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Case 172015

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Entire mandible

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Canaray 172015

Odontogenic cyst or cystic tumor in posterior left mandible

There is a well-defined, multilocular corticated, radiolucency located within the posterior left mandible and ramus. This entity extends from the mid-ramus to the periapical area of tooth 35, and from the inferior mandibular cortex to the level of the alveolar crest. The lesion communicates with the oral mucosa through a dehiscence at the left mental foramen. This lesion has caused lingual and inferior displacement of the left mandibular nerve canal, and effaces the superior border of the nerve canal. The lingual cortex of the left mandibular body and medial cortex of the ramus appear slightly expanded, but these cortices remain intact. Mild apical resorption may be present at the distal root of tooth 36 and root of tooth 35. Internally, the lesion exhibits coarse and thick septations apical to tooth 38. Areas of high attenuation within the soft tissue of the lesion may represent calcification or accumulation of keratin.

These findings suggest the presence of an odontogenic cyst or cystic tumor, with the most likely interpretation being that of a keratocystic odontogenic tumor. However, the possibility of an ameloblastoma should also be considered. Biopsy with histopathologic evaluation is necessary to substantiate this interpretation.

Orthogonal measurements of the cystic lesion

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic entity in the posterior left mandible and ramus.

Partially impacted tooth 38 in linguoversion

Tooth 38 is partially impacted, and is in severe linguoversion likely secondary to the odontogenic lesion adjacent to the tooth. The left inferior alveolar nerve canal passes inferior to the roots of the tooth. The residual follicle of the tooth appears slightly hyperplastic along the lingual aspect of the crown and communicates with the lesion at this site.

1. Caries on tooth 37D

A small carious lesion is present in the distal portion of the crown of tooth 37. This lesion extends into dentin but does not encroach the pulp system of the tooth.

2. Dense bone island interproximal to teeth 13/14

A small dense bone island is present within the maxillary alveolar process interproximal to the coronal third of the roots of teeth 13 and 14. This represents an incidental finding with no clinical significance.

3. Buccal and palatal exostoses in maxilla

Palatal exostoses are present overlying the maxillary premolar and molar areas, and buccal exostoses are present along the maxillary teeth. These are non-significant incidental findings.

4. Dense bone island interproximal to teeth 34/35

A small dense bone island is present within the mandibular alveolar process interproximal to the middle third of the roots of teeth 34 and 35. This represents an incidental finding with no clinical significance.

5. Concha bullosa

The left middle nasal concha contains air. This represents a concha bullosa and is an incidental finding with no clinical significance.

6. Palatine tonsilloliths

Tonsilloliths are present in the palatine tonsils. This is an incidental finding with no clinical significance due to the spontaneous exfoliation of tonsilloliths.

7. Elongated styloid processes

The styloid processes are elongated bilaterally. This is an incidental finding with no significance.

8. Posible enlarged sella turcica

The sella turcica measures 11.9 x 11.4 mm in diameter, which appears to be at the upper limit. Referral to the patient's physician may be indicated.

9. Physiologic intracranial calcification

A midline physiologic calcification is present intracranially. This is an incidental finding with no significance.

10. Nasal jewellery in place during scan

A single item of nasal jewellery was left in place during the scan.