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Case 183925

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Referral category

Disease / syndrome / tumor / condition

Region of interest

lesions in left mandible

Referral reason

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Canaray 183925

Possible keratocystic odontogenic tumour in posterior left mandible

There is a well-defined, corticated radiolucency with scalloping borders in the posterior left mandibular body and ramus, which extends from the periapical region of the distal root of tooth 46 to the region adjacent to the sigmoid notch of the mandible. The internal structure of this lesion is comparable to fluid or soft tissue. This lesion has caused a modest expansion of the anterior, medial and lateral borders of the right ramus. The mandibular nerve courses inferior to the lesion and its borders appear intact. The alveolar crest at site 38, the anterior and medial borders of the ramus are focally dehiscent, which suggests that this lesion may be partially marsupialized. No significant resorption is evident involving teeth 46 and 47. These findings suggest the presence of an odontogenic cyst or cystic tumor, with the most likely interpretation being that of a keratocystic odontogenic tumor. Biopsy with histopathologic correlation is necessary to rule out the possibility of other similarly-appearing lesions.

Mesiodistal views of the left mandible without nerve tracking

These mesiodistal cross-sectional images demonstrate the normal path and caliber of the mandibular canal as well as normal inferior cortical border of the left mandible. The lesion has not affected the mandibular nerve canal. No radiographic sign of pathology is evident around the mandibular nerve canal.

1. Accessory neurovascular canal at site 38B

An accessory neurovascular canal is evident along the buccal aspect of the alveolar process at the edentulous site 38, which extends from the left inferior alveolar nerve canal to the buccal aspect of the lesion. This is an anatomic variant, and a non-significant incidental finding, but may cause extra bleeding at the time of potential enucleation or surgery of the cyst.

2. Secondarily affected tooth 37

The lesion in the posterior left mandibular body extends into the periapical region of tooth 37. However, this tooth has been secondarily affected and is not the source of any lesion. The lamina dura around the apical third of the roots has been lost adjacent to the lesion, but there is no significant root resorption on the roots of tooth 37.

3. Secondarily affected tooth 36D

The lesion in the posterior left mandibular body extends to the apical third of the distal root of tooth 36. However, this tooth has been secondarily affected and is not the source of any lesion. The lamina dura around the apical third of the distal root of the tooth has been lost adjacent to the lesion, but there is no significant root resorption on the roots of tooth 36.

Mild mucositis in the right maxillary sinus

Mild mucositis is present within the right maxillary sinus. This is a non-significant incidental finding.

4. Mucous retention cysts in left maxillary sinus + mucositis

Two mucous retention cysts are evident along the floor and lateral wall of the left maxillary sinus, which are partially captured in this image volume. This is a non-significant finding. Mild mucositis may be present within the left maxillary sinus.

5. Lingual mandibular tori

Lingual tori composed of cortical bone are present along the alveolar process of the mandible adjacent to the canine-premolar regions. This is a non-significant incidental finding.

6. Buccal exostoses in maxilla

Buccal exostoses are present in the posterior maxilla at the level of the alveolar crest. This is a non-significant incidental finding.

7. Calcification of the vertebral artery

Linear calcification is visible lining the fourth segment of the right vertebral artery, at the level of the base of the skull. This could represent a sign of cardiovascular disease.

8. Calcified stylohyoid ligaments

The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.

9. Mild cervical degenerative joint disease

Small osteophytes and joint mice 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.