Oral and Maxillofacial Pathology
Oral and Maxillofacial Pathology
This domain tests a systematic diagnostic approach to jaw, mucosal, salivary, and neck lesions. The exam expects you to relate clinical and radiographic findings to histopathology and behavior, not to memorize isolated names.
Core rules
- Take a structured history: onset, duration, growth, pain, ulceration, smoking, alcohol, and systemic disease.
- Small accessible lesions may be excised; large or suspicious lesions need incisional biopsy with representative tissue.
- Common odontogenic cysts include radicular, dentigerous, and odontogenic keratocyst; tumors include ameloblastoma, odontoma, and odontogenic myxoma.
- Fibro-osseous lesions require correlation of imaging and histology; avoid overdiagnosis of ossifying fibroma versus fibrous dysplasia.
- Red flags include induration, fixation, paresthesia, cervical nodes, and persistent ulceration.
Worked example
A 32-year-old has a multilocular posterior mandibular radiolucency associated with an impacted molar. Differential diagnosis includes dentigerous cyst, odontogenic keratocyst, and ameloblastoma. Reasoning: a dentigerous cyst surrounds the crown; keratocyst tends to grow along the bone with satellite cysts; ameloblastoma is locally aggressive. Incisional biopsy before definitive surgery is the safe step.
Traps
Enucleating a large lesion without a diagnosis; calling every pericoronal radiolucency a dentigerous cyst; relying on brush cytology for a definitive diagnosis; missing mucosal malignancy that mimics trauma.