagnosis

Abstract

Radiopaque jaw lesions are frequently encountered at radiography and computed tomography, but they are usually underevaluated or underdescribed in radiology reports. A systematic approach to the evaluation of radiopaque jaw lesions is necessary to diagnose the lesion or at least provide a meaningful differential diagnosis. To evaluate a radiopaque jaw lesion, the first, most important step is to categorize the lesion according to its attenuation, its relationship to the teeth, and its location with respect to the tooth. These basic observations are essential to the evaluation of any type of jaw lesion. Once these observations have been made, it is easy to create a proper differential diagnosis. The presence of important characteristics, such as margination, a perilesional halo, bone expansion, and growth pattern, as well as whether the lesion is sclerotic, has ground-glass attenuation, or is mixed lytic and sclerotic, further narrows the differential diagnosis. It is important to note that some radiopaque jaw lesions may be entirely lucent early in their evolution. Awareness of the demographic distribution of these lesions and their associated clinical features, as well as the radiologic approach, is important to explore the "terra incognita" of radiopaque jaw lesions.

Ossifying Fibroma of the Mandible

“…Ossifying fibromas are most frequently diagnosed during the third and fourth decades with a marked female predilection (female:male ratio: 4:1). A , ore aggressive, juvenile variant exists that most commonly affects boys younger than 15 years [1,3,4]. The clinical presentation usually consists of a painless slowly growing mass.…”

“…The mass is covered with normal mucosa. Lymphadenopathy is not seen [3][4][5][6]. Different radiographic patterns have been described depending on the amount of mineralized tissue.…”

Benign fibroosseöz lezyonlar

“…6,7,10,11,[13][14][15] Jaffe tipi fibröz displazide ise kraniyofasiyal kemiklerle birlikte vücuttaki diğer kemikler de etkilenmiştir ve deride cafe-au-lait lekeleri bulunabilir. 18 Çene ve yüz bölgesi kemikleri fibröz displazilerin oldukça sık olarak görüldüğü kemiklerdir. Primer olarak maksillayı etkiler fakat bunun yanında mandibula, zigoma, sfenoid, frontal, oksipital kemiklerde de tutulum görülebilir.…”

“…10,13 Vücutta baş ve boyun bölgesi dışındaki kemiklerde izlenen fibröz displazide ise lezyonlar iyi sınırlı ve daha radyolusent olabilir. 7,15,18 Erken evrelerde radyolüsensi hakim iken ileri evrelerde opasite artış gösterir. Maksiller lezyonlarda sinüsün dolduğu vakalarda lateral grafilerde kafa tabanında opasite artışı görünümü oluşur.…”

“…Zamanla sklerotik değişiklik göstererek buzlu cam görünümünde izlenebilir. 6,15,18,25 Juvenil trabeküler ossifiye fibrom; psammomatoid tipe göre daha küçük çocuklarda görülen, neredeyse her zaman çene kemiklerini tutan, kapsülsüz ve infiltratif olabilen bir tümördür. Kadın ve erkekler eşit olarak etkilenir.…”