Oral Medicine and Pathology Center

Well-defined dome-shaped opacities of the maxillary sinus antrum can represent mucus retention cysts or antral pseudocysts when they are non-odontogenic in origin. In some cases apical cysts or other odontogenic cysts can mimic these lesions, but clinical and radiographic parameters and correlation usually allow for clear distinction between primary sinus cyst pathology versus odontogenic pathology. These lesions are common on X-rays and usually need no treatment just observation. In some cases they can be associated with symptoms and require treatment e.g. by ENT or OMFS. Biopsy can be helpful for definitive histologic diagnosis in some of these cases, or prior to grafting and dental implant placement in the area. Recent literature and reviews interestingly show that dental implant placement after sinus lift procedures in patients with mucous retention cysts and pseudocysts are safe and present high survival regardless of the removal of the lesion or not.

Well-defined dome-shaped opacities of the maxillary sinus antrum can be mucus retention cysts or antral pseudocysts when they are non-odontogenic in origin. In some cases an apical or another odontogenic cyst can mimic these sinus lesions, but clinical correlation (e.g. vitality testing of teeth in the area) along with other clinical and radiographic parameters usually allow for a clear distinction between odontogenic versus primarily sinus pathology. These sinus cysts or pseudocysts are common and usually asymptomatic and require no treatment just periodic observation. In some cases they can cause symptoms and require treatment, and biopsy can be helpful for more definite diagnosis in such cases. These lesions can also pose dilemmas during dental implant therapy and sinus grafting, and recent reviews indicate that dental implant placement after sinus lift procedures in patients with mucous retention cysts and pseudocysts are safe and present high survival regardless of the removal of the lesion or not.

April is oral cancer awareness month, and a little known fact is that there are significant risk factors for oral cancer/squamous cell carcinoma beyond the typically described risk factors such as tobacco/alcohol, betel quid/paan, HPV, UV/sun exposure for lower lip cases, family history or personal history of oral cancer, age, s*x, and ethnicity. These less known risk factors include inherited genetic conditions like Fanconi anemia, dyskeratosis congenita, xeroderma pigmentosum, and Li Fraumeni syndrome. Also, conditions like proliferative verrucous leukoplakia, lichen planus, and GVHD can increase the risk for oral cancer. Additionally, occupational exposure to certain toxins, acid reflux, drinking very hot drinks like mate, and diets high in red meat and low in vegetables are thought to increase risk for oral SCC. Knowing these risk factors can help with active surveillance and early detection/biopsy in these patient populations, and also impacts prevention efforts in addition to outcomes like morbidity and mortality.

Here is a helpful acronym for remembering the differential diagnosis of unilocular to multilocular demarcated radiolucencies in the jaws (basically a more comprehensive variation of the MACHO acronym). In many cases, biopsy is needed for more definitive histologic diagnosis and to rule out some of the conditions in the DDx.

Here is a helpful acronym for remembering the differential diagnosis of demarcated unilocular to multilocular radiolucencies of the jaws (a more comprehensive version of the common MACHO acronym). In many cases, definitive diagnosis requires biopsy for histologic assessment and to rule out some of these conditions in the DDx.

Solitary and brownish pigmented lesions of the oral mucosa are usually melanocytic lesions, and can range from benign to malignant conditions. The differential diagnosis for such lesions includes (but is not limited to) melanotic macule, post-inflammatory melanosis, nevus, melanoacanthoma, and rarely melanoma. The clinical features/morphology of the lesion and ABCDs of melanoma are helpful tools to inform diagnosis, but only biopsy is definitive for the diagnosis in most cases. In the case shown here a young healthy female presented with this painless melanotic macule which was wisely biopsied (as sometimes these are not), and the histologic diagnosis was an early melanoma in situ arising from a mucosal melanocytic nevus, with positive margins requiring wider excision for cure. She is very lucky to have this caught early enough, literally saved her life as oral melanoma once established is aggressive with high mortality and poor prognosis unfortunately. This is why we biopsy most pigmented lesions, or at the least follow them periodically for any changes that would then warrant biopsy. Clinically, lesions can really look like an amalgam tattoo or a melanotic macule or a blue nevus but that end up being premalignant or malignant on biopsy; this is why biopsy for histologic diagnosis is the gold standard not clinical diagnosis.

Another great symposium by LACOMS, high level education and what a cool venue

When you see a well-demarcated opacity with a thin lucent rim around the apex of a tooth (left x-ray) think of osseous dysplasia (cemento-osseous dysplasia), and when you see a similar opacity but around the crown of an impacted tooth (right x-ray) think odontoma! There are exceptions, and other differentials to consider depending on the specific case, but this is generally a good rule to follow.

This is a case of a severe and painful jawbone infection where the radiography shows so many of the characteristic/combined features that enable a radiographic diagnosis of osteomyelitis regardless of the skeletal site of involvement (since long bone osteo can look the same). In the setting of certain medications this could be called osteonecrosis of the jaw (MRONJ), but is essentially the same radiographically as osteomyelitis of the jaw (OMJ), and that’s why clinical and medication history is key to accurate diagnosis.
Can you guess if this case is OMJ or MRONJ knowing only that this is a female 83 years old.
And can you spot these characteristic and defining radiographic features:
1. Lytic poorly-defined lucency
2. Sequestrum
3. Involucrum
4. Codman’s triangle
5. Periosteal reaction (onion-skinning)
6. Cortical fracture/perforation

Swipe for case 4…

Both these patients are older women that have the same painful condition but with different presentations as you can see. The key to accurate diagnosis of this condition requires good history taking…so what is/are the most important history questions you would ask to diagnose these cases accurately?

Swipe for the before and after

Here’s an interesting case of a young adult healthy male that developed this severely painful oral complication post-Covid that wouldn’t resolve.

Diagnosis on this case was post-Covid HSV-associated Erythema Multiforme with superimposed Candida infection/thrush.

Treatment comprised pharmacotherapy with high dose tapered steroid/prednisone, antihistamine/diphenhydramine, antifungal/clotrimazole, and antiviral/valacyclovir. Here is the follow-up image a few weeks later showing complete resolution of the condition.

Happy Monday!

Please don’t hesitate to contact us with any questions. Our staff is available Monday-Friday from 9a-5p. You can also dm us at anytime.

Swipe 👈🏼 for Case l

27 yo male with painless, non-healing oral lesions for several months. What’s your differential diagnosis?

Pt has focal epithelial hyperplasia by histopathology diagnosis and HPV subtyping (usually HPV 13 and 32 subtypes in these lesions). It’s important for these lesions to be removed/biopsied and examined histologically for definitive diagnosis. Treatment options include laser and cryotherapy once accurate diagnosis is established.

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Thank you to everyone for your support and words of encouragement. It means the world to me. I look forward to helping you with your patient needs.

Oral Pathology and Oral Pain & Medicine services

• Once we receive the biopsy, we aim to have results provided within 72 hours.
• If you prefer to have Dr. Parish perform the biopsy, you can refer the patient directly to OMPC.

We love a good view

Providing clinical care along with laboratory and imaging services in a state-of-the-art practice by Dr. Parish Sedghizadeh, Oral & Maxillofacial Pathologist.

Patients can be treated here at OMPC, or biopsies can be sent directly to our practice for histologic diagnosis.

Please call, email, or text the practice to learn more about OMPC or to request referral cards and biopsy kits. 


• Meet Dr. Parish •

Dr. Parish has served as a Professor at USC Ostrow School of Dentistry with over 100 publications and many awards and honors for his teaching, research, clinical, and service activities. With almost 20 years of teaching and clinical experience in the field, Dr. Parish is excited to continue to provide excellent, first-class care to patients in his own practice. 

Welcome to OMPC!

Oral Medicine & Pathology Center located in West Hollywood, California

Oral medicine, orofacial pain, and oral pathology led by Parish Sedghizadeh, DDS, MS

Oral Medicine and Pathology Center updated their phone number.