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Referral details

Case 128443

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

25/26 area

Referral reason

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2 Files Info

Canaray 128443

1. Large residual cyst in left maxilla

A well-defined unilocular radiolucent lesion with a corticated periphery and an expansile cystic shape is present in the periapical regions of sites 25 and 26. This entity has displaced the sinus floor, and has occupied almost the entire volume of the left maxillary sinus. The medial wall of the sinus has been displaced by the cystic entity, and has reduced the airway space in the left nasal cavity. The origin of this entity in the maxillary alveolar process suggests that it has an odontogenic origin and may represent a residual cyst originating at site 25. The lesion drains through the alveolar crest at site 25. This is the source of the patient's clinically observed draining abscess.

1. Large draining residual cyst occupies left maxillary sinus

A well-defined unilocular radiolucent lesion with a corticated periphery is present in the periapical region of tooth 26. This entity has displaced the sinus floor, and has occupied a large portion of the left maxillary sinus. the origin of this entity in the maxillary alveolar process suggests that it has an odontogenic origin and may represent a residual cyst originating at site 25. The lesion drains through the alveolar crest at site 25. This is the source of the patient's clinically observeved draining abscess.

The entity was partially captured in this scan. The patient will return for a medium field scan of the maxilla at no charge, and this report will be revised at that time.

Axial views of maxilla

These axial cross-sectional images demonstrate the well defined unilocular cystic lesion that is present in the left maxilla. Note the extension of the lesion into the lumen of the left maxillary sinus, as well as the extension of the medial and lateral walls of the maxillary sinus.

Coronal views of maxilla

These coronal cross-sectional images demonstrate the expansion of the cystic lesion to occupy almost the entire left maxillary sinus, as well as the displacement of the medial wall of the sinus and the reduction of the volume of the nasal cavity.

Sagittal views of left maxilla

These sagittal cross-sectional images demonstrate the well-defined corticated border of the cystic lesion that is present in the left maxillary sinus. Note the drainage of the lesion through the alveolar process at site 25.

2. Rarefying osteitis at tooth 26MB: Tooth appears to be secondarily affected

Rarefying osteitis is present in the periapical region of the mesiobuccal root of tooth 26. This rarefying osteitis is continuous with the cystic lesion that has displaced the sinus floor. Based on the absence of any pathology at the distobuccal and palatal root apices of tooth 26, it is possible that tooth 26 is secondarily affected, and is not the source of the lesion.

Axial views of tooth 26

These axial cross-sectional images demonstrate the rarefying osteitis in the periapical region of the mesiobuccal root of tooth 26, as well as the normal appearance of the alveolar bone surrounding the remaining root surfaces of the tooth. The absence of any pathology at the distobuccal and palatal root apices of the tooth suggests that tooth 26 remains vital.

Buccolingual views of tooth 26

These buccolingual cross-sectional images demonstrate the intact alveolar bone on the buccal and lingual surfaces of the roots of tooth 26. The rarefying osteitis that is present in the periapical region of the mesiobuccal root of the tooth is continuous with the cystic lesion evident in these images.

Mesiodistal views of tooth 26

These mesiodistal cross-sectional images demonstrate the rarefying osteitis that is present in the periapical region of the mesiobuccal root of tooth 26, as well as the normal appearance of the bone on the remaining mesial and distal surfaces of the roots of the tooth. The drainage of the cystic lesion through a tract at site 25 is also evident in these images.

3. Orthogonal views of cyst drainage and reparative bone formation at site 25

These orthogonal cross-sectional images demonstrate the drainage of the cystic lesion through the alveolar crest at site 25. The extraction socket in this region has partially healed, and exhibits low-density granular bone at its periphery.