Professional Documents
Culture Documents
Radio Session 5
Radio Session 5
Cases 2
Swellings of the Jaws
Tumours
“In medicine, clinicians are constantly • Cysts
reminded to look for the horses, not the • Non-odontogenic tumours
zebras. • Odontogenic tumours
While that remains good advice, especially • Giant cell lesions
to those just beginning their careers, a
mind that is open to the unusual remains • Fibro-osseous lesions
important when developing a differential • Metastatic lesions
diagnosis.” • Chronic Osteomyelitis
1
History
• A 45 year-old woman of negro ancestry
presented for routine dental care.
• Bony lesions below the apices if the lower
incisors were noted on full mouth p.a.
radiographs.
• No signs or symptoms associated with the
lesions.
• The teeth tested vital within normal limits.
History
• A 55 year old man attended a dental
prosthetist asking for part upper and lower
dentures.
• The prosthetist noticed that “his lower jaw
felt a bit lumpy" and asked the patient to
Cemento-osseous Dysplasia 2
be examined by his dentist.
• There was no pain & the swellings were
firm.
Cemento-osseous dysplasia 3
2
History
• A 23 year old Indian woman was referred
to an oral surgeon for removal of
troublesome lower third molars.
• On OPG, there appeared to be well
corticated lesions surrounding the apices
of 34,36 & 46.
• The teeth were non-carious & there was
no advanced periodontal disease.
• When tested, the teeth were vital.
History
• A 45 year old Caucasian woman was
referred for oral and maxillofacial
evaluation of a recurrent dental condition
by a general dental practitioner.
• The dentist had taken a radiograph and
Fibrous Dysplasia
thought that the physical findings may
have been consistent with a fibro-osseous
lesion of the jaw.
Fibrous Dysplasia 2
3
History
• An 40 year old patient broke his denture in
an accident & attended asking for a
replacement. It was decided to remove
the remaining upper tooth & make him F/P
dentures.
• Clinical examination revealed a firm
swelling on the buccal aspect of the
mandible on both sides.
Salivary Calculus
4
Sialography
History
• An 45 year old emergency patient attends
for an extraction of a carious 14.
Case 16 • The tooth was impossible to loosen, and
when more pressure was applied the
adjacent teeth began to wobble
Hypercementosis
Biopsy no:88/48 • A radiograph was then taken.
• The patient is then referred to an oral
surgeon.
5
Implications of Hypercementosis in a Barbados Slave
Skeletal Collection.
Corruccini RS, Jacobi KP, Handler JS, Aufderheide AC.
Department of Anthropology, Southern Illinois University, Carbondale 62901.
History
• A 16 year old immigrant boy from the Horn
of Africa had a routine medical
Case 17 examination.
• While examining his throat, the doctor
noticed that his teeth were of an odd
Congenital Syphilis
shape and referred him to the dental
hospital.
Congenital Syphilis
• Hutchinson’s peg shaped incisors
• “Mulberry” molars
• Depressed bridge of nose
• Prominent frontal bones
• Abnormal maxilla development
• Deafness
• Anterior tibial bowing
• Clutton joints (arthritis of both knees)
6
Case 18A
History
• A patient went to his doctor complaining about a
painless swelling on the right hand side of his
jaw.
• He felt that it was getting larger quite rapidly.
• An OPG radiograph revealed a large radiolucent
lesion with scalloped borders in the body of the
mandible.
• There was root resorption of involved teeth.
Case18 B
Fibro-osseous lesion
7
Case 19
Odontogenic Keratocyst
Biopsy No: 85/657
Odontogenic Keratocyst 2
8
History
• An old patient who has not attended for a
long time presents complaining of a slowly
growing swelling on the right hand side of
his lower jaw.
• He also says that he thinks his “teeth are
moving”.
• Clinical exam reveals a smooth painless
lump over the 44,45 region. The overlying
mucosa is normal.
Further Investigations
• Following examination of the radiograph,
the patient was referred to an oral surgeon
who performed an aspiration biopsy which
produced a thick, cheesy material that
“smelt like old socks”.
Keratocyst 3
History
• A 8 year old child was brought in for a dental
examination because her mother thought that
her teeth were “slow”. She was concerned that
the upper lateral incisors might be missing.
• Clinical examination revealed the deciduous
lateral incisors to be still in place and firm, and
there was a swelling on the left hand side of the
mandible.
• A radiograph was taken which revealed a large
lesion on the lower right hand side. A swelling
was obvious on palpation but the child’s face
appeared normal.
9
History
• A young man of 20 years noticed a
smooth swelling in the buccal vestibule
and lower border of the left mandible.
• It was not painful nor were there any
dental symptoms.
Simple (Traumatic) Bone Cyst • All the teeth on the left hand side were
vital.
• An aspiration biopsy produced only a
small amount of blood.
Residual Cyst
History
• A 35 year old patient attended as she had
noticed a swelling behind the last standing
molar on the lower left hand side.
• It was increasing in size and she was
beginning to bite on the mucosa which
caused pain.
• She was certain she had had her wisdom
teeth extracted some years previously.
10
Case 20
Ameloblastoma 1
Biopsy No:85/656
11
History
• A 6 year old child attends the school
dental therapist who notices that 85 has
Case 19 not erupted. The mother was unaware of
this.
• Clinical examination reveals a smooth
Dentigerous Cyst 1
swelling over the area. It is not
erythematous nor painful.
12
Case 20
Dentigerous cyst 2
History
• A new patient attends for an examination.
• He mentions that he has a swelling at the
back of his last molar on the upper right
hand side that seems to be getting bigger
and it is now annoying him when he bites
on it.
• He says he has never had an extraction in
the area.
History
• An 18-year-old girl was referred by her
general dentist to an oral surgeon for the
removal of four third molar teeth.
• He had noticed a unilocular radiolucent
lesion associated with impacted tooth 48.
Dentigerous Cyst 3 • The radiolucency was corticated and was
displacing 48 inferiorly.
• There was no evidence of facial swelling
or pain.
13
Odontogenic Myxoma
History
• A 20 year old patient presents complaining
of a swelling on the left hand side of the
mandible. It is painless but he feels it is
growing rapidly.
14
History
• A fifty-one year old female patient without any
medical history of interest was referred to the
dental hospital for extraction of an impacted 38.
• The referring dentist had taken a radiograph and
formed the tentative diagnosis of a dentigerous
cyst.
• Clinical examination revealed a bony swelling in
the vestibular region in the left side of the jaw.
• The overlying oral mucosa was normal.
History
• An elderly homeless patient attends the
dental hospital complaining of an ulcer on
Case 21 the mandibular ridge on the left hand side.
• It has been there for a while & he thinks it
is getting bigger.
Squamous Cell Carcinoma 2
• He has a history of tobacco smoking and
alcohol abuse.
Case 22
15
• A forty nine year old male patient was referred to
the oral surgery dept. after having had an
extraction of 48.
• The pain and swelling in the region of the 48 had
not resolved after several months following the
extraction.
• Clinical examination revealed a bony swelling
and a normal mucosa.
• The patient admitted to a smoking habit of 35
cigarettes per day and drinking 4 glasses of
brandy per day.
History
• A homeless drug addict attended casualty
with a markedly swollen face on the left
hand side. The skin overlying the area was
erythemations and there was a draining
fistula anterior to the ear.
• He was febrile and found
Acute Osteomyelitis
it difficult to open his
mouth.
16
Osteonecrosis
“Phossy Jaw”
17
Pyknodysostosis
Clinical Features
• Skull deformities
– persistent fontanelles (failure of closure of the cranial
sutures)
– an obtuse gonial angle
– hypoplastic maxilla
– hypoplastic paranasal sinus
• History of multiple fractures of limbs and
clavicles
• Oral manifestations
– anterior crossbite
– increased incidence of dental caries
18