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Case 106054

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Maxilla and mandible

Referral reason

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Canaray 106054

1. Cystic lesions in maxilla and mandible

Multiple well-defined, corticated cystic lesions are evident in the right maxilla and the posterior left and right mandible, in the alveolar processes of the edentulous sites 13, 35, and 36, and also apical to tooth 45. These cystic lesions have caused thinning of their contiguous buccal and palatal/lingual cortical plates, but these cortices appear intact. The epicenter of the cystic entity in the posterior right mandible appears to be located slightly apical to the periapical region of tooth 45, which suggests that it may not have arisen secondary to persistent inflammatory disease in this tooth. The radiographic appearances of these lesions are non-specific, and could represent the presence of residual and radicular cysts, and/or the presence of multiple keratocysts. Biopsy with histopathologic correlation is necessary to make this distinction. Note that the presence of multiple keratocysts is a feature of nevoid basal cell carcinoma syndrome.

2. Healing in posterior left maxilla

Granular bone is observed along the floor of the maxillary sinus apical to the edentulous sites 26 and 27, and the sinus floor demonstrates an irregularly elevated contour in this region. These findings suggest a history of extensive rarefying osteitis or previous odontogenic cyst associated with the extracted tooth 26, which appears to be healing following surgical intervention. However, correlation with the patient's dental history is necessary to substantiate this interpretation.

Orthogonal measurements of cystic lesion in right maxilla

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic lesion in the right maxilla.

Orthogonal measurements of the cystic lesion in the posterior left mandible

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic lesion in the posterior left mandible.

Orthogonal measurements of the posterior right mandible

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic lesion in the posterior right mandible.

Axial views of the maxillae

These axial cross-sectional images demonstrate the presence of a cystic lesion in the right maxilla, in the alveolar process of site 13. The buccal surface of the maxilla appears slightly expanded adjacent to this region, and the buccal cortex appears thinned, but remains intact.

Axial views of the mandible

These axial cross-sectional images demonstrate the presence cystic lesions in the posterior left and right mandible. These cystic lesions demonstrate a greater mesiodistal extension than its buccolingual dimension, and there is minimal evidence of buccolingual expansion. The contiguous buccal and lingual cortical plates appear thinned, but remain intact.

Mesiodistal views of the posterior left mandible

These mesiodistal cross-sectional images demonstrate that the cystic lesion in the posterior left mandible is well-defined and corticated, and exhibits an attenuation comparable to fluid or soft tissue. The left inferior alveolar nerve canal passes immediately inferior to this cystic entity, but does not appear to be significantly displaced or compressed by this entity.

Mesiodistal views of the posterior right mandible

These mesiodistal cross-sectional images demonstrate that the epicenter of growth of the cystic lesion appears to be located apical to the root apex of tooth 45, which suggests that it likely did not arise secondary to persistent inflammatory disease in association with this tooth. Mild external resorption is evident along the root apex of tooth 45, which suggests that this tooth has been secondarily affected by the cystic lesion. Note that the right inferior alveolar nerve canal and mental foramen is located immediately inferior to this cystic entity. There is no evidence displacement or compression of the nerve canal.

3. Periodontal-endodontic lesion + root resorption in tooth 25

There is extensive circumferential bone loss around the roots of tooth 25, which extends from the alveolar crest to involve its periapical regions. These findings suggest inflammatory disease arising from a combined endodontic and periodontal origin. A large resorptive defect is also evident along the distal aspect of the palatal root of this tooth, at the mid-root level. Extraction of this tooth is indicated.

4. Rarefying osteitis on tooth 44

There is rarefying osteitis located periapical to tooth 44. The buccal cortex overlying this region appears dehiscent. These findings suggest that tooth 44 may be devitalized, but clinical correlation is necessary to substantiate this interpretation.

Generalized periodontal bone loss

There is generalized moderate to severe horizontal bone loss involving the imaged dentition. Vertical bone loss is evident along the mesial and distal aspects of tooth 12, the mesial aspect of tooth 11, the mesial aspect of tooth 21, the mesial aspect of tooth 38, the distal aspect of tooth 43, and the mesial aspect of tooth 47. A combined periodontal-endodontic lesion is evident in tooth 25.

5. Mild mucositis of both maxillary sinuses

Mild mucositis is present in both maxillary sinuses. This represents an incidental finding with no clinical significance.

6. Left palatine tonsilloliths

Tonsilloliths are present in the left palatine tonsil. This is an incidental finding with no clinical significance.

7. Mild cervical degenerative joint disease

Small osteophytes and mild subchondral sclerosis are present in the articular regions of the Atlas and dens of the cervical vertebrae. This is a common incidental finding with no clinical significance that is suggestive of mild cervical degenerative joint disease.