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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Infiltrative malignancy in right posterior mandible
Multiple small osseous defects are present within the buccal, lingual, and inferior cortical plates in the right posterior mandible. A faint lamellar periosteal bone reaction is present overlying the buccal aspect of the right mandibular body adjacent to the canine-premolar region. Lytic bone loss is evident around tooth 45, and the buccal cortical plate is partially effaced. No signs of sclerotic bone formation are noted, which is uncharacteristic of an inflammatory process. The right mandibular nerve canal and mental foramen appear normal at this time.
These radiographic features are highly suggestive of an infiltrative malignancy, such as an extranodal lymphoma. Medical referral is indicated for further investigation and management.
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 adjacent to the canine-premolar area. The right mental foramen appears normal.
Mesiodistal views of right posterior mandible
These mesiodistal cross-sectional images demonstrate the presence of lytic bone loss around tooth 45. This bone loss does not appear to be periodontal in origin. The osseous defects within the inferior mandibular cortex are also apparent.
Buccolingual views of right posterior mandible
These buccolingual cross-sectional images demonstrate small foci of lytic cortical bone loss within the right posterior mandible. The periosteal reaction along the buccal aspect of the mandible in the canine-premolar region is also evident in these images.