JAW LESIONS
ODONTOGENIC CYSTS
55%—RADICULAR, PERIAPICAL, PERIODONTAL CYST
INFLAMMATORY ETIOLOGY—DEVELOPES IN A PERIAPICAL GRANULOMA AT THE APEX OF A DEVITALIZED, ERUPTED, USUALLY CARIOUS TOOTH
10%—DENTIGEROUS, FOLLICULAR, PERICORONAL CYST
NON INFLAMMATORY ETIOLOGY—SURROUNDS THE CROWN OF AN UNERUPTED TOOTH (USUALLY AN IMPACTED 3RD MOLAR)
MOST LIKELY CYST TO TRANSFORM INTO AN AMELOBLASTOMA
ODONTOGENIC NEOPLASMS
1%—AMELOBLASTOMA—A TRUE ENAMEL NEOPLASM—-CAN BE FROM A DENTIGEROUS CYST
PREDILECTION FOR 3RD MOLAR REGION
X-RAY APPEARANCE—SOAP BUBBLE/HONEY COMB SEPTATED APPEARANCE
Rx: WLE (CURRETAGE CONDEMNED)
ODONTOGENIC CYSTIC NEOPLASM
OKC(ODONTOGENIC KERATOCYST)—A PAINFUL, EXPANSIVE, LOCALLY AGGRESSIVE NEOPLASM
CAN BE ASSOC. WITH GORLIN’S NEVOID BASAL CELL CA SYNDROME (AD)
Rx: COMPLETE WIDE EXCISION(CURRETTAGE CONDEMNED)
35% RECURRENCE
BENIGN GIANT CELL TUMOR (GIANT CELL REPARATIVE GRANULOMA)–1953-JAFFE
USUALLY A SOLITARY LESION
DEBATE OVER PATHOGENESIS
BENIGN BUT LOCALLY AGGRESSIVE—EXPANSILE–DESTRUCTIVE
Bx—-MULTINUCLEATED GIANT CELLS WITH ABUNDANT CYTOPLASM AND IRREGULAR SHAPES—IN A SPINDLE STROMA
X-RAY—-RADIOLUSCENT OSTEOLYTIC PATCHY LESION
Rx: EXCISION—-BEST
RECURRENCE 10-15%
RT IF EXCISION NOT POSSIBLE —-SARCOMATOUS TRANSFORMATION POSSIBLE
BAD Px IF DYSESTHESIAS, PAIN, LOOSE TEETH, NON-HEALING SOCKET
LISTEN FOR BRUITS
GET PANOREX, CT SCAN, CXR AND A BIOPSY
ODONTOGENIC CYSTS
55%—RADICULAR, PERIAPICAL, PERIODONTAL CYST
INFLAMMATORY ETIOLOGY—DEVELOPES IN A PERIAPICAL GRANULOMA AT THE APEX OF A DEVITALIZED, ERUPTED, USUALLY CARIOUS TOOTH
10%—DENTIGEROUS, FOLLICULAR, PERICORONAL CYST
NON INFLAMMATORY ETIOLOGY—SURROUNDS THE CROWN OF AN UNERUPTED TOOTH (USUALLY AN IMPACTED 3RD MOLAR)
MOST LIKELY CYST TO TRANSFORM INTO AN AMELOBLASTOMA—OR RARELY A SCCA
OTHER CYSTS—GLOBULOMAXILLARY, NASOPALATINE
ODONTOGENIC CYSTIC NEOPLASM (A MUSTICYSTIC BENIGN NEOPLASM)
OKC(ODONTOGENIC KERATOCYST)—A PAINFUL, EXPANSIVE, LOCALLY AGGRESSIVE NEOPLASM
CAN BE ASSOC. WITH GORLIN’S NEVOID BASAL CELL CA SYNDROME (AD)
BASAL CELL NEVUS SYNDROME=NEVOID BCCA SYNDROME–BCNS
AFFECTS PTS AT A YOUNG AGE(PUBERTY-30’S)
CUTANEOUS:
MULTIPLE BCCA(FEW TO THOUSANDS)-NEED EVAL Q 3 MONTHS
NEVOID PHASE(CHILDHOOD)–NEOPLASTIC PHASE(ADULTHOOD)
PALMAR AND PLANTAR KERATOTIC PITTING(65%)
MULT. MILIA(SMALL EPIDERMAL INCLUSION CYSTS) AND DERMAL CALCINOSIS
SKELETAL:
MULTIPLE OKC’S-+KERATIN FORMATION  (Rx: COMPLETE EXCISION)
HIGH RECURRENCE RATE 10-60%
RADIOGRAPHICALLY UNILOCULAR/WELL CIRCUMSCRIBED WITH THIN RADIO-OPAQUE BORDERS
MAXILLA>MANDIBLE
BIFID RIBS AND OTHER RIB ABNL’S
PROGNATHISM
HYPERTELORISM/TELECANTHUS
FRONTAL BOSSING—WIDENED NASAL DORSUM
SCOLIOSIS
SHORT 4TH METACARPAL(LIKE TURNER’S)
NEURO:
CALCIFICATION OF FALX CEREBRI(85%)
+MEDULLOBLASTOMA
DYSGENESIS OF CORPUS CALLOSUM
MR
Rx: COMPLETE WIDE EXCISION(CURRETTAGE CONDEMNED)
35% RECURRENCE
BENIGN GIANT CELL TUMOR (GIANT CELL REPARATIVE GRANULOMA)–1953-JAFFE
USUALLY A SOLITARY LESION
DEBATE OVER PATHOGENESIS
BENIGN BUT LOCALLY AGGRESSIVE—EXPANSILE–DESTRUCTIVE
Bx—-MULTINUCLEATED GIANT CELLS WITH ABUNDANT CYTOPLASM AND IRREGULAR SHAPES—IN A SPINDLE STROMA
X-RAY—-RADIOLUSCENT OSTEOLYTIC PATCHY LESION
Rx: EXCISION—-BEST
RECURRENCE 10-15%
RT IF EXCISION NOT POSSIBLE —-SARCOMATOUS TRANSFORMATION POSSIBLE
ODONTOGENIC NEOPLASMS
1%—AMELOBLASTOMA—A TRUE ENAMEL NEOPLASM—-CAN BE FROM A DENTIGEROUS CYST
PREDILECTION FOR 3RD MOLAR REGION
X-RAY APPEARANCE—SOAP BUBBLE/HONEY COMB SEPTATED APPEARANCE
Rx: WLE —-MARGINAL MANDIBULECTOMY–(CURRETAGE CONDEMNED) (RT CONDEMNED)