Clasificacién TNM y Lista de diagnosticos diferenciales (Este listado se encuentra en el libro de texto A partir de la pagina 851)CLASIFICACION TNM F Tx Tumor primario no puede ser evaluado To No hay evidencia de tumor Tis Carcinoma in situ TL Tumor mide de 2 cm o menos T2 Tumor mide de 2a 4 cm 3 Tumor mide mas de 4 cm o se extiende a la superficie lingual de la epiglotis 14 Tumor avanzada que mide mds de 4 cm y que invade estructuras adyacentes N ENVOLVIMIENTO REGIONAL DE NODULOS LINFATICOS Nx Nédulos linfaticos no pueden ser valorados NO No hay metastasis a nédulos linfaticos Ni Metastasis a Un tinico nddulo ipsilateral (mismo lado del tumor) de 3 am o menos N2 Metéstasis a un nico nédulo ipsilateral (mismo lado del tumor) de 3 cm a 6 cm / metdstasis en miltiples nédulos ipsilaterales no mayores a 6 cm /metdstasis bilateral o contralateral no mayores € 6 cm. LN3 Metastasis en un nédulo (0 varios) mayor a6 cm M METASTASIS Mo. No hay metdstasis a distancia Mi Hay metastasis a distancia Estadio segdn la clasificaclon TINM Supervivencia aS afios Estadio NM Cavidad Oral Estadi Tis NOMO | __Estadiot | Ti NO MO 72% |__ Estadio ll T2.NO MO 58% Estadio Ill T3 NO MO 45% T1N1 MO T2.N1 MO 13 N1 MO Estadio IV T4 NO MO 32% 48% T4.N1 MO T1N2 MO T2.N2 MO T3.N2.MO T4.N2 MO Cualquier TN3 MO T4 cualquier N MO Cualquier T cualquier N M1Petechial, B. Blue and/or Purple Lesions c ci ; Hr ya Sr andlor Black Lesions Part 2: Mucosal and Soft Tissue Pathology: Surface Alterations A. Vesiculocrosive and Ulcerative Lesions: Aeute (Shore Duration and Sudden Onseo) B. Vesiculocrosive and Ulcerative Lesions: Chronic (Long Duration) C. Papillary Growths: Focal or Diffuse Part 3: Mucosal and Soft Tissue Pathology: Masses or Enlargements A. Soft Tissue Masses (Lumps and Bumps): Lower Li ip B. Soft Tissue Masses (Lumps and Bumps): Upper Lip C. Soft Tissue Masses (Lumps and Bumps): Buccal Mucosa D. Soft Tissue Masses (Lumps and Bumps): Gingiva/Alvcolar Mucosa E. Soft Tissue Masses (Lumps and Bumps): Floor of Mouth B. Soft Tissue Masses (Lumps and Bumps): Tongue G. Soft Tissue Masses (Lumps and Bumps): Hard or Soft Palate H. Soft Tissue Masses (Lumps and Bumps): Multiple Lesions I. Soft Tissue Masses (Lumps and Bumps): Midline Neck Lesions J. Soft Tissue Masses (Lumps and Bumps): Lateral Neck Lesions K. Generalized Gingival Enlargement Ecchymotic, and ‘Telangicctatic Lesions ase 857 aso 859 859 860 860 860 861 E. Radiolucencies: Poorly Defined or Ragged Borders E. Radiolucencies: Multifocal or Generalized G. Radiopacities: Well-Demarcated Borders H. Radiopacities: Poorly Demarcated Borders I. Radiopacities: Multifocal or Generalized J. Mixed Radiolucent/Radiopaque Lesions: Well-Demarcated Borders K. Mixed Radiolucent/Radiopaque Lesions: Poorly Demarcated Borders L. Mixed Radiolucent/Radiopaque Lesions: Multifocal or Generalized Unique Radiographic Appearances: “Ground Glass” (Frosted Glass) Radiopacities Unique Radiographic Appearances: “Cotton Wool” Radiopacitics O. Unique Radiographic Appearances: “Sunburst” Radiopacities P. Unique Radiographic Appearances: “Onion-Skin” Radiopacities Q Soft Tissue Radiopacities M. he Part 5: Pathology of Teeth A. Hyperdontia (Extra Teeth) B. Hypodontia (Missing Teeth) C. Macrodontia (Larger Than Normal Teeth) Microdontia (Smaller Than Normal Teeth) - Malformed Crown Enamel Loss After Tooth Formation Extrinsic Staining of Tecth Intrinsic Discoloration (“Staining”) of Teeth . Abnormally Shaped Roots Enlarged Pulp Chamber or Canal Pulpal Calcification Thickened Periodontal Ligament - Generalized Loss of Lamina Dura . Premature Exfoliation of Teeth ZSrA>rEOmpye 870 870 871 871 871May be scraped off sighty, with difcutly oN ee “Nik Curd or ‘cottage cheese" appearance: may leave fed Base when rubbed off Surlace may appear to be peeling off ern! Filmy whiteness; leaves normal appearing mucosa when rubbed off 320 as ‘Thermal burn Example: pizza bum 262 a ‘Sloughing traumatic lesion Example: cotton rofl "bum" 266 ad Chernical burn Example: aspirin bur secondary ta direct application for toothache 264 a ‘Secondary syphilis: Mucous patch; may be only partially scraped off At : Diphtheria Gray-white pseudornerbrane of oropharynx 168 8, White Lesions: Gan ccraped Of aaiptUue blan Go que ao wud SOO Buccal mucosa along occlusal plane FC Uo ila S959 xsi nea alba ~ Leukoedema Primarily in blacks; miky white alteration of buccal mucosa 7 bilaterally; disappears when stretched = Leukoplakia May show benign hyperkeratosis, epithelial dysplasia, or invasive 355 carcinoma’ - Tobacco pouch keratosis Usually in mandibular vestibule; associated with use of snuff or 364 chewing tobacco rs ‘White: coated! tongue Diffuse involvement of dorsal tongue 12 oe Uchen planus Wickham's striag; typically bilateral on buccal mucosa 729 = Morsicatio Most common on anterior buccal mucosa, lablal mucosa, and 259 lateral border of tongue; exhibits ragged surface = Actinic chellosis Pale, gray-white, scaly alteration of lower lip, usually in older men 370 with history of chronic sun exposure; precancerous : Nicotine stornatitis Usually assoclated with pipe smoking; occurs on hard palate 368 b Hairy leukoplakia Usually lateral border of tongue; rough surface with vertical 242 fissures; Ususlly associated with HIV infection * Hyperplastic candidiasis Most commonly affects anterior buccal mucosa, 195, 2 Lupus erythematosus Most common on buccal mucosa; may mimic lichen planus or 740 Jeukoplakd: iated skin lesions usually present . Skin graft History of previous surgery ex : ‘Submucous fibrosis More common in South As ‘ociated with betel quid chewing 966 ° White sponge nevus Hereditary, onsot in childhood; generalized lesions, especialy 601 ‘buccal tre * Hereditary benign Hereditary; o in childhood; generalized lasions, especially intraepithakal ‘bucval mucosa; ocular involvement possible dyskeratosis Pachyonychia congenita Hereditary; onset in childhood; most common on dorsal tongue and areas of trauma; nail, palmar, and plantar changes also nt 'idhood, dystrophic nail changesPale, gray-white and red alteration to usually | 370 with history of chron aun exposure i Usually shows epithelial dysplasia or carcinoma 389 Cinnamon reaction Related to cinnamon and lateral tongue Ned 947 Wpically on buccal mucosa 322 a Nicotine stomatitis Usually associated with pipe smoking; occurs on hard palate 368 = Lupus erythematosus Most common on buccal : n rilcosa; ray minic chen planus oF 740 i ‘Scarlet fever Secondary to a ‘pam Mtc streptococcal Infection; strawoery/ 167 . ‘Verruciform xanthoma Most common on gingiva and hard palate; surface may be Bat D. Red Lesions ( 0 SIONS Roja > on! Pharyngitis Examples: strep throat, viral pharyngitis 166 EEE ss on = ‘Traumatic erythema Caused by local inttation = ial Denture stomatitis Denture-bearing palatal mucosa 194 _ Gythematous candidiasis Example: central papillary atrophy (median rhomboid glossitis) 192 as Erythema migrans Geographic tongue (cases with absence of white borders); 726 continually changing pattern; rarely involves other mucosal sites - Angular chelltis Erythema and cracking at labial commissures 194 ~ ‘Thermal burns Example: caused by hot liquids 262 ~ Erythroplakia Usually shows epithelial dysplasia or carcinoma 363 * Anemia Atrophic, red tongue; can be due to pemicious anemia, ron- m deficiency anemia, hypovitarinosis B . Hemangioma Develops in younger patients; may Iblanch; may show bluish hue 504 % Lupus erythernatosus Usually with associated skin lesions 740 * Scarlot fever Secondary to fi-hemolytic streptococcal infection; stranvberry/ 167 raspberry tongue . Plasma cell gingivitis Allergic reaction usually related to flavoring agents 145 - Radiation mucositis Patient curently undergoing radiotherapy 266 E ial, Ecchymotic. and TAgngiectati a> [Pe sl case Mee y a Nonspecific trauma History of injury to lesional site Telan gi ectr ya a7 = Joper respiralory Soft palate pelechia ss infections ContinuedComments or Special Characteristics = Infectious mononucleosis Soft palate: petechiae; tonsils and/or pharyngitis may be present 220 $ Kesopathic -Aroas of trauma; gingival blending possibly present S45 t trombocytopenic purpura = Traurna from feta Posterior palatal petechiae oF ecchymosis oe) - Hemophilia Hereditary; chilthood onset; gingival bleeding may be present = 5 Lovkenia (Caused by secondary thromboaylopenia; gingival Bloading may be 547 resent s Hereditary hemorhagic: NMudtiplo, pinhead-sized talangiectaslan possblo ry at 702 telangiectasia Nosebleeds or gastrointestinal bleeding = GAEST syndrome Muttiple, pinhead-sized telangiectasias; Galcinasis cutis, Raynauds 747 henomenon, Esophageal motiity defect, Sclerodacty, __Toangiectastas ons ales ¥ porpers a Varicositos Especially aftor 4 yoars of age; mest common on veriral tongue 13. es : and ips s Sumucosal homonhage Algo soe Appendix List, Part 1, E. prevous topic) aie Potechia, Eochymotic, nid Telangieclatic Lesions as ‘Amalgam tattoo ‘Most common on gingiva; blue-gray, radiopaque amalgam Pyostoratts wagers “Snal-rase partes eanockted wn toneatay bowel deeese 702Recurrent herpes labialis Primary herpetic Verrnilion and labial skin; begins as multiple vesicles; often recurs: Fever and malaise; chien net young. eck, Titre Vane fingivostomatitis gingiva consistontly att “ Necratizing Ucerative Painful destruction of gingival papillae; fetid odor, mostly aingivtis (NUS) loanagors and wou eae A es Mucosal burns Ghornical or thermal Recurrent intraoral herpes Gingiva or hard palate (excep in irrnunocompromésed;, focal i simplax ‘luster of vesicles and shallow ulcers, ‘ Allergic reactions Sxample: Caused by topical medications or dental materials; ee erythema and vesicles ~ Erythoma multiforme / Predominantly in children and young adults; muftiple blisters and 723 ‘Stevens-Jobnson Ulcers aften crusting, hemorrhagic fip lesions; may have ‘syndrome associated “target” skin lesions or involvement of ocular and genital mucosa - Herpangina Especially in chiléron; rrultiple small cers on soft palate and 233 tonsillar pillars > Varicella (chickenpox) Associated with skin eruption; few oral vesicles and ulcers; usually 224. in children z Herpes zoster : Hand-fool-and-mouth Unilateral involvement along nerve distribution; usually middle-aged aT and older adults; painful vesides and cers Especially in children; mulliple vesicles and ulcers; associated 233 Tuberculosis Z disease vesicles on hands and feet S Necrotizing Usually posterior lateral hard palate; prior swelling may be present; 439 slalometaplasia deep craterlike ulcer; may be only minimal pain + ‘Anesthetic necrosis Usually at site of palatal injection 27 e Primary syphilis Chancre at site of inoculation; usualy painless with clean ulcer bed 170 i Behget syndrome Aphthous-ike Ulcers; genital ulcers and ocr inflammation 308 B. Vesiculocrosive and Ulcerative Le an} ont Erosive lichen planus Associated with white sttiag; usualy in middle-aged and older 723 adults; most common on buccal mucosa and gingiva (desquamative gingivitis”) =~ Traumatic granuloma Solitary, non-healing ulcer 260 my ‘Squamous cell carcinoma —_Usually in middle-aged and older adults; usually indurated and may 374 have rolled border; may be painless oa ‘Mucous membrane Most common in middle-aged and older women; most commonly 718 pemphigoid presents as a “desquamative gingivitis"; may involve ocular and genital mucosa > [Lupus erythematosus ‘May have associated red and white change; usually with skin 740 involvement Pemphigus vulgaris Usually in middle-aged and older patients; multiple oral blisters and 742 es Ulcers usually precede skin lesions Deep fungal infections Examples: histoplasmosis, blastornycosis; may be painless Chapter 6 Associated mass may be present; may be painless 176Hereditary (except epidermolysis bullosa acquisita), . and childhood; multiple skin blisters c reas sf Stee) aN ee Pyostornatiis vegetans _—_Yolowish “snail-tracie™ : — : me Pusttles; associated with inflammatory 792 Wegener grandomatosis Usually palatal ulceration and destruction; associated : | = : Kidney involvement may be present may show “eam = ‘ | . gingivitis" a Extranodal NK/T-cell Palatal lymphoma with uceration | piesisrna, nesaltyoe getind aly gil and destruction of underlying $62 (midiine lethal grandoma) i Norma Gangrenous necrosis i scan i ee eee 181 individuals SeRSTeeE a Tertiary syphilis Gurrma; associated be eS mass may be present; may be painless; may 172 6. Papitiary or Coccami mites pilerw- j - Hairy tongue Usually brown or black discoloration; hyperkeratotic elongation of 12 filiform papillae on posterior dorsal tongue } = Papilloma Can be white or pink: most common on soft palate and tongue; 332 usually pedunculated a Inflammatory papillary Usually involves midportion of hard palate beneath denture 478 hyperplasia = Leukoplakia (some Examples: proliferative verrucous leukoplakia, granular or nodular 355 variants) leukoplakia * ‘Squamous cell carcinoma Examples with papilary surface changes 374 = Giant cell fibroma Usually in children and young adults; most common on gingiva 473 * Vernuca vulgaris ‘Common wart; especially in younger patients; most common on: 3u4 labial mucosa 7 Hairy leukoplaida Usually lateral border of tongue; rough surface with vertical 242 fissures; Usually associated with HIV infection i \Verruciform xanthonna Most common on gingiva and hard palate oat : \Verrucous carcinoma Especially in older patients with long history of snuff or chewing 389 tobacco Use; especially in mandibular vestibule and buccal mucosa; may be white or red * frequentty multiple > Multifocal epithelial Usually rmultiple, flat-topped papuaar lesions; usually in chidren 336 hyperplasia most common in Native Americans and Inuit; color may vary from normal to white . Darier's dissase Most commonly appears as pabbly appearance of hard palate; 800 n ‘associated crusty, greasy skin lesions; hereditary . 7centhoss nigricans —_-‘Mast commonly appears as generalized pebbW slteraion of Wepst 748 lip; pigmented, pebbly skin changes in flexural areas; associated een gastrointestinal malignancy‘Savemous cl carcinoma Tuer wih rough, crake, gear surface, Usiy on varTanON tumors : Eero bw abt can = = chery gare troy Uy raced carcroa ur ft 5 ert ‘aro dps ass wh contain Big ack olopren S72 vermin tac oy - Foren say era el ara = Mor dare site hard uronic ay bola ar ~ ‘Saar dad tor Un creat adver (de Yar age 40 or eororpie Graton ‘sheen ouroa nage 4) 5 Say cont Way be ish aw - tar reer amps: range alana cr unie 72 5 Rascal ot Fchart owe oll tide 24 ~ Fora at ned ck org oct hare a3 = pore May bo yen 2 pation 1 = Mucoorlo Tica) pote: oon es Ore owing and nang Aza g Hyparadic irph rode sat buccater no: menatie atrocsal ass 555 5 Otter meson Bangles harangirrm, remota Genie noe Sayers ca cachora Tuna’ wih gh war Release wa > Shey glrd tmrer——__‘Promomtic adenoma and mcossiemoid canara met Ghar 1 ~ Paris Fa ra nor tooth $24 E Eps fissuraiun ating dente Z 475, = Progen ganas Usual red, crated, ay blo; reresad Femuaneyh AB pregnant worn = Paipherd osding May bo roc or noel calor may bo oat “a7 ‘nore = Ftrome stad ror ear a Ss Porphera gart cal ede pure: roqunty carted aEspecially in AIDS patients; usually purple Peripheral odontogenic Example: peripheral adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma; may have bluish hue 660 eonuental eos Usually in females; especially anterior madila aa lanot Ant : 5 zi tumor MO"OF maxilla: destroys underlying bone; may be pigmented 490 Chapter 12 ec ebGconets: pay aie fluctuant swelling 424 Sialolith Usually hard mass in submandibular di lave pinroee duct may be associated wih) 427 Lymphoepithelial cyst ‘Simall, yellow-white submucosal lesion 34 = ‘Squamous cell carcinoma Tumor with rough, granular, ireguiar surface 374 = Epidermoid or dermoid \Midline yellow-white submucosal lesion 30 Chapter 11 Chapter 12 = Fibroma Usually normal in color, most common on margins of tongue 473 = ‘Squamous cell carcinoma Tumor with rough, granular, irregular surface; usually lateral or 374 ventral border es Mucocele Usually anterior ventral surface; usually buish or clear color 42 = Pyogenic granuloma Usually red, ulcerated, easily bleeding 453, ic Granuar cell tumor Dome-shaped; usually on dorsum of tongue 502 Other mesenchymal Eire: Setearcarin mrarihe ececeoetoad oe ‘Chapter 12 tumors ; Salivary gland tumors See es Chapter 11 carcinoma * Lingual thyroid Usually posterior rridine of dorsal surtace; usually in women 10 ~ &, Soft Tissite Masses (t fumps): Hare - Pdatal abscess Associated with nonvital tooth 123 = Leaf-like denture fibrorna__ Pedunculated hyperplastic growth beneath fitting denture 477 = ‘Salivary gland turnors Especially pleomorphic adenoma, mucoepidermoid carcinoma, ‘Chapter 11Tumor with igh, granular, irreguar surface; occasionally z y arises: ftom maxilary cis r Mucocele/salivary duct Usually has bluish hue 422 7 cyst ai Melanocytic nevus/ Usually pigmented 350, 401 _ melanoma cs Necrotizing Euly stage lesion; often associated with pain or paresthesa 439 ; sialometaplasia a Adenomatoid hyperplasia Asymptornatic, painless mass 433 5 = Multiple fibromas. Some patients may develop more than ane fisroma on the oral 473 ; mucosa . Kaposi sarcoma Usually purple lesions of palate and menilary gingiva; usually 244 ‘ associated with AIDS a : Neurofiromatosis type | _Oral and siin neurofibromas; café au lait edn pigmentation 495 . Multifocal epitholial Usually flat-topped papular lesions; usually in chikiren, most 336 hyperplasia ‘common in Native Americans and Inuit; color may vary from normal to white ° ‘Amyboidosis Pale, firm deposits, especially in tongue; periocular cutaneous 766 lesions frequently present; most often associated with rnultiple myeloma B Granulomatous diseases Examples: sarcoidosis, Crohn disease, leprosy 310 ¢ Multiple endocrine. Mucosal neuromas of lips and tongue; adrenal 497 neoplasia type 2B. Ehsoctverocytornen, medullary thyroid carcinoma; marfanoid body = Tuberous sclerosis ‘Small fiorora-tke growths on gingiva; angiofibromas of face: 705 epilepsy; intellectual disability . Multiple hamartoma Cowden: syndrome; snail fibroma-ike growths on: gingiva; multiple. = 707 syndrome hamartornas of various tissues; breast cancer in affected women i. Sort Tissue Masses (Lumps aps): Miciiine Neck Lesions Se Thyroid gland enlargement Examples: goiter, thyroid tumor = - Thyroglossal duct cyst May move up and down with tongue motion 32 : Dermoid cyst Soft and fluctuant 30 . Plunging ranula Soft and compressible 424 J. Soft Tissue Masses (j unips anc Sumps}: Lateral Neck lasiana wns Reactive ‘Secondary to oral and maxillofacial infection; often tender to §33 lymphadenopathy Palpation a Epidermoid cyst Soft and movable 29Deposits from oral and pharyngeal carcinomas; usually indurated and pairless: may be fixed : ar 4 eat Nan be uate ct lateral usualy paless; Hodgkin and 53 2 Infectious mencnucleosis Fatigue; sore throat; tender lymph nodes 229 me Salivary gland tumors ‘Arising from submandibular gland or tal of parotid gland Chapter 11 gd Submandibular sialadenitis Example: secondary to sialolithiasis 429 = Branchial cleft cyst Soft and fluctuant; most common in young adults 33 q Granulomatous diseases _ Examples: tuberculosis, sarcoidosis 176, 310 z Cat-scratch disease History of exposure to cat 184 2 Ostic hygrome Infants; soft and fluctuant S10 : lunging ranula Soft and compressible 424 Examples: neurofibroma, carotid body tumor Chapter 12 Racands mimte s Javete emia Nein witty ep ee 140 Exarnples: phenytoin, calcium-channel blockers, cyclosporine; may 148. bbe fibrotic May be hereditary; onset in childhood 151 Usually boggy and hemorthagic sae “Strawberry’ gingivitis; may have palatal Uceration and destruction; 315 lung and kidney involvement = Scurvy Vitamin C deficiency uyAmelotlastic fibroma Usually in younger patients 1 5 Adenomatoic odontogenic Usually in antetior region of jaws; most often with maxillary canine; 664 _ tumor usually in teenagers: = = Galcitying odontogenic Gorlin cyst 647 cyst 5 Carcinoma arising in Mostly in older adults oe dentigerous cyst a = Intraosseous muco- Mc in posterior mandible epidermoid carcinoma | Other odontogenic lesions Examples: calcifying epithelial odontogenic turnor, odontogenic: myxoma, central odontogenic fibroma. Nonvital tooth WT Nonvital tooth ic} Especially in black females; usually apical to mandibular anteriors; 597 teeth are vital Usually endedontically treated tooth with destruction of cortical 119 plate . Dentin dysplasia type | Multiple periapical granulomas or cysts; shortened, malformed 402 roots a awomicnn cies: Other Locations Developing tooth bud — Within alveolar bone : = ~ Lateral radicular cyst Nonwital tooth; lateral canal 120 = Nasopalatine duct cyst Between and apical to maxilary central incisors; Palatal swelling 26 may occur = Lateral periodontal cyst Especially in mandibular bicuspid-cuspid region 645 = Residual (periapical) cyst Edentulous area 124 so Odontogenic keratocyst — 636 - Central giant ceil Especially in anterior mandible 584 granuloma Ss Stafne bone defect Angle of mandible below mandibular canal 22 , Cemento-osseous Early stage; usually in young adult and middle-aged black women; 596 ‘dysplasia usually in manditale Central ossifying fibroma Early-stage lesion 602 .Lesion or Condition Comments or Special Characteristics I Buccal bifurcation cyst ‘Buccal aspect of erupting mandibular first of second molar 650 : Other odontogenic cysts Ex be cori CR oe a eee Chapter 15 ? Langethans cell “Histiocytosis X*; i a istiocytosis X"; usually in children or young adults 550 = ‘Molunotic ‘Antodior maxi, may bo pigmontod Hwuroectoden ned Luror iia a of infancy 2 Median palatal cyst Clinical midline swelling of hard palate 28 : ‘Schwannoma/ Usually associated with mandibular nerve 404 neurofibroma Odontogenic keratocyst = 636 ey ‘Arneloblasioma Expecially in postrior mandible; often assodated wih impacted G53 | 001 Ey Central giant cell Especially in anterior mandible a4 ‘granuioma = < ‘Amelotlastic fibroma Especially in young patients 660 7 ‘Odontogenic myxoma “Cobweb” trabecuation 679 B Central odontogenic = 676 froma . Calcifying epithelial Often associated with impacted tooth 666 ‘odontogenic tumor i Orthokeratinized: Often associated with impacted tooth 639 ‘odontogenic cyst ; Lateral periodontal cyst Especially in mandibular bicuspid-cuspid region 645 fbotryoid type) > Calcifying odontogenic Especially in cases with minimal or no calefications; often 6a? cyst essociated with impacted tooth : Central hemangioma/ Especially in younger paints; may have honeycornibed 506 arteriovenous radiographic appearance; may pusate malformation . ‘Aneurysmal bone cyst Especially in younger patients. ET - ‘Cherubism Hereditary, onset in childhood; multiple quadrants involved ‘S87 : Hyperparathyroidiamn Usually elovated serum calcium lovals 71 forown tumor) - Intraosseous muco- Usually in posterior mandible 457 epidermoid carcinoma < Fibrous dysplasia Very rarely on panoramic flms of mandibular lesions 592 tie Sina Be Norvital tooth 417 = Focal osteoporotic Especially edentulous areas in posterior mandible; mow common 579. rnarrow Gelect in females: ContinuedComments or Special Characteristics (Usually painful or tender 2 i ‘exposed necrotic bone; most often associated with bisphosphonate drugs Mandioutar lesion that scallops up between roots of ‘usually: in younger patients eer Paint, paresthesia; usually in older adults History of radiation therapy. painful May bo painful in older adutts Qdontogenic or salivary origin 260 = 661 Often painful; usually in young adufts 2 Ewing sarcoma Usually in children i Other primary bone Examples: fibrosarcorna, lyphoma malignancies: = Desmoplastic roma of Especially in younger patierits 614 618 621 S81 - Massive osteolysis Phantorn (vanishing) bone disease F. Radiolucencies: Multito: a a Cemento-osseous Eaity stage lesions: usually in black fernales; usually in mandible ‘S96 dysplasia = Nevoid basal call Odontogenic keratocysts 640 carcinoma syndrome = Multiple myeloma Painful; in older adults; “punched-out” lesions 563 “ Cherubism Usually multilocular; onset in chiidhood; hereditary 587 ™ Hyperparathyroidism Multiple brown tumors 7a1 S Langerhans cell “Histiocytosis X°; in chikdren and young adults: teeth “floating in air’ 550. ss G._ Radiopacities: Well-Demarcated Borders Torus or exostosis Associated with bony surface mass : 18 fos, Retained root tip Remnants of periodontal ligament usually seen = i Idiopathic asteosclerosis Most commonly associated with roots of posterior teeth; no 573 @pparent inflammatory etiology = Pseudocyst of the Homogeneous, dome-shaped relative opacity rising above bony 203 maxillary sinus floor of maxdlary sinus - Condensing osteitis Usualy at apex of nonvital tooth 134 ca Qdontoma, compound ToothlKe structures with thin, radiolucent rim at junction with 674 ‘surTounding bone; may prevent eruption of teeth; more common in anterior segments of jaws. ~ ‘Odontorna, complex ‘Amorphous mass with thin, radiolucent rim at junction with ‘Surrounding bone; may prevent eruption of teeth; more common in posterior segments of jaws. Late-stage lesions; especially in middle-aged and older black women; usually in mandible 674: Furcation area of molar tooth Osteoblastoma/osteoid Late-stage lesions ‘osteoma! cementoblastoma H. Rachopacities: Poorly Demarcated Borers ne Pj Cemento-osseous Lalo tage leone: especialy in midlo-oged etek . SS dysplasia women; usually in ae S06 - r Medication-retated ‘Sclerosis of alveolar crestal bone; exposed necrotic bone; 7 osteonecrosis of the often associated with bisphosphonate drugs eS ees jaw 2 Condensing osteitis Usually at apex of nonvital tooth 134 = Sderosing osteomyelitis May be painful 131 = Fibrous dysplasia “Ground glass" appearance; onset usually in younger patients. 592 Fi Paget disease of bone “Cotton wool" appearance; late-stage lesions; in older patients 582 . Proliferative periostitis “Onion-skin” cortical change; in younger patients; often associated 184 with nonvital tooth: F Osteosarcoma May have “sunburst” cortical change; frequently painful; usualy in 614 young adults . Ci ane = 618 1, Radiopacities; Multifocal or Gen. ad Florid cemento-osssous Late stags lesions: eepectsly i risse-aged and oki lee 598 dysplasia wornen; usually in mandible = Madication-related Mulifocal stes of rwolvement sclerosis of avaclr crestl bone: 27 ‘osteonecrosis of the ‘exposed necrotic bone; most often associated with jaw bisphosphonate drugs g Kiopathic osteosclerosis Occasionally may be muttfocal S73 E Paget disease of bone “Catton woot” appearance; late-stage lesions; in older patients; 582 more common in media - . Gardner syndrome Multiple osteornas; epidermoid cysts; gastointestind polyps with 606 high tendency toward malignant transformation; hereditary = Polyostatic fibrous “Grind dae stoesrenen ea Se eel $93 dysplasia ‘be associated with café au lait skin pigmentation and endocrine abnormalities (McCune-Albxight syndrome) - Osteopetrosis Hereditary; recessive formn may be associated with secondary Sra osteomyelitis, visual and hearing impairment GL Mixed Radilucent/Hadiopaque Lesions: Well-Demarcated Borders - Developing tooth = = = Cemento-osseous Intermediate-stage lesions; especially in middle-aged black: 596 dysplasia wornen; usually in mandibleUsually in anterior region of jaws; most often with maxillary Usually iv teenagers oo Caleitying epithelial Pindborg tumor, often associated with impacted tooth; may show @dontogenic tumor “arvon snow opactios Calcitying odontogenic Gorlin cyst; may be associated with odontoma cyst 2 Osteoblastoma/ostecid Intermediate-stage lesion; usually in younger patients; often painful osteoma . Comentobiastoma Intormediato-stago losion; attached to tooth root K. Mixed Radiolucer sions: Poorly Oemarcated harders Bs Medication-related Exposed necratic bone; most often associated with poemerons of the bisphosphonate drugs S Osteomyelitis ‘With sequestrum formation or with sclerosing type; often painful . Metastatic carcinorna, Especially prostate and breast carcinomas; may be painful : Osteosarcoma/ May be painful chondrosarcoma L, Mixed Radioliicent/Radiopaque L Multifocal or Generalized o Florid cemento-ossuous ——_Initurnediate-stayy esloris; espacially ini middle-aged black dysplasia women; usually in manditte ss Modication-rolated Exposed necrotic bone; most often associated with ects of the bisphosphonate drugs. = Pagat disease of bone 1h older patients; more common in maxilla M, Uniave Radiographic Appearances: "Ground Glass” (Frosted Glaas) Radiopacities * Fibrous dysplasia Onset usually in younger patients fF Hyperparathyroldism May cause loss of larnina dura Cotton Weal” Radiopasities N. Unique Radiographic Appearances ae Cemento-osseous Especially in micidle-aged black wornen; usually in mandible dysplasia . Paget disease of bone in older patients; more common in maxilla * Gardner syndrome Multiple osteomas; epidermoid cysts; gastrointestinal polyps with high tendancy toward ralignant transformation; hereditary . Gigantiform comentoma —_ Hereditary; facial enlargement may be present ©. Unique Radiographic Appearances: "Sunburst" Radiopacities a Osteosarcoma Often painful; usually in young adults 2 Iniraosseous hemangioma Especially in younger pationisPhieboiith ‘May occur in varicosities or hemangiomas ‘ 7 Calcified lymph nodes Example: tuberculosis + ‘Osseous and cartilaginous Most common on tongue S18 ‘choristomas ‘Calcinosis cutis May be seen with systemic sclerosis (especially CREST syndrome) 747 Myositis ossificans Reactive calcification in muscle =Fodor ining of two tooth germs sé ‘Goriation Incorreete sping ofa tooth germ 7 Kopathic macrodoniia—__— 76 Facil herityperplasia_Alloctod side ory; nondrtal tzaues aso erlaged 35 75 ‘Abnormal tal tare ‘Than Normal Teeth ‘Supemarnorary toeth Mesiodons; fourth molars 70 Pogrshaped lateral incisors Cono-chaped teoth 76 Dons inaginaus ‘Gone-shaped teeth; tendency for pulpal death and periapical 82 pathos Iefopathic microdontia Usually ganeraizad 76 Hereditary hypohicroic Gone-shaped teeth, sparse, lond hak; Grinished sweating 600) ectodarral dysplasia Radiotherapy dung ‘Stunted tooth davdopenant 82 chilchood Congenital syphiis Hutchinson's elsors 172. ‘Assodated dwartam 774 ‘Gone’ shaped testh or ricrodont 7% ‘Grample high fevor during tooth development 49 (Cone-shaped teath 76 tooth; tendency toward pulpal death (Cone: shaped tooth; tendency toward pulpal death and peripical 82 Turner tooth Infection or trauma to associated primary tooth 50 ¥P Regional odontodysplasia in i Congenital syphilis Hutchinson's incisors; mulberry molars ~ Vitarrin D-resistant rickets Hereditary condition; high pulp homs: eS 1 Renal osteodystrophy. Abnormal calcium and phosphate metabolism 782 = Hypoparathyroidisrn Possible associated endocrine-candidiasis syndrome 780 > * Pseudohypoparathyroidiam = — Tat Sa ‘Stunted tooth development 52 i & Globodontia Associated with otodental syndrome ot = Lobodontia Cusp anatomy resembles teeth of camivores 91 F. Enamel Loss After Toath Formation ] Es Caries — = =a" Piha = Attrition Physiologic loss of tooth structure 55 ] eon Abrasion, Pathologic loss of tooth structure sé = Erosion Chemical loss of tooth structure 56 | Dentinogenesis imperfecta Hereditary defect in dentin forrnatton; poor junction between 98 enamel and dentin = ‘Aselogenesis imperfecta ea ale Pa ae Sa 92 = Tobacco = - } = Coffee, toa, and cola e ~ ‘Ghromagenic bacteria = | = 7 a rieniniinsis Oiscoloraton {Staining ) ae dgeg Yellow-brown; less translucency = = Death of pup Gray-blact; less translucency: & = micas White; yellow-brown; brown; mottled S2 | ~- Tetracycine Yellow-brown; yellow fluorescence 65 ~ internal resorption “Pink tooth of Mummery”sloining of teeth by cementum Pulpal abliteration by excess dentin; “chevron"-shaped pulp chambers Taurodontism Enlarged pulp chambers; shortened roots = es Enamel peart Ectopic enamel in furcation Be : Benign comentoblastoma ‘Tumor attached to root ze Radiotherapy during ‘Stunted root development. 2 ss Dentinogenesis imperfecta Shortened roots; obliterated pulps B : Dentin dysplasia type | Shortened, pointed roots (‘rootless teeth", obliterated pulps; 102 Periapical pathosis 2 2 ca Intemal resorption Secondary to caries or trauma 58 = ‘Taurodontism Enlarged pulp chambers; shortened roots. 86 a Dentinogenesis imperfecta “Shell teeth” 98 . Regional odontodysplasia “Ghost teeth” 104 2 Vitamin D-resistant rickets High pulp homs 783 : Hypophosphatasia = 788 2 Dentin dysplasia type I “Thistle-tubbe” pulps; pulp stone formation 104 ee Pulp stones ‘Asymptomatic radiographic finding 115 er. Secondary dentin Response to caries 3 = Galcific metamarphosis Pulpal obliteration secondary to aging or trauma 114 i Dentinogenesis imperfecta Pulpal obliteration by excess dentin 98 s Dentin dysplasia type | 4102 Pulpal obliteration of primary teeth; pulp stones in permanent teeth 101Calcium removed from bones; bone may have “ground glass” appearance Osteomelacia Vitamin D deficiency in adults, : Paget disease of bone “Cotton wool” change hides lamina dura a Fibrous dysplasia “Ground glass” change hides lamina dura Ky Premature Exfoliation of Teeth eS Entoliation of Teeth oo or Trauma Avused tooth Aggressive periadontitis Premature alveolar bone loss 187 a Immunocomprorrised AIDS, leukemia, chemotherapy 246 Slates i Diabetes mefitus. Increased susceptibility to infection and severity of periodontitis 785, > Osteomyelitis Bone destruction loosening teeth 128 5 Oyaiic oF chronic Increased susceptibility to infection; premature alveolar bone oss 544 neutropenia 5 eat ok “Histiocytosis X*; eosinophilic granuloma; premature alveolar bone 550 paiaec be x Denti dvecisa' ype! “Rootless teath” as : Regional odontodysplasia_ “Ghost teath™ 104 - Papillon-Lefewre syndrome Palmar and plantar hyperkeratosis; premature periodontitis = > Down syndrome Premature periodontitis : = i dypophosphainsia Lack of cementum production in primary teeth = 710 Souvy Vitamin C deficiency