This document discusses the most common radiolucent pathologies seen in the mandible, including radicular cysts, residual cysts, dentigerous cysts, keratocystic odontogenic tumors (OKCs), ameloblastomas, and traumatic bone cysts. It provides details on the location, patient demographics, clinical and radiographic features, histopathological characteristics, and differential diagnosis of these conditions. A case report is then presented of a 38-year-old female patient with a radiolucent lesion in the left mandibular molar region, which was diagnosed histopathologically as an OKC based on characteristic epithelial features.

1. Most Common Radiolucent
Pathologies of the mandible:
A pattern-based approach &
its essential differential
diagnosis
Presenter-Sushil Chavan
(INTERN KIMSDU SDS KARAD)
Guide-Dr.Nupura mam

2. Contents
-Introduction
-Most common radiolucent lesion with well defined
borders
-Discussion
-Case presentation
-References

3. Introduction
There are different pathologies seen in head
and neck region but to achieve a final diagnosis
a biopsy is considered as gold standard.
But before going for final diagnosis a
differential is essential,
for that radiographic diagnosis is must.

4. IOPAR
OPG
IMAGING
MODALITIES
Commonly used are

5. Coronal & Axial CT
PET Scan & MRI

6. Radicular Cyst
Residual Cyst
Dentigerous Cyst
Keratocyst
Ameloblastoma
Traumatic Bone Cyst
Most Common Pathologies With
Ramus & 3rd Molar Region

7. -Most common.
-Granuloma Cyst
-Asymptomatic
-20-60 yr age group
-Most common in anterior maxilla (rarely
mandibular PM & M)
-Non vital tooth
-Aspirate of cyst-intense albumin pattern and
globulin zones on polyacrylamide gel
electrophoresis in contrast granulomas
-Rushton and hyaline bodies
Radicular Cyst

8. Starts as an asymptomatic lesion incidentally
found with radiographs, gradually it enlarges
causing a hard-bony swelling. Later the bone may
be thinned causing an egg shell crackling under
finger pressure

12. -occurs mostly in edentulous alveolar ridge
-occurs due to extraction of tooth{leaving
periapical pathology untreated or incomplete
removal of periapical granuloma or a cyst}
-usually asymptomatic
-Radiopaque lumen indicative of dystrophic
calcifications
-usually does not recur if infectious foci near cyst
are eliminated
Residual Cyst

14. -most common developmental odontogenic cyst
-Site: Commonly around permanent mandibular
third molars. (Most likely to be impacted)
-2nd and 3rd decade
-M>F
-rushton bodies
Follicular Cyst
Hollowing out of ramus
extending upto coronoid
and condylar process
When cystic
involvement seen
with unerupted
mand.3rd M

15. Syndrome associated ?

19. -occurrence at any age{2nd and 3rd decade}
-M>F
-occurs in 2nd and 3rd molar mandible{rarely in
cuspids}
-Aspirate is cheesy and sometimes straw coloured
fluid
-may be confused with dentigerous cyst,ameloblast
-histological features-corrugated/rippled/wrinkled
epithelial thickness {6-10 cells thickness}
picket fence /tombstone appearance
-epithelial islands-dentinoid formation
OKC

23. -most common variant-acanthomatous
-usually slow growing ,painless ,bony hard swelling
-most common in molar-ramus-angle area
-sometimes this lesion is in similar location with
same histologic feature have been reported under
the term basal cell carcinoma of gingiva
-R/F-soap bubble
compartmented appearance {septa extending
into the tumour mass}
Ameloblastoma

24. -Desmoplastic variant-occurs more anterior than in
molar[it mimicks fibro osseous lesion as it has ill
defined border]
Histopathology
-Follicular
-Plexiform
-Acanthomatous
-Granular
-Basal cell
-Desmoplastic
Follicular{highest recurrence -22.9%}

27. -pseudo cyst
-2nd decade mostly{18 yrs }
-mostly seen in mandible posterior part
-C/c-swelling and rarely pain if secondary
-differential –have to be separated from lingual
salivary gland depression as it is below mandibular
canal
while traumatic bone cyst lies above mandibular
canal
Traumatic bone cyst

31. Biochemical analysis
The cystic fluid in radicular cysts is usually brown in color.The
presence of cholesterol crystals imparts a shimmering gold or
straw color. Yellow mural nodules of cholesterols may project
into the cavity. Total protein content is usually between 5 and
11 g/100 ml.
The cystic fluid of dentigerous cyst is straw colored fluid. The
total protein content in the dentigerous cyst is usually 4-8
g/100 ml.
Dirty white cheesy material was found on aspiration in all the
cases of OKC. Keratin squames are usually found in the
aspirated cystic fluid. Electrophoretic analysis revealed that
the ratio of soluble protein to total protein content was lower
than that in serum. Total protein content is <5 g/100 ml
Comparison of components of odontogenic cyst fluids:A review
Roopan Prakash, K. Shyamala, H. C. Girish, Sanjay Murgod, Sneha Singh, P. S. Vidya
Rani
Department of Oral Pathology, Raja Rajeswari Dental College, Bengaluru, Karnataka,
India

32. A 38 year old female patient
reported to Department of Oral
Pathology and Microbiology, School of
Dental Sciences, Sharda University,
Greater Noida, Uttar Pradesh with
the chief complaint of
swelling in the lower left back
teeth region since 4 months.
Patient was apparently normal
four months back when she
noticed a swelling which gradually
increased to the present
size. Patient had visited the
dentist 6-7 years for extraction of
teeth in the same area. Extra
oral examination revealed no
abnormality
Case report

33. Intra-oral examination
revealed a swelling could on
the left
retromolar region of mandible
which was oval in shape
measuring 2cm × 2 cm
approximately with smooth
surface
. The swelling was soft and
fluctuant on palpation.
Hard tissue examination
showed mild stains, moderate
calculus, missing 16, 35, 36,
37, 46, 47 and recession in
relation to 26, 27.

34. Orthopantomogram defined, unilocular radiolucent lesion in
the edentulous left mandibular molar region.

35. Histopathological examination revealed
parakeratinized stratified squamous epithelium with
underlying
connective tissue capsule The cystic lining was 6-8 cell layer
thick with surface corrugation and basal cell showed
palisading appearance Connective tissue capsule bundles of
collagen fibroblasts, chronic inflammatory infiltrate chiefly
lymphocytes and plasma cells and endothelial lined blood
vessels

36. Differential Diagnosis ?

37. Radicula
r cyst
Residual
cyst
Follicular
cyst
OKC Ameloblas
toma
Traumat
ic bone
cyst
20-60 yr age
group
2nd and 3rd
decade
2nd and 3rd
decade
2nd decade
mostly{18
yrs }
Non vital
tooth
mostly in
edentulous
alveolar
ridge
Commonly
around
permanent
mandibular
third molars.
2nd and 3rd
molar
mandible
molar-ramus-
angle area
mandible
posterior
part
egg shell
crackling
under finger
pressure
incomplete
removal of
periapical
granuloma
or a cyst
(M) Aspirate is
cheesy and
sometimes
straw
coloured fluid
R/F-soap
bubble
R/F -lies
above
mandibula
r canal
Rushton and
hyaline
bodies
Radiopaque
lumen
indicative of
dystrophic
calcifications
rushton
bodies
6-10 cell
thick &
tombstone
appearance
KEY HISTOLOGIC
FEATURE

39. REFERENCES
 Traumatic bone cyst of the mandible of possible iatrogenic origin: a case report
and brief review of the literature –ncbi
 Radiolucent lesion of mandible a pattern based diagnosis-research gate
 General and oral pathology a hygienist-Delong and Burkhart
 Shafers oral pathology
 Neville textbook of oral pathology
 John cacoway reference article photos
 Article odontogenic cyst- slideshare
 Department of Oral Pathology and Microbiology, School of Dental Sciences,
Sharda University, Greater Noida, Uttar Pradesh- okc case report
 Purkait textbook of oral pathology

40. Thank you!!!