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Case 128385

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Referral category

Disease / syndrome / tumor / condition

Region of interest

mandible

Referral reason

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1 Files Info

Canaray 128385

1. Possible keratocyst in posterior right mandible

There is a well-defined, corticated radiolucency in the posterior right mandible, which extends from the periapical region of tooth 46 to the height of the coronoid notch. The margins of this entity are corticated and exhibit a scalloping appearance. The internal structure of this lesion is comparable to fluid or soft tissue. A small pocket of gas is evident in the anterior ramus, which likely arose secondary to necrosis and bacterial breakdown. This lesion has caused a modest expansion of the lingual and inferior surfaces of the mandibular body, and the contiguous lingual and inferior cortical plates appear significantly thinned. The alveolar crest overlying site 48 appears focally dehiscent, which suggests that this lesion may be partially marsupialized. Mild apical resorption is also evident involving tooth 47. These findings suggest the presence of an odontogenic cyst or cystic tumor, with the most likely interpretation being that of a keratocystic odontogenic tumor. Biopsy with histopathologic correlation is necessary to rule out the possibility of other similarly-appearing lesions.

Axial views of the posterior right mandible

These axial cross-sectional images demonstrate the presence of a well-defined, corticated radiolucency involving the posterior right mandible. The periphery of this entity appears to be scalloped along the endosteal surfaces of the right mandibular body and ramus, and the roots of teeth 48 and 47. The internal structure of this entity is comparable to fluid or a soft tissue, but a pocket of gas is evident within the anterior aspect of the right mandibular ramus. This lesion has caused expansion along the lingual surface of the right mandibular body, which appears modest relative to the extensive size of this lesion in the mesiodistal dimension.

Buccolingual views of the posterior right mandible

These buccolingual cross-sectional images demonstrate that the buccal and lingual cortical plates overlying the cystic lesion in the posterior right mandible appear thinned. Small dehiscences may be present along the contiguous lingual cortical plate. The right inferior alveolar nerve canal has been displaced in a lingual direction, and its cortices are not fully visualized, which could infer communication between this lesion and the canal contents.

Mesiodistal views of the posterior right mandible

These mesiodistal cross-sectional images demonstrate that the cystic lesion in the posterior right mandible has caused a modest expansion along its inferior border, and the inferior mandibular cortex appears significantly thinned and may be partially dehiscent. The alveolar crest overlying site 48 appears partially dehiscent, which could suggest that this lesion is partially marsupialized. Although this lesion envelops the impacted tooth 48, there are no signs of root resorption. Mild apical resorption is evident involving the mesial and distal roots of tooth 47. There is no evidence of root resorption in tooth 46. Note the scalloping appearance of the posterior-most margins of this entity.

Generalized periodontal bone loss

There is generalized moderate to severe horizontal bone loss involving the imaged dentition. Vertical bone loss is evident along the mesial aspects of teeth 17, 37, and 47.

2. Dense bone island apical to tooth 25

A dense bone island is present in the alveolar bone just apical and palatal to tooth 25. This dense bone island demonstrates no effects on its surrounding structures. This is a non-significant incidental finding.

3. Osseous dysplasia apical to tooth 36

There is a region of dense, amorphous bone located within the posterior left mandibular body, apical to site 36. This region of abnormal bone pattern appears to be surrounded by a radiolucent lining of variable width, and the contiguous lingual cortical plate appears thinned, but remains intact. These findings are consistent with a focus of osseous dysplasia, which does not require treatment. Aside from continued radiographic monitoring, no further action is necessary.

5. Mild mucosal thickening in left maxillary sinus

Mild mucosal thickening is evident in the left maxillary sinus, which is suggestive of mucositis. This is a common incidental finding with no clinical significance.

4. Mild mucosal thickening and mucous retention cyst in right maxillary sinus

Mild mucosal thickening and mucous retention cyst formation are evident in the right maxillary sinus. These represent non-significant incidental findings.

6. Hypoplastic middle conchae

The bilateral middle conchae appears slightly hypoplastic relative to the expected range of normal. Unless there is a history of sinus surgery, these findings are likely developmental in origin.

7. 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.

8. Dural calcifications

Linear calcifications are present superior to the temporal petrous ridges bilaterally. This likely represents calcification of the petroclinoid ligaments, which is a non-significant incidental finding.

9. Intracranial calcification of internal carotid arteries

Focal calcifications are visible lining the walls of the cavernous segments of the left and right internal carotid arteries. These findings may represent signs of atherosclerosis. The significance of this finding cannot be determined based on CBCT imaging alone.

10. Extracranial calcification of carotid artery

Calcifications are visible lining the walls of the left carotid artery at the level of C3. This finding may be a sign of atherosclerosis and cardiovascular disease.

12. Calcification within paraspinal soft tissues

A calcification is present within the paraspinal soft tissues anterior to the body of C2, and posterior to the odontoid process of C2. These likely represent localized calcification of the anterior longitudinal ligament and partial calcification of the transverse ligament, respectively.

11. Moderate cervical degenerative joint disease

Osteophytes and subchondral sclerosis are present in the articulating regions of the atlas and dens of the cervical vertebrae. This is an incidental finding that is suggestive of moderate cervical degenerative joint disease.

13. Calcified stylohyoid ligaments

The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.