Abstracts

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E1401. Bite Into This: A Radiographic Overview of Various Lesions Within the Jaw
Authors
  1. Gaurav Rana; John H Stroger Hospital of Cook County
  2. Eleanor Yu; John H Stroger Hospital of Cook County
  3. Haziq Zahir; John H Stroger Hospital of Cook County
  4. Alexander Ree; John H Stroger Hospital of Cook County
  5. Corrine Atty; John H Stroger Hospital of Cook County
Background
In various settings for the reading radiologist, unfamiliarity with the wide range of benign and malignant mandibular and maxillary lesions poses potential implications for patient care, as an unclear report may be misleading to the clinician. As with any other lesion in the body, the ramifications of errors related to a lack of knowledge can lead to unfortunate consequences. The range of pathology, from those lesions originating in the teeth versus the surrounding neurovascular or bony structures, is broad, with each etiology potentially having many common properties. It is essential for the radiologist to become familiar with the array of potential benign, malignant, infectious, and miscellaneous lesions of the jaw to better facilitate appropriate workup and management of the patient.

Educational Goals / Teaching Points
Goals for the reading radiologist and resident include proper identification and classification of lesions involving the mandible. This includes evaluation of the imaging characteristics of the lesion (density) and relationship of the lesion to the underling and adjacent structures (teeth, alveolar bone, cortical bone, traversing nerves, soft tissues). Clinical and pathologic correlation may also provide guidance when attempting to further characterize an unclear case. Identifying imaging characteristics which may aid in differentiating a benign from a malignant lesion and that may facilitate the development of a helpful differential diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Lesions of the mandible can be characterized by various properties such as location, relationship to underlying structures, aggressiveness, and density (including the presence of solid, cystic and/or sclerotic components). Having a knowledge of the pathophysiology associated with various mandibular lesions may help further differentiate lesions which could have overlapping or confusing clinical presentations. For the purposes of organization, one could classify mandibular lesions into benign solid and benign cystic groups, malignant lesions, infectious lesions, and miscellaneous or acquired lesions. Cementoblastomas, Cementoosseus dysplasias, odontomas, osteosclerosis, and condensing osteitis are a few types of sclerotic lesions. Cystic lesions include periapical cysts, dentigerous cysts, keratocystic odontogenic tumors, as well as simple or traumatic bone cysts. Acquired lesions include sequelea of renal osteodystrophy and osteoradionecrosis. Lesions of infectious etiologies include osteomyelitis, apical periodontitis, and periapical abscesses. Malignant lesions include odontogenic carcinoma, squamous cell carcinoma, angiosarcoma, metastatic disease, and malignant ameloblastoma.

Conclusion
Having an adequate knowledge of the various lesions of the jaw can significantly improve the ability of a radiologist to accurately characterize these lesions, thus leading to improved patient care. Understanding the basic pathophysiology of these lesions will enable the radiologist to develop clear, concise reports with helpful differential diagnosis and appropriate recommendations for further imaging and workup.