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Radiology · patient case question

Which feature on the radiograph would most favor odontogenic keratocyst over dentigerous cyst?

Patient case: Radiographic Differential — Impacted Canine

demo: 19-year-old male

chief: Referred for evaluation of a retained primary canine.

history: Non-contributory.

meds: None

findings: Panoramic radiograph shows tooth #6 impacted high in the maxilla with an associated well-defined radiolucency surrounding the crown. Images below illustrate two of the entities under consideration.

  1. Attachment strictly at the cementoenamel junction
  2. Uniform ballooning expansion of both cortices
  3. A radiopaque tooth-like mass within the lumen
  4. Growth along the length of the marrow space with minimal buccolingual expansion
Show answer and explanation

Correct answer: D. Growth along the length of the marrow space with minimal buccolingual expansion

  • A. CEJ attachment is the defining feature of a dentigerous cyst.
  • B. Marked balloon-like expansion is more typical of a dentigerous cyst or ameloblastoma.
  • C. Tooth-like radiopacities within the lumen describe an odontoma.
  • D. Correct. OKCs characteristically propagate anteroposteriorly through cancellous bone with little cortical expansion, which is why they reach a large size before detection.

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