Mandibular lesions are myriad and common. The presence of teeth results in lesions specific to the mandible (and maxilla) and a useful classification that defines them as odontogenic or non-odontogenic. While it may often not be possible to make a diagnosis using imaging alone, this approach to aetiology helps narrow the differential diagnosis.

Pathology

Aetiology

Although a histological approach is probably the most scientifically sound, radiologists are presented with an image. Therefore, it is easier to classify lesions according to their location in the mandible and appearance. For a detailed classification of odontogenic tumours, many more than even the keenest neuro/head and neck radiologists can remember, please refer to the WHO histological classification of odontogenic tumours.

Below, the lesions are divided into cystic and solid. Cystic should not be confused with lytic as solid radiolucent lesions can also appear lytic (see: radiolucent lesions of the jaw).

Cystic lesions

• periapical cyst (or radicular cyst): common

• dentigerous cyst (or follicular cyst of the mandible): common

• odontogenic keratocyst (OKC): uncommon

• primordial cyst of the mandible

• Stafne cyst (or static bone cavity): uncommon

• solitary bone cyst of the mandible (or traumatic or haemorrhagic bone cysts)

• aneurysmal bone cyst (ABC): rare in the mandible

• residual cyst of the mandible

• lateral periodontal cyst

Solid lesions

Odontogenic

• benign

  • odontoma: most common odontogenic tumour

  • ameloblastoma: relatively common

  • odontogenic myxoma (looks just like an ameloblastoma): rare

  • calcifying epithelial odontogenic tumour (or Pindborg tumour) (looks just like an ameloblastoma): rare

  • cementoblastoma: rare

  • ameloblastic fibroma

  • adenomatoid odontogenic tumour: rare

  • condensing osteitis of the mandible

• malignant

  • odontogenic carcinoma (e.g. ameloblastic carcinoma): rare

  • odontogenic sarcoma: rare

  • odontogenic carcinosarcoma: rare

Non-odontogenic

• benign

  • idiopathic osteosclerosis

  • cemento-ossifying fibroma

    • juvenile ossifying fibroma

  • exostosis (or torus mandibularis)

  • osteoma

  • fibrous dysplasia

  • Paget disease

  • central giant cell lesion/granuloma (giant cell reparative cyst)

  • eosinophilic granuloma

  • neurofibroma

  • schwannoma

• malignant

  • squamous cell carcinoma of mandible: common

  • osteosarcoma

  • Ewing sarcoma

  • chondrosarcoma

  • metastasis

  • multiple myeloma/plasmacytoma

  • lymphoma/leukaemia

  • fibrosarcoma

  • leiomyosarcoma