Predicting Odontogenic Jaw Lesions and Initial Surgical Treatment Based on Size of Lesion and Distance from Inferior Alveolar Nerve on Panoramic Radiographs

Abstract

Aims: The purpose of this small pilot study was to determine the type and initial management of relatively common radiolucent lesions that occur at the mandibular angle based on size of the lesion and its relation to the inferior alveolar nerve on panoramic radiograph. We also wanted to determine if useful information could be gained from the pattern of lesion expansion. Methods: A retrospective review of the panoramic images of patients from New York University College of Dentistry from 2005 to 2018 with mandibular angle radiolucent lesions was performed. The lesions included were dentigerous cysts (DC), ameloblastomas, and odontogenic keratocysts (OKCs). A total of 63 patients met the inclusion criteria. The size of each lesion along with its distance from the superior border of the inferior alveolar nerve canal, both horizontally and vertically, was measured from the panoramic images. Formal statistical analysis was deemed unnecessary for this small pilot study. Results: Our data suggest that mandibular angle lesions which were smaller in size and further from the inferior alveolar nerve were more likely to be dentigerous cysts. Those mandibular angle lesions with larger size and less distance from the nerve canal were more likely to be OKCs or ameloblastomas. Furthermore, based on our data, ameloblastomas had the largest average lesion size, both horizontally and vertically. Our data also showed that dentigerous cysts appear to grow relatively symmetrically, while ameloblastomas and OKCs have an asymmetrical growth pattern. Conclusion: This study demonstrates how a surgeon can effectively utilize the panoramic radiograph to classify the lesion and thus guide initial surgical management of whether an immediate excisional biopsy can be definitive treatment or if the patient can benefit from immediate decompression therapy, thereby decreasing the necessity of further surgery.