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Neuroradiology

E1048. Essential Knowledge for Defining Odontogenic Lesions of the Mandible

Holwerda R,  Loeb J,  Kumar V,  Acosta N. University of Missouri - Kansas City, Kansas City, MO

Address correspondence to R. Holwerda (ross.holwerda@gmail.com)

Background Information: Mandibular lesions deriving from odontogenic origin is an often-overlooked area of head and neck imaging. Understanding tooth development and anatomy can provide a foundation for classifying odontogenic lesions by tissue of origin and better comprehension of the underlying pathophysiology of these lesions.

Educational Goals/Teaching Points: The goals of this exhibit are to review basic tooth anatomy and development, provide a high yield review of epidemiology, clinical manifestations, pathophysiology, and imaging findings of odontogenic lesions, and classify these lesions by tissue of origin, including enamel, dentin, and cementum. We focus on distinctive imaging characteristics that help distinguish different lesions, such as location (periapical or pericoronal), association with impacted or supernumerary teeth, and internal calcification or cystic change. Lastly, we will concentrate on common nonodontogenic lesions with similar imaging features to include in the differential diagnosis for each lesion. For example, cementoosseous dysplasia has nonodontogenic origin but may mimic cementoblastoma.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: In this exhibit, we will review the following: cementum and cementoblastoma (characteristic periapical sclerotic lesion with thin, lucent halo), enamel and ameloblastoma (true neoplastic lesion with four primary pathologic categories including unilocular, multilocular, and desmoplastic; associated with apical tooth erosion), and dentigerous cyst (cystic lesion surrounding crown of impacted tooth). We will also review dentin or mixed lesions including odontoma (hamartomatous pericoronal lesion classified as compound or complex based on identifiable tooth components), odontogenic keratocyst (unilocular, expansive cystic mass), and calcifying epithelial odontogenic tumor (mixed lucent and sclerotic lesion).

Conclusion: This exhibit will provide a high-yield review of common odontogenic lesions, including their CT and radiographic appearances, to facilitate characterization and diagnosis by the practicing radiologist. Pathology and other matters of clinical significance, such as differential diagnoses, will also be explained.