MULTILOCULAR RADIOLUCENCIES OF THE JAWS

Introduction The jaws differ in various aspects from all other bones in the skeleton.

Embryologically Major part derived from migrating cells of the cranial neural crest, the so-called ectomesenchyme, and not merely from mesoderm, and they contain teeth.

Embryogenesis Teeth develop from epithelial cells from the mucosal lining of the oral cavity and cranial neural crest derived ectomesenchymal cells. The

epithelial part forms the cap-shaped enamel organ consisting of an inner-side of high cylindrical inner enamel epithelium that differentiates into enamel-forming ameloblasts, an external surface consisting of cuboidal outer enamel epithelium and an intervening loose epithelial structure known as Stellate reticulum.

The ectomesenchymal part that is enclosed by the enamel organ is known as the dental papilla: dental papilla cells at the border with the inner enamel epithelium develop into dentin-forming odontoblasts. Both enamel

organ and dental papilla together are surrounded by a fibrous capsule, the dental sac or dental follicle.

As the enamel organ elongates through downward proliferation, it creates a tube that maps out the form and size of the roots of the teeth. Therefore, remnants of odontogenic epithelium can be found in the jaw bone at a level as deep as the root tips of the teeth. Those that lie in the connective tissue that connects the tooth with the jaw, the so-called periodontal ligament, are known as rests of Malassez. Corresponding epithelial remnants in the gingiva are named rests of serres.
Histopathology 2009,54,401-418. DOI : 10.1111/j.1365-2559,2008.03097.x

Differntial diagnosis Despite many different conditions that affect the jaw, they can present radiographically only as areas of relative radiolucency or radiopacity compared to the surrounding bone. Even this distinction is not clearcut as sometimes some lesions fall into both categories, but at different stages in their development. As a result many of the pathological conditions resemble one another creating a great deal of confusion. Sites where the lesions develop, how they grow and the effects they have on adjacent structures tends to follow recognizable patterns.

Recognition of these particular patterns to the key to interpretation & formation of a radiological differential diagnosis. Making a differntial

diagnosis hence depends on a systemic approach. A systemic description of a lesion should include its: Site or anatomical position Size

 Shape Outline/edge or periphery Relative radiodensity & internal structure Effect on adjacent surrounding structures Time present, if known.

Lesion Characteristics Location Density Shape Borders Effects Size

Location Anterior / posterior Maxilla / mandible Relationship to teeth (periapical, pericoronal interradicular, edent) Soft tissue / bone

Density Radiolucent Radiopaque Mixed

Shape Regular Irregular

Divisions No Yes : : Unilocular Multilocular

Borders Well-defined Corticated Circumscribed Diffuse Non-corticated Non-circumscribed

Effects on surrounding tissue Resorption Expansion Displacement

Effects on surrounding tissue Resorption Expansion Displacement