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Case 120237

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Referral category

Wisdom Teeth

Region of interest

28

Referral reason

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1 Files Info

Canaray 120237

Volume rendering of tooth 28

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1. "Double wall" radiographic sign confims that lesion in left maxilla does not originate within sinus

The presence of a "double wall" radiographic sign in the posterior superior aspect of the left maxillary sinus suggests that the pathology in the left maxilla originates in the maxillary alveolar process, rather than the sinus. The sinus floor has been substantially displaced by the lesion. In essence, the lesion has completely displaced and occupied the former space of the sinus.

2. Large dentigerous cyst at tooth 28

A large well-defined unilocular, radiolucent and cystic entity is present in the pericoronal region of tooth 28. This entity has displaced tooth 28 superiorly and anteriorly into the apical region of tooth 27. The sinus floor has been displaced superiorly, and the cyst essentially occupies the entire space formerly occupied by the sinus. The walls of the cyst and sinus are thickened and sclerotic, which is suggestive of a long-standing lesion, which has likely been secondarily infected. Multiple dehiscences are present within the cyst wall.

Axial views of left maxilla

These axial cross-sectional images demonstrate the almost complete displacement of the left maxillary sinus by the dentigerous cyst originating at tooth 28. The displacement of tooth 28 into the periapical region of tooth 27 by the cyst is also evident in these images. Note the significant thickening and sclerosis of the wall of the cyst and left maxillary sinus, which is indicative of a long-standing history of secondary infection of the cyst.

Coronal views of left maxilla

These coronal cross-sectional images demonstrate the thickened and sclerotic walls of the left maxillary sinus, and the displacement of the sinus floor by the dentigerous cyst originating at tooth 28.

Sagittal views of left maxilla

These sagittal cross-sectional images demonstrate the almost complete displacement of the left maxillary sinus by the dentigerous cyst originating at tooth 28. A dehiscence is present at the alveolar crest at site 28, which may be a potential site of drainage of the cyst.

Images demonstrating the relationship of tooth 28 to tooth 27

These high-resolution images demonstrate the periapical position of the crown of tooth 28 relative to the roots of tooth 27. Mild apical resorption is present at the mesiobuccal root and distobuccal root apices of tooth 27. In addition, periapical rarefying osteitis is present at the mesiobuccal root apex. The root apices of tooth 28 are positioned in the aspect of the alveolar process in the periapical region of tooth 27.

High-resolution axial views of teeth 27 and 28

These high-resolution axial images demonstrate the rarefying osteitis in the periapical region of the mesiobuccal root of tooth 27, as well as the periapical position of tooth 28 relative to tooth 27.

Mesiodistal views of teeth 27 and 28

These mesiodistal cross-sectional images demonstrate the mild external resorption of the apical regions of the mesiobuccal and distobuccal roots of tooth 27. The periapical position of tooth 28 relative to tooth 27 is evident in these images.

3. Hypoplastic or absent right inferior nasal concha

The right inferior nasal concha is hypoplastic or absent. This is a non-significant incidental finding. The nasal cavity appears normal otherwise.

4. Mild cervical degenerative joint disease

Small osteophytes, a subchondral cyst, 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.

5. Elongated styloid processes

The styloid processes are elongated bilaterally. This is an incidental finding with no significance.