RADIOLOGICAL DIFFERENTIAL DIAGNOSIS OF COMMON LESIONS IN ORO MAXILLO FACIAL REGION

1. PERIAPICAL RADIOLUCENCIES

·           Granuloma

·           Radicular cyst

·           Abscess

·           Apical scar

·           Surgical defect

·           Periodontal disease

·           Chronic suppurative osteomyelitis

·           Periapical cemental dysplasia (osteolytic stage)

·           Cementoblastoma (osteolytic stage)

·           Cementifying and ossifying fibromas (osteolytic stage)

·           Odontogenic and nonodontogenic cysts

·           Odontogenic and nonodontogenic benign tumors

·           Malignant tumors

2. PERIAPICAL RADIOPACITIES

·         Periapical cemental dysplasia (calcified stage)

·         Cementoblastoma (calcified stage)

·         Cementifying and ossifying fibromas (calcified stage)

·         Condensing osteitis

·         Osteosclerosis

·         Socket sclerosis

·         Florid osseous dysplasia (diffuse cementosis)

·         Tori

·         Hypercementosis

3. PERICORONAL RADIOLUCENCIES

Do NOT contain radiopacities:

·         Follicular space

·         Dentigerous cyst

·         Unicystic (mural) ameloblastoma

·         Odontogenic keratocyst

·         Ameloblastoma

·         Ameloblastic fibroma

MAY contain radiopacities:

·         Ameloblastic fibro-odontoma

·         Adenomatoid odontogenic tumor

·         Calcifying epithelial odontogenic tumor (Pindborg tumor)

·         Calcifying odontogenic cyst (Gorlin cyst)

4. SOLITARY CYSTLIKE RADIOLUCENCIES

Normal anatomy and Variations

·         Tooth follicle (early stage)

·         Large marrow space (wide inter-trabecular space)

·         Post extraction socket

·         Surgical defect

Odontogenic cysts:

·         Primordial

·         Lateral periodontal

·         Residual

·         Odontogenic keratocyst

Fissural cysts:

·         Incisive canal (nasopalatine)

·         Globulomaxillary

·         Median palatine

·         Median mandibular

False cysts:

·         Traumatic bone cyst

·         Stafne bone cavity

Odontogenic tumors:

·         Ameloblastoma

·         Odontogenic adenomatoid tumor

·         Calcified epithelial odontogenic tumor(Pindborg tumor)

·         Ameloblastic fibroma

·         Cementifying and ossifying fibromas (osteolytic stage)

Giant cell and nonodontogenic tumors:

·         Central giant cell granuloma

·         Giant cell lesion of hyperparathyroidism

·         Non-odontogenic benign tumors

5. SOLITARY RADIOLUCENCIES WITH DIFFUSE IRREGULAR BORDERS

·         Chronic alveolar abscess

·         Chronic osteomyelitis

·         Osteoradionecrosis

·         Squamous cell carcinoma

·         Metastatic tumors to the jaws

·         Fibrous dysplasia (early stage)

·         Histiocytosis X

·         Osteosarcoma and chondrosarcoma

·         Ewing's sarcoma

·         Burkitt's lymphoma

6. MULTILOCULAR RADIOLUCENCIES

Cysts:

·         Odontogenic keratocyst (basal cell nevus syndrome)

·         Aneurysmal bone cyst

Tumors:

·         Ameloblastoma

·         Odontogenic myxoma

·         Central hemangioma of bone

·         Metastatic tumors to the jaws

Others:

·         Cherubism

·         Central giant cell granuloma

·         Giant cell lesion of hyperparathyroidism

7. SOLITARY RADIOPACITIES

·         Exostoses and tori

·         Osteoma

·         Retained root

·         Osteosclerosis

·         Socket sclerosis

·         Mature cementoma

·         Complex composite odontoma

·         Compound composite odontoma

·         Calcifications in soft tissue

·         Foreign objects in the jaws

·         Fibrous dysplasia

·         Garré's osteomyelitis

8. MIXED RADIOLUCENT - RADIOPAQUE LESIONS

Inflammatory:

·         Condensing osteitis

Osteomyelitis:

·         Chronic suppurative osteomyelitis

·         Tuberculous osteomyelitis

·         Syphilitic osteomyelitis

·         Actinomycotic osteomyelitis

·         Osteoradionecrosis

Cementomas (intermediate and calcified stages):

·         Periapical cemental dysplasia

·         Cementifying and ossifying fibroma

·         Cementoblastoma

·         Florid osseous dysplasia (diffuse cementosis)

Others:

·         Fibrous dysplasia

·         Paget's disease

·         Osteosarcoma

·         Chondrosarcoma

·         Osteoblastic metastatic carcinoma

Pericoronal mixed lesions:

·         Ameloblastic fibro-odontoma

·         Odontogenic adenomatoid tumor

·         Calcifying epithelial odontogenic tumor (Pindborg tumor)

·         Calcifying odontogenic cyst (Gorlin cyst)

9. GENERALIZED RADIOPACITIES

·         Florid osseous dysplasia (diffuse cementosis, sclerotic cemental masses)

·         Paget's disease

·         Osteopetrosis

·         Gardner's syndrome

·         Infantile cortical hyperostosis

·         Albright’s syndrome