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Case 166762

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Referral category

Disease / syndrome / tumor / condition

Region of interest

teeth #44-48 region

Referral reason

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1 Files Info

Canaray 166762

1. Infiltrative malignancy in right posterior mandible

Multiple small osseous defects are present within the buccal and lingual cortical plates in the right posterior mandible. A lamellar periosteal bone reaction is present overlying the buccal aspect of the right posterior mandibular body, and a soft tissue mass appears to be present between this area of periosteal bone formation and the buccal cortical plate. The right mental foramen appears to be enlarged, but the left mental foramen is not captured in this imaging volume for comparison. Irregular periodontal ligament space widening is present around the roots of tooth 47, and the lamina dura is effaced. The extraction socket at site 48 exhibits no evidence of osseous healing.

These radiographic features are highly suggestive of an infiltrative malignancy, such as an extranodal lymphoma. Medical referral is indicated for further investigation and management.

Additional views of periosteal bone formation

These orthogonal images demonstrate the lamellar periosteal reaction along the buccal aspect of the right mandibular body, which extends apically between teeth 43 and 47. Multiple cortical defects are present along the buccal aspect of the mandible adjacent to this periosteal bone formation. The presence of a radiolucency between this periosteal reaction and the residual mandibular cortex suggests a soft tissue mass is present in this region.

Orthogonal views of tooth 47 demonstrating irregular PDL widening and loss of lamina dura

These orthogonal images of tooth 47 exhibit lytic bone loss around the root apices, as well as irregular widening of the periodontal ligament space around the roots. The lamina dura is largely effaced. This appearance suggests the presence of an infiltrative malignancy.

Orthogonal views of extraction socket at site 48

These orthogonal cross-sectional images demonstrate the absence of healing bone formation within the extraction socket at site 48. There is no evidence of communication between the socket and the right mandibular nerve canal, which suggests the extraction was not the source of paresthesia.

Axial views of right posterior mandible

These axial cross-sectional images demonstrate small cortical defects within the buccal and lingual cortices of the right posterior mandible, as well as lamellar periosteal bone formation along the buccal aspect of the right mandibular body. This periosteal bone formation extends apically between teeth 43 and 47. The mental foramen appears to be enlarged and the cortex is not well-defined.

Mesiodistal views of right posterior mandible

These mesiodistal cross-sectional images demonstrate the presence of lytic bone loss around the apical aspect of tooth 47, as well as the irregularly widened periodontal ligament space around the roots. Note that the extraction socket at site 48 does not directly communicate with the right mandibular nerve canal.

Buccolingual views of right posterior mandible

These buccolingual cross-sectional images demonstrate small foci of lytic bone loss within the buccal and lingual cortices of the right posterior mandible. The periosteal reaction is also evident in these images.

2. Mild cervical degenerative joint disease

Small osteophytes 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.

3. Calcified right stylohyoid ligament

The right stylohyoid ligament is partially calcified. This is an incidental finding with no clinical significance.