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Case 11659

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Mandible

Referral reason

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Canaray 11659

1. Sequestrum at mandibular midline

A large well-defined sequestrum is present at the mandibular midline adjacent to the mental spine. This sequestrum will require removal in order to facilitate healing.

3. Axial views of periosteal bone reaction

These axial cross-sectional images demonstrate the periosteal bone formation on the lingual surface of the anterior mandibular arch. The presence of a periosteal reaction is consistent with a diagnosis of osteomyelitis.

2. Axial views of drainage site into sublingual region

These axial cross-sectional images demonstrate the defect in the lingual surface of the mandible that serves as one of the drainage points into the sublingual region.

4. Periosteal bone reaction in anterior right mandible

These cross sectional images demonstrate the laminated periosteal bone reaction on the lingual and inferior borders of the mandible, as well as the defects in the cortical surface of the mandbiular bone through which the drainage into the sublingual region occurs.

5. Retained mandibular roots with rarefying osteitis

All of the retained roots without crowns in the mandible exhibit periapical rarefying osteitis. These may have been the original source of the osteomyelitis in the anterior mandible.

Osteomyelitis of anterior mandible

These radiographic features are suggestive of osteomyelitis in the anterior right mandible. The distinguishing features of osteomyelitis are the presence of sequestra and the periosteal bone reaction. The radiographic feature that is more suggestive of osteomyelitis than osteonecrosis is the presence of the periosteal reaction. The presence of pain is also more suggestive of osteomyelitis than osteonecrosis.