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IMAGING CONTRIBUTION IN THE DIAGNOSIS OF MAXILLOMANDIBULAR LESIONS

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. INTRODUCTION.

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IMAGING CONTRIBUTION IN THE DIAGNOSIS OF MAXILLOMANDIBULAR LESIONS

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  1. 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

  2. INTRODUCTION • There are a variety of cysts and tumors that affect the osseous marrow and cortex of the jaw bones, which may be uniquely derived from the tissues of developing teeth. • It is important as a radiologist to know the different types of maxillo-mandibular lesions, their semiological presentation, and to guide the otolaryngologist before any treatment.

  3. SUBJECTS AND METHODS • Study of radio-clinical cases of 6 patients • 4 men and 2 women with an average age of 37.6 years ranging from 18 to 58 years. • The clinical call signs were bone pain, tooth mobility and maxillomandibulartumefaction. • All patients were investigated by means of: - Dental Panoramic X-Ray - Facial CT scan • Pathologically confirmed by surgery or biopsy.

  4. RESULTS • The Dental Panoramic X-Ray shows a radiolucent lesion located in - The maxilla (1case) - The mandible (5 cases) • The CT scan shows these osteolytic lesions and specify their anatomical relationship with adjacent structures. • Histological examination identified: - Radicular cyst (4 cases) - Ameloblastoma(1 case) - Mandibularbone localization of Langerhans cell histiocytosis (LCH) (1 case).

  5. MK, 20 years CT scan shows Multilocular radiolucent lesion with undefinedborders of the maxilla. Ameloblastoma

  6. BM, 54 years • Panoramic radiograph shows large, unilocular, expansilelesionon left molar region of mandible. • Root of third molar Is partly absorbed.

  7. MK, 20 years CT shows samelesionwithroot resorption and thinned cortex. Pathologically, radicularcystwasproven.

  8. AH, 18 years periapicalradiolucency on right molar region of mandible . Radicular Cyst

  9. Patient known to have a LCH. Panoramic radiograph shows large, unilocular, expansilelesion of the mandible. Biopsy: Bone localization of Langerhans cell histiocytosis.

  10. 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 periapicalgranulomas. • 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.

  11. Radicular (Periapical) Cyst • Radiographic findings consist of a pulpless, nonvital tooth that has a small well-defined periapicalradiolucency 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.

  12. Ameloblastoma • The most common odontogenic tumor. • Young adults withoutsexpredilection. • Originatesfromepithelialremnants of dental embryogenesis, without the participation of the odontogenicectomesenchyme. • It is a benign but locally invasive neoplasm.

  13. 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.

  14. Ameloblastoma • Any location in the mandible or maxilla, but the regions of the inferior molars and mandibularramus 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 duraand rootresorption. • In solid or multicysticameloblastomas, a multilocularradiolucentlesionwithundefined borders is the most characteristic radiographic aspect (soap bubble or honeycomb appearance).

  15. 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 theseosteolytic 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.

  16. Langerhan’s cell histiocytosis • Langerhan’s cell histiocytosis is defined as an abnormal proliferation of Langerhans cells in various organs and tissues (bone, skin, lymphnodes…) • Maxillo-mandibular localisation is the most commun, itrepresents 20,8% of non odontogenictumors. • Among facial locations, mandibular involvement is the most frequent and occurs in young people less than 20 years.

  17. Langerhan’s cell histiocytosis • It ischaracterized 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.

  18. Others • Besidetheselesionsthereothermanylesions. • In fact, tumoral and pseudotumoral (odentogenic) pathology of the maxilla forms a large diverse group with three types of tumors: • Thosederivedfromodontogenicdevice • Tumors and pseudotumors of boneorigin • Epithelialcysts of the maxilla • Theycanbedevidedalso in:

  19. Others • Odontogenic Cysts: • Inflammatory Cysts: Radicular (periapical) Cyst, paradental Cyst • Developmental Cysts: Dentigerous (follicular) Cyst, developmental Lateral Periodontal Cyst, odontogenicKeratocyst, glandular Odontogenic Cyst (GOC).

  20. Others • Nonodontogenic cysts Incisive Canal Cyst, stafne Bone Cyst, traumatic Bone Cyst, surgical Ciliated Cyst (of Maxilla) • Odontogenic Tumors • Epithelial Odontogenic Tumors • Ameloblastoma • Calcifying Epithelial Odontogenic Tumor • MesenchymalOdontogenic Tumors • OdontogenicMyxoma • Central OdontogenicFibroma • Cementoblastoma • Mixed Odontogenic Tumors

  21. Others • And thenwecanfindotherrelated Jaw Lesions: • Giant Cell Lesions: Central Giant Cell Granuloma, Brown Tumor of Hyperparathyroidism, Aneurysmal Bone Cyst • Fibroosseous Lesions: Fibrous Dysplasia, Ossifying Fibroma, Condensing Osteitis

  22. In general, well-demarcated lesions outlined by sclerotic borders suggest benign growth, while aggressive lesions tend to be ill-defined lytic lesions with possible root resorption. • With larger more aggressive lesions, CT may more clearly identify bony erosion and/or invasion into adjacent soft tissues.

  23. CONCLUSION • The Dental Panoramic X-Rayand facial CT scan can often guide the diagnosis of maxillomandibular lesions, specify the relationship with adjacent structures and monitor its progress. • The ultimate diagnosis is still histological.

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