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PART I
General Principles of Differential Diagnosis
Infants Caffey's disease (birth to 2 years of age) Letterer-Siwe disease (ages 1-3) Lingual mandibular bone defect? Osteopetrosis (malignant) Rickets Thalassemia major
Children Acute leukemia Basal cell nevus syndrome (ages 5-30) Burkitt's tumor (ages 2-14) Central hemangioma (ages 10-20) Cherubism Dentigerous cyst (ages 10-20) Fibrous dysplasia (ages 10-20) Hand-SchUller-Christian disease (ages 1-10) Lingual mandibular bone defect Multilocular cyst (over age 15) Osteoid osteoma Osteopetrosis (malignant) Proliferative periostitis (ages 5-12) Rickets Thalassemia major
Persons Under Age 30 Acute leukemia Adenomatoid odontogenic tumor (peak at age 16) Ameloblastic fibroma (peak at age 16) Aneurysmal bone cyst (under age 20) Basal cell nevus syndrome (ages 5-30) Burkitt's tumor (ages 2-14) Caffey's disease (birth to 2 years of age) Cancer Ewing's sarcoma (peak at ages 14-18) Osteogenic sarcoma of jaws (ages 10-40, peak at age 27) Reticulum cell sarcoma of bone (70% under age 40) Cementifying and ossifying fibroma (young adults) Cementoblastoma (under age 25) Central giant cell granuloma (60% under age 20) Central hemangioma (ages 10-20) Cherubism Dentigerous cyst (ages 10-20) Developing tooth crypt (under age 20) Eosinophilic granuloma Fibrous dysplasia (ages 10-20)
TWO OR MORE LESIONS PRESENT From time to time, clinicians examine patients with various combinations of lesions. Perhaps one patient will present with two lesions in the oral cavity. Another patient may have a lesion in the oral cavity and another in the neck. In still another patient the examination may reveal a lesion in the oral cavity and another in a more distant site, for example, the lung. After some thought, it becomes ob-
Hand-SchUller-Christian disease (ages 1-10) Letterer-Siwe disease (ages 1-3) Lingual mandibular bone defect Multilocular cyst (over age 15) Mural ameloblastoma (ages 18-30) Odontogenic fibroma (under age 25) Odontogenic keratocyst (ages 10-20) Odontoma in developing stages (under age 20) Osteoblastoma (75% under age 20) Osteoid osteoma Osteopetrosis (malignant) Parulis Primordial cyst (ages 10-30) Proliferative periostitis (under age 25) Rickets Sickle cell anemia Thalassemia major Thalassemia minor Traumatic bone cyst (under age 25)
Persons Over Age 30 Ameloblastoma (ages 20-50, peak at age 40) Chondrosarcoma (ages 20-60, peak in 50s) Osteopetrosis (benign) Pindborg tumor (ages 28-48) Primary hyperparathyroidism (ages 30-60) Residual cyst (peak at age 52) Florid cementoosseous dysplasia
Persons Over Age 40 Artery calcification Calcified node Cancer Chondrosarcoma (ages 20-60; peak in 50s) Metastatic carcinoma Minor salivary tumor Multiple myeloma (ages 40-70) Squamous cell carcinoma (peripheral) Osteomalacia Osteomyelitis Paget's disease Periapical cemental dysplasia Postextraction sockets Secondary hyperparathyroidism (ages 50-80) Sialolith
vious that it is necessary to develop the differential diagnc sis along distinctly contrasting lines in each of these case~ Basically, when two or more lesions are present. seve possibilities or propositions must be considered (modi tied from Mitton et aI 8 ): I. Lesions are related a. Lesion A and lesion B are identical (two aphl hous ulcers)