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Case 101808

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Referral category

Dental implants

Region of interest

Mandible

Referral reason

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1 Files Info

Canaray 101808

1. Chronic osteomyelitis in posterior left mandible

In comparison to the initial scan dated September 9, 2015 (case ID: 79134), the osteomyelitis in the posterior left mandible has entered into a chronic state. The alveolar crest apical to sites 35/36 remains dehiscent, and the lingual cortical plate overlying this region has been mostly lost. A completely sequestered fragment of bone remains within the body of the mandible in this region. A newly formed sinus tract is evident along the contiguous inferior mandibular cortex, which was not observed in the initial scan. The previously observed periosteal bone formation has since remodeled into the adjacent buccal and inferior cortical plates, and the inferior border of the mandible exhibits a convex contour in this region.

These findings suggest non-resolution of the osteomyelitis in the posterior left mandible, which has now entered into a chronic phase.

Axial views of the posterior left mandible

These axial cross-sectional images demonstrate the presence of a completely sequestered fragment of bone located within the left mandibular body at sites 35 and 36.

Buccolingual views of the posterior left mandible

These buccolingual cross-sectional images of sites 35 and 36 demonstrate that the lingual cortical plate overlying the sequestrum has been mostly lost. The contiguous buccal cortex remains intact, and appears thickened due to the remodeling of periosteal bone formation.

Mesiodistal views of the posterior left mandible

These mesiodistal cross-sectional images demonstrate that the bone loss in the posterior left mandible has now extended through the inferior mandibular cortex, which suggests the presence of a draining sinus tract. Note that the left inferior alveolar nerve canal passes through this region of osteomyelitis, which may complicate surgical debridement in this region. The inferior border of the mandible exhibits a convex contour due to the remodeling of periosteal bone formation.

2. Extraoral fistula from posterior left mandible

The sinus tract emanating from the inferior mandibular cortex of the posterior left mandible appears to be draining extraorally through a fistula formed within the soft tissues overlying this region. Clinical correlation is recommended to substantiate this interpretation.

3. Right antral pseudocyst

An antral pseudocyst is present within the right maxillary sinus. This represents an incidental finding with no clinical significance.

4. Extracranial calcification of carotid arteries

Calcifications are visible lining the walls of the left and right carotid arteries at the level of C3. This finding may be a sign of atherosclerosis and cardiovascular disease.

5. Severe cervical degenerative joint disease

Severe degenerative joint disease is present in the cervical vertebrae. The radiographic findings that support this diagnosis are the reduced joint spaces, the ossification of the intervertebral regions, the formation of large osteophytes and joint mice, and the presence of subchondral sclerosis.

6. Calcified stylohyoid ligaments

The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.