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Case 160928

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Upper + lower jaw, 35

Referral reason

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1 Files Info

Canaray 160928

Benign odontogenic cyst or tumor in left posterior mandible

A well-defined, round, thickly-corticated radiolucency is centered in the left posterior mandible, extending from the apex of tooth 35 to the superior border of the mandibular nerve canal. The mandibular nerve canal is inferiorly displaced, and is mildly compressed. No significant buccolingual expansion is noted. Internally, the lesion exhibits a faint circular calcification within the center of the lesion. The contiguous buccal cortex is thinned, but appears intact. These radiographic features are most consistent with a benign odontogenic cyst or cystic tumor, and there are no signs in favour of a metastatic or malignant lesion associated with a purported history of prostate cancer. A residual cyst is the most likely interpretation. A biopsy and histopathologic evaluation is required for definitive diagnosis.

Orthogonal measurements of cystic lesion in posterior third quadrant

These orthogonal cross-sectional images demonstrate the dimensions of the expansile cystic lesion in the posterior third quadrant from various perspectives.

Normal periapical and periradicular bone associated with tooth 35

The periapical and periradicular bone associated with tooth 35 appears normal radiographically. No signs of endodontic or periradicular pathology are present. The periodontal ligament space is of uniform width around the tooth and the lamina dura is intact. No radiographic signs of root fracture are present. This feature suggests that tooth 35 is not the source of the benign lesion developing apical to this tooth.

1. Rarefying osteitis at tooth 13

Tooth 13 exhibits a focus of periapical rarefying osteitis at the root apex. The bone surrounding the remaining root surfaces of tooth 13 appears normal. The existing obturation in the root canal of the tooth extends slightly beyond the radiographic apex. This radiographic appearance is suggestive of a persistent endodontic pathology or healing post-treatment scar tissue. Clinical correlation is recommended to substantiate the diagnosis.

2. Persistent osseous defect in right maxillary sinus

A persistent osseous defect is present at the anterior wall of the right maxillary sinus, which extends to communicate with a buccal osseous defect at site 14. Mild mucositis along the floor of the sinus fills this defect. This may represent a history of apical or sinus surgery. Clinical correlation with the patient's history is recommended to confirm the diagnosis.

Generalized periodontal bone loss + abrasions

There is generalized mild horizontal bone loss involving the imaged teeth. Abrasions are present along the buccal surfaces of the mandibular incisors, at the level of the cemento-enamel junction. The teeth appear normal, otherwise.

Normal maxillary and mandibular arches

The maxillary and mandibular bone appears normal radiographically. There is no evidence of intra-osseous pathology other than the benign cystic lesion.

3. Right palatine tonsilloliths

Tonsilloliths are present in the right palatine tonsil. This is an incidental finding with no clinical significance because tonsilloliths exfoliate spontaneously.

4. Mucous retention cyst in left maxillary sinus

A mucous retention cyst is evident along the medial wall of the left maxillary sinus. This a non-significant incidental finding with no clinical significance.

5. Buccal and palatal exostoses in right maxilla

Buccal and palatal exostoses are present overlying the right molar area. This is a non-significant incidental findings.