DIFFERENTIAL DIAGNOSIS

OF FIBRO-OSSEOUS LESION

PRESENTED BY: SHIVANI

(INTERN)
• Premordial cyst: It is associated with missing permanent tooth.
• Ameloblastoma: It occurs in the posterior most part of the
mandible.
• Paget disease: Cotton wool appearance and enlargement of
theaffected bone.
• Condensing osteitis: It can be ruled out because it occurs at the
periapex of the non vital tooth. It does not have radioluscent rim
which is seen on the fibro-osseous lesion.
 DIFFERENTIAL DIAGNOSIS

• Ossifying fibroma: Juvenile ossifying fibromas occurs at far

lower mean age(8.5years) than the ossifying fibroma(26.4 yers).
Ossifying fibroma contains lamellar bone and cementicles as
well as smoothly contoured cells, poor curvilinear trabaculae
features that are absent in the juvenile ossifying fibroma.
FIBROUS DYSPLASIA
• Traumatic bone cyst: There is no cortical bulging and
displacement of teeth.
• Dental cyst: It has a well defined cortex which is
smooth while in fibrous dysplasia cortex tends to be
wider and more granular.
• Aneurysmal bone cyst: There is hemorrhagic
aspirate.
• Metastatic tumor: seen in older age groups and
predilection for premolar & molar region of mandible.
CENTRAL GIANT CELL
GRANULOMA
 INTRODUCTION
• Non-neoplastic bone disease.
• Has been called as OSTEOCLASTOMA, MYELOIDSARCOMA,CHRONIC
HEMORRHAGIC OSTEOMYELITIS initially but now a days , it is called as
GIANT CELL GRANULOMA only.

1. Non-aggressive: It exhibits slow growing benign behaviour.

2. Aggressive: It shows typical features of rapidly growing
destructive lesion.
 CLINICAL FEATURES
• Age: Lesions of adolescent and young adults with 60% cases in
in younger than 20 years & 74 % cases in younger that 30 years.
• Sites: Mandible is twice frequently involved than maxilla, with
anterior half showing greatest incidence with fairly high
percentage crossing the symphysis. Commonest site in maxilla
are canine fossa & ethmoid region & in mandible are anterior &
bicuspid region.
• Symptoms: Expansion of bone with premature loosening and
shedding of deciduos tooth. Facial asymmetry & is usually
painless.
• Growth: slow.
• Teeth: Become mobile.
DIFFERENTIAL DIAGNOSIS
• Ameloblastoma: Uncommon in younger age group, seen in
posterior mandible in contrast to GCG, which occurs anterior to
the first molar.
• Aneurysmal bone cyst: It does not occur in the anterior segment
of the mandible.
• Odontogenic myxoma: Multiloculated, missing or impacted tooth
is usually a finding.
• Traumatic bone cyst: No bodily movement of the teeth is present,
no expansion of overlying bone cortex.
• Cherubism: It is bilateral in the posterior part of the mandible &
there is the history of family involvement. It does not cross the
midline.
 DIFFERENTIAL DIAGNOSIS
• Fibrous dysplasia: Cherubism is bilateral.
• Giant cell granuloma: It occurs frequently in the anterior segment of
mandible in contrast to cherubic lesions which are seen in the posterior
part of the mandible.
• Central hemangioma: There is localised gingival bleeding.
• Ameloblastoma: Seen unilaterally and frequently in the older age group.
• Multiple dentigerous cyst: Impacted teeth present.
• Giant cell lesions of the Hyperthyroidism: These are not bilateral & they
can be differentiated on the abnormal blood chemistry levels.
 DIFFERENTIAL DIAGNOSIS
 EARLY STAGE RADIOLUSCENT APPEARANCE:

• Giant cell lesions of hyperparathyroidism: In Paget disease,

increase in the serum alkaline phosphatase only, whereas in these
lesions, increase in the serum phosphatase & serum calcium levels
with decrease in serum phosphate levels.
• Osteomalacia: Pseudo-fractures are common in these cases. There
is decrease in serum calcium and serum phosphorous levels
whereas these are normal in paget’s disease.
 SECOND STAGE MIXED
• Cementifying & ossifying fibroma: Predominantly seen in younger age group & they
show well defined margins whereas in Paget’s disease there are diffuse margins.
• Chronic osteomyelitis: It is rare in maxilla.
• Chondroma: It produces pain which is not a feature of Paget’s disease.
• Osteogenic sarcoma: It occurs in younger age group than Paget’s disease.

• Florid osseuos dysplasia: It is confined to jaw bone & hypercementosis is

present.
• Osteosclerosis: Small & confined to jaw bone.
DIFFERENTIAL DIAGNOSIS
• Paget disease: No radioluscent capsule & increased serum alkaline
phosphate levels. Paget disease affects entire mandible while the
FCOD occur above the inferior alveolar canal.
• Chronic sclerosing osteomyelitis: Signs of infection are present in
the osteomyelitis.
• Osteopetrosis: Profused thickening of the skull base & diffuse bony
radio-opacities. It will cause the enlargement of the bone which is
not the feature of FCOD.