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Case 119542

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Referral category

Disease / syndrome / tumor / condition

Region of interest

RIGHT MANDIBLE

Referral reason

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1 Files Info

Canaray 119542

1. Ameloblastoma in posterior right mandible

There is a well-defined, corticated, multi-locular radiolucency located within the posterior right mandible, between teeth 45 to 47. This lesion extends from the alveolar crest adjacent to teeth 45 and 46 inferiorly to abut the superior cortex of the right mandibular nerve canal. The nerve canal appears inferiorly displaced and moderately compressed by this lesion, but its cortices appear to be intact. This lesion has caused extensive expansion of the lingual surface of the mandible, and the lingual cortical plate appears significantly thinned and may be partially dehiscent. As well, the buccal cortex adjacent to tooth 46 has been breached by this entity, and its cortex appears focally thinned and may also be dehiscent. This lesion has caused severe directional resorption of the roots of tooth 46, and also mild resorption of the root of tooth 45. These findings suggest the presence of an odontogenic neoplasm, with the most likely interpretation being that of an ameloblastoma. However, biopsy with histopathologic correlation is necessary to substantiate this interpretation.

Orthogonal measurements of the lesion

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

Axial views of the posterior right mandible

These axial cross-sectional images demonstrate the presence of well-defined, corticated, multi-locular radiolucency located within the posterior right mandible. This lesion extends from the lingual aspect of tooth 45 to the lingual aspect of the mesial root of tooth 47.

Axial views of the posterior right mandible: without the nerve overlay

The same cross-sectional images are provided without the nerve overlay so as to provide better visualization of the cortices of the nerve canal.

Buccolingual views of the posterior right mandible

These buccolingual cross-sectional images demonstrate that the lingual surface of the mandible appears significantly expanded by this lesion, and the lingual cortical plate appears thinned and may be partially dehiscent. As well, the buccal cortex overlying the roots of tooth 46 appears thinned and may be focally dehiscent. Note that this entity extends from the alveolar crest inferiorly to the level of the inferior mandibular cortex.

Buccolingual views of the posterior right mandible: without the nerve overlay

The same cross-sectional images are provided without the nerve overlay so as to provide better visualization of the cortices of the nerve canal.

Mesiodistal views of the posterior right mandible

These mesiodistal cross-sectional images demonstrate that this lesion has caused inferior displacement of the right inferior alveolar nerve canal, but the canal cortices appear to be intact. Note the presence of severe directional resorption involving the mesial and distal roots of tooth 46, and mild resorption involving the apical third of the root of tooth 45. Although this lesion abuts the mesial root of tooth 47, there is presently no evidence of root resorption.

Mesiodistal views of the posterior right mandible: without the nerve overlay

The same cross-sectional images are provided without the nerve overlay so as to provide better visualization of the cortices of the nerve canal.

2. External resorption in tooth 45

Mild external resorption is evident along the distolingual aspect of the root apex of tooth 45 due to its close proximity to the radiolucent lesion. This tooth appears otherwise normal.

3. Severe external resorption in tooth 46M+D

The lesion in the posterior right mandible has caused severe external resorption in the mesial and distal roots of tooth 46 in a directional fashion. The apical halves of these roots appear to have been resorbed, and the apical root canal system of this tooth appears exposed. The concurrent presence of periapical inflammatory disease associated with tooth 46 cannot be definitively ruled out.

4. Caries on tooth 46M+D

A large carious lesion is evident along the distal aspect of the crown of tooth 46, which appears to abut its pulp canal system. A smaller carious lesion is also noted within the mesial enamel lining of this tooth.

5. Enamel caries in tooth 47M

A small carious lesion is evident within the mesial enamel lining of tooth 47, which does not yet extend into dentin.

No evidence of root resorption in tooth 47

The radiolucent lesion in the posterior right mandible abuts the apical half of the mesial root of tooth 47, and also the mesial surface of the apical third of its distal root. There is no radiographic evidence of root resorption involving tooth 47, despite this finding.

Impacted tooth 48

Tooth 48 is mesioangularly impacted and partially captured in this imaging volume. The crown of this tooth is located immediately distal to the cervical region of tooth 47, but there is no evidence of root resorption. Based on what can be visualized, there is no radiographic evidence of pathology involving this impacted tooth. The relationship between the right inferior alveolar nerve canal and the roots of this tooth is not captured in this imaging examination.