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Cystic lesions of the mandible arise from both odontogenic and nonodontogenic sources. Given the wide range of pathologic features but similar imaging findings, familiarity with embryologic characteristics and with secondary imaging findings is crucial. The prevalence and location in the mandible of a particular lesion often help narrow the differe...
Citations
... By providing broad views at a relatively low radiation dose and relatively low cost, panoramic radiography is widely available and often used for the evaluation, diagnosis, and monitoring of jaw lesions [8]. Radiolucent lesions are the most prevalent type, and interpreting and describing them can be challenging, either due to the non-specific clinical presentation or the inherent limitations of this imaging modality, such as image blurring, distortion, and superimposition of structures [9][10][11][12][13][14]. ...
To evaluate the performance of a commercially available Generative Pre-trained Transformer (GPT) in describing and establishing differential diagnoses for radiolucent lesions in panoramic radiographs.
Twenty-eight panoramic radiographs, each containing a single radiolucent lesion, were evaluated in consensus by three examiners and a commercially available ChatGPT-3.5 model. They provided descriptions regarding internal structure (radiodensity, loculation), periphery (margin type, cortication), shape, location (bone, side, region, teeth/structures), and effects on adjacent structures (effect, adjacent structure). Diagnostic impressions related to origin, behavior, and nature were also provided. The GPT program was additionally prompted to provide differential diagnoses. Keywords used by the GPT program were compared to those used by the examiners and scored as 0 (incorrect), 0.5 (partially correct), or 1 (correct). Mean score values and standard deviation were calculated for each description. Performance in establishing differential diagnoses was assessed using Rank-1, -2, and − 3.
Descriptions of margination, affected bone, and origin received the highest scores: 0.93, 0.93, and 0.87, respectively. Shape, region, teeth/structures, effect, affected region, and nature received considerably lower scores ranging from 0.22 to 0.50. Rank-1, -2, and − 3 demonstrated accuracy in 25%, 57.14%, and 67.85% of cases, respectively.
The performance of the GPT program in describing and providing differential diagnoses for radiolucent lesions in panoramic radiographs is variable and at this stage limited in its use for clinical application.
Understanding the potential role of GPT systems as an auxiliary tool in image interpretation is imperative to validate their clinical applicability.
... During regular dental examinations, panoramic radiographs can provide meaningful information about maxillofacial structures and teeth with relatively low radiation exposure. Ameloblastoma (AB), odontogenic keratocysts (OKC) and dentigerous cysts (DC) are representative maxillofacial diseases that usually progress without pain or symptoms, making early diagnosis crucial 8 . ...
... Secondly, there are also non-trivial class imbalances between the lesion categories due to the different incidences of the diseases 14 . For example, AB or OKC cases are less frequent than DC cases 8 . As a result, the number of samples from AB or OKC cases in our dataset is only half that of DC cases. ...
... (13), we then evaluated the prediction of Gaussian heatmaps with the distribution as Eq. (8). ...
The classification and localization of odontogenic lesions from panoramic radiographs is a challenging task due to the positional biases and class imbalances of the lesions. To address these challenges, a novel neural network, DOLNet, is proposed that uses mutually influencing hierarchical attention across different image scales to jointly learn the global representation of the entire jaw and the local discrepancy between normal tissue and lesions. The proposed approach uses local attention to learn representations within a patch. From the patch-level representations, we generate inter-patch, i.e., global, attention maps to represent the positional prior of lesions in the whole image. Global attention enables the reciprocal calibration of path-level representations by considering non-local information from other patches, thereby improving the generation of whole-image-level representation. To address class imbalances, we propose an effective data augmentation technique that involves merging lesion crops with normal images, thereby synthesizing new abnormal cases for effective model training. Our approach outperforms recent studies, enhancing the classification performance by up to 42.4% and 44.2% in recall and F1 scores, respectively, and ensuring robust lesion localization with respect to lesion size variations and positional biases. Our approach further outperforms human expert clinicians in classification by 10.7 % and 10.8 % in recall and F1 score, respectively.
... With the development of endoscopic techniques in recent years, the histological diagnosis is often already known from the first examination. Of diverse histological type, the imaging technique must therefore be adapted to each pathology in order to assess as early as possible a remote extension, the best guarantee of the treatment and the distant prognosis of these pathologies which often remain formidable in these locations [8, [38][39][40][41]. ...
Benign maxillofacial tumors are more common than malignant tumors. Primary or secondary malignant tumors are rare but very varied. In our country Mali, their discovery is always linked to the appearance of clinical signs such as swelling. If the definitive diagnosis is made by histological data, it is first assumed based on clinical and radiological information. The place of CT is fundamental in this diagnostic research and the aim of this work is to highlight its role. We will start from the description of TDM with its principle, its advantages, its disadvantages as well as the indications and also the description of the majority of the various benign and malignant maxillofacial tumors through 65 of the cases collected in our service in Bamako and review of the literature including 36 malignant tumors dominated by odontogenic cyst and 29 cases of malignant tumors with squamous cell carcinoma at the top.
... A cyst is an epithelium lining cavity that contains fluid material. Pathologic analysis of the epithelial lining is mandatory to make a definitive diagnosis 18 . The term 'cystic-appearing lesion' is used to distinguish cyst-like lesions on radiographic imaging 19 . ...
This cross-sectional study aimed to classify the radiographical characteristics of impacted maxillary canines that were surgically exposed following orthodontic traction and to find out which factor is most closely related to traction duration. This study enrolled 74 patients with 87 maxillary canines. Cone-beam computed tomography images, panoramic radiographs, and medical records were analyzed. Cystic-appearing lesion and resorption of adjacent roots were observed in 26.4% and 23.0% of cases, respectively. Impacted maxillary canines were mostly distributed in the lateral incisor area. The mean (± standard deviation) traction duration for the 47 teeth that met the study criteria was 13.9 (± 8.9) months. Impacted maxillary canines treated with surgical exposure and orthodontic traction showed increasing possibilities of palatal impaction and resorption of the adjacent root as they were located mesially ( p < 0.05). The distance from the occlusal plane to the impacted maxillary canine showed the strongest positive correlation with traction duration ( r = 0.519, p < 0.01). When establishing treatment plans for patients with impacted maxillary canines, distance from the occlusal plane to the impacted canines, rather than the angle, should be considered in predicting the duration of treatment.
... All authors have seen and approved manuscript. Bagalad et al., 2016, Cankurtaran et al., 2010, Che et al., 2006, Devenney-Cakir et al., 2011, Dunfee et al., 2006, Fechner and Mills, 1992, Gleason et al., 2008, Goldman, 2019, Greenspan and Borys, 2016, Greenspan and Remagen, 1998, Gross, 2019, Heatley et al., 2004, Holt and Wright, 1948, Jahanshahi et al., 2011, Kawai et al., 2000, Lichtenstein, 1977, Lucas et al., 1994, Meyer et al., 2011, Nielsen and Rosenberg, 2017, Rath et al., 2016, Resnick, 2002, Roth, 1964, Sauer and Dunlap, 1985, Scholl et al., 1999, Surej et al., 2015, Takaichi et al., 2018, Taylor-Brown et al., 2018, Varano, 2016, Wang et al., 2003, Wuehrmann and Manson-Hing, 1973 . ...
Many tyrannosaurid specimens preserve unusual pathologies in the caudal half of the mandible that are of uncertain origin. The two main hypotheses put forth to date both suggest these pathologies are lesions resultant from infection either due to bacteria or protozoans. In light of this controversy, we provide a comparative anatomical study to characterize the pathophysiology of these enigmatic pathologies in order to elucidate their underlying cause. Human individuals that had been subjected to cranial trepanation and specimens of the late Triassic reptile Stagonolepis exhibiting healing fractures provide phylogenetic bracketing for investigating bone surface alterations induced by trauma in dinosaurs. Examination of mandibular pathologies in Tyrannosaurus rex FMNH PR2081 reveals all the characteristics of wound healing in the absence of infection. Additional evidence that refutes the previous hypothesis that these pathologies result from infection by the protozoan, Trichomonas gallinae, is discussed. Behavioral evidence suggests that these pathologies may be wounds induced through intraspecific combat.
... These lesions are usually diagnosed by modern medical means. The differential diagnostic consideration of expansile lesions in humans incorporates infections [e.g., osteomyelitis (Meyer et al., 2011;Nielsen and Rosenberg, 2017), tuberculosis (Greenspan and Remagen, 1998;Resnick, 2002;Xing et al., 2018), echinococcus (Greenspan and Remagen, 1998;Resnick, 2002;Nielsen and Rosenberg, 2017)], metabolic illnesses [(e.g., hyperparathyroidism (Scholl et al., 1999), Paget's disease of bone (Greenspan and Remagen, 1998;Resnick, 2002;Nielsen and Rosenberg, 2017)], benign entities [e.g., osteomas/osteoblastomas (Fechner and Mills, 1992;Lucas et al., 1994;Dunfee et al., 2006), ossifying fibromas (Dunfee et al., 2006;Li, 2011;Goldman, 2019), fibrous dysplasia (Dunfee et al., 2006;Gleason et al., 2008), simple and aneurysmal bone cysts (Wang et al., 2003;Dunfee et al., 2006;Devenney-Cakir et al., 2011;Li, 2011;Surej et Lichtenstein, 1977), ameloblastomas (Scholl et al., 1999;Dunfee et al., 2006;Cankurtaran et al., 2010;Li, 2011;Meyer et al., 2011;Goldman, 2019)], and neoplasia [e.g., sarcoma (Kawai et al., 2000;Dunfee et al., 2006;Li, 2011), metastatic cancers (Kawai et al., 2000;Dunfee et al., 2006;Meyer et al., 2011), hemangioendotheliomas (Taylor-Brown et al., 2018, neuroectodermal tumour (Bagalad et al., 2016;Che et al., 2006;Dunfee et al., 2006;Greenspan and Borys, 2016;Holt and Wright, 1948;Jahanshahi et al., 2011;Rath et al., 2016;Takaichi et al., 2018), chondromyxoid fibromas (Scholl et al., 1999;Simon et al., 2003), malignant fibrous histiocytoma (Li, 2011)]. ...
Parataxidea is a Late Miocene-Early Pliocene genus of omnivorous mustelids best known from the fossil record of China. Here we report a new skull of Parataxidea sp. from the Liushu Formation, Linxia Basin, which is unusual in having abnormal cellular hyperplasia in the region of P4-M1 on maxillae and a bulbous bone growth on the right side. The hyperplasia and bulbous growth resulted in the damage of the left P4, infilling of left M1 alveolus, and closed right P4-M1 alveoli. Initial medical CT scanning revealed the outer edge of the hyperplasia to be denser than the other bone tissue. Additional scanning using a micro-CT revealed evidence of fibrous tissue and mineraliz、sed irregular cementicle within the hyperplasia. These characteristics are consistent with ossifying fibroma, a kind of benign odontogenic tumour well-documented in the medical literature and that commonly occurs in the faces and jaws of humans. In the case of the Parataxidea specimen, the tumours do not appear to have been the direct cause of death, but the resulting tooth loss likely interfered with normal feeding. This is the first record of Ossifying Fibroma Mustelidae.
... Males and females were equal affected with slight predilection for males. Mandible was affected more than maxilla, particularly around the crown of an impacted, unerupted teeth or absent teeth, especially on posterior region of the jaws (lower molars, premolars, third molar, upper canine, upper third molars and lower canine) [6][7][8][9][10][11]. Non-odontogenic cysts were developing from the proliferation of the epithelial remnant which entrapped on the fusion lines of the developing facial process during the embryonic period of the life. ...
... Histopathologically, ameloplastoma can divided into three distinct types; solid, cystic, and peripheral ameloplastoma, they observed most between the3rd and 5th decades of life with very broad of the age range, that extended from childhood to the adulthood, mainly between 20 -50 years, with mean age of 27 years. Males and females were equal affected [5,[13][14][15][16][17]. Ameloplastoma can occur in anywhere on the jaw bones, most commonly on the posterior region of both jaws (80% on the mandible and 20% on the maxilla [1,6,8,9]. Odontogenic myxoma was the second most common type of odontogenic tumors in the literature reviews, they derived from primitive dental pulp or primitive dental papilla. It's a benign tumor but have locally aggressive less than ameloplastoma and comprise 15-20% of odontogenic tumors. ...
... The majority of cases 62.1% were located on the mandible, particularly on the posterior region. This is in agreement with many previous reports, that found in a large series of previous studies [6][7][8]10,11]. ...
Objective: The aims of this study were to determine the common causes of jawbone swellings, common affected sites, the relationship of these causes to the age, gender of the patients and compare the findings of this study with many previous studies from various countries. Material and methods: The study design as a prospective descriptive hospital-based study, carried out at Al-gomhori teaching hospital in Sana'a Republic of Yemen. Material consists of 125 patients who attending to the department of oral and maxillofacial surgery and to the consultant unit of head and neck oncologic surgery and diagnosed clinically, radiographically as having jawbone swellings. Histopathological results of biopsy were used to confirm the diagnosis. Data; were collected from clinical examination of the patients (interview, inspection and palpation of the suspected swelling), patient history(using questionnaire sheet), radiographs and histopathological examinations. They entered the computer and analysis using statistical package for social science (SPSS) version 24. Results; were presented as simple frequencies and descriptive statistics. Chi-square test used to assess the association and the level of significance among categorical variables. P-value less than 0.05 were considered to be statistically significant. Results: Sixty eight of 125 patients(54.4%) were males and 57 (45.6%) were females, giving a male to female ratio of 1.2:1. Patients age ranged from 3 to 80 years with a mean age of 28.8 years ± 17.9 years. The majority of patients (80.0%) were in their 1st to 4th decades of life, with a peak incidence(40.8%) was found in the third and fourth decades of life. The most common causes of jawbone swellings were, jaw cysts, benign tumors (odontogenic and non-odontogenic tumor/tumor like-lesions) and malignant tumors, accounting 40.0%, 39.2% and 20.8% respectively. Conclusion: Jawbone swellings were observed more commonly in male patients, with a male to female ratio of 1.2:1 They may be found on any age of patients, with average age of 28.8 years (age range from 3-80 years). Jaw cysts were the most common causes of jaw bones wellings, following by benign tumors (odontogenic and nonodontogenic tumor/ or tumor lick-lesion) and malignant tumors which accounting 40.8%,39.2% and 20.8%.
... Cysts are cavities that contain liquid or semi-liquid material. This material is surrounded by an inner membrane of epithelial tissue and an external wall of fibrous connective tissue (Devenney-Cakir et al., 2011;Dias et al., 2007;Dunfee et al., 2006;Dunlap, 2000). ...
Blessed Egidio was a revered Catholic friar who lived in Basilicata (southern Italy) between the 15th and 16th centuries A.D. His natural mummy is preserved in the Mother Church of Laurenzana, the village where he lived. During the recent restoration and conservation of the relic, palaeopathological analysis was carried out. This revealed osteolytic lesions that affected the maxillary bones, as two injuries that were different in morphology and size that distinctly afflicted the right and left maxillae. The macroscopic and radiographic appearance of the lesion on the right maxilla and its proximity to the right premolar tooth that showed periapical granuloma suggest a diagnosis of an inflammatory odontogenic cyst (radicular cyst). The second lesion, of the left maxilla, was non‐specific and might have been the consequence of an inflammatory process. Odontogenic cysts are common in modern human populations, but have been poorly described to date in ancient populations. The case of Blessed Egidio represents a new and rare case diagnosed in the field of palaeopathology.
... Radiologically, they appear as multilocular radiolucencies with internal bone septa and poorly defined margins. They are usually associated with unerupted or impacted teeth (Devenney-Cakir et al., 2011). Bone destruction can be observed, which may displace teeth, although root resorption is usually not a feature (Koong, 2017;Noffke et al., 2007). ...
... Vestibular and lingual cortical expansion is frequently present. The reabsorption of the roots of the teeth adjacent to the tumour is common (Devenney-Cakir et al., 2011). Ameloblastoma occurs predominantly in the third to fifth decades of life. ...
Objective
This article discusses the differential diagnosis of an unusual lesion found in the mandible of an adult male individual (late 19th to early 20th century).
Materials
A cranium from the Identified Skulls Collection Escolas Médicas of the University of Coimbra, Portugal.
Methods
Macroscopic analysis, conventional radiography.
Results
Macroscopically, a conspicuous osteolytic lesion was identified in the middle vestibular area of the mandible. The conventional radiography examination revealed a multilocular and non-expansive lesion, with undefined contours and irregular walls.
Conclusions
These characteristics are compatible with a benign lesion, possibly an ameloblastoma or an odontogenic keratocyst.
Significance
The present work contributes substantially to the knowledge of the development of cystic and tumour lesions in the past and generates a broader body of knowledge about these lesions.
Limitations
Destructive methods were not authorized.
Suggestions for Further Research
In the future, computed tomography scans and 3D reconstruction analysis, not performed in the current study, may add new and valuable information.
... 3 On CT, it appears as a unilocular radiolucent periapical lesion with well-defined, sclerotic borders in close vicinity of the apical portion of the root of a nonvital carious tooth, most commonly the upper lateral incisor. 3,10 Residual cyst is the periapical cyst retained in the jaw after surgical removal of a nonvital tooth. 3 ...
... 2). 3,10 The crown generally protrudes into the cyst, whereas the root of the affected tooth is outside the lesion, and the distance between the crown and the dental sac is usually greater than 3 mm. 3 Convergence of cyst walls at the cementoenamel junction is an important diagnostic clue. ...
... 3 OKC appears as unilocular or multilocular lytic lesion with well-corticated margins typically involving the posterior body or ascending ramus of the mandible. 3,9,10 Important diagnostic clue is tendency of growth within the medullary space along the length of bone in an anteroposterior direction with minimal buccolingual expansion, which helps differentiation of a unilocular OKC with the crown of an unerupted tooth from the dentigerous cyst. 7,10 Root resorption is uncommon, and weak enhancement of the uniformly thin and regular cyst walls with no obvious soft tissue helps differentiation from unilocular ameloblastoma. ...
Jaw lesions in the pediatric population, although infrequently encountered in clinical practice, can cause functional impairment and cosmetic disfiguring. It is further complicated by the difficulty in diagnosis due to complex anatomy and facial developmental process during infancy and childhood. Intraosseous pediatric jaw lesions may vary from odontogenic to nonodontogenic types with nonspecific clinical features in most cases. They deserve careful attention by a systematic approach to provide a relevant diagnosis or differential diagnosis for timely management. Imaging plays a major role in diagnosis with orthopantomograph being the foremost investigation, followed by cross-sectional imaging, essentially computed tomography as a problem-solving tool. This article highlights the imaging spectrum of various jaw lesions in the pediatric population with a pattern-based approach for radiological diagnosis.
