European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 237–238
Available online at
ScienceDirect www.sciencedirect.com
What is your diagnosis?
A painful lesion of the mandible D.-T. Ginat a,∗ , J. Schulte b , E.A. Blair c a
Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago IL 60637, United States Department of Pathology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago IL 60637, United States c Department of Otolaryngology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago IL 60637, United States b
1. Description The patient is a 58-year-old female who presented with several months’ history of left jaw pain and history of tooth #18 extraction. CT demonstrated a ground-glass attenuation lesion
in the left mandibular body adjacent to the roots of tooth #19 and inferior alveolar nerve canal with associated dehiscence of the overlying buccal cortex (Fig. 1a). MRI was also performed, which showed homogeneous enhancement of the lesion (Fig. 1b).
Fig. 1. a: axial CT image show a ground-glass attenuation lesion surrounding the roots of ADA 19, with associated dehiscence of the overlying buccal cortex of the mandible (arrow); b: coronal fat-suppressed post-contrast T1-weighted MRI shows an avidly enhancing lesion within the left body of the mandible (arrow).
What is your diagnosis?
∗ Corresponding author. E-mail address: [email protected] (D.-T. Ginat). http://dx.doi.org/10.1016/j.anorl.2014.12.002 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.
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D.-T. Ginat et al. / European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 237–238
The lesion proved to be focal cemento-osseous dysplasia, which is a non-neoplastic condition comprising a connective tissue matrix that is likely derived from the periodontal ligament, most commonly located in the posterior body of the mandible [1,2]. Radiographically, focal cemento-osseous dysplasia often appears as non-expansile and well-defined, with irregular mixed attenuation. MRI serves a complimentary role to CT in the evaluation of mandibular lesions by more precisely delineating possible soft tissue involvement and depicting cystic versus solid enhancing components [3]. MRI is also more sensitive for the detection of inflammatory and infectious conditions, as well as bone marrow involvement [3]. While focal cementosseous dysplasia may not have pathognomic features on MRI, it is important to realize that this lesion can demonstrate solid enhancement. Although the diagnosis of typical focal cemento-osseous dysplasia is often made based on clinical and radiological assessment, atypical presentations of this entity may pose a diagnostic challenge. Furthermore, the appearance of focal cemento-osseous dysplasia can vary depending on the stage of the lesion [1,4]. Thus, there are several potential differential diagnostic considerations, including other types of fibro-osseous lesions, apical granuloma, odontoma, malignant neoplasms, such as lymphoma, and inflammatory or infectious processes, such as chronic sclerosing osteomyelitis. Although obtaining a tissue sample can be helpful for elucidating the differential diagnosis, focal cemento-osseous dysplasia can potentially be misdiagnosed as cemento-ossifying fibroma on histopathology.
Focal cement-osseous dysplasia lesions are usually asymptomatic and may be incidentally discovered on radiological examinations [5]. Furthermore, cemento-osseous dysplasia typically exhibits limited growth and does not require further surgical intervention, although periodic follow-up is recommended because, occasionally, this type of dysplasia progresses into florid osseous dysplasia [5]. However, extraction of the underlying teeth is generally not indicated, due to potential complications and insufficient evidence of clinical benefit. Indeed, no invasive treatment was performed in this case. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Cankaya AB, Erdem MA, Olgac V, Firat DR. Focal cemento-osseous dysplasia of mandible. BMJ Case Rep 2012;3:2012. [2] Summerlin DJ, Tomich CE. Focal cemento-osseous dysplasia: a clinicopathologic study of 221 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1994;78:611–20. [3] Avril L, Lombardi T, Ailianou A, Burkhardt K, Varoquaux A, Scolozzi P, et al. Radiolucent lesions of the mandible: a pattern-based approach to diagnosis. Insights Imaging 2014;5:85–101. [4] Su L, Weathers DR, Waldron CA. Distinguishing features of focal cementoosseous dysplasia and cemento-ossifying fibromas. II. A clinical and radiologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:540–9. [5] Bulut EU, Acikgoz A, Ozan B, Zengin AZ, Gunhan O. Expansive focal cementoosseous dysplasia. J Contemp Dent Pract 2012;13:115–8.
Available online at
ScienceDirect www.sciencedirect.com
What is your diagnosis?
A painful lesion of the mandible D.-T. Ginat a,∗ , J. Schulte b , E.A. Blair c a
Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago IL 60637, United States Department of Pathology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago IL 60637, United States c Department of Otolaryngology, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago IL 60637, United States b
1. Description The patient is a 58-year-old female who presented with several months’ history of left jaw pain and history of tooth #18 extraction. CT demonstrated a ground-glass attenuation lesion
in the left mandibular body adjacent to the roots of tooth #19 and inferior alveolar nerve canal with associated dehiscence of the overlying buccal cortex (Fig. 1a). MRI was also performed, which showed homogeneous enhancement of the lesion (Fig. 1b).
Fig. 1. a: axial CT image show a ground-glass attenuation lesion surrounding the roots of ADA 19, with associated dehiscence of the overlying buccal cortex of the mandible (arrow); b: coronal fat-suppressed post-contrast T1-weighted MRI shows an avidly enhancing lesion within the left body of the mandible (arrow).
What is your diagnosis?
∗ Corresponding author. E-mail address: [email protected] (D.-T. Ginat). http://dx.doi.org/10.1016/j.anorl.2014.12.002 1879-7296/© 2015 Elsevier Masson SAS. All rights reserved.
238
D.-T. Ginat et al. / European Annals of Otorhinolaryngology, Head and Neck diseases 132 (2015) 237–238
The lesion proved to be focal cemento-osseous dysplasia, which is a non-neoplastic condition comprising a connective tissue matrix that is likely derived from the periodontal ligament, most commonly located in the posterior body of the mandible [1,2]. Radiographically, focal cemento-osseous dysplasia often appears as non-expansile and well-defined, with irregular mixed attenuation. MRI serves a complimentary role to CT in the evaluation of mandibular lesions by more precisely delineating possible soft tissue involvement and depicting cystic versus solid enhancing components [3]. MRI is also more sensitive for the detection of inflammatory and infectious conditions, as well as bone marrow involvement [3]. While focal cementosseous dysplasia may not have pathognomic features on MRI, it is important to realize that this lesion can demonstrate solid enhancement. Although the diagnosis of typical focal cemento-osseous dysplasia is often made based on clinical and radiological assessment, atypical presentations of this entity may pose a diagnostic challenge. Furthermore, the appearance of focal cemento-osseous dysplasia can vary depending on the stage of the lesion [1,4]. Thus, there are several potential differential diagnostic considerations, including other types of fibro-osseous lesions, apical granuloma, odontoma, malignant neoplasms, such as lymphoma, and inflammatory or infectious processes, such as chronic sclerosing osteomyelitis. Although obtaining a tissue sample can be helpful for elucidating the differential diagnosis, focal cemento-osseous dysplasia can potentially be misdiagnosed as cemento-ossifying fibroma on histopathology.
Focal cement-osseous dysplasia lesions are usually asymptomatic and may be incidentally discovered on radiological examinations [5]. Furthermore, cemento-osseous dysplasia typically exhibits limited growth and does not require further surgical intervention, although periodic follow-up is recommended because, occasionally, this type of dysplasia progresses into florid osseous dysplasia [5]. However, extraction of the underlying teeth is generally not indicated, due to potential complications and insufficient evidence of clinical benefit. Indeed, no invasive treatment was performed in this case. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Cankaya AB, Erdem MA, Olgac V, Firat DR. Focal cemento-osseous dysplasia of mandible. BMJ Case Rep 2012;3:2012. [2] Summerlin DJ, Tomich CE. Focal cemento-osseous dysplasia: a clinicopathologic study of 221 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1994;78:611–20. [3] Avril L, Lombardi T, Ailianou A, Burkhardt K, Varoquaux A, Scolozzi P, et al. Radiolucent lesions of the mandible: a pattern-based approach to diagnosis. Insights Imaging 2014;5:85–101. [4] Su L, Weathers DR, Waldron CA. Distinguishing features of focal cementoosseous dysplasia and cemento-ossifying fibromas. II. A clinical and radiologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:540–9. [5] Bulut EU, Acikgoz A, Ozan B, Zengin AZ, Gunhan O. Expansive focal cementoosseous dysplasia. J Contemp Dent Pract 2012;13:115–8.
