RADIOLUCENT NON-ODONTOGENIC LESIONS

Slide 2 Radiolucent Non-Odontogenic Lesions

Radiolucent Non-Odontogenic Lesions (from textbook)

Nasolabial Cyst

Nasopalatine Canal
Cyst

Idiopathic Bone
Cavity

Stafne Bone Cyst

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 RADIOLUCENT NON-ODONTOGENIC LESIONS

Central Giant Cell

Granuloma

Hemangioma/Vascular
Malformation

Osteoporotic Bone
Marrow Defect

Slide 4 Components Of A “Regular” Cyst

① Innermost cavity: lumen ② Epithelial cover: lining ③ Outermost capsule: wall

Slides 5-12 Nasolabial Cyst

● General Information:
○ Soft tissue enlargement
○ Prevalence: ♀3:1♂
○ Develops from remnants of nasolacrimal duct
● Clinical Features:
○ Elevation of the ala of the nose
○ Swelling of upper lip lateral to midline
● Histopathology:
○ Its pseudostratified columnar epithelium
contain cilia and goblet cells.
● Treatment: Surgical excision, recurrence is rare

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Slides 13-22 Nasopalatine Duct Cyst (incisive canal cyst)

● General Information:
○ Most common non-odontogenic cyst
○ Develops from remnants of nasopalatine duct
● Clinical Features:
○ Swelling of the anterior palate, with drainage and pain
● Radiographic Features:
○ Radiolucent
○ Well-circumscribed
○ Round/oval
○ Inverted pear/heart-shaped
● Histopathology:
○ Squamous or columnar epithelium with nerves and vessels in wall
● Treatment:
○ Treated by surgical excision
○ Biopsy required

Slide 24 What is the key difference between pseudocysts and “regular” cysts?
Pseudocysts lack an epithelial lining, while "regular" cysts have an epithelial lining.

Slides 26-37 Idiopathic Bone Cavity

● Other Names:
○ Traumatic bone cyst or Simple bone cyst
● General Information:
○ An empty defect without epithelium surrounded by thin layer of connective
tissue and reactive bone
○ Affects children 10-20 years
○ 90% in the posterior mandible
● Etiology:
○ Trauma-Hemorrhage Theory: Trauma, hematoma, liquefaction
● Clinical Features:
○ Benign, empty or fluid-containing cavity within bone
○ Interdental SCALLOPING (without jaw expansion)
● Radiographic Features:
○ Well-defined radiolucency, incidentally discovered
● Histopathology:
○ Most of the time the cavity is filled with blood (65% fluid-filled, 35% empty)
○ KEY: Lack of epithelial lining, NOT A CYST
○ Reactive bone
● Treatment: After surgical exploration, heals in 6 months

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Slides 38-45 Stafne Bone (Defect)Cyst

● General Information:
○ Focal concavity of bone on lingual surface of mandible associated with the
submandibular gland
○ Prevalence: 90% in males
● Radiographic Features:
○ Radiolucency below mandibular canal (IAC)
○ Usually has thick corticated borders
○ CT scans show a well-defined concavity on mandible
● Histopathology:
○ Biopsy shows normal submandibular gland tissue
● Treatment:
○ No treatment required
○ Prognosis is excellent

Slides 46-59 Central Giant Cell Granuloma

● General Information:
○ More common in children and young adults but can occur in all ages
○ More common in mandible but also occur in maxilla (predilection, not a hard rule)
○ All CGCG lesions are benign, but aggressive lesions demonstrate rapid growth
○ Predilection: females, 60% of cases occur before 30 y/o, 70% in the mandible
● Types:
○ Aggressive vs. Non-aggressive Central Giant Cell Granuloma (CGCG)
○ Most CGCG lesions are non-aggressive: asymptomatic, slowly growing, no root
resorption, no perforation of cortical bone. Tend not to recur following curettage
○ Aggressive CGCG have pain or paresthesia, root resorption, cortical perforation
and higher recurrence rate following curettage
● Radiographic Features:
○ Radiolucent lesion with well-defined borders similar to odontogenic tumors &
cysts. May or may not have a corticated border
○ Unilocular or multilocular depending on size
○ Can cause expansion and/or perforation of cortical plate
○ Tends to resorb roots horizontally
● Location:
○ Unilocular or multilocular defect, classically found in the anterior mandible
BUT can be found in the posterior mandible
● Microscopic Features:
○ Fibrous tissue, numerous multinucleated giant cells, hemorrhage and
hemosiderin
○ Identical microscopic features present in:

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1. Hyperparathyroidism
● Eliminate from DDX by if serum calcium and parathyroid hormone
levels are normal
2. Cherubism
● Eliminate from DDX if lesion acquired in patients older than 4 y/o
since cherubism is familial and occurs in bilaterally in the jaws
● Treatment:
○ Usually curettage is used (15-20% recurrence rate)
○ Aggressive Lesions: intralesional corticosteroids, calcitonin, interferon

Slides 60-66 Vascular Lesions of Bone: Hemangioma & Vascular Malformation

● General Information:
○ Hemangioma is a benign proliferation of small blood vessels
○ Vascular malformation is also called arteriovenous malformation and high-flow
angioma. It is a proliferation of small blood vessels and larger arterial vessels
associated with more blood flow and can result in excessive bleeding during
surgery. It is part of Sturge-Weber syndrome
○ Usually detected during first 3 decades of life
○ Vascular malformations may have thrill (pulsatile to palpation) or bruit (heard
upon auscultation)
● Radiographic Features:
○ Radiolucent lesion with well-defined, corticated borders. Arteriography can
determine flow rate of lesion (AP: he often finds the borders to be irregular)
○ Usually radiolucent but may have radiopaque areas and/or multilocular
“honeycombed” or “soap-bubble” appearance
○ May have coarse internal trabeculae (may cause periosteal reaction)
● Treatment:
○ Aspiration of all bony lesions is done before biopsy or tooth extraction to rule
out vascular malformations
○ Treatment is angiography and complete surgical resection
○ Thromboembolization of vascular malformations may be required before
surgery

Slides 67-70 Focal Osteoporotic Bone Marrow Defect

● General Information:
○ Area of hematopoietic marrow that produces a radiolucency
○ May be confused with an intraosseous neoplasm, but

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☁ FOBMD is usually asymptomatic and discovered incidentally on

radiographs. Intraosseous neoplasms may cause pain, swelling,
paresthesia, or tooth mobility depending on their size and location.
☁ FOBMD is typically located in the posterior mandible, often in edentulous
areas. Intraosseous neoplasms can occur anywhere in the jawbones.
☁ FOBMD is typically slow-growing or stable, while neoplasms can exhibit
variable growth rates depending on their nature (benign vs. malignant).
☁ These are tendencies and not hard rules.
○ Variation of normal; radiographic features may look pathosis
○ 75% in adult women, typically in posterior mandible
● Key to differentiate from lesions:
○ Shape is irregular
○ Trabecular pattern still seen inside the lesion
○ Typically asymptomatic & incidental finding on radiograph
○ No jaw expansion, “cortication” is not real,

MCQs from yellow texts:

1. What is the most common non-odontogenic cyst?

A. Nasolabial Cyst
B. Nasopalatine Duct Cyst
C. Stafne Bone Cyst

2. What is the key difference between pseudocysts and "regular" cysts?

A. Pseudocysts are lined by epithelium, while "regular" cysts are not.
B. Pseudocysts lack an epithelial lining, while "regular" cysts have an epithelial lining.
C. Pseudocysts are malignant, while "regular" cysts are benign.

3. Which lesion is a focal concavity of bone on the lingual surface of the mandible associated with the
submandibular gland?
A. Nasopalatine Duct Cyst
B. Stafne Bone Cyst
C. Idiopathic Bone Cavity

4. Which lesion is more common in children and young adults and has a predilection for females?
A. Idiopathic Bone Cavity
B. Central Giant Cell Granuloma
C. Focal Osteoporotic Bone Marrow Defect

5. Which lesion is a benign proliferation of small blood vessels?

A. Hemangioma
B. Central Giant Cell Granuloma
C. Idiopathic Bone Cavity

6. Which lesion is an area of hematopoietic marrow that produces a radiolucency and is a variation of normal?
A. Hemangioma
B. Focal Osteoporotic Bone Marrow Defect
C. Central Giant Cell Granuloma

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7. What is the etiology of an Idiopathic Bone Cavity?

A. Trauma-Hemorrhage Theory
B. Remnants of nasolacrimal duct
C. Proliferation of small blood vessels

8. What are the microscopic features of a Central Giant Cell Granuloma?

A. Squamous or columnar epithelium with nerves and vessels in the wall
B. Normal submandibular gland tissue
C. Fibrous tissue, numerous multinucleated giant cells, hemorrhage, and hemosiderin

9. What can vascular malformations have that can be felt upon palpation or heard upon auscultation?
A. Root resorption and cortical perforation
B. Thrill and bruit
C. Cilia and goblet cells

10. What is required before biopsy or tooth extraction to rule out vascular malformations?
A. CT Scan
B. Aspiration
C. Biopsy

11. What syndrome is a vascular malformation a part of?

A. Gardner Syndrome
B. Sturge-Weber Syndrome
C. Gorlin Syndrome

12. What are the tendencies of a Focal Osteoporotic Bone Marrow Defect?
A. Asymptomatic and discovered incidentally on radiographs
B. Located in the anterior mandible
C. Causes pain, swelling, paresthesia, or tooth mobility

13. Where is the typical location of a Focal Osteoporotic Bone Marrow Defect?
A. Anterior mandible
B. Maxillary sinus
C. Posterior mandible

14. What is the shape of a Focal Osteoporotic Bone Marrow Defect?

A. Round
B. Oval
C. Irregular

15. What can a Focal Osteoporotic Bone Marrow Defect be confused with?
A. Intraosseous neoplasm
B. Odontoma
C. Ameloblastoma

16. What is the trabecular pattern of a Focal Osteoporotic Bone Marrow Defect?
A. Soap bubble
B. Honeycomb
C. Still seen inside the lesion

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17. What is NOT present in a Focal Osteoporotic Bone Marrow Defect, unlike a Central Giant Cell Granuloma and
Simple Bone Cyst?
A. Root resorption
B. Jaw expansion
C. Pain

It’s time for… THIS or THAT?!

Definitive diagnosis: idiopathic bone cyst (pseudocyst)

DDX:
1. OKC but unlikely → way down the DDX

Exclude:
1. Odontogenic myxoma b/c myxoma is multilocular
and slowly growing therefore will displace teeth WHILE
idiopathic bone cyst does NOT push teeth or expand jaws.

Definitive diagnosis: CGCG

DDX:
1. Ameloblastoma b/c multilocular RL

Definitive diagnosis: CGCG

DDX:
1. Odontogenic myxoma b/c of the septation & RL

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← Definitive diagnosis: CGCG

← DDX:
1. Ameloblastoma when lesions are RL,
multilocular

Definitive diagnosis: CGCG →

DDX: periapical granuloma/cyst →
To rule out PAG/PAC, lesion should not be due
to inflammation, tooth should be vital unless lesion causes
severe HORIZONTAL root resorption which may lead to pulpal necrosis.

DDX same priority

1. CGCG
2. Cherubism
3. Hyperparathyroidism

ONLY MICROSCOPICALLY IDENTICAL

Clinically and radiographically different

Definitive diagnosis: Odontogenic myxoma

DDX: Ameloblastoma
Odontogenic myxoma Ameloblastoma

Ill-defined borders Well-defined borders

Often non-corticated Often corticated

NO root resorption Root resorption

Anywhere in the jaws Prefers posterior mandible

Shared features: commonly in the mandible, unilocular or

multilocular radiolucencies, slowly growing, painless,
may cause jaw expansion, honeycomb or soap-bubbles

Definitive diagnosis: bone marrow defect

Decoy: residual cyst at first sight, but looks at how

irregular the shape of the lesion is.