Radiolucent Lesion Research Articles

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review

ObjectiveThis systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm. Study DesignA literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included. ResultsOf 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk. ConclusionThis study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

Classical radiolucent lesion of the mandible in a child, uncommon diagnosis

Classical radiolucent lesion of the mandible in a child, uncommon diagnosis

Retrospective Evaluation of Radiological Findings in Patients with Oral Malignancy

Aim: Oral cancer ranks among the most prevalent cancers worldwide. Imaging methods play a vital role in assessing patients. This study aimed to evaluate the age, sex, and localization distribution as well as panoramic and cone-beam computed tomography (CBCT) image findings in patients with oral malignancy with bone involvement. Materials and Method: Patients who were histopathologically diagnosed with malignant oral lesions at Gazi University, Faculty of Dentistry, Department of Oral Pathology between 2009 and 2023 were reviewed. Patients with oral malignancies whose panoramic images or CBCT images were available in the radiology archive were included in this study. Age-sex distribution was recorded. Localization of lesions and radiological features such as internal structures, borders, and effects on surrounding tissues were evaluated. Results: The mean age of the patients was 58.2 years; nine of them were female and thirteen were male. The incidence of malignancies included in this study was higher in men than in women, and the mandible/maxilla ratio was equal. The most common primary tumor was squamous cell carcinoma (SCC) (n=12). SCC lesions caused destruction in the cortical borders of neighboring structures in the region where they were located and showed the potential to spread toward these regions. Mucoepidermoid carcinoma was observed as an unilocular radiolucent lesion with clear borders, and it was determined that it destroyed the cortical bone. Conclusion: Panoramic radiography and CBCT images are valuable imaging methods in the evaluation of bone involvement of oral malignancies.

Clinicopathological comparison of periapical cyst and periapical granuloma in a cohort of Tamil population

Aim: The aim of this study was to present and analyze detailed clinicopathological data of periapical cysts (PCs) and periapical granuloma (PG) in a cohort of 135 cases from the South Indian Population. Methodology: The present study included 135 cases of PC and PG out of 2696 biopsies submitted over 3 years. The clinicodemographic data which included age, gender, location, radiographic appearance, and treatment were collected along with the histopathological examination of the biopsied specimen. Data were entered in a Microsoft Excel spreadsheet, 2021, and analyzed using SPSS software ver. 26. Results: There were 71 cases of PG and 64 cases of PC. The mean age of occurrence in PG was slightly lower than cases in PC. Irrespective of the group, there was a clear male preponderance, and maxillary permanent central incisors were most commonly affected. However, no significant difference was noted. Radiographically, PC significantly showed more well-defined corticated radiolucent lesions compared to PG where most cases were ill-defined (69.01%). Histologically, all cases showed classic features for diagnosis with additional histological characteristics which may aid in diagnosis. Conclusion: PG was more common than PC. There was a predilection for the male gender in both lesions. The actual incidence of these lesions would be actually high, as some cases are lost to private practitioners, and not all the lesions are submitted for histopathological examination.

A Hybrid Ameloblastoma in Posterıor Mandible: A Case Report

Objective: Hybrid ameloblastoma refers to the tumors that contain two or more different histologic types of ameloblastoma. Till date, only 49 cases of hybrid ameloblastoma with different combinations have been reported. Here we present a case of hybrid ameloblastoma containing follicular, plexiform, and acanthomatous types. Case Report: A 24-year-old male patient referred to our clinic with a slow-growing asymptomatic swelling on the right side of the mandible. Radiographic assessment revealed a well-defined radiolucent lesion associated with an impacted third molar. Following incisional biopsy, which was compatible with ameloblastoma, total excision of the lesion along with Carnoy fixation was performed. Final histopathologic assessment revealed a hybrid ameloblastic lesion which contained follicular, plexiform, and acanthomatous types. Conclusion: Hybrid ameloblastoma has variable clinical, radiological, and histopathological presentation. As a rare entity, the biological behavior of the lesion still needs to be analyzed extensively with further clinical research. Keywords: Carnoy, Enucleation, Hybrid ameloblastoma.

Comparison of computed tomographic findings for radiolucent lesions of the mandibular ameloblastoma, odontogenic keratocyst, dentigerous cyst, and simple bone cyst

Background/purposeRadiolucent lesions of the mandible, including ameloblastoma, odontogenic keratocyst (OKC), dentigerous cyst (DC) and simple bone cyst (SBC), are frequently encountered in clinical practice. However, they vary in type and occasionally in appearance. Each lesion needs a different treatment and approach; therefore, accurate diagnosis is crucial before treatment. However, the radiographic findings, including computed tomography (CT), are often similar. This study aimed to compare the CT findings of 41 ameloblastomas, 74 OKCs, 87 DCs, and 13 SBCs in the mandible. Materials and methodsPatients were evaluated on initial CT images focusing on features such as long/short diameters, relationship with adjacent teeth, cortex appearance, locularity, scalloped margins, and sclerotic rims. Multivariate logistic regression analysis was performed to determine the most useful features for differential diagnosis. Criteria for differential diagnosis were finally established for three lesions, excluding SBC, which had a relatively small number of cases. ResultsThe relationship with the affected tooth, short diameters, sclerotic rims, and locularity were found to be significant features in the differential diagnosis. Ameloblastomas were characterized by relatively larger short diameters, frequently accompanied by root resorption and adjacent tooth displacement, while SBCs lacked these features. Sclerotic rims were commonly observed in OKCs and DCs, and most DCs were unilocular, containing a crown within the lesion. Based on these results, criteria were established for differential diagnosis with a diagnostic accuracy of 84.2%. ConclusionThis is the first study to attempt to characterize each lesion's radiological features, and these criteria are likely to assist in clinical diagnosis.

Post-traumatic cortical cystic lesions in children: three case reports and a systematic review of the literature.

Post-traumatic cortical cystic lesions are rare radiolucent lesions that appear as a complication of low-severity fractures in children. Their relevance lies in the fact that few cases of these lesions have been described to date, so they are little known among clinicians caring for children. Three case reports of well-circumscribed cortical lytic lesions detected at 2-4months during the follow-up of non-displaced distal radius fractures in children aged 9, 7, and 2years are presented. The consistent clinical history and typical radiological features allowed the accurate diagnosis of post-traumatic cortical cystic lesion, without the need for advanced imaging tests or biopsy. At 12-, 8- and 11-month follow-ups, respectively, the lesions either disappeared or decreased in size. This benign and self-limited lesion should be correctly recognized to avoid confusion with other diagnoses, advanced imaging tests or biopsies, and unnecessary parental concerns.

Radiological features of Stafne mandibular bone cavity in panoramic image and cone beam computed tomography

BackgroundStafne mandibular bone cavity (SMBC) is an asymptomatic radiolucent lesion observed in the mandible on X-ray images, with well-defined borders. This lesion does not require treatment, and size changes are very rare. The purpose of this article is to summarize the radiological and clinical features of SMBC, aiming to prevent misinterpretation of this benign lesion as other pathologies and aid in differential diagnosis within the field of dental practice.MethodsA total of 32 patients who visited our hospital and were radiologically diagnosed with SMBC based on cone-beam computed tomography (CBCT) and panoramic images between 2005 and 2021 were included in this study. Among them, surgical intervention was performed in one case. Gender and age distribution of the patients, radiographic location and size of the lesion, relationship with the mandibular canal in CBCT, presence of cortical bone erosion in the mandibular lingual area in panoramic images, and the amount of residual cortical bone on the affected side in CBCT were investigated.ResultPatients were 26 men (81.3%) and 6 women, with a mean age of 54.3 years. The average horizontal and vertical length was 16.6 mm and 10.6 mm. Out of a total of 32 cases, 29 cases were found in the posterior region of the mandibular body, while 3 cases were in the angle of the mandible. Lesions located below the mandibular canal were observed in 29 cases, while lesions involving the mandibular canal were present in 3 cases. Erosion of the mandibular lingual cortical bone was observed in 11 cases (34.4%), while 21 cases (65.6%) showed no erosion on panoramic images. Among the total of 14 cases (43.8%) where the cortical bone on the affected side was invaded, the average residual cortical bone thickness was 1.1 mm.ConclusionSMBC is a benign lesion primarily found in the mandibular angle and posterior body of the mandible. In most cases, treatment is not necessary, and differentiation from other lesions can be achieved by understanding its clinical characteristics and features on panoramic radiographs and CBCT.

Performance of a commercially available Generative Pre-trained Transformer (GPT) in describing radiolucent lesions in panoramic radiographs and establishing differential diagnoses.

To evaluate the performance of a commercially available Generative Pre-trained Transformer (GPT) in describing and establishing differential diagnoses for radiolucent lesions in panoramic radiographs. Twenty-eight panoramic radiographs, each containing a single radiolucent lesion, were evaluated in consensus by three examiners and a commercially available ChatGPT-3.5 model. They provided descriptions regarding internal structure (radiodensity, loculation), periphery (margin type, cortication), shape, location (bone, side, region, teeth/structures), and effects on adjacent structures (effect, adjacent structure). Diagnostic impressions related to origin, behavior, and nature were also provided. The GPT program was additionally prompted to provide differential diagnoses. Keywords used by the GPT program were compared to those used by the examiners and scored as 0 (incorrect), 0.5 (partially correct), or 1 (correct). Mean score values and standard deviation were calculated for each description. Performance in establishing differential diagnoses was assessed using Rank-1, -2, and - 3. Descriptions of margination, affected bone, and origin received the highest scores: 0.93, 0.93, and 0.87, respectively. Shape, region, teeth/structures, effect, affected region, and nature received considerably lower scores ranging from 0.22 to 0.50. Rank-1, -2, and - 3 demonstrated accuracy in 25%, 57.14%, and 67.85% of cases, respectively. The performance of the GPT program in describing and providing differential diagnoses for radiolucent lesions in panoramic radiographs is variable and at this stage limited in its use for clinical application. Understanding the potential role of GPT systems as an auxiliary tool in image interpretation is imperative to validate their clinical applicability.

Intraosseous vascular malformation of the skull: a case report and literature review.

A 59-year-old woman presented to our clinic with a 3.5× 3-cm protruding mass on her forehead. A skull X-ray revealed a radiolucent osteolytic lesion on the left side of the frontal bone. Additionally, computed tomography showed a 3.1× 1.7× 3.6-cm mass exhibiting a "sunburst" pattern situated between the outer and inner tables of the skull, just superior and lateral to the left frontal sinus. This pattern suggested the presence of an intraosseous vascular malformation (IVM). The lesion was approached via a bicoronal incision. En-bloc resection was performed, removing the mass along with approximately 0.5 cm of the surrounding normal bone without injury to the exposed frontal sinus mucosa. The exposed mucosa was reinforced with a galeal flap, and cranioplasty with bone cement was performed to repair the resulting bony defect. Pathological examination confirmed a diagnosis of intraosseous cavernous-type malformation with mixed cavernous and capillary histological features. We report this case of IVM and review the existing literature, highlighting the satisfactory functional and aesthetic outcomes after surgery.

Performance of a deep learning system for simultaneously diagnosing radiolucent and radiopaque lesions in the anterior maxilla on panoramic radiographs

AbstractAimTo validate the performance of a deep learning system with detection and classification functions for a mix of radiolucent and radiopaque lesions in the anterior maxilla on panoramic radiographs.MethodsPatients with radiolucent or radiopaque lesions in the anterior maxilla on panoramic radiographs were selected retroactively from May 2022 until Feb 2002 to obtain 100 preoperative radiographs each for nasopalatine duct cysts (NDCs), radicular cysts (RCs), and impacted supernumerary teeth (ISTs). An additional 100 patients with no lesions in the anterior maxilla were selected. Two deep learning systems (Systems 1 and 2) were created and tested. For System 1, the models were created and tested using datasets of radiolucent lesions (NDCs and RCs) and No lesions. For developing System 2, the data of radiopaque lesions (ISTs) were added to those used in System 1. The neural network used was You Only Look Once ver. 7 (YOLOv7). The recall, precision, F1 score, and accuracy calculated from the confusion matrix were used to evaluate diagnostic performance.ResultsThe performance of System 2, which included the IST data, was worse than that of System 1. Even when NDCs and RCs were addressed as a joint category of radiolucent lesions, the addition of IST data resulted in a worse performance than that of System 1.ConclusionOur results indicate that combined use of radiopaque lesions (ISTs) with radiolucent lesions (NDCs and RCs) reduces the deep learning performance for radiolucent lesions with the volume of data used in the present study.

Diagnosis and Current Treatment of Aneurysmal Bone Cysts.

The purpose of this review is to increase awareness about the evolution and development of current trends in the diagnosis and treatment of aneurysmal bone cysts (ABCs). ABCs are benign, but locally aggressive bone tumors that mainly affect children. ABCs comprise 1% of all primary bone tumors and occur most frequently during the first two decades of life. The diagnosis is made using a variety of imaging modalities and has the characteristic features of an expansile, radiolucent lesion that is often seen in the metaphyseal region of the bone and has fluid-fluid levels that are apparent on MRI. In the pediatric population, telangiectatic osteosarcoma and unicameral bone cyst (UBC) are the main differential diagnoses of an ABC. Giant cell tumors (GCTs) also include in differential diagnosis, which often manifest in patients older than 15 and do not penetrate the open physis although they develop after the physeal closure. Imaging alone cannot rule out telangiectatic osteosarcoma; therefore, a biopsy is recommended. A variety of treatment options have been described; traditionally, most patients are treated with curettage and bone grafting. Curettage alone, however, usually results in tumor recurrence following excision. A variety of adjuvants have been utilized with varying degrees of effectiveness to reduce the risk of local recurrence. When a cyst is in the pelvis, its location and size are such that surgery is a very risky option. Selective arterial embolization has significantly contributed to the development of effective treatments for these situations. Embolization or radiation, as well as denosumab therapy, are widely used as therapies for ABCs in anatomic locations where surgery would significantly increase morbidity.

Surgical Management of Radicular Cyst with the Application of a Natural Platelet Concentrate and Ostoden: A Case Report

ABSTRACT The most frequent cystic lesions that affect the jaw are radicular cysts. The current case report describes the surgical management of a radicular cyst in the periapical region of maxillary central and lateral incisors, and highlights the efficacy of natural platelet concentrate [platelet-rich fibrin (PRF)] along with Ostoden bone graft material used for postoperative healing. A 46-year-old male patient presented to the department with swelling in the palatal aspect of the maxillary anterior region. On radiographic examination, a radiolucent periapical lesion was evident in relation to the left maxillary central and lateral incisor. In the maxillary anterior region, root canal therapy was performed, followed by periapical surgery, and PRF with Ostoden bone graft was placed in the surgical site to initiate the healing at a faster rate. The patient was recalled at follow-ups after 7 days, 3, 6, and 9 months. No symptoms such as pain, inflammation, or discomfort were observed during the review period.

Lytic lesions in bone in a CKD patient, brown tumor is a must on the differential

Brown tumor is a focal lesion of giant cells without neoplastic potential encountered in association with hyperparathyroidism. These lesions can occur anywhere in the skeletal system producing various local symptoms. In this case report, we present a 15-year-old boy with stage 5 chronic kidney disease (CKD) on maintenance hemodialysis who presented with hip pain for 1 week. On investigating, the patient had normal parathyroid levels (PTH) but the previous metabolic bone disorder (MBD) parameters revealed a high PTH. Imaging showed expansile radiolucent lesions involving the left hip. Considering the clinical, metabolic and the radiological picture the patient was diagnosed to have brown tumor with secondary hyperparathyroidism and was treated with Cinancalcet, vitamin D and immobilization with a brace.

Conservative treatment of large unicystic ameloblastoma in a young patient: a 7-year follow-up

The unicystic ameloblastoma is an odontogenic tumor that is frequently found in young patients and usually affects the posterior region of the mandible. This paper aimed to describe a case report and 7-year follow-up of a young patient. The 12-year-old patient presented with increased volume in the lower third of the right hemiface with a duration of 6 months. Radiographic examination showed a unilocular radiolucent lesion extending along the body, angle and right mandibular ramus. An incisional biopsy was performed and a histological diagnosis of luminal unicystic ameloblastoma was obtained, opting for a conservative treatment with decompression and subsequent complete enucleation of the lesion. The patient has been under follow-up for 7 years, with a good evolution of the condition and without clinical and radiographic signs of recurrence of the lesion. Thus, it is ratified that timely conservative intervention and conservative surgical treatment should be the first choice for ameloblastoma management in young patients.

Late recurrence of calcifying odontogenic cyst: Report of a rare case and review of the literature

AbstractCalcifying odontogenic cyst (COC) is a relatively uncommon cyst of odontogenic origin, occurring in the second decade of life, with no jaw predilection. Radiographically, it typically appears as a well‐defined unilocular radiolucency containing irregular calcifications of varying size and opacity. Treatment consists of conservative surgical excisions with low recurrence rates. The purpose of this paper is to report a rare case of late COC recurrence and review the pertinent literature. A 42‐year‐old female patient presented for evaluation of a painless swelling in the palate, which had been present for 5 years with a gradual, slow increase in dimensions. Twenty years before, a lesion at the same site was surgically excised with a diagnosis of COC. Clinical examination revealed a hard‐in‐consistency swelling in the anterior segment of the hard palate. Radiographically, a radiopaque lesion with an irregular outline was noticed in the left palate adjacent to the left maxillary canine and first premolar, along with a well‐defined radiolucent lesion between the maxillary central incisors. Both lesions were surgically excised, and histopathological examination revealed that the main lesion in the left palate was consistent with recurrent COC, while the lesion between the central incisors was compatible with a nasopalatine duct cyst. Even though the recurrence rate of COC is low, estimated at 3.4% based on our review of the relevant English‐language literature, the current case highlights the possibility of a late recurrence, even several years after the initial diagnosis and treatment, and therefore the need for long‐term follow‐up.

A radiolucent cystic lesion in a chest radiograph of a breathless child − a case report

A radiolucent cystic lesion is a common finding on chest radiographs of children presenting with acute breathlessness, and congenital pulmonary airway malformation (CPAM) is a relatively uncommon cause of it. The majority of children with CPAM present with respiratory distress of varying severity in the neonatal period. Here, we discuss the case of an 18-month-old child who had a recent history of worsening breathlessness, and on thorough evaluation, he was diagnosed as having CPAM (type 1 variant). Inadvertent chest tube insertions should be avoided in these cases, as it can worsen the underlying condition. A computerized tomography (CT) chest scan plays a key role in diagnosing and assessing the therapeutic intervention in these cases. Surgical resection of the lesion is curative and has an excellent prognosis in the majority of cases of type 1 CPAM.

Odontogenıc Keratocyst: A Case Report

Odontogenic keratocyst was first mentioned in the literature by Mikulicz in 1876, and described by Philipsen in 1956. These cysts are developmental odontogenic cysts arising from dental laminate remnants. Generally, these cysts can be seen in the second or third decade of life, in both mandibular and maxillary jaws; but most often they are localized in the mandibular jaw. A 23-year-old male patient who came to our clinic complaining of swelling in the lower jaw and did not have a systemic disease had a radiolucent lesion measuring about 4 * 2 cm in the mandible and lateral tooth area in the maxilla. Enucleation of radiolucent lesions which are localized in maxillary and mandibular jaws was performed. Both lesions were sent to the pathology laboratory for detailed examination. Extraction of the impacted right mandibular canine was made. According to the pathology report, a diagnosis of odontogenic keratocyst was made to both lesions. In this case keratocysts were seen as multiocular, and it was suspected that there could be Gorlin Goltz syndrome. According to the medical genetic report of the patient, who does not have any systemic diseases, Multilocular Odontogenic Keratocysts could not be associated with Gorlin Goltz syndrome.

Cystic Extrafollicular Adenomatoid Odontogenic Tumour: A Case Report and Pictorial Update

Adenomatoid Odontogenic Tumour (AOT) constitutes about 5% of all odontogenic tumours and is most commonly seen in young females, in association with impacted maxillary canines in a Dentigerous Cyst (DC) like relationship. Extrafollicular AOT is an uncommon variant seen unassociated with impacted teeth. Rare cystic presentation is reported with most cases seen arising from or in association with DC. Here, the authors present a case of extrafollicular AOT in a 29-year-old Dravidian male, who reported with a chief complaint of swelling of lower anterior jaw region. Radiographically, a well-defined radiolucent lesion was noted extending from mesial aspect of the roots of right mandibular second molar, crossing the midline to involve the body of mandible till mesial aspect of lower left canine. There was evidence of cortical perforation. The lesion was excised and sent for histopathological evaluation. Histopathologically, the lesion was diagnosed as cystic AOT-extrafollicular variant. There was adequate healing and no signs of recurrence or residual disease were noted 18 months after the surgery. The present case is a unique presentation of cystic extrafollicular AOT with pictorial demonstration and detailed explanation of its pathogenesis.

Brodie's Abscess of the Ankle Presenting as a Tumor: A Summary of Five Cases.

A Brodie's abscess is a form of subacute osteomyelitis that is often considered in the differential diagnosis of other benign and malignant bone lesions. The authors summarize the findings of five cases of Brodie's abscesses in the distal tibia initially thought to be tumors by the referring physicians. All five cases were presented to the referring physicians with a chief complaint of ankle pain. All patients complained of chronic ankle pain and swelling that was aggravated by activity without constitutional symptoms. On physical examination, all patients presented with point tenderness over the distal tibia/malleolar regions. Three out of the five cases had a full range of ankle motion; the other two had limited dorsiflexion secondary to pain. All inflammatory laboratory values were within normal limits or only slightly elevated. All initial radiographs of the cases described demonstrated a well-defined radiolucent lesion within the distal tibia. In all cases, patients were treated with curetting, with or without bone graft. Bacterial and fungal cultures were negative in all five patients and no long-term post-operative antibiotics were administered. In this report, we discuss the clinical, radiographic, and pathologic features of this relatively rare condition in the distal tibia. The distinct clinicopathologic features of the disease process are presented to distinguish Brodie's abscess from a bone tumor.