Common Lesions showing Multilocular Radiolucency

A good dentist should have keen knowledge and expertise to make an accurate diagnosis based on the radiographical image of various conditions. It is often said that "The eyes do not see what the brain doesn't know." That is absolutely correct. We must have a good knowledge about the condition, its clinical presentations and radiological appearance in our mind to make an accurate diagnosis.

Common lesions which show multilocular radiolucency are:

  • Ameloblastoma
  • Odontogenic keratocyst
  • Odontogenic Myxoma
  • Central Giant Cell Granuloma
  • Central Hemangioma
  • Aneurysmal bone cyst
  • Cherubism

1. Ameloblastoma
- Soap bubble or honeycombed appearance
- Most common in 3rd molar- ramus area
- Notching is seen in advancing end of tumor
- Root resorption and displacement of adjacent teeth is seen
- Rarely causes perforation

2. Odontogenic Keratocyst
- Soap bubble appearance
- No expansion of cortical plates, because the lesion grows anteroposteriorly

3. Odontogenic myxoma
- Exclusively seen in Jaws, only in tooth-bearing portions
- angular or tennis racket or honeycomb appearance
- May be found in association with an impacted tooth

4. Central giant cell granuloma
- It is a reactive process, but not a neoplasm
- Soap bubble or honeycomb appearance
- a characteristic feature is that the septa are perpendicular to the periphery of the lesion and notching is seen corresponding to outline where septa arise.

5. Central hemangioma
- soap bubble appearance
- Swelling of Jaws, gingival bleeding through sulcus is seen
- " Pumping action " is a characteristic clinical feature. If tooth in the region of the tumor is pushed into the tumor, it will be rebound back to the original.

6. Aneurysmal bone cyst
- history of trauma, the cyst is reactive process  secondary to trauma
- honeycomb or soap bubble appearance
- frank blood on aspiration
- pseudocyst
- multinucleated giant cells are seen histologically

7. Cherubism
- seen at 2-6 years of age with a familial history
- When maxilla is involved, the skin over it is stretched with pulling of skin below eyes. The sclera is visible giving "angelic look" or "eyes towards heaven".
- Multiple unerupted teeth are seen which appear to be floating in cyst-like spaces.