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Case 143685

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Disease / syndrome / tumor / condition

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Pathology - rescan

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Canaray 143685

1. Expansile osseous dysplasia in posterior right maxilla

This is a follow-up craniofacial scan to the previous, localized study of the posterior left maxilla study dated October 18, 2016 (case ID: 131754). In this study, a similarly-appearing mixed radiolucent/radiopaque entity is noted in the posterior right maxilla. The internal structure of this entity is composed of a haphazard distribution of speckled and granular bone against a relatively radiolucent background. This entity has caused elevation of the sinus floor, and expansion along the buccal and palatal surfaces of the alveolar process. The overlying sinus floor and the contiguous buccal and palatal cortical plates appear thinned, but remain intact. Teeth 16 and 15 appear slightly displaced in a distal and mesial direction by this entity, respectively. Mild external resorption is evident along the furcal surfaces of the mesiobuccal and palatal roots of tooth 16, but there are no signs of endodontic pathology.

These findings, in conjunction with the presence of other foci of dysplastic bone in the maxillae and mandible, suggest the presence of florid osseous dysplasia, which can very rarely cause expansion of bone, and displacement and resorption of teeth. Unlike ossifying fibromas, osseous dysplasias do not require treatment. Interval radiographic follow-ups at 6-12 months is recommended.

2. History of biopsy in posterior left maxilla

In comparison to the previous study dated October 18, 2016 (case ID: 131754), a well-defined defect is evident along the buccal and crestal aspects of the alveolar process, between teeth 23 and 25. This defect is presently filled with soft tissue and a small pocket of air. These findings are consistent with the history of biopsy. No other interval change is apparent.

3. Osseous dysplasia in posterior left mandible

There is a moderately well-defined region of granular bone located periradicular to teeth 36 and 37, which appears to be surrounded by a radiolucent lining that is further surrounded by a margin of slightly sclerotic bone. These findings are consistent with another focus of osseous dysplasia, which does not require treatment. There are no signs of root resorption in teeth 36 and 37. The multifocal appearance of this dysplastic bone suggests an interpretation of florid osseous dysplasia.

4. Osseous dysplasia in posterior right mandible

Amorphous, granular bone is evident adjacent to the buccal aspect of the middle third of the root of tooth 45, which appears to be surrounded by a radiolucent capsule of variable width. The buccal cortex overlying this region appears thinned, but is likely intact. Another focus of low-density granular bone is evident just lingual to the mid-root region of tooth 44, which appears to be surrounded by a radiolucent lining that is further surrounded by a margin of sclerotic bone. There is no evidence of root resorption in teeth 44 and 45. These findings are consistent with foci of osseous dysplasia, which does not require treatment. The multifocal presentation of this dysplastic bone favors an interpretation of florid osseous dysplasia.

5. Dense bone island at site 48

A dense bone island is present in the alveolar bone at site 48. This dense bone island demonstrates no effects on its surrounding structures. This is a non-significant incidental finding.

Left inferior alveolar nerve canal apical to tooth 38

Tooth 38 is mesioangularly impacted. The left inferior alveolar nerve canal passes immediately apical to the root apices of this tooth. There is no evidence of nerve compression. The periodontal ligament space surrounding the root circumference of this impacted tooth is visualized, which suggests that it is not ankylosed. The residual follicle surrounding the crown of tooth 38 appears normal.

6. Mild external resorption on tooth 37D

Very mild external resorption is evident along the distal surface of tooth 37, at the level of the cemento-enamel junction, due to its close proximity to the impacted tooth 38. This tooth appears otherwise normal, and there are no signs of periapical or periradicular pathology.

8. Mild mucositis of right maxillary sinus

The right maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.

7. Mucous retention cyst in left maxillary sinus

A small mucous retention cyst is evident within the left maxillary sinus. This a non-significant incidental finding with no clinical significance.