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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
Maxilla and mandible
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1. Multifocal PDL widening in left posterior mandible suggestive of infiltrative malignancy
The periodontal ligament spaces around the roots of teeth 34, 35, and 36 are widening, and the contiguous lamina dura is partially effaced. The alveolar crest is lost and multiple fenestrations are evident within the buccal cortical plate overlying the teeth in the left posterior mandible. The trabecular bone is osteopenic, and the cortex of the left mandibular nerve canal is poorly discerned. In combination with the clinical presentation of left-sided V3 paresthesia, soft tissue swelling, and a purported history of lymphoma, this radiographic appearance is highly suggestive of an infiltrative malignancy involving the left posterior mandible. Medical referral is required.
Axial views of posterior 3rd quadrant
These axial cross-sectional images demonstrate focal areas of dehiscence within the buccal cortical plate in the left posterior mandible, as well as an osteopenic appearance of the trabecular bone. The lamina dura around the roots of the teeth is partially effaced.
Buccolingual views of posterior 3rd quadrant
These buccolingual cross-sectional images demonstrate partial dehiscence of the buccal cortical plate within the left posterior mandible. The caliber of the mental foramen appears normal.
Mesiodistal views of posterior 3rd quadrant
These mesiodistal cross-sectional images demonstrate loss of the crestal bone between teeth 34, 35, 36, and 37. The trabecular bone is osteopenic in the left posterior mandible. The residual extraction socket is visible at site 38.
2. Cervical lymphadenopathy causing oropharyngeal airway displacement
Multiple enlarged lymph nodes are present within the left cervical and submandibular regions. The oropharyngeal airway demonstrates a right lateral displacement, but remains patent.
Periodontal bone loss
Teeth 18 and 28 demonstrate mild to moderate horizontal periodontal bone loss.
3. Dense bone island adjacent to tooth 47D
A dense bone island is present adjacent to the buccal surface of the distal root of tooth 47. This is a non-significant incidental finding.
4. Maxillary sinus mucositis
Mild mucositis is present in the left maxillary sinus. This is a non-significant incidental finding.
5. Multiple subcutaneous calcifications
Subcutaneous calcifications are dispersed throughout the facial region. This is an incidental finding with no clinical significance.