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Case 18284

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Referral category

Disease / syndrome / tumor / condition

Region of interest

TMJ, lower left

Referral reason

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Canaray 18284

Normal TMJs in mandibular open position

In the mandibular open position, the condylar heads are positioned at the crests of the articular eminences bilaterally. This is normal.

Normal right TMJ in the mandibular closed position

In the mandibular closed position, the right condylar head is centrally positioned in the glenoid fossa. This is normal.

Anteriorly displaced disc in left TMJ

In the mandibular closed position, the left condylar head is slightly posteriorly positioned in the glenoid fossa, which is suggestive of an anteriorly displaced disc. The superior border of the left condylar head exhibits mild irregularities, which is suggestive of early degenerative changes.

This appearance is suggestive of an anteriorly displaced disc with reduction in the left temporomandibular joint.

1. Rarefying osteitis on tooth 34

Tooth 34 exhibits a broad zone of periapical rarefying osteitis that has extended through the buccal cortex of the mandibular alveolar process. This rarefying osteitis is secondary to a necrotic pulp in tooth 34. Endodontic treatment of tooth 34 will be curative.

The overlying soft tissue swelling and lymphadenopathy is secondary to the necrotic pulp and rarefying osteitis associated with tooth 34. Tooth 34 is the source of all the patient's symptoms in the region.

2. Axial slices of mandible and overlying soft tissue

These axial cross-sectional images demonstrate the lymphadenopathy in the submandibular region, as well as the soft tissue swelling buccal to site 34. The epicenter of this soft tissue swelling is the periapical region buccal to tooth 34.

3. Widened PDL space on tooth 47D

The distal root of tooth 47 exhibits a widened periapical periodontal ligament space. It is not possible to ascertain whether this represents a healing bone pattern or rarefying osteitis from this scan alone. Comparison with previous radiographs would be necessary to make this determination.