Radiological spectrum of metastasis to the oral and maxillofacial region.

OBJECTIVE: Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region. METHODS: Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis. RESULTS: Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast. CONCLUSION: Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals.

Calcifying odontogenic cysts: A 20-year retrospective clinical and radiological review.

OBJECTIVE: Calcifying odontogenic cysts (COCs) exhibit diverse clinical behaviours and may be associated with other benign odontogenic tumours. In this study, the clinical and radiological features of COCs were analysed according to subtypes based on the classification by Praetorius et al. Emphasis was placed on cases exhibiting atypical or aggressive radiological appearances. This information may assist the clinician to better understand the radiological spectrum of COCs. METHODS: Histologically confirmed cases of COCs were retrospectively reviewed in a 20-year period from three tertiary institutions. The following clinical information was reviewed: patient demographics, main complaint, clinical duration, anatomical site and detailed radiological features. RESULTS: Twenty-seven cases of COCs were included in the study. Asymptomatic swelling was the main clinical presentation with infrequent reports of associated pain. COCs had an anterior mandibular predilection. Well-demarcated borders were seen in all cases with isolated cases showing focal areas with loss of demarcation. Unilocular lesions were more common than multilocular variants. Internal calcifications were frequent and six cases presented with associated odontomas. Maxillary COCs resulted in the displacement of the maxillary sinus and/or nasal cavity walls. Radiological signs of aggression, including cortical destruction, were noted in a few cases. CONCLUSION: Given the fact that COCs can present with a spectrum of clinical behaviours and radiological presentations, the academic debate regarding the cystic versus neoplastic nature of the entity is justifiable. The cases in the current sample presented with diverse presentations, ranging from indolent to lesions with significant growth and aggression.

Odontogenic myxoma: a clinicopathological study in a South African population.

BACKGROUND: Odontogenic myxoma is a benign, locally aggressive neoplasm of the jaws. Prevalence rates range between 0.5% and 17.7% of odontogenic tumours. There are few reports in the literature on this lesion in African populations, and therefore, this study aimed to report on odontogenic myxoma in a South African population over a 40-year period. METHODS: The clinical records and orthopantomograms of 29 histopathologically diagnosed odontogenic myxoma were retrospectively analysed. Details of age, gender, ethnic origin and clinical, histological as well as radiological features were recorded. RESULTS: The ages of patients ranged from 7 to 44 years with a mean of 21.3 years. The male-to-female ratio was 1:2.6 with the majority of patients being of mixed race and Africans. Clinically, 31% complained of pain while 58.6% had a history of swelling. The majority of odongenic myxomas (62.1%) were located in the mandible with the posterior region being most commonly affected. Multilocular lesions (69.2%) were more common and were significantly larger than unilocular lesions (P < 0.05). The outline of these tumours was mostly well-defined (84.6%) with different degrees of cortication. Only one tumour caused tooth resorption, while 20 cases (76.9%) caused tooth displacement. Six tumours expanded into the maxillary sinus, and 14 tumours caused expansion of the mandible. CONCLUSIONS: Odontogenic myxomas have variable clinical, radiological and histological features. Most of these features in this population were similar to other populations. It is mandatory to use conventional radiographs along with histopathological examination to aid in arriving at an accurate diagnosis.

The imaging characteristics of odontogenic myxoma and a comparison of three different imaging modalities.

OBJECTIVE: To report the imaging characteristics of odontogenic myxoma (OM) and compare the different imaging modalities used. STUDY DESIGN: The radiological images of 33 OM cases were retrospectively analyzed. The radiographs were severally examined to describe the features of OM as seen on conventional radiographs (CRs), computed tomography (CT) scans, and magnetic resonance images (MRIs). RESULTS: MRI was effective in displaying the true extension and contents of OMs. CT scans demonstrated the extensions of OMs, expansion, growth pattern, and rendered it possible to compare density of OM with that of surrounding muscles. Assessment of CRs revealed great limitations about the diagnostic values and failed to display important features. CONCLUSIONS: All 3 radiographic techniques, conventional radiography, CT, and magnetic resonance imaging (MRI), have inherent advantages and disadvantages; however, all 3 should be routinely used in the diagnosis of OM. The results of CT and MRI can accurately reveal margins of tumors and greatly aid in diagnosis.

Nevoid basal cell carcinoma syndrome: a 40-year study in the South African population.

BACKGROUND: Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary autosomal dominant syndrome presenting with a number of signs and symptoms in different population groups. METHODS: The investigators implemented a 40-year retrospective analysis of the clinical and radiological features of South Africans affected by NBCCS presenting at the Departments of Oral Surgery, Pathology and Radiology of two major referral hospitals. Details of age, gender, ethnic origin, clinical, and radiological findings were recorded and compared to previous reports. A list of diagnostic criteria for diagnosis of NBCCS in this population was complied. Descriptive statistics were computed, and the P value was set at 0.05 or less. RESULTS: The sample was composed of 15 patients. The mean age at the time of diagnosis was 22.7years (SD 20.9) with eight (53.3%) patients diagnosed before 20years of age (P=0.0001). The male: female ratio was 2:1. The most frequent major criteria were keratocystic odontogenic tumors (KCOTs) (100%), calcification of falx cerebri (40%), palmo-plantar pits (26.7%), and basal cell carcinomas (BCCs) (20%). The most frequent minor criteria were bifid ribs (20%), skull anomalies (20%), and hypertelorism (20%). CONCLUSIONS: The results of this study indicate that there was a low frequency of falx cerebri calcifications, BCCs, skull, and rib anomalies in this sample compared to other population groups. These differences could be attributed to genetic, racial, and environmental factors. Future studies are needed to compile diagnostic criteria specific to different population groups.

Keratocystic odontogenic tumor: a recurrence analysis of clinical and radiographic parameters.

OBJECTIVE: The aim of this study was to analyze the clinical and radiologic features of keratocystic odontogenic tumors (KCOT) and their recurrence patterns. STUDY DESIGN: The authors undertook a retrospective analysis of 145 histopathologically proven KCOT. Recurrence was analyzed for age, sex, site, size, radiographic appearance, treatment, and association with nevoid basal cell carcinoma syndrome (NBCCS). RESULTS: The mean age at presentation was 34.5 years, with a male predilection. Most KCOT (75.2%) were located in the mandible, with the posterior regions being most commonly affected. Radiographically, the majority of KCOT were unilocular (71.0%) in appearance, and 16.5% had scalloped margins. There was no significant association of recurrence rate with sex, site, size, radiographic appearance, and treatment. However, KCOT had significantly higher recurrence associated with age (P < .01) and NBCCS (P = .001). CONCLUSIONS: Most clinical and radiologic features of KCOT were similar to earlier reports. Recurrence was significantly associated with second and eighth decades of life and NBCCS.