Differential Diagnosis for Expansive Sinus Lesion in a 16-year-old Related to a Tooth
- Single most likely diagnosis
- Periapical cyst (radicular cyst): This is the most common odontogenic cyst and is often associated with a non-vital tooth. It can expand the cortical bone and cause sinus lesions, especially in the maxillary sinus.
- Other Likely diagnoses
- Dentigerous cyst: This cyst surrounds the crown of an unerupted tooth and can displace or expand into the sinus, especially if associated with an impacted canine or third molar.
- Odontogenic keratocyst (now referred to as keratocystic odontogenic tumor): Although less common, this lesion can be aggressive, expand into the sinus, and is associated with teeth, often with a history of recurrent lesions.
- Periapical granuloma: While not typically expansive, a large periapical granuloma could potentially expand into the sinus, especially if associated with a large periapical lesion.
- Do Not Miss diagnoses
- Squamous cell carcinoma: Although rare in teenagers, any expansive lesion in the sinus area that does not have an obvious odontogenic source should prompt consideration of malignancy to avoid delayed diagnosis.
- Langerhans cell histiocytosis: This condition can cause lytic bone lesions that might expand into the sinus and can be associated with teeth, either by direct involvement or as part of a systemic condition.
- Osteomyelitis: Chronic osteomyelitis can cause expansive lesions in the jaw and sinus area, especially if there's a history of infection or trauma.
- Rare diagnoses
- Ameloblastoma: A rare, benign (but locally aggressive) odontogenic tumor that can expand into the sinus, although it's more commonly found in the mandible.
- Calcifying epithelial odontogenic tumor (CEOT): Another rare odontogenic tumor that can cause expansive lesions and potentially involve the sinus.
- Central giant cell granuloma: While more common in the mandible, this lesion can occur in the maxilla and expand into the sinus, especially in younger patients.