Differential diagnosis of head and neck swellings /certified fixed orthodontic courses by Indian dental academy

Differential Diagnosis Of
Swellings Of Head & Neck

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INDIAN DENTAL ACADEMY
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The method of
differential diagnosis
was first suggested
in use by
Emil Kraepelin

In medicine, differential diagnosis
(sometimes abbreviated DDx or ΔΔ) is the
systematic method physicians use to
identify the disease causing a patient's
symptoms.
Before a medical condition can be treated,
it must be identified. The physician begins
by observing the patient's symptoms,
examining the patient, and often taking the
patient's personal and family history. Then
the physician lists the most likely causes.

The physician asks questions and performs
tests to eliminate possibilities until he or
she is satisfied that the single most likely
cause has been identified.
Once a working diagnosis is reached, the
physician prescribes a therapy. If the
patient's condition does not improve, the
diagnosis must be reassessed

NEED FOR DIFFERENTIAL
DIAGNOSIS?
► Lesions of oral and perioral areas must be

identified and characterized so that specific
therapy can lead to elimination of the lesion.


ORDERLY STEPS TO IDENTIFY AND
CHARECTERIZE THE LESION
► Health history
► History of the specific lesion
► Clinical examination
► Radiographic examination
► Laboratory examination
► Biopsy- If indicated.


Reason for Health History ?
Two basic reasons :
► A pre-existing medical problem may affect
or be affected by the surgeons treatment of
the patient
► Lesion under investigation may be an oral

manifestation of a systemic disease.

History of the lesion
Duration ?
2. Change of Size of the lesion ( size & rate )?
3. Has the lesion changed its
character( Did the lump become an ulcer
etc ) ?
4. Symptoms(Pain,dysphagia,anesthesia,
Tenderness of adjacent L.N) associated with
the lesion?
5.Any historic reason for the lesion ?
(ex:Trauma,recent tooth ache etc )
1.


CLINICAL EXMINATION
To determine the clue to its nature.
► Includes Inspection,palpation,percusion
and auscultation.
►

1.
►
►

Role of anatomic location of the lesion ?
Is to know which tissue are contributing to
the lesion.
Cause has to be elicited based on the
anatomic location.

2 Surface of the lesion.
► Smooth,lobulated/irregular
3.Color of the lesion .
► Ex:A bluish swelling which blanch on
pressure –A vascular lesion. One
which do not blanch may be indicative
of a Mucus containing lesion.

Sharpness of the boundaries of the lesion.
► To determine whether mass is fixed to
bone, arising from bone and extending to
soft tissues/Infiltrating in nature.
4.Consistancy of the lesion :
► As SOFT in case of Lipoma
► As FIRM –In case of FIBROMA
► As HARD –in case of an osteoma/tori


5 Presence of fluctuation & pulsation .
► Pulsation : Indicates the fluid with in the
mass
► Fluctuation : Indicates a large vascular
component.
6. Lymph Node examination : Five imp.
Characteristics has to be included.
► LOCATION
► SIZE (giving the diameter in centimeters)
► TENDERNESS (painful versus nonpainful)
► DEGREE OF FIXATION (Movable/fixed)
► TEXTURE ( soft, hard/firm )

Radiographic examination
► Gives clue to the true nature of the lesion.
► Ex : A cyst appears as a radiolucency with

sharp radiographic borders
► A ragged radiolucency may be indicative of the
more aggressive lesion, such as malignancy.
► Use of radiographic dyes/Instruments in
conjunction with routine radiographic
procedures.

MID LINE SWELLINGS:
From above downwards:
In Sub Mental Region:
► Ludwig's Angina
► Enlarged sub mental lymph nodes
► Sublingual dermoid
► Lipoma

► In Supra sternal Space of Burns :
► Retrosternal goitre
► Thymic swelling
► A dermoid cyst may appear anywhere in the

midline.


COMMON MIDLINE SWELLINGS
► Thyroid Swellings
► Ludwig's Angina
► Enlarged Lymph node
► Thyroglossal cyst

Dermoid Cyst
► Lipoma
►


DIFFERENTIAL DIAGNOSIS OF THYROID
SWELLINGS

A Thyroid Swelling is recognized by its position, its
shape and by the fact that it moves upwards during
deglutition.
Term GOITRE denotes any enlargement of thyroid
gland irrespective of its pathology.
D.D Includes:
1.
NON TOXIC GOITRE
2.
TOXIC GOITRE
3.
NEOPLASTIC
4.
THYROIDITIS
5.
OTHER RARE TYPES; AMYLOID GOITRE

A.Non-Toxic Goitre{Simple Goitre}
►
►
►
►

►

Age b/w 5-20 yrs
Enlargement is uniform and is soft.
Due to increased TSH stimulation in response to low
level of circulating Thyroid hormones
This goitre may develop PHYSIOLOGICALLY at the
time of puberty when metabolic demands are high
and in pregnancy when there is too much stress
This goitre may subsides by it self [NATURAL
INVOLITION] or with Iodine therapy.

PRESSURE EFFECTS are rare unless swelling is
enormous

B. TOXIC GOITRE :
PRIMARY TOXIC GOITRE: Has five characteristic
features:
1.
Exopthalmus
2.
Some enlargement of Thyroid Gland
3.
Loss of weight in spite of good appetite
4.
Tachycardia
5.
Tremor
SECONDAY TOXIC GOITRE:It must be remembered
that brunt of attack falls on CVS. There may be NO
exopthalmus, NO tachycardia , but the pulse
becomes irregular in rate and rythum.The patient
complains of PRECORDIAL PAIN and exhaustion,
later on auricular fibrillation and heart failure may

C . NEOPLASTIC

►
►

Benign tumors are rare and can be either
papillary or follicular adenoma.
Malignant tumors :

DIAGNOSTIC FEATURE :
►

Hard feel & Indistinct outline of thyroid swelling.

►

Infiltrates to neighboring struc.like
trachea,infrahyoid muscles, esophagus etc
causing dyspnoea,dysphagia and hoarseness of
voice.

►

Metastasis in bone may be the first symptom
with pathological fracture/pulsating bone tumor.

►

No movement of thyroid due to fixation to
surrounding structures.

Retrosternal goitre
► It may be substernal,wholly intrathorasic

/plunging I.e. intrathorasic but forced in to
the neck while coughing.

DIAGNOSTIC FEATURE:

Presence of engorged veins over the
upper part of the chest.
► Deviation of trachea
► Pt. becomes dysopneic on lying on one
side only.

LUDWIGS ANGINA
Is a severe form of cellulites where infection
spreads Bilaterally involving tissue spaces of
submandibular area: A.
Submaxillary,B.Sublingual C. Sub mental
spaces.
► Odontogenic in origin and rarely from
trauma.
► DIAGNOSTIC FEATURE:
INTRA ORALLY:
► Board like swelling of the tongue
► Elevated floor of the mouth
► Hoarseness of the voice
► Difficulty in swallowing and breathing
► ODEMA GLOTTIS is the most is the most
dangerous complication
► Uncontrolled spread result in
Mediastinitis,Sub phrenic abscess
►

LYMPH NODE SWELLING
Tuberculous Lymphnodes:Most commonest cause of
L.N swelling in Indian sub-continent.

First stage has solid enlargement → Periadenitis and
glands become matted → whole mass liquefies
“COLD ABSCESS" Fluctuation is not possible due
to tough fascia superficial to abscess) →”COLLAR
STUD “ abscess → Inflamed skin and sinus which
refuses to heal.


► Carcinomatous

L.N: Majority of them lies deep
to the anterior edge of sternomastoid muscle.

NOTE : Greater cornu of hyoid is often mistaken
for Carcinomatous L.N. Pt. should be asked to
swallow in which case the bone will move up
but not the L.N
►A

careful search for primary focus in mouth
tongue, Larynx nasopharynx has to be made
when ever a secondary Carcinomatous L.N is
detected.

THYROGLOSSAL TRACT CYST:
DIAGNOSTIC FEATURE:
► Typically present as
Asymptomatic midline
swelling that display
vertical movement with
tongue protrusion and
swallowing.
► Majority of them are
seen below Hyoid bone
with 70% arising before
pt. reaches age 20yrs .


DERMOID CYST
►

Its lining is derived from
multipotential cells with the
capability of giving raise to
tissues of one or more germ
layers. If the cyst wall consists
of cutaneous structures ,it is
called DERMOID CYST, if
tissues such as
cartilage,muscle,and brain from
other germ layers are present
,it is called TERATOMA.

DIAGNOSTIC FEATURE:
► Presence of the secondary skin structures;

Hair& Sebaceous glands.
► If the dermoid cyst develops superior to the
Mylohyoid muscle ,the tongue is displaced
,leaving a mass in the floor of the mouth.
► When develops inferior to the Mylohyoid
and geniohyoid muscle ,mass appears in
the midline of the neck.

LATERAL SWELLINGS:
According to their sites may be divided in to
► Sub mandibular Triangle
► Carotid Triangle
► Posterior Triangle


SUBMANDIBULAR TRAINGLE
► Enlarged lymph nodes
► Enlargement of submandibular salivary

gland
► Deep / Plunging ranula
► Extension of growth from the jaw
► Sjogren’s syndrome


CAROTID TRIANGLE
► Thyroid swelling – will be deep to

sternomastoid
► Aneurysm of the carotid artery
► Carotid body tumor
► Branchial cyst
► A Sternomastoid tumor in a new born


POSTERIOR TRIANGLE
► Enlarged supraclavicular lymph nodes
► Cystic Hygroma
► Pharyngeal pouch
► Sub clavian aneurysm
► Lipoma [Dercum’s Disease]


SWELLINGS WHICH MAY OCCUR
ANY WHERE IN NECK
► Sebaceous cyst
► Lymph node swellings
► Thyroid enlargement
► Branchial cyst
► Lipoma


COMMON LATERAL SWELLINGS
►Lymph

node swelling
►Thyroid Swelling
►Salivary gland enlargement
►Branchial cyst


SWELLINGS OF
SALIVARY GLANDS


DIFFERENTIAL DIAGNOSIS OF PAROTID
GLAND ENLARGEMENT

Acute suppurative Parotitis :
► Brawny oedematous swelling over parotid
region with all signs of Inflammation.
► Fluctuation is the late feature owing to
presence of strong fascia over the gland.
Acute parotitis , due to mumps : Is a nonsuppurative condition .May be unilateral
but may become bilateral with in few
days.

► Sub

Acute & Acute parotitis: May be

uni/bilateral.
► Swelling seen during meals.
► Gland is firm ,Tender & Rubbery.
► DIAGNOSIS confirmed by purulent/watery saliva
ejected from duct on pressure.
AURICULOTEMPORAL NERVE SYNDROME
( FREY’S SYND.):
► Occurs due to injury. Parotid region and cheek in
front of it becomes red ,hot & painful during meals.
► Very soon beads of perspiration appears appear
in this area.


SJOGRENS SYNDROME
►

►
►

Is a chronic autoimmune
disease in which
lymphocytes infiltrates and
replace parenchyma of
salivary glands. Bilateral
swelling of Parotid Gland.
PRIMARY SJOGRENS:Dry
eyes, Dry Mouth
SECONDARY SJOGRENS:
Prim. + Autoimmune
disease, such as Rheumatic
arthritis.

►
►
►

DIAGNOSIS : By SCHIRMER’S TEST-Decreased
lacrimal secretion
Significant lab changes includes:
Identification of auto antibodies (Rheumatoid
factor, antinuclear antibodies,Sjogren’s syndrome
–associated antibodies SS-A & SS-B.


SUB MANDIBULAR & SUBLINGUAL
SALIVARY GLANDS
CALCULUS :
►
►

►

More common in submandibular gland .
Pathognomic feature : Swelling of the
gland during meals often preceded by
salivary colic.
Bi digital palpation if stone is present in
the duct.

MUCUS CYCT :
►
►

Due to cystic degeneration of glands of
Blandin & Nunh.
Fluctuant ,Blue/amber colored and
translucent mass

TUMORS OF SALIVARY GLAND
►
►

90 % of neoplasms of salivary glands occur in
PAROTID GLANDS.
10% in Sub mandibular glands and very rarely in
the sublingual and ectopic salivary glands.

►¾ of epithelial lesions in parotid are clearly
►

►

BENIGN .
Remaining 1/4 is composed of definite carcinomas
along with muco-epidermoid and acinic cell tumors
which are considered as cancers of variable
aggressiveness.
Majority of tumors in sub-mandibular gland are
MALIGNANT.

SALIVARY GLAND CANCERS IN
DESCENDING ORDER OF FREQUENCY
► Muco epidermoid

tumors
► Adenoid cystic carcinoma
► Epidermoid carcinoma
► Undifferentiated carcinomas
► Carcinomas arising in PLEOMORPHIC
ADENOMAS (MALIGNANT MIXED
TUMORS )


PLEOMORPHIC ADENOMA
MIXED TUMOR –As there is

cartilage besides epithelial
cells.
► Second decade of life and has
female prediction
DIAGNOSTIC FEATURE:
►
►
►
►

Lobulated painless swelling
persisting over many months/years
It is neither adherent to skin/
masseter
Tumor is firm but variable
consistency is a diagnostic feature
Facial nerve remains free.

WARTHINS TUMOR
►
►

►

Seen in sixth and
seventh decade of life.
Almost always occurs
in the lower portion of
the parotid overlying
the angle of the
mandible.
These are
encapsulated lesions
and do not undergo
malignant
transformation

Carcinoma of Parotid gland
► Pts

are over 50yrs of age
► No sex predilection is seen
DIANNOSTIC FEATURE:
Main complaint is rapidly enlarging swelling
which is painless to start but becomes painful
later on jaw movements.
► Pain is radiating to ear& over sideof the face.
► Surface is irregular and margin is often
indistinct
► Consistency is firm to hard
► Facial nerve is involved
► Swelling is fixed to deeper structures and
gradually restricts jaw movements

ADENOID CYSTIC CARCINOMA
►
►

►
►
►

Seen in adults with no
gender predilection
Is the malignancy of both
major & minor salivary
gland
DIAGNOSTIC FEATURE:
Growth rate is slow but
persistent
Have propensity for nerve
innervations and may
cause facial paralysis when
occurring in parotid region

►

►
►

The characteristic
“SWISS CHEESE”
patterns that
characterizes this
lesion may be a very
prominent one.
Diagnostic microscopic
feature:
Cribriform,tubular,trabe
cular,&solid
patterns,areas showing
distinct &
separate[ cookie cutter]
islands of tumor.

Swellings of jaws

Arising from mucoperiosteum :

Granulomatous,Fibrous,Sarcomatous&
Carcinomatous
Arising from tooth germs:
► ODONTOMES:Dental cyst,Dentigerous
cyst,Adamantinoma
►

Osseous Tumors
Inflammatory Group: Alveolar
abscess,Osteomyelitis,Actinomycosis etc.

COMMON JAW SWELLINGS :

► Dentigerous

cyst

► Dental

cyst
► Adamantinoma
► Alveolar abscess
► Osteomyelitis
► Giant –cell granuloma


Dentigerous cyst:
It originates after the crown of the
tooth has been completely formed by
the accumulation of fluid between
the reduced enamel epithelium and
the tooth crown.
► Bone expansion with extreme
displacement of the teeth.
DIAGNOSTIC FEATURE:
► Associated always with impacted/
unerupted tooth.
► Cystic involvement may result in
HOLLOWING OUT of the entire
ramus extending up to coronoid
process as well as condyle and
cortical expansion due to pressure of
the lesion.
► X-RAY: Always radiolucent and
unilocular.
►

Dental cyst/Periapical cyst
► Arises

from periapical
granuloma containing
epithelium that organizes In
to a true cyst.
► Is associated with carious
tooth.
► Develops at the apex of the
tooth with necrotic pulp
► EGG SHELL CRACKLING
when bone is thinned out
► Fluid within the cyst is clear
and contains Cholesterol.

► Age

AMELOBLASTOMA

20-30yrs
► Is a true neoplasm which does
not undergo differentiation to
the point of enamel formation
► Mandible is more commonly
effected
► DIAGNOSTIC

FEATURE:
► Unicentric,NonFunctional,Intermittent,Anatom
ically benign & Clinically
persistent


► Tends

to expand the bone rather that
perforating it
► Donot produce signs of nerve involvement
► Seldom painful unless secondarily
infected.
► X-ray: Multilocular cyst like lesion of the
jaw.
► Compartmented appearance with septa of
the bone extending into the R.L tumor
mass.

THREE TYPES BASED ON CLINICAL
RADIOGRAPHIC& HISTOPATHOLOGIC
APPERARENCES.
CONVENTIONAL AMELOBLASTOMA
2. UNICYSTIC AMELOBLASTOMA
3. PERIPHERL[EXTRAOSSEOUS]
1.


CONVENTIONAL
TYPE
Arise from de
novo/pre existing
unicystic type.
85% - in mandible
60% - in molar
region

UNICYSTIC TYPE
Second/third
decade.

Pain less, Slow
growing which are
asymptomatic unless
reach large size.

Multilocular
R.lucency.

Painless Swelling of
bone is the presenting
feature.Buccal&
lingual cortical
expansion is common

HONEY COOMB –
When loculations are
small. Well defined
margins

Can not be
differentiated from
Dentigerous
cyst/OKC.Definitive
diagnosis requires
correlation of clinical
finding of a cyst at the
time of surgery

SOAP BUBBLE-When
loculations are large

Typically shows
unilocular R.L
associated with
crown of unerrupted
tooth.

ALVEOLAR ABSCESS
Arises as a result of
infection following carious
involvement of the tooth &
Pulp infection.
► Tends to bulge towards
the external surface
DIAGNOSTIC FEATURE:
Dull and constant aching
with slightly extruded
tooth
EXCRUCIATING PAIN is a
characteristic feature
►

OSTEOMYELITIS OF JAW

Acute form :

Is a serious sequela of
periapical infection that often results in a
diffuse spread of infection throughout the
medullary spaces, with subsequent
necrosis of variable amount of bone.
► Because of intense exudation of plasma
fluids & blood cells ,pain is primary feature
of this bony encased inflammatory
response.
► Involved teeth are loose & sore
► Lip anesthesia is a common development
in case of mandibular involvement.
X-RAY :Diffuse lytic changes in the bone
begin to appear, Individual trabeculae
become fuzzy and indistinct.

CHRONIC OSTEOMYLITIS

► Represents

the proliferative reaction of the
bone to a low-grade infection
► Pain & swelling are variable in chronic
osteomylitis.It is usually low-grade
&intermittent.
► Radiographic patterns vary from case to
case, ranging from radiolucent to mixed
MOTH EATEN to opaque, depending on
duration, intensity of inflammation &
individual biologic response.
► Generally a slow progressive lesion yields
more opaque material [sclerotic bone/bony
scar]

CLINICOPATHOLOGIC SUBTYPES
1.Chronic Osteomyelitis with periostitis
‘garre’s osteomylitis’ :
► In more active lesions bony inflammatory
process may extend to involve the
periostium,resulting in peripheral expansion
of the mandible, which characterizes
‘garre’s Osteomyelitis’
► Radiographically: Concentric opaque layers
,representing the several stages of cortex
expansion
► MAY MIMIC FIBROUS DYSPLASIA BOTH
CLINICALLY & MICROSCOPICALLY

2.CHRONIC DIFFUSE
SCLEROSING OSTEOMYLITIS
:
► Cause

appear to be
related to low grade
bacterial infection through
periodontal membrane..
► X-RAY: Dense generalized
opacification of the entire
jaw.
► May be confused with
fibrous dysplasia.

3.Focal sclerosing
Osteomyelitis: [BONY
SCAR] Is a common focal
bone opacification seen in
relation to low grade
inflammation at the apex
of teeth with chronic
pulpitis.

► Also

seen after healing of
an extraction socket

TUMORS OF THE JAW
►
►
►
►
►
►
►
►
►
►
►
►
►
►

Lymphoma
Hodgkins lymphoma
Pagets disease
Hemangioma
Centrl gaint cell granuloma
Burkitts lymphoma
Osteoma
Annurysmal bone cyst
Cystic hygroma
Ewings sarcoma
Multiple Myloma
Osteosarcoma
Maxillary sinus carcinoma
Rhabdomyoma


LESION
osteosarcoma

Ewings sarcoma

C/F

X-ray

Mandible.Pain,paresth Penetration of
esia.
the tumor
outside the
Microscopic D.D:
cortex results
CGCG.
in “SUN
BURST"
pattern of bone
formation
Facial neuralgia, lip
Laminated
paresthesia .Bones
periosteal
involved : long
hyperplasia of
bones,skull,pelvic
cortical bone
girdle. may be assoc. overlying
with significant
tumor bed
necrosis
shows ‘ONION
and confused with
SKINNING’
inflammatory process appear.

HISTOLO
G

Diagnosis require
presence of
atypical cells in
association with
immature
haphazardly
distributed
calcifies osteoid
Demonstration of
MIC-2 gene
product with
o13A antibody
can be an
diagnostic tool

Burkitts

High grade
Poorly
child hood
define
lymphoma
malignancy.co d
mmon in
radiolu
maxilla.Tumor cency
growth is
expressed in
jaws with pain
&paresthesia,
abdomen&retr
operitonium,ab
Multiple myloma domen
Charect.
Multiple
sharply
marginated
punched out
lesion with
pain &some
times

Poorly defined
lymphoid cells are
seen.reactive
phagocytic macropha.
in tumor gives
“STARRY SKY”
appear.

Abnorm.AB is
responsible for
hyperviscosity
&rouleaux formation
of bd.vessel &
appearance of light
chains in urine
(Bence-Jones

CYSTIC
HYGRO
MA
Is a
variety
of
lymphan
gioma.
Rhabdo
myoma.

Charec. By large ,deeply
located cyst like lymphatic
vessels.pressure effects
are not uncommon.

Common in
pharynx,larynx, and grow
considerable size.fetal
rhabd. Occurs in children
and common on face & pre
auricular region

Histology:
Circum. Mass
of cells with
eosinophillic
cytplasm is
charec.`

HEMANGIOMA
Benign tumor of
bd.vessel.
Present as flat /raised
lesion appearing
red/purple.

When congenital on
skin called BIRTH
MARKsize:1cm –
severe
disfigurement

Size:1cm-severe
disfigurement.
Are often asymptomatic
but exhibit hemorrhage
when traumatized

FIBRO-OSSEOUS LESIONS OF
JAW


► OSSYFYING FIBROMA
► FIBROUS DYSPLASIA
► DESMOPLSTIC FIBROMA
► OSTEOBLASTOMA
► OSTEOMA
► TORUS
► EXOSTOSIS

Ossyfying
fibroma
(A benign
neoplasm of
bone )

Fibrous
dysplasia.
Gradual
displacement
of normal
bone by
fibrous
connective
tissue
&structurally
weak fibrillar

Molar ramus
region.More common
in women.A well
circumscribed lesion
with distinct margins.

Radiolucent

May be
ILL defined
mono/polystotic.polystoti margins&
c associated with
blends in
endocrine
surrn.bone.
disorders[ Albrights
Character.
syndrome]It is self
limiting,slow growing
unilateral swelling & is
ground glass
asymptomatic.Invol. of
appear.
cranial ostia may cause
nasal
seen best
obstruction,sinusitis,hea
in occlusal
ring&visual

It is sharply
demarcated
from
surrounding
bone.promin
ant
osteoblast
rimming the
new bone

EXOSTOSIS

Bilateral row of exophytic
bone along facial
surfaceof alveolar ridge
A reactive hyperplasia of
buccal cortical bonecoz
of excessive occlusal
forces

Has dense
hyperplastic
cortical type
bone

TORUS:

Is a nodular bony
protruberance of
either mid-line of
palate/lingual
mandible

Microscopic
ally:Dense
hyperplastic
cortical type
bone.

Develops in second
decade of life

Asymptomatic unless

GAINT CELL LESIONS OF THE
JAW


► CENTRAL GAINT CELL GRANULOMA
► ANEURYSMAL BONE CYST
► HYPERPARATHYROIDISM
► CHERUBISM
► LANGERHANS CELL DISEASE
► PAGET’S DISEASE


LESION

CGCG

C/F

X-RAY

2/3 decade Uni/multilocular.cor
Mand. Ant. tex may be
thin/perforated
Portion.
Localised
expansion
of the
affected
bone

MICROSCOPIC
D.D :Aneurysmal
bone cyst,
Cherubism,osteosa
rcoma with gaint
cells.,
Hyperparthyroidism
.


HISTOLO
GY
Stroma may
be
fibrotic.New
bone may be
present,esp.
at the
peripheryRe
cent/old
hemorrhage
is typically
found.

Aneurysmal
bone cyst.
Intra bony
accumulation
of the blood
filled spaces
surrounded
by reactive
C.T may be
due to

Common in
mandible
Sudden
increase in
size of bone

Shows “expansile
soap bubble R.L or
“Honey Coomb”
appearance.

Stroma may show
sinosidal vascular
channels that are
not lined by
endothelial
cells.Varying
amount of
haemosiderin is
seen.

DD:
CGCG

secondary
reaction to
intraossous
haematoma.


Cherubism

Self limiting. Bilaterally
symmetrical painless
expansion & all 4
quadrants are affectd .
After puberty.
Typical cherubic
facies.Teeth may be
missing/malformed/disp
laced.single involv. Of
maxilla results in
stretching of skin of
upper face to expose
sclera below iris of eye
resultingin “Eyes
upturned to heaven”
appearance.

Charec.”
Soap
Bubble”
appeara
nce.

Distinctive
perivascul
ar cuffing
of
collagen
may be
seen
around
cappilarie
s
D.D :
CGCG

PAGETS
DISEASE

R.L alterations follow. In early phase
By develop. Of
osteoclasts &
Intermixed radiopacity. capillaries
Symmetric
dominate.End stage
maxillary
Exibits charec.
is densly sclerotic and
enlargement
COTTON WOOL
exhibits a mosaic
pattern.
LOINLIKE
pattern that reflects
FACE.Non-fitting Hypercementosis
remodelling process.
dentures.
/resorption may be
seen.
Lab Feat:
Elevated serum
alik.phosp.,&
Urinary
hydroxyproline
levels but
calcium & phos.
Levels are


Langerhans cell disease
►
►

►
►
►
►
►

Is proliferationof langerhans
Cells.
L.Cells have
immunosurvillance function
.Tumor formation is related to
chronic antigenic stimulation
Three forms:
1 . Letterer siwe disease
2.Hand-Schuller-christian
syndrome
3.Eosinophilic granuloma
Pain,swelling and spontaneous
tooth loss. FLOATING TEETH
radiographic image is seen
when alv. Process is involved

►

Microscopically: Pale cells
with macrophage like
appearance dominate the
field. When process appears
near the apex of the tooth it
may be confused with
periapical granuloma.

►

The normal cellular counter
parts to these tumor cells are
found among prickle cells.


► both

normal lang. cells and tumor
cells are negative for macrophage
antigens

► Ultra

structure of tumor cells shows
numerous langerhans/BIRBECK
granules that characterizes normal
langerhans cell .

REFERENCES:
► Differential diagnosis - MOORE
► Atlas of oral& maxillofacial pathology

REGEZI,SCIUBBA,POGREL
► Atlas of Clinical oral pathology
BRAD W. NEVILLE ,DOUGLAS D.DAMM
► Text book of Oral pathology- SHAFERS
► Text book of General surgery - DAS

Thank you
Leader in continuing dental education


Differential diagnosis of head and neck swellings /certified fixed orthodontic courses by Indian dental academy

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