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DOI: 10.1148/rg.266055189
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Radiologic and Pathologic Characteristics of Benign and Malignant Lesions of the Mandible1

Brian L. Dunfee, MD, Osamu Sakai, MD, PhD, Robert Pistey, MD and Anita Gohel, BDS, PhD

1 From the Departments of Radiology (B.L.D., O.S.) and Pathology (R.P.), Boston University School of Medicine, Boston Medical Center, 715 Albany St, Boston, MA 02118; and the Department of Diagnostic Sciences and Pathology, Boston University Goldman School of Dental Medicine, Boston, Mass (A.G.). Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received October 19, 2005; revision requested March 7, 2006 and received May 30; accepted May 31. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1a.  Odontogenesis and tooth anatomy. (a) Drawings illustrate the major stages of tooth development: the bud stage, cap stage, bell stage, and crown stage. Pink = oral epithelium, brown = dental mesenchyme, dark blue = ameloblasts, light blue = odontoblasts, yellow = dentin, white = enamel, red = pulp. Although mandibular lesions may originate from cells of early tooth development, they often do not manifest until later in life. (b) Radiograph demonstrates the anatomy of a mature tooth. Lesions of the mandible typically arise from characteristic locations within and surrounding a tooth.

 

Figure 1
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  		Figure 1b.  Odontogenesis and tooth anatomy. (a) Drawings illustrate the major stages of tooth development: the bud stage, cap stage, bell stage, and crown stage. Pink = oral epithelium, brown = dental mesenchyme, dark blue = ameloblasts, light blue = odontoblasts, yellow = dentin, white = enamel, red = pulp. Although mandibular lesions may originate from cells of early tooth development, they often do not manifest until later in life. (b) Radiograph demonstrates the anatomy of a mature tooth. Lesions of the mandible typically arise from characteristic locations within and surrounding a tooth.

 

Figure 2
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  		Figure 2a.  Periapical cyst in a 60-year-old woman. Computed tomographic (CT) scan (a) and coronal reformatted CT image (b) demonstrate a radiolucent lesion (arrows) surrounding the apex of a molar. A defect with dental filling (arrowhead) is present within the crown of the tooth.

 

Figure 2
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  		Figure 2b.  Periapical cyst in a 60-year-old woman. Computed tomographic (CT) scan (a) and coronal reformatted CT image (b) demonstrate a radiolucent lesion (arrows) surrounding the apex of a molar. A defect with dental filling (arrowhead) is present within the crown of the tooth.

 

Figure 3
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  		Figure 3.  Periapical cyst in a 40-year-old man. Panorex image demonstrates a circular radiolucent lesion (arrow) at the apex of a molar. Note the dental filling (arrowhead) from a prior procedure.

 

Figure 4
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  		Figure 4.  Follicular cyst in a 40-year-old man. Coronal reformatted CT image reveals a cystic lesion with an unerupted tooth in the right molar region (arrow). The crown of the tooth is contained within the lesion. Note the presence of bone remodeling rather than expansion.

 

Figure 5
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  		Figure 5.  OKCs in a 22-year-old man. Panoramic reformatted CT image demonstrates cystic lesions with well-demarcated borders (arrows) within the mandible. There is no evidence of adjacent tooth root erosion. Note the slight expansile change and remodeling of the mandibular cortex without bone destruction.

 

Figure 6
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  		Figure 6.  OKC in a 41-year-old man with basal cell nevus syndrome (Gorlin-Goltz syndrome). Contrast material–enhanced CT scan shows multiple cysts (arrows) in the mandible. Cystic lesions (arrowheads) are also identified within the maxilla. CT also demonstrated a calcified falx and large frontal sinuses, findings that helped establish the diagnosis.

 

Figure 7
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  		Figure 7.  Static bone cavity (Stafne cyst) in a 35-year-old man. CT scan reveals a cortical defect (arrow) in the lingual surface of the right mandibular angle, a finding that does not represent a true cyst.

 

Figure 8
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  		Figure 8.  Solitary (hemorrhagic) bone cyst in a 25-year-old woman. Coronal reformatted CT image demonstrates a cystic lesion (arrows) within the mandibular body. The mandibular cortex is thinned. Note the normal tooth (arrowhead) within the lesion, a finding that helps distinguish the cyst from radicular or other odontogenic cysts.

 

Figure 9
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  		Figure 9.  Compound odontoma in a 28-year-old woman. Panorex image demonstrates a focus of radiopaque enamel surrounded by a thin radiolucent follicle (arrow). Note the impacted tooth (arrowheads) deep to the odontoma.

 

Figure 10
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  		Figure 10a.  Ameloblastoma in a 20-year-old man. (a) CT scan demonstrates a multiloculated cystic lesion (arrow) within the left mandible. The crown of an impacted tooth (arrowhead) identified within the lesion is a clue to the diagnosis. (b) Photograph shows a soft-tissue mass in the resected mandible. (c) High-power photomicrograph (hematoxylin-eosin [H-E] stain) reveals numerous well-defined islands of odontogenic epithelium with palisading and polarizing nuclei (arrows).

 

Figure 10
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  		Figure 10b.  Ameloblastoma in a 20-year-old man. (a) CT scan demonstrates a multiloculated cystic lesion (arrow) within the left mandible. The crown of an impacted tooth (arrowhead) identified within the lesion is a clue to the diagnosis. (b) Photograph shows a soft-tissue mass in the resected mandible. (c) High-power photomicrograph (hematoxylin-eosin [H-E] stain) reveals numerous well-defined islands of odontogenic epithelium with palisading and polarizing nuclei (arrows).

 

Figure 10
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  		Figure 10c.  Ameloblastoma in a 20-year-old man. (a) CT scan demonstrates a multiloculated cystic lesion (arrow) within the left mandible. The crown of an impacted tooth (arrowhead) identified within the lesion is a clue to the diagnosis. (b) Photograph shows a soft-tissue mass in the resected mandible. (c) High-power photomicrograph (hematoxylin-eosin [H-E] stain) reveals numerous well-defined islands of odontogenic epithelium with palisading and polarizing nuclei (arrows).

 

Figure 11
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  		Figure 11a.  Desmoplastic ameloblastoma in a 30-year-old woman. CT scan (a) and contrast-enhanced T1-weighted magnetic resonance (MR) image (b) demonstrate an expansile enhancing lesion within the right mandibular body (arrows) that causes significant buccal cortical destruction. (Fig 11 courtesy of Akifumi Fujita, MD, Jichi Medical University, Shimotsuke, Japan.)

 

Figure 11
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  		Figure 11b.  Desmoplastic ameloblastoma in a 30-year-old woman. CT scan (a) and contrast-enhanced T1-weighted magnetic resonance (MR) image (b) demonstrate an expansile enhancing lesion within the right mandibular body (arrows) that causes significant buccal cortical destruction. (Fig 11 courtesy of Akifumi Fujita, MD, Jichi Medical University, Shimotsuke, Japan.)

 

Figure 12
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  		Figure 12.  Ameloblastic fibroma in a 15-year-old boy. Coronal reformatted CT image reveals a slightly lobulated, well-defined expansile lesion (arrows) within the right mandibular body. Note the prominent internal calcifications.

 

Figure 13
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  		Figure 13.  Adenomatoid odontogenic tumor in a 14-year-old boy. CT scan demonstrates a unilocular radiolucent lesion with a linear calcification (arrow) centered between the lateral incisor tooth and canine tooth. Note that the impacted tooth (arrowhead) is unaffected, a finding that indicates that the tumor developed after completion of odontogenesis.

 

Figure 14
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  		Figure 14.  Ossifying fibroma in a 33-year-old woman. CT scan reveals a circular, partially calcified lesion (arrow) within the mandible. Note the internal ground-glass calcifications.

 

Figure 15
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  		Figure 15.  Periapical cemental dysplasia in a 48-year-old woman. Occlusal radiographs demonstrate a well-defined radiopaque lesion (arrows) at the apex of a tooth. The advanced degree of calcification indicates maturity of the lesion.

 

Figure 16
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  		Figure 16a.  Ameloblastic carcinoma in a 17-year-old boy. (a) Contrast-enhanced CT scan (bone windowing) shows a multiloculated, enhancing soft-tissue mass (arrows) with adjacent bone destruction. (b) Axial contrast-enhanced T1-weighted MR image demonstrates the enhancing soft-tissue mass (arrows). (c) High-power photomicrograph (H-E stain) reveals innumerable ameloblastic cells with reversed polarity and nuclear pleomorphism (arrows).

 

Figure 16
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  		Figure 16b.  Ameloblastic carcinoma in a 17-year-old boy. (a) Contrast-enhanced CT scan (bone windowing) shows a multiloculated, enhancing soft-tissue mass (arrows) with adjacent bone destruction. (b) Axial contrast-enhanced T1-weighted MR image demonstrates the enhancing soft-tissue mass (arrows). (c) High-power photomicrograph (H-E stain) reveals innumerable ameloblastic cells with reversed polarity and nuclear pleomorphism (arrows).

 

Figure 16
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  		Figure 16c.  Ameloblastic carcinoma in a 17-year-old boy. (a) Contrast-enhanced CT scan (bone windowing) shows a multiloculated, enhancing soft-tissue mass (arrows) with adjacent bone destruction. (b) Axial contrast-enhanced T1-weighted MR image demonstrates the enhancing soft-tissue mass (arrows). (c) High-power photomicrograph (H-E stain) reveals innumerable ameloblastic cells with reversed polarity and nuclear pleomorphism (arrows).

 

Figure 17
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  		Figure 17a.  Osteosarcoma in a 41-year-old man. (a) CT scan reveals osteoblastic changes (arrows) within the right mandibular body. Note the abnormal soft-tissue ossification (arrowhead). (b) Contrast-enhanced T1-weighted MR image demonstrates an ill-defined lesion (arrow) arising from periosteum. Note the decreased marrow signal intensity (arrowhead) involving the entire right mandibular body.

 

Figure 17
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  		Figure 17b.  Osteosarcoma in a 41-year-old man. (a) CT scan reveals osteoblastic changes (arrows) within the right mandibular body. Note the abnormal soft-tissue ossification (arrowhead). (b) Contrast-enhanced T1-weighted MR image demonstrates an ill-defined lesion (arrow) arising from periosteum. Note the decreased marrow signal intensity (arrowhead) involving the entire right mandibular body.

 

Figure 18
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  		Figure 18a.  Mucoepidermoid carcinoma in a 66-year-old man. CT scan (soft-tissue windowing) (a) and sagittal reformatted CT image (bone windowing) (b) show a large soft-tissue mass (arrows) that has destroyed the posterior body of the left mandible and extends into the buccal space. Note the invasion of the mandibular canal (arrowhead).

 

Figure 18
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  		Figure 18b.  Mucoepidermoid carcinoma in a 66-year-old man. CT scan (soft-tissue windowing) (a) and sagittal reformatted CT image (bone windowing) (b) show a large soft-tissue mass (arrows) that has destroyed the posterior body of the left mandible and extends into the buccal space. Note the invasion of the mandibular canal (arrowhead).

 

Figure 19
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  		Figure 19a.  Multiple myeloma in a 67-year-old man. (a) Panoramic reformatted CT image demonstrates sclerotic (arrow) and lytic (arrowhead) lesions in the mandible. (b) Axial T1-weighted MR image shows loss of the marrow fat within the right mandibular angle (arrow) and mandibular foramen (arrowheads).

 

Figure 19
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  		Figure 19b.  Multiple myeloma in a 67-year-old man. (a) Panoramic reformatted CT image demonstrates sclerotic (arrow) and lytic (arrowhead) lesions in the mandible. (b) Axial T1-weighted MR image shows loss of the marrow fat within the right mandibular angle (arrow) and mandibular foramen (arrowheads).

 

Figure 20
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  		Figure 20.  Metastatic hepatocellular carcinoma in a 61-year-old man. Contrast-enhanced CT scan demonstrates an expansile, osteolytic mass (arrows) within the right mandibular body.

 

Figure 21
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  		Figure 21a.  Periapical and perimandibular abscess in a 10-year-old boy. (a) Contrast-enhanced CT scan demonstrates a rim-enhancing fluid collection (arrows) within the perimandibular soft tissues. (b) Oblique coronal reformatted CT image reveals a periapical abscess (thick arrow) within the mandibular body and a fistula (arrowhead) that extends to the lingual surface. Note the cavity (thin arrow) within the crown of the tooth.

 

Figure 21
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  		Figure 21b.  Periapical and perimandibular abscess in a 10-year-old boy. (a) Contrast-enhanced CT scan demonstrates a rim-enhancing fluid collection (arrows) within the perimandibular soft tissues. (b) Oblique coronal reformatted CT image reveals a periapical abscess (thick arrow) within the mandibular body and a fistula (arrowhead) that extends to the lingual surface. Note the cavity (thin arrow) within the crown of the tooth.

 

Figure 22
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  		Figure 22a.  Acute suppurative osteomyelitis in a 44-year-old woman. (a) CT scan (bone windowing) demonstrates a nonexpansile, osteolytic lesion (arrow) within the right mandible. Perimandibular soft-tissue inflammatory change (arrowheads) is also present. (b) High-power photomicrograph (H-E stain) reveals loss of osteocytes from lacunae and severe inflammatory cell infiltrates (arrows).

 

Figure 22
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  		Figure 22b.  Acute suppurative osteomyelitis in a 44-year-old woman. (a) CT scan (bone windowing) demonstrates a nonexpansile, osteolytic lesion (arrow) within the right mandible. Perimandibular soft-tissue inflammatory change (arrowheads) is also present. (b) High-power photomicrograph (H-E stain) reveals loss of osteocytes from lacunae and severe inflammatory cell infiltrates (arrows).

 

Figure 23
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  		Figure 23.  Chronic osteomyelitis in a 47-year-old man. CT scan reveals an osteolytic lesion (arrow) containing a bony sequestrum (arrowhead) within the left mandibular body.

 

Figure 24
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  		Figure 24.  Sclerosing osteomyelitis in a 10-year-old boy. CT scan shows diffuse sclerotic changes with expansion of the left mandibular body (arrows). Note the diffuse soft-tissue swelling (arrowheads).

 

Figure 25
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  		Figure 25a.  Central giant cell granuloma in a 34-year-old man. (a) CT scan (bone windowing) demonstrates a cystic lesion (arrows) within the mandible. Note the erosion of the mandibular cortex. (b) Photograph of the gross resected specimen shows multiple cystic cavities (arrows). Photomicrography with H-E stain revealed multinucleated giant cells within the lesion.

 

Figure 25
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  		Figure 25b.  Central giant cell granuloma in a 34-year-old man. (a) CT scan (bone windowing) demonstrates a cystic lesion (arrows) within the mandible. Note the erosion of the mandibular cortex. (b) Photograph of the gross resected specimen shows multiple cystic cavities (arrows). Photomicrography with H-E stain revealed multinucleated giant cells within the lesion.

 

Figure 26
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  		Figure 26a.  AVM in a 28-year-old man. (a) Contrast-enhanced CT scan reveals multiple dilated and tortuous vessels (arrow) within the right masseter muscle. Note the abnormal enhancement (arrowhead) within the marrow of the mandible. (b) Axial T1-weighted MR image demonstrates a slightly expansile lesion (arrow) within the right mandibular angle and body. Multiple flow voids are present within the right masseter muscle. Note the loss of normal fatty marrow (arrowhead) within the mandible.

 

Figure 26
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  		Figure 26b.  AVM in a 28-year-old man. (a) Contrast-enhanced CT scan reveals multiple dilated and tortuous vessels (arrow) within the right masseter muscle. Note the abnormal enhancement (arrowhead) within the marrow of the mandible. (b) Axial T1-weighted MR image demonstrates a slightly expansile lesion (arrow) within the right mandibular angle and body. Multiple flow voids are present within the right masseter muscle. Note the loss of normal fatty marrow (arrowhead) within the mandible.

 

Figure 27
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  		Figure 27.  Renal osteodystrophy in a 75-year-old man. CT scan reveals diffuse sclerotic changes (arrows) throughout the entire mandible.

 

Figure 28
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  		Figure 28.  Torus mandibularis in a 35-year-old man. CT scan shows bilateral exostosis (arrows) in the lingual aspects of the mandible.

 

Figure 29
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  		Figure 29.  Gardner syndrome in an 80-year-old man. Panorex radiograph demonstrates multiple osteomas (arrows) throughout the mandible. Note the osteoma within the right maxilla (arrowhead).

 

Figure 30
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  		Figure 30a.  Epulis fissuratum in a 22-year-old woman. (a) CT scan shows calcification and soft-tissue thickening (arrow) in the lingual aspect of the right mandible. (b) Intraoral photograph reveals a lump (arrow) in the gingiva.

 

Figure 30
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  		Figure 30b.  Epulis fissuratum in a 22-year-old woman. (a) CT scan shows calcification and soft-tissue thickening (arrow) in the lingual aspect of the right mandible. (b) Intraoral photograph reveals a lump (arrow) in the gingiva.

 

Figure 31
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  		Figure 31.  Fibrous dysplasia in a 28-year-old man. Contrast-enhanced CT scan demonstrates an expansile lesion containing numerous unorganized bone trabeculae (arrow) within the left mandibular body.

 

Figure 32
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  		Figure 32.  Osteoradionecrosis in a 56-year-old man with a history of radiation therapy for oropharyngeal squamous cell carcinoma. Panoramic reformatted CT image shows ill-defined osteolytic lesions (arrows) within the left mandibular body, findings that represent osteonecrosis. In addition, a diffusely sclerotic region (arrowheads) is identified within the right mandibular body, a finding that represents osteitis.

 




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