Benign and malignant lesions of the mandible and maxilla: imaging findings and systematic approach

Savarese, Leonor Garbin; Cintra, Murilo Bicudo; Nogueira-Barbosa, Marcello Henrique; Boasquevisque, Gustavo Santos

doi:10.1590/0100-3984.2025.0066

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Pictorial Essay • Radiol Bras 59 • 2026 • https://doi.org/10.1590/0100-3984.2025.0066 linkcopy

Benign and malignant lesions of the mandible and maxilla: imaging findings and systematic approach

Authorship SCIMAGO INSTITUTIONS RANKINGS

Although lesions of the mandible and maxilla are relatively common findings on imaging examinations, they still pose a diagnostic challenge for radiologists in clinical practice. Many of these lesions share similar radiographic characteristics, making it difficult to differentiate between benign, infectious, and malignant entities, which can delay appropriate management. This article aims to illustrate the main imaging findings and present a systematic approach based on radiological patterns, such as attenuation type, margins, relationship with dental structures, and anatomical distribution, in order to facilitate the differential diagnosis, as well as to guide clinical and therapeutic management.

Keywords:
Mandible; Magnetic resonance imaging; Tomography, X-ray computed; Maxilla

Lesion	Imaging finding(s)
Radicular cyst	Radiolucent, unilocular, well-defined, and radicular (< 1 cm), with thin cortical margins and slight bone expansion
Dentigerous cyst	Radiolucent, unilocular, well-defined, surrounding the crown of an impacted tooth, with continuous margins and possible expansion
Odontogenic keratocyst	Radiolucent, unilocular or multilocular, with thin, sclerotic margins, discreet expansion, and root resorption; anteroposterior growth and potential cortical erosion
Ameloblastoma	Expansile, unilocular or multilocular, soap-bubble pattern, root resorption, and cortical thinning; on MRI, solid areas with enhancement and restriction
Ossifying fibroma	Well-defined with sclerotic margins, variable density (lytic, mixed, or ground-glass), and bone remodeling; juvenile variant more aggressive
Aneurysmal bone cyst	Expansile, unilocular or multilocular, with enhancing septa and fluid-fluid levels on CT/MRI; may be associated with preexisting lesions
Multiple myeloma	Radiolucent, ovoid, well-defined, without periosteal expansion or reaction; may exhibit a “punched-out” pattern
Giant cell granuloma	Radiolucent, unilocular or multilocular, expansile tumor with cortical erosion and remodeling; differential diagnosis includes a brown tumor
Odontoma	Radiopaque or mixed, well-defined, with a radiolucent halo; can be compound (tooth-like) or complex (amorphous mass)
Osteoma	Radiopaque, sclerotic, and well-circumscribed, usually pedunculated and unrelated to the teeth; multiple cases suggest Gardner’s syndrome
Torus	Dense, homogeneous, and well-defined cortical exostosis, without halo or expansile effect
Cementum-osseous dysplasia	Initially radiolucent, evolving to ground-glass or radiopacity, with well-defined margins and a multifocal pattern
Brown tumor	Radiolucent, expansile, unilocular or multilocular lesion with cortical thinning and associated diffuse demineralization. Related to hyperparathyroidism
Fibrous dysplasia	Ground-glass, poorly defined margins, infiltrative pattern, and longitudinal growth; can be monostotic or polyostotic
Osteoradionecrosis	Irregular lytic and sclerotic areas, with bone sequestra and cortical interruption
Osteomyelitis	Lytic, sclerotic, or mixed pattern, with chronic periosteal reaction, sequestra, and obliteration of the fat planes; may result from untreated dental infection
Malignant tumors	Extensive, ill-defined margins, infiltrative pattern, necrosis, heterogeneous enhancement, and soft-tissue invasion

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