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Case 1

Antral Pseudocyst

A 52-year-old male presents to the dental clinic for an admitting visit. Radiographic examination revealed a dome shaped radiopacity in the right sinus. What is the most likely diagnosis?

 

INCORRECT.

True sinus mucocele is an accumulation of mucin that is completely encased by epithelial lining. It can occur by trauma (such as sinus surgery) or it can arise from an obstruction of the sinus ostium, thereby blocking normal drainage.

 

 

INCORRECT.

Periapical cysts and granuloma cannot be differentiated by radiographic examination alone. Both lesions are related to non-vital tooth and radiographically appear radiolucent with absence of lamina dura at the apical area.

 

 

INCORRECT.

Periapical cysts and granuloma cannot be differentiated by radiographic examination alone. Both lesions are related to non-vital tooth and radiographically appear radiolucent with absence of lamina dura at the apical area.

 

 

CORRECT.

Antral Pseudocyst is a retention pseudocyst, where the process consists of inflammatory exudate primarily serum. It accumulates under the maxillary sinus mucosa and causes a dome shaped elevation. It is asymptomatic and the patient is usually unaware of the lesion. The lesion does not require treatment because they can resolve spontaneously without any residual effect on antral mucosa.

 

 

INCORRECT.

Odontogenic cysts, such as keratocystic odontogenic tumors, displace the floor of the antrum and the border of the cyst becomes coincident with the bony sinus floor.

 


Case 1 References

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 3rd Edition, W.B. Saunders Co.; 2009

White SC, Pharoah MJ. Oral Radiology: Principles and Interpretation, 6th Edition, Mosby; 2009

 

Case 2

A 77-year-old female presented to the dental clinic for a routine visit. Upon radiographic examination, a linear radiopacity near the spinal column was noted. During extra-oral examination, patient was asymptomatic. What is the most likely diagnosis?

 

INCORRECT.

 

 

CORRECT.

The styloid process is a long cartilaginous bone located on the temporal bone. The muscles and ligaments which have a role in mastication and swallowing are attached to the styloid process. Ossification of stylohyoid ligament can be detected on panoramic radiographs as linear radiopacity extending from posteroinferior aspect of the ramus toward the hyoid bone. Symptoms, such as neck and cervicofacial pain, related to elongated stylohyoid process or ossification of stylohyoid ligament is called Eagle Syndrome. For asymptomatic individuals, no treatment is required. For symptomatic patients, recommended treatment can include steroid or lidocaine injections into tonsillar fossa or amputation of stylohyoid process.

 

 

INCORRECT.

 

 

INCORRECT.

Arterial calcifications can be seen in facial artery and are less commonly in the carotid artery. Calcified vessels appear as a parallel pair of thin, radiopaque lines that follow the anatomy of the artery (straight or tortuous).

 

 

INCORRECT.

Sialolith involving the parotid gland appears as a round to cylindrical in shape radiopacity and will superimpose on the body of the ramus radiographically.

 


Case 2 References

White SC, Pharoah MJ. Oral Radiology: Principles and Interpretation, 6th Edition, Mosby; 2009

 

Case 3

A 13-year-old female presents to the dental clinic for routine care. Upon radiographic examination, a teardrop-shaped, well-defined radiolucency is noted between the right mandibular lateral incisor and canine, causing displacement of teeth. Both teeth were vital. What is the most likely diagnosis?

 

INCORRECT.

Dentigerous cysts are related exclusively to impacted teeth in coronal position.

 

 

INCORRECT.

Lateral radicular cysts appear to be laterally positioned to the tooth mimicking lateral periodontal cysts, however, the associated tooth will be non-vital.

 

 

CORRECT.

Lateral periodontal cyst is thought to arise from epithelial rests entrapped in the lateral periodontium of the tooth. The lesion is asymptomatic and found mostly in the region extending from the lateral incisor to second premolar. It appears as a well-defined radiolucency with prominent cortical boundary and round or oval shape. The radiographic differential diagnosis of such lesions includes keratocystic odontogenic tumor (KOT) or radicular cyst (related to non-vital tooth) at foramen of lateral or accessory pulp canal. The treatment includes excisional biopsy or simple enucleation. There is no recurrence.

 

 

INCORRECT.

Gingival cyst of adult is the soft tissue counterpart of a lateral periodontal cyst. It usually does not demonstrate any bony involvement.

 

 

INCORRECT.

Radicular (periapical) cyst is associated to the root of non-vital tooth.

 


Case 3 References

White SC, Pharoah MJ. Oral Radiology: Principles and Interpretation, 6th Edition, Mosby; 2009



Case 4

A patient presents to the dental clinic with a white, papillary, exophytic lesion on the right anterior portion of the tongue. What is the most likely clinical diagnosis?

 

CORRECT.

Squamous papilloma is a benign proliferation of stratified squamous epithelium which has papillary presentation. The lesion appears as a soft, painless, exophytic lesion with numerous finger-like projections that can be pointed or blunted (“cauliflower” or wartlike appearance). The lesion is induced by human papilloma virus (low risk HPV 6 and 11 seen in 50% of oral papillomas). The viruses in oral squamous papilloma have extremely low virulence and infectivity rate.

 

 

INCORRECT.

Fibroma is the most common reactive lesion of the oral cavity caused because of irritation or trauma. It appears as a smooth-surfaced nodule (sessile or pedunculated) that is similar in color to the surrounding mucosa.

 

 

INCORRECT.

Condyloma acuminatum, also known as venereal wart, is a virus-induced prolifera­tion of squamous epithelium of the genitalia, perianal region, mouth, and larynx. Condyloma is considered to be a sexually transmitted disease (STD), with lesions devel­oping at a site of sexual contact or trauma. The typical condyloma appears as a sessile, pink, well-demarcated, nontender exophytic mass with short, blunted surface projections. The condyloma tends to be larger than the papilloma and is characteristically clustered with other condylomata.

 

 

INCORRECT.

Verruca vulgaris, also known as a wart, is a benign, virus-induced, focal epithelial hyperplasia. It is contagious and can spread to other parts of a person’s skin or mucous membranes by way of autoinoculation. It infrequently develops on oral mucosa but is extremely common on the skin. Clinically, it appears as painless, exophytic, papillary lesion that is white in color.

 

 

INCORRECT.

Focal epithelial hyperplasia is a virus-induced, localized proliferation of oral squamous epithelium. This disease typically appears as multiple soft, nontender, flattened or rounded papules, which are usually clustered and the color of normal mucosa, although they may be scattered, pale, or rarely white. Occasional lesions show a slight papillary surface change.

 


Case 4 References

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 3rd Edition, W.B. Saunders Co.; 2009




Case 5

 

A 55 y.o. African-American male presents to dental clinic for initial visit. Upon radiographic examination, a mixed radiolucent/radiopaque lesion was noted at the apex of #20. The lesion had a radiolucent rim around radiopaque center. Patient was asymptomatic and the tooth was vital. No expansion noted clinically. What is the most likely diagnosis?

 

INCORRECT.

Idiopathic osteosclerosis presents as a focal area of increased radiodensity that is of unknown cause. Radiographically, the lesions are characterized by a well-defined, rounded, or elliptic radiodense mass without a radiolucent rim.

 

 

INCORRECT.

Cementoblastoma is an odontogenic neoplastic process (derived from cementum). Radiographically, the tumor appears as a radiopaque mass that is fused to one or more tooth roots (distorting the lamina dura) and is surrounded by a thin radiolucent rim.

 

 

INCORRECT.

Condensing osteitis presents as localized areas of bone sclerosis associated with the apices of teeth with pulpitis or pulpal necrosis. It is associated with a non-vital tooth. Radiographically, the lesion appears as a uniform zone of increased radiodensity adjacent to the apex of a tooth that exhibits a thickened periodontal ligament space or an apical inflammatory lesion. The lesion does not exhibit a radiolucent border.

 

 

CORRECT.

Focal osseous dysplasia is a reactive process that occurs in the tooth-bearing (dentulous and edentulous) areas of the jaws and is probably the most common fibro-osseous lesion encountered in clinical practice. Radiographically, the lesion varies from completely radiolucent to densely radiopaque with a thin peripheral radiolucent rim. Mixed radiolucent and radiopaque is the most common pattern seen. The lesion tends to be well defined, but the borders are usually slightly irregular.

 

 

INCORRECT.

Osteoblastoma is benign bone tumor. It presents as painful swelling. Radiographically, the osteoblastoma may appear as a well-defined or ill-defined radiolucent lesion often with patchy areas of mineralization.

 


Case 5 References

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 3rd Edition, W.B. Saunders Co.; 2009


Case 6

An 11-year-old African-American male presented to the pediatric clinic with a red lesion at marginal gingiva of #6. What is the most likely diagnosis?

 

INCORRECT.

Pyogenic granuloma represents an exuberant tissue response to local irritation or trauma that grows rapidly. In spite of its name, it is not a true granuloma. It is a smooth or lobulated mass that is usually pedunculated. The surface is characteristically ulcerated and ranges from pink to red to purple.

 

 

CORRECT.

Localized juvenile spongiotic gingival hyperplasia is characterized by gingival overgrowth as determined by clinical or histopathologic features rather than a pure inflammatory process with minimal to no tissue swelling. The lesion occurs between 5-15 years of age and classically presents as a small, localized, papillary or velvety, bright red, and easily bleeding gingival overgrowth with predilection for facial gingiva. The hyperplasias are confined to attached gingiva, but not all cases involve marginal gingiva.

 

 

INCORRECT.

Inflammatory papillary hyperplasia is characterized by reactive tissue growth as a result of ill-fitting maxillary denture or poor denture hygiene. Clinically, the mucosa is erythematous and has a pebbly or papillary surface.

 

 

INCORRECT.

Squamous papilloma is a benign proliferation of stratified squamous epithelium which has papillary presentation. The lesion appears as a soft, painless, exophytic lesion with numerous fingerlike projections that can be pointed or blunted.

 

 

INCORRECT.

Puberty gingivitis occurs around the time of puberty (period of increased susceptibility to gingivitis). The inflammatory lesion exhibits diffuse involvement of marginal gingiva.

 


Case 6 References

Chang JY, Kessler HP, Wright JM. “Localized juvenile spongiotic gingival hyperplasia.” Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106, no. 3 (2008): 411-8.

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 3rd Edition, W.B. Saunders Co.; 2009