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Referral details

Case 117801

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Referral category

Temporomandibular joints (TMJ)

Region of interest

right TMJ

Referral reason

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1 Files Info

Canaray 117801

1. Lytic bone loss in right condylar head: Medical referral indicated to rule out malignancy

An extensive zone of lytic bone loss is present within the right condylar head. The residual joint space is reduced, and mild subchondral sclerosis is present within the temporal and remaining condylar components of the joint. While this area of bone loss may be attributed to severe degenerative changes within the joint, medical referral is indicated to assess the surrounding soft tissue structures and to rule out the possibility of a malignancy within the joint.

Sagittal views of right TMJ

These sagittal cross-sectional images demonstrate the extensive area of bone loss associated with the right condylar head. Note the diminished joint space and subchondral sclerosis within the residual condyle and temporal components of the joint, which suggests degenerative joint disease is also present.

Coronal views of right TMJ

These coronal cross-sectional images demonstrate partial loss of the superior cortex of the right condylar head, as well as the extensive area of lytic bone loss. The glenoid fossa remains intact.

Orthogonal views of TMJs in mandibular closed position

These orthogonal cross-sectional images demonstrate the central position of both condyles within the respective glenoid fossae in the mandibular closed position, which is normal. No osseous abnormalities are noted within the left temporomandibular joint.

2. Residual cyst at site 21

A unilocular radiolucent cystic lesion is present in the alveolar process at site 21. The buccal cortex is expanded and thinned, and the palatal cortical plate is partially dehiscent. The left lateral border of the incisive canal is effaced, but the epicenter of bone loss suggests this radiolucency has not arisen within the canal itself. Teeth 11 and 22 have not been affected.

This radiographic appearance is most suggestive of a residual cyst at site 21. A biopsy is required for a definitive diagnosis.

Axial views of anterior maxilla

These axial cross-sectional images demonstrate the epicenter of bone loss within the alveolar process at site 21. This radiolucency exhibits a cystic appearance, and does not appear to originate within the incisive canal. A residual cyst at site 21 is the most likely interpretation.

3. Enamel defect on tooth 13DB

A focal defect is present within the enamel on the distobuccal aspect of the crown of tooth 13. The tooth appears normal otherwise.

4. Enamel defect on tooth 33DB

A focal defect is present within the enamel on the distobuccal aspect of the crown of tooth 33. The tooth appears normal otherwise.

5. Enamel defect on tooth 43

A defect is present within the enamel on the distobuccal aspect of the crown of tooth 43, which appears to extend into the dentin.

6. External resorption on tooth 44Bu

External resorption is present on the buccal aspect of the coronal third of the root of tooth 44. No pulpal communication is noted.

Periodontal bone loss on mandibular incisors

The mandibular incisors exhibit mild horizontal periodontal bone loss.

7. Hypoplasia of the right maxillary sinus

The floor of the right maxillary sinus has failed to descend below the level of the nasal floor. This appearance is consistent with mild hypoplasia of the right maxillary sinus.

8. Intracranial calcification of left internal carotid artery

Calcifications are visible lining the wall of the cavernous segment of the left internal carotid artery. This finding may represent a sign of atherosclerosis. The significance of this finding cannot be determined based on CBCT imaging alone.

9. Elongated right styloid process

The right styloid process is elongated. This is an incidental finding with no significance.

10. 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.

11. Physiologic intracranial calcification

A midline physiologic calcification is present intracranially. This is an incidental finding with no significance.