Session 5 without Questions Third Year Session 5

Cases 2
Swellings of the Jaws

“In medicine, clinicians are constantly
reminded to look for the horses, not the
zebras.
While that remains good advice, especially
to those just beginning their careers, a
mind that is open to the unusual remains
important when developing a differential
diagnosis.”
Tumours
• Cysts
• Non-odontogenic tumours
• Odontogenic tumours
• Giant cell lesions
• Fibro-osseous lesions
• Metastatic lesions
• Chronic Osteomyelitis

Dysplastic lesions arising in the

tooth-bearing area
• Fibrous Dysplasia
• Periapical cemento-osseous dysplasia
Focal cemento-osseous dysplasia Case 14
• Florid cemento-osseous dysplasia
• Fibro-osseous neoplasms
Cemento-Osseous Dysplasia
• Cementifying fibroma
• Ossifying fibroma
• Cemento-ossifying fibroma

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 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

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 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

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 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.

• 75 year old man attended complaining of

intermittent swelling in the floor of the
mouth.
Case 15 • Pain occurs when he goes into the kitchen
when his wife is
Salivary Calculus preparing the dinner.

Salivary Calculus

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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.

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 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.

Am J Phys Anthropol. 1987 Oct;74(2):179-84.

A 17th- to 19th-century cemetery sample of 104 slaves
from Newton Plantation (Barbados) shows uniquely high
hypercementosis prevalence, as well as unexpectedly
high and variable skeletal lead content. A variety of
biological and archeological factors indicates that
individuals with lower amounts of these anomalies
(relative to age at death) were probably African-born,
first-generation slaves. The hypercementosis is related
to the progression of periodontal disease as assessed
from alveolar bone. Although the hypercementosis is
endemic in the Caribbean black population, it does not
as yet have a clear explanation. We suggest the etiology
might relate to chronic malnutrition involving periodic,
seasonal rehabilitation.

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)

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 Case 18A

Central Giant Cell Lesion

Biopsy no:86/664A

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

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 Case 19

Odontogenic Keratocyst
Biopsy No: 85/657

click image to return

Odontogenic Keratocyst 2

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 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.

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Simple (Traumatic) Bone Cyst
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.
• 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.

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 Case 20

Ameloblastoma 1
Biopsy No:85/656

• A 22 year old army cadet had a routine

screening dental examination.
Case 21 • He had no symptoms.
• A firm mandibular lesion was observed in
Ameloblastoma 2 the retromolar region of the right mandible
Biopsy no:85/211
• It was non-mobile and not tender to
palpation.

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 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.

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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.
Dentigerous Cyst 3
Case 20
Dentigerous cyst 2
click image to return
click image to return
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.
• The radiolucency was corticated and was
displacing 48 inferiorly.
• There was no evidence of facial swelling
or pain.
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 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.

Squamous Cell Carcinoma 1

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 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

Squamous cell Carcinoma 3

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• 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.

Lymphatic Drainage of the Head

Post-operative

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.

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History
• An elderly woman taking phosamax for
osteoporosis complains that her jaw hurts
where she had her teeth out earlier. She
has a history of having teeth extracted
several years ago and a denture inserted.
Osteonecrosis
“Phossy Jaw”
Arrows point to vertical remnants of old extraction sockets still
present decades after the teeth were extracted. This "laminar
rain" (lamina dura) is not diagnostic for osteonecrosis but does
show that something prevented proper remodeling of the bone
after extraction. The "X" overlies an area of mushy, dark, oily
area of "moist rot" of the mandible, i.e. ischemic osteonecrosis.
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 Pyknodysostosis

• (PKND) is a rare genetic sclerosing bone

disorder, characterized with generalized
Now for something you will diffuse osteosclerosis.
never see!! • A 4-year-old male child, first referred for
evaluation with a possible diagnosis of
Pyknodysostosis
osteopetrosis, because of his multiple
fractures.

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

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