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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
37/38 L mandible
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1. Odontogenic keratocyst in left posterior mandible and ramus
A well-defined, corticated, multilocular radiolucency is present in the left posterior mandible and ramus. This entity extends from the buccal aspect of tooth 37 to the superior cortex of the left mandibular nerve canal within the ramus, and from the level of the mandibular notch to the inferior border of the mandible. This radiolucency has caused endosteal thinning and scalloping, and minimal buccolingual expansion given the mesiodistal extent of this radiolucency. Partial dehiscence of the contiguous cortical borders of the mandible suggests the presence of lesional soft tissue communication. The left mandibular nerve has been inferiorly deflected. No root resorption has occurred to tooth 37.
This radiographic appearance is consistent with a benign odontogenic cystic neoplasm. An odontogenic keratocyst is the most likely interpretation. Biopsy and histopathologic confirmation is indicated.
Orthogonal views of left posterior mandible and ramus
These orthogonal cross-sectional images demonstrate partial dehiscence of the buccal and lingual cortices, as well as loss of the alveolar crest at site 38 and the anterior border of the ramus. The multilocular nature of this radiolucency is apparent. The minimal degree of buccolingual expansion is most typical of an odontogenic keratocyst.
2. Calcified stylohyoid ligaments
The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.
3. Mild cervical degenerative joint disease
Small osteophytes and joint space narrowing 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.