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Head and Neck Pathology Mar 2023Cystic lesions of the gnathic bones present challenges in differential diagnosis. This category includes a smorgasbord of odontogenic and non-odontogenic entities that... (Review)
Review
BACKGROUND
Cystic lesions of the gnathic bones present challenges in differential diagnosis. This category includes a smorgasbord of odontogenic and non-odontogenic entities that may be reactive or neoplastic in nature. While most cystic jaw lesions are benign, variability in biologic behavior makes distinction between these entities absolutely crucial.
METHODS
Review.
RESULTS
Two clinical cases are presented in parallel and are followed by an illustrated discussion of the ten most likely differential diagnoses that should be considered when confronted with a cystic jaw lesion. Strong emphasis is placed on the histologic differences between these entities, empowering readers to diagnose them with confidence. Perhaps even more importantly, the more common diagnostic pitfalls in gnathic pathology are discussed, recognizing that a definitive diagnosis cannot be rendered in every situation. The histologic diagnoses for the two clinical cases are finally revealed.
CONCLUSION
Cystic lesions of the maxilla and mandible may be odontogenic or non-odontogenic. The most common cystic lesions are the reactive periapical cyst, and the dentigerous cyst (which is developmental in nature). It is important to note that cystic neoplasms also occur in the jaws, and that the presence of inflammation may obscure the diagnostic histologic features of lesions like odontogenic keratocyst and unicystic ameloblastoma. Ancillary testing is of limited diagnostic value in most scenarios. However, both clinical and radiographic information (such as the location, size, duration, associated symptoms, and morphology of the lesion in its natural habitat) are significantly useful.
Topics: Humans; Diagnosis, Differential; Jaw Neoplasms; Odontogenic Cysts; Odontogenic Tumors; Ameloblastoma; Maxilla
PubMed: 36928736
DOI: 10.1007/s12105-023-01525-1 -
Journal of Surgical Oncology Jan 2021
Topics: Humans; Mandible; Mandibular Neoplasms; Retrospective Studies
PubMed: 33259642
DOI: 10.1002/jso.26323 -
BMJ Case Reports Dec 2021Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits diverse clinical and radiological presentations. In fact there are several differential...
Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits diverse clinical and radiological presentations. In fact there are several differential diagnoses during histopathological evaluation too. Lack of adequate reports could not establish the predominant demographic, clinical and radiological presentations. For the same reasons, the role of adjuvant radiotherapy and chemotherapy is also unsubstantiated yet. This case discusses the innocuous clinical and radiological presentation of ameloblastic carcinoma in a 55-year-old man where the diagnostic confirmation was achieved through histopathological evaluation. The differential diagnoses, treatment and follow-up details of this case are discussed in light of the previous published case reports and systematic reviews of case reports in an attempt to increase the sensitisation among dentists towards ameloblastic carcinoma.
Topics: Ameloblastoma; Carcinoma; Diagnosis, Differential; Humans; Male; Mandibular Neoplasms; Middle Aged; Odontogenic Tumors
PubMed: 34906959
DOI: 10.1136/bcr-2021-246907 -
Otolaryngologic Clinics of North America Aug 2023The premises of mandibular reconstruction are the restoration of occlusion and mandibular contour for the purpose of preserving the facial identity, oral airway, and... (Review)
Review
The premises of mandibular reconstruction are the restoration of occlusion and mandibular contour for the purpose of preserving the facial identity, oral airway, and effective speech and mastication. Establishing functional occlusion is the primary tenant in all mandibular reconstruction. In cases of segmental defects, particularly in dentate regions of the mandible, there has been a paradigm shift over the past two decades in how surgeons are approaching the restoration of load-bearing mandibular continuity with capacity for dental implantation. Here we discuss considerations for deciding the most effective method of reconstruction in segmental defects.
Topics: Humans; Mandibular Neoplasms; Mandibular Reconstruction; Bone Transplantation; Mandible; Face
PubMed: 37246030
DOI: 10.1016/j.otc.2023.04.009 -
Journal of the American Dental... Dec 2022
Topics: Humans; Palatal Neoplasms; Palate; Male; Aged; Radiography, Panoramic
PubMed: 34836619
DOI: 10.1016/j.adaj.2021.07.031 -
BMJ Case Reports Dec 2020Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue...
Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.
Topics: Adult; Facial Asymmetry; Fibroma, Ossifying; Fibula; Humans; Imaging, Three-Dimensional; Jaw; Male; Mandibular Neoplasms; Orthognathic Surgical Procedures; Printing, Three-Dimensional; Tomography, X-Ray Computed
PubMed: 33372024
DOI: 10.1136/bcr-2020-239286 -
Oral Radiology Jan 2021To describe the radiographic features of odontogenic keratocysts (OKCs) and ameloblastomas and to compare the radiographic findings between these 2 lesions.
OBJECTIVES
To describe the radiographic features of odontogenic keratocysts (OKCs) and ameloblastomas and to compare the radiographic findings between these 2 lesions.
METHODS
Radiographs of OKCs and ameloblastomas were retrospectively reviewed. Location, border, shape, association with impacted tooth, tooth displacement, root resorption, and bone expansion were evaluated. Chi-squared or Fisher's exact tests were used for statistical analysis. A p value < 0.05 was considered to indicate statistical significance.
RESULTS
One hundred OKCs and 101 ameloblastomas were reviewed. The ratios of maxilla to mandible were 1:1.4 and 1:9.1 in OKCs and ameloblastomas, respectively. All evaluated features significantly differed between OKCs and ameloblastomas (p ≤ 0.001). Most OKCs showed smooth border (60%) and unilocular shape (82%), while most ameloblastomas showed scalloped border (77.2%) and multilocular shape (68.3%). Association with impacted tooth was found in 47% of OKCs and 18.8% of ameloblastomas. Adjacent tooth displacement was found in 33.7% of OKCs and 55.8% of ameloblastomas. Root resorption was more common in ameloblastomas (66.7%) than in OKCs (7%). Bone expansion was also more common in ameloblastomas (96.3%) than in OKCs (63.6%).
CONCLUSION
A unilocular radiolucent lesion with smooth border, no adjacent tooth displacement, no root resorption and causing mild or no bone expansion is suggestive of an OKC rather than an ameloblastoma.
Topics: Ameloblastoma; Humans; Jaw Neoplasms; Odontogenic Cysts; Odontogenic Tumors; Retrospective Studies
PubMed: 32030659
DOI: 10.1007/s11282-020-00425-2 -
Atlas of the Oral and Maxillofacial... Sep 2023
Review
Topics: Humans; Allografts; Bone Transplantation; Mandible; Mandibular Neoplasms; Mandibular Reconstruction; Male; Adult; Middle Aged; Mandibular Osteotomy
PubMed: 37500203
DOI: 10.1016/j.cxom.2023.03.001 -
Scientific Reports Feb 2022We aimed to develop an explainable and reliable method to diagnose cysts and tumors of the jaw with massive panoramic radiographs of healthy peoples based on deep...
We aimed to develop an explainable and reliable method to diagnose cysts and tumors of the jaw with massive panoramic radiographs of healthy peoples based on deep learning, since collecting and labeling massive lesion samples are time-consuming, and existing deep learning-based methods lack explainability. Based on the collected 872 lesion samples and 10,000 healthy samples, a two-branch network was proposed for classifying the cysts and tumors of the jaw. The two-branch network is firstly pretrained on massive panoramic radiographs of healthy peoples, then is trained for classifying the sample categories and segmenting the lesion area. Totally, 200 healthy samples and 87 lesion samples were included in the testing stage. The average accuracy, precision, sensitivity, specificity, and F1 score of classification are 88.72%, 65.81%, 66.56%, 92.66%, and 66.14%, respectively. The average accuracy, precision, sensitivity, specificity, and F1 score of classification will reach 90.66%, 85.23%, 84.27%, 93.50%, and 84.74%, if only classifying the lesion samples and healthy samples. The proposed method showed encouraging performance in the diagnosis of cysts and tumors of the jaw. The classified categories and segmented lesion areas serve as the diagnostic basis for further diagnosis, which provides a reliable tool for diagnosing jaw tumors and cysts.
Topics: Case-Control Studies; Deep Learning; Humans; Jaw Cysts; Jaw Neoplasms; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Radiography, Panoramic; Reproducibility of Results
PubMed: 35115624
DOI: 10.1038/s41598-022-05913-5 -
The Journal of Clinical Endocrinology... Nov 2023Hyperparathyroidism-jaw tumor (HPT-JT) syndrome is a heritable form of primary hyperparathyroidism caused by germline inactivating mutations in CDC73 encoding...
CONTEXT
Hyperparathyroidism-jaw tumor (HPT-JT) syndrome is a heritable form of primary hyperparathyroidism caused by germline inactivating mutations in CDC73 encoding parafibromin and is associated with an increased risk of parathyroid cancer. There is little evidence to guide the management of patients with the disease.
OBJECTIVE
(1) Characterize the natural history of HPT-JT, (2) correlate genotype and histology of parathyroid tumors with parafibromin immunostaining, (3) understand molecular changes downstream to CDC73 loss.
DESIGN
Retrospective study of patients with HPT-JT syndrome (genetically confirmed or affected first-degree relatives). Independent review of uterine tumor from 2 patients and staining for parafibromin on parathyroid tumors from 19 patients (13 adenomas, 6 carcinomas) was performed. RNA-sequencing was performed in 21 parathyroid samples (8 HPT-JT-related adenomas, 6 HPT-JT-related carcinomas, and 7 sporadic carcinomas with wild-type CDC73).
RESULTS
We identified 68 patients from 29 kindreds with HPT-JT with median age at last follow-up of 39 [interquartile range, 29-53] years. A total of 55/68 (81%) developed primary hyperparathyroidism; 17/55 (31%) had parathyroid carcinoma. Twelve of 32 (38%) females developed uterine tumors. Of the 11 patients who had surgical resection for uterine tumors, 12/24 (50%) tumors were rare mixed epithelial mesenchymal polypoid lesions. Four of 68 patients (6%) developed solid kidney tumors; 3/4 had a CDC73 variant at p.M1 residue. Parafibromin staining of parathyroid tumors did not correlate with tumor histology or genotype. RNA-sequencing showed a significant association of HPT-JT-related parathyroid tumors with transmembrane receptor protein tyrosine kinase signaling pathway, mesodermal commitment pathway, and cell-cell adhesion.
CONCLUSIONS
Multiple, recurrent atypical adenomyomatous uterine polyps appear to be enriched in women with HPT-JT and appear characteristic of the disease. Patients with CDC73 variants at p.M1 residue appear predisposed to kidney tumors.
CLINICAL TRIAL NUMBER
NCT04969926.
Topics: Humans; Female; Adult; Middle Aged; Male; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Retrospective Studies; Jaw Neoplasms; Adenoma; Transcription Factors; Carcinoma; Uterine Neoplasms; Kidney Neoplasms; RNA
PubMed: 37339334
DOI: 10.1210/clinem/dgad368