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Case 110190

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Referral category

Disease / syndrome / tumor / condition

Region of interest

craniofacial, posterior maxilla & mandible

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[Only visible to logged-in users]

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Canaray 110190

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1. Central giant cell granulomas in right and left posterior mandibular rami

Well-defined, corticated, multilocular radiolucencies are present in the right and left posterior mandibular rami. The internal septae exhibit a granular appearance, and buccolingual expansion of both rami is noted. The molar teeth adjacent to these lesions are displaced and tooth 36 is partially impacted, but no resorption has occurred.

This radiographic appearance is consistent with central giant cell granulomas of the mandible. Bilateral central giant cell granulomas are seen in the following syndromes: cherubism, Noonan syndrome, neurofibromatosis type-1 and systemic diseases such as hyperparathyroidism. Further investigation is required to determine whether these findings are part of a syndrome.

Mesiodistal views of right posterior mandible

These mesiodistal cross-sectional images demonstrate multiple curved, granular septae within the lesion in the right posterior mandible and ramus. The anterior border of the ramus is expanded and partially dehiscent, and the cortices of the coronoid process are expanded and effaced.

Mesiodistal views of left posterior mandible

These mesiodistal cross-sectional images demonstrate the multilocular appearance of the lesion in the left posterior mandible and ramus. The anterior border of the ramus is expanded and partially effaced.

Axial views of mandible

These axial cross-sectional images demonstrate the presence of expansile multilocular lesions in the right and left posterior mandible and ramus. Displacement of the mandibular molar teeth is noted.

Axial views of right posterior mandible

These axial cross-sectional images demonstrate mesial displacement of tooth 46, buccal displacement of the developing tooth 47, and mesial displacement of the developing tooth 48 due to the central giant cell granuloma within the right posterior mandible and ramus.

Axial views of left posterior mandible

These axial cross-sectional images demonstrate lingual displacement and partial impaction of tooth 36, mesiobuccal displacement of the developing tooth 37, and mesial displacement of the developing tooth 38 due to the presence of a central giant cell granuloma in the left posterior mandible and ramus.

Coronal views of mandible

These coronal cross-sectional images demonstrate buccolingual expansion associated with the multilocular radiolucencies in the right posterior mandible and ramus. The inferior alveolar nerve canals are displaced inferiorly.

Mesially displaced tooth 46 + future impaction of tooth 45

Tooth 46 is fully erupted and mesially displaced, which has obstructed the eruptive path of the developing tooth 45.

Developing teeth 18 and 28

Teeth 18 and 28 demonstrate an early phase of development. No pathology is associated with these teeth at this time.

2. Adenoid hyperplasia

The pharyngeal tonsils are enlarged, which is an appearance consistent with adenoid hyperplasia. In a pediatric patient, this represents an incidental finding with no clinical significance.

3. Enlarged palatine tonsils

The palatine tonsils are enlarged bilaterally, which has resulted in a relative constriction of the oropharyngeal airway.

4. Normal development of clivus

The spheno-occipital synchondrosis is clearly visible within the clivus. This represents normal osseous development of the clivus and should not be interpreted as pathology.