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Insights into Imaging
Published in: Insights into Imaging 1/2014

Open Access 01-02-2014 | Pictorial Review

Radiolucent lesions of the mandible: a pattern-based approach to diagnosis

Authors: Laurène Avril, Tommaso Lombardi, Angeliki Ailianou, Karim Burkhardt, Arthur Varoquaux, Paolo Scolozzi, Minerva Becker

Published in: Insights into Imaging | Issue 1/2014

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Abstract

Objectives

Radiolucent mandibular lesions seen on panoramic radiographs develop from both odontogenic and non-odontogenic structures. They represent a broad spectrum of lesions with a varying degree of malignant potential. The purpose of this review is to illustrate the characteristic imaging findings—as well as the clinical and histological features—of common and uncommon radiolucent lesions of the mandible.

Methods

This review article is based on the retrospective evaluation of 11,725 panoramic radiographs seen in our institution during the past 6 years. It provides a comprehensive, practical approach to the radiological interpretation of radiolucent lesions of the mandible. To facilitate the diagnostic approach, we have classified radiolucent lesions into two groups: lesions with well-defined borders and those with ill-defined borders.

Results

Lesion prevalence, age of manifestation, location within the mandible, relationship to dental structures, effect on adjacent structures and characteristic findings at computed tomography (CT), cone beam CT (CBCT) and magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) are discussed. Pitfalls including malignant lesions mimicking benign disease and pseudo-lesions are equally addressed.

Conclusion

Knowledge of the characteristic imaging features of radiolucent mandibular lesions narrows the differential diagnosis and is crucial for the identification of those lesions, where biopsy is indicated for definitive histology.

Teaching points

• Panoramic X-rays, CT and MRI are essential for the work-up of radiolucent mandibular lesions.
• Lesion borders, location within the mandible, relationship to dental structures and tissue characteristics on cross-sectional imaging are indispensable to narrow the differential diagnosis.
• High-resolution CT and CBCT play a major role for the assessment of lesion margins and their relationship to important anatomic structures, such as the inferior alveolar nerve.
• Although most radiolucent lesions with well-defined sclerotic borders are benign, MRI may reveal clinically unsuspected malignant disease.
Literature
1.
Dunfee BL, Sakai O, Pistey R, Gohel A (2006) Radiologic and pathologic characteristics of benign and malignant lesions of the mandible. Radiographics 26:1751–1768PubMedCrossRef
2.
3.
Scholl RJ, Kellett HM, Neumann DP, Lurie AG (1999) Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics 19:1107–1124PubMedCrossRef
4.
Cotti E, Campisi G (2004) Advanced radiographic techniques for the detection of lesions in bone. Endod Top 7:52–72CrossRef
5.
Minami M, Kaneda T, Ozawa K, Yamamoto H, Itai Y, Ozawa M et al (1996) Cystic lesions of the maxillomandibular region: MR imaging distinction of odontogenic keratocysts and ameloblastomas from other cysts. AJR Am J Roentgenol 166:943–949PubMedCrossRef
6.
Schuknecht BF, Carls FR, Valavanis A, Sailer HF (1997) Mandibular osteomyelitis: evaluation and staging in 18 patients, using magnetic resonance imaging, computed tomography and conventional radiographs. J Craniomaxillofac Surg 25:24–33PubMedCrossRef
7.
Varoquaux A, Rager O, Lovblad KO, Masterson K, Dulguerov P, Ratib O et al (2013) Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging 40:842–852PubMedPubMedCentralCrossRef
8.
Varoquaux A, Rager O, Poncet A, Delattre BM, Ratib O, Becker CD et al (2013) Detection and quantification of focal uptake in head and neck tumours: F-FDG PET/MR versus PET/CT. Eur J Nucl Med Mol Imaging. doi:10.​1007/​s00259-013-2580-y
9.
Freitas DQ, Tempest LM, Sicoli E, Lopes-Neto FC (2006) Bilateral dentigerous cysts: review of the literature and report of an unusual case. Dentomaxillofac Radiol 35:464–468PubMedCrossRef
10.
Maeda T, Tateishi U, Terauchi T et al (2007) Unsuspected bone and soft tissue lesions identified at cancer screening using positron emission tomography. Jpn J Clin Oncol 37:207–215PubMedCrossRef
11.
Barnes L, Eveson JW, Reichart P, Sidransky D (2005) World Health Organization Classification of Tumours. Pathology and genetics of head and neck tumours. IARC Press, Lyon
12.
Sham E, Leong J, Maher R, Schenberg M, Leung M, Mansour AK (2009) Mandibular ameloblastoma: clinical experience and literature review. ANZ J Surg 79:739–744PubMedCrossRef
13.
Colbert S, Brennan PA, Theaker J, Evans B (2012) Squamous cell carcinoma arising in dentigerous cysts. J Craniomaxillofac Surg 40:e355–e357PubMedCrossRef
14.
15.
Shear M (2003) Odontogenic keratocysts: natural history and immunohistochemistry. Oral Maxillofac Surg Clin N Am 15:347–362CrossRef
16.
Lindeboom JA, Kroon FH, de Vires J, van den Akker HP (2003) Multiple recurrent and de novo odontogenic keratocysts associated with oral-facial-digital syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:458–462PubMedCrossRef
17.
Nguyen BD (2005) Malignant ameloblastoma with thoracic vertebral metastasis: PET/CT and MR imaging. Clin Nucl Med 30:450–452PubMedCrossRef
18.
19.
20.
Mueller WP, Melzer HI, Schmid I, Coppenrath E, Bartenstein P, Pfluger T (2013) The diagnostic value of 18F-FDG PET and MRI in paediatric histiocytosis. Eur J Nucl Med Mol Imaging 40:356–363PubMedCrossRef
21.
Schutz P, El-Bassuoni KH, Munish J, Hamed HH, Padwa BL (2010) Aggressive central giant cell granuloma of the mandible. J Oral Maxillofac Surg 68:2537–2544PubMedCrossRef
22.
23.
24.
Baltensperger M, Eyrich GK (2008) Definition and classification. In: Baltensperger M, Eyrich GK (eds) Osteomyelitis of the jaws. Springer, Berlin Heidelberg, pp 5–50
25.
26.
Advisory Task Force on Bisphosphonate-Related Ostenonecrosis of the Jaws, American Association of Oral and Maxillofacial Surgeons (2007) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg 65:369–376CrossRef
27.
Bisdas S, Chambron Pinho N, Smolarz A, Sader R, Vogl TJ, Mack MG (2008) Biphosphonate-induced osteonecrosis of the jaws: CT and MRI spectrum of findings in 32 patients. Clin Radiol 63:71–77PubMedCrossRef
28.
Becker M, Schroth G, Zbären P, Delavelle J, Allal A, Greiner R, Rüfenacht DA, Vock P, Terrier F (1997) Long-term changes induced by high-dose irradiation of the head and neck region: imaging findings. Radiographics 17:5–26PubMedCrossRef
29.
Chong J, Hinckley LK, Ginsberg LE (2000) Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients. AJNR Am J Neuroradiol 21:175–178PubMed
30.
31.
Kaur H, Verma S, Jawanda MK, Sharma A (2012) Aggressive osteoblastoma of the mandible: a diagnostic dilemma. Dent Res J (Isfahan) 9:334–337
32.
33.
Trotta BM, Pease CS, Rasamny JJ, Raghavan P, Mukherjee S (2011) Oral cavity and oropharyngeal squamous cell cancer: key imaging findings for staging and treatment planning. Radiographics 31:339–354PubMedCrossRef
34.
35.
Scolozzi P, Becker M, Lombardi T (2012) Mandibular condylar metastasis mimicking acute internal derangement of the temporomandibular joint. J Can Dent Assoc 78:c77PubMed
36.
Raut D, Khedkar S (2009) Primary intraosseous mucoepidermoid carcinoma of the maxilla: a case report and review of literature. Dentomaxillofac Radiol 38:163–168PubMedCrossRef
37.
Martínez-Madrigal F, Pineda-Daboin K, Casiraghi O, Luna MA (2000) Salivary gland tumors of the mandible. Ann Diagn Pathol 4:347–353PubMedCrossRef
38.
Bodner L, Manor E, Shear M, van der Waal I (2011) Primary intraosseous squamous cell carcinoma arising in an odontogenic cyst: a clinicopathologic analysis of 116 reported cases. J Oral Pathol Med 40:733–738PubMedCrossRef
39.
Nomura T, Monobe H, Tamaruya N, Kishishita S, Saito K, Miyamoto R, Nakao K (2013) Primary intraosseous squamous cell carcinoma of the jaw: two new cases and review of the literature. Eur Arch Otorhinolaryngol 270:375–379. doi:10.​1007/​s00405-012-2235-9PubMedCrossRef
40.
Manor E, Kachko L, Puterman MB, Szabo G, Bodner L (2012) Cystic lesions of the jaws—a clinicopathological study of 322 cases and review of the literature. Int J Med Sci 9:20–26PubMedPubMedCentralCrossRef
41.
42.
Terzic A, Becker M, Imholz B, Scolozzi P (2013) Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease. Oral Radiol 29:160–165CrossRef
43.
Imaizumi A, Kuribayashi A, Watanabe H, Ohbayashi N, Nakamura S, Sumi Y et al (2012) Non-Hodgkin lymphoma involving the mandible: imaging findings. Oral Surg Oral Med Oral Pathol Oral Radiol 113:e33–e39PubMedCrossRef
Metadata
Title
Radiolucent lesions of the mandible: a pattern-based approach to diagnosis
Authors
Laurène Avril
Tommaso Lombardi
Angeliki Ailianou
Karim Burkhardt
Arthur Varoquaux
Paolo Scolozzi
Minerva Becker
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 1/2014
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-013-0298-9

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