Radiographic features of large cystic lesions of the jaws in children

Background: The surgical approach to cystic lesions of the jaws is either marsupialisation or enucleation. The treatment of choice is dependent on the size of the lesion, the bony integrity of the cyst and its proximity to anatomical structures. Obectives: To assess large (> 2.0 cm) cystic lesions of the jaws using plain film radiography (PFR), CT, multiplanar reconstruction program (MPR) and three-dimensional CT (3D-CT). Patients and methods: Twelve children aged 7-14 years. Results: The classic radiological feature was a unilocular radiolucent area surrounded by a well-defined radio-opaque margin adjacent to the root of a non-viable tooth or associated with the crown of an unerupted tooth. Malposition of teeth and root resorption were more common in dentigerous cysts. The features seen on CT were clear and more precise than those seen on PFR. MPR, by the three-dimensional visualisation of the jaw (axial, panoramic, and bucco-lingual), provided useful information for determining the outline of the cyst and its proximity to adjacent anatomical structures, such as teeth, nerves or maxillary sinus. 3-D CT further and more clearly demonstrated discontinuity in the buccal or palatal/lingual cortices of the jaw bone. PFR was very accurate in determining root resorption. Conclusions: CT with MPR and, ideally, 3-D CT should be used for the comprehensive diagnostic work-up and meticulous surgical management of large cystic lesions of the jaws in children.