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Case 116541

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

55,65

Referral reason

[Only visible to logged-in users]

2 Files Info

Canaray 116541

Volume rendering of tooth 15

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1. Hyperpneumatization of the maxillae + constricted palate

The bilateral maxillae appear hyperpneumatized. The pneumatization of the right side appears more extensive than the left, and extends to the intermaxillary suture. The palatal processes of the maxillae appear expanded and bowed in a medial direction, which may be a rare sequela of pneumatization (pneumosinus dilatans). Mild mucosal thickening is evident in the left maxillary sinus, while moderate mucosal thickening is evident on the right side. A constricted V-shaped palatal vault is present, which may be secondary to the extensive pneumatization, and/or arising from a developmental or parafunctional origin. Correlation with the patient's medical history and previous dental records is recommended.

These findings suggest hyperpneumatization of the maxillary sinuses with a constricted palatal vault, which should not be misinterpreted as a cystic growth within the antral space.

Axial views of the paranasal sinuses

These axial cross-sectional images demonstrate that the ethmoid, sphenoid, and maxillary sinuses all exhibit hyperpneumatization. The pneumatization of the right maxillary sinus appears particularly prominent, which extends to the anatomic midline. The enlarged ethmoid sinuses have caused a slight lateral bowing of the medial walls of the orbits. The sphenoid sinus has pneumatized the greater wings of the sphenoid bone. In spite of these findings, the walls of these sinuses appear intact.

Coronal views of the paranasal sinuses

These coronal cross-sectional images demonstrate that the alveolar and palatal processes of the maxillae appear pneumatized, and that the pneumatization extends to the anatomic midline. The palatal surfaces of the alveolar process appear bowed in a medial direction, which could be secondary to the extensive pneumatization. The contiguous palatal cortical plates appear intact, despite this finding, and a V-shaped and constricted palatal vault is evident as a result. Note the intact appearances of the walls and floors of the nasal cavity. Also evident in these cross-sectional images is the extensive pneumatization of the sphenoid sinus, which extends to the base of the pterygoid plates.

Sagittal views of the right maxillary sinus

These sagittal cross-sectional images demonstrate the partial opacification of the right maxillary sinus, which extends into the pneumatized region in the palatal process of the right maxilla. However, a corticated boundary cannot be visualized superior to this opacification, which suggests that this represents mucosal thickening as opposed to the presence of a cystic lesion. The underlying floor of the maxillary sinus appears intact.

2. Mucositis in ethmoid sinus and sphenoid sinus

The ethmoidal air cells are partially opacified, and mild mucosal thickening is noted in the sphenoid sinus. These findings suggest the presence of mucositis involving the ethmoid and sphenoid sinuses.

3. Concha bullosae

The left and right middle nasal conchae contain air. These represent concha bullosae and are incidental findings with no clinical significance. The nasal cavity appears normal otherwise.

Impacted tooth 15

Tooth 15 is transversely impacted in the right maxilla. The crown of this tooth is located immediately mesial to the middle third of the palatal root of tooth 16, but there is no evidence of root resorption. Root development in this tooth is complete, and its root apex is located adjacent to the palatal cortical plate, just palatal to the palatal root of tooth 16. The root apex of tooth 15 appears curved in a mesial direction. The periodontal ligament space surrounding the root circumference of this impacted tooth is visualized, which suggests that it is not ankylosed. The crown of this impacted tooth can be surgically accessed from the palatal aspect of the alveolar process at site 15, just mesial to the middle third of the palatal root of tooth 16.

4. Possible dentigerous cyst associated with tooth 15

The follicle surrounding the crown of tooth 15 appears enlarged, and extends buccally to surround the deciduous tooth 55, and abuts the contiguous buccal cortex of the alveolar process. The adjacent buccal cortex and overlying alveolar crest appear partially dehiscent, which suggests that this lesion may be partially marsupialized. These findings suggest a partially marsupialized dentigerous cyst associated with tooth 15, but biopsy with histopathologic correlation is necessary to substantiate this interpretation.

No evidence of ankylosis in tooth 15

These axial cross-sectional images demonstrate that the periodontal ligament space lining the root circumference of tooth 15 is visualized, which suggests the absence of ankylosis.

Normal tooth 16

Tooth 16 appears normal radiographically. There is no evidence of displacement or root resorption in association with its close proximity to the impacted tooth 15. The crown of tooth 15 is located immediately mesial to the middle third of the palatal root of tooth 16.

Retained tooth 55

The deciduous tooth 55 is retained within the alveolar process, and exhibits extensive physiologic root resorption. The cystic lesion associated with the crown of tooth 15 completely envelops tooth 55.

Axial views of the first quadrant

These axial cross-sectional images demonstrate the presence of a transversely impacted tooth 15, and the mesial positioning the crown of this tooth relative to the palatal root of tooth 16. There is no evidence of root resorption in tooth 16.

Developmentally absent tooth 25

Tooth 25 appears to be developmentally absent.

Nearly exfoliated tooth 65

The deciduous tooth 65 exhibits severe physiologic root resorption, and appears close to exfoliation.

5. Apical resorption + high crown-to-root ratio in teeth 12-22

The root apices of teeth 12, 11, 21, and 22 appear shortened and blunted, which is consistent with apical resorption. This results in a high crown-to-root ratio in these teeth, which could adversely affect their longevity. There is no radiographic evidence of endodontic pathology involving these teeth.