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Case 191899

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Referral category

Disease / syndrome / tumor / condition

Region of interest

MANDABLE

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Canaray 191899

Odontogenic cyst or cystic tumour in left mandibular ramus

There is a large well-defined, corticated, radiolucency located within the right mandibular ramus, which extends from its base to slightly elevate the sigmoid notch. This entity scallops along the endosteal surfaces of the medial and lateral cortices of the ramus. Cortical thinning and mild expansion are present, and the medial cortex of the ramus appears partially dehiscent around the mandibular foramen. This lesion extends further mesially to efface the anterior border of the ramus and crestal bone at site 38, which could suggest partial communication with the oral cavity.

The internal attenuation of this entity appears homogeneously radiolucent, with a density comparable to soft tissue or fluid. This entity surrounds the left mandibular nerve canal, and the course of the canal cannot be defined within the ramus.

These findings suggest the presence of an odontogenic cyst or cystic tumour. Its relatively mild expansion and scalloping periphery favor an interpretation of an odontogenic keratocyst, but histopathologic correlation is necessary to reach a definitive diagnosis.

1. Accessory neurovascular canal in left mandible

An accessory neurovascular canal is evident emanating from the left mandibular nerve canal to the anterior margin of the base of the left mandibular ramus adjacent to the border of the cystic lesion. This is an anatomic variant.

Mesiodistal views of the cystic lesion

These mesiodistal cross-sectional images demonstrate the scalloping periphery of the cystic lesion in the left ramus, which is a characteristic feature of a keratocystic odontogenic tumor. Note the extension of the lesion to the mandibular notch and elevation of its base border. The anterior border of the ramus appears partially dehiscent.

Mesiodistal views of the cystic lesion without nerve tracing

These mesiodistal cross-sectional images demonstrate the passage of the mandibular nerve canal within the cyst, as well as the loss of the borders of the nerve canal at this region.

Axial views of the cystic lesions without nerve tracing

These axial cross-sectional images demonstrate the inferior extension of the lesion beyond the mandibular nerve canal. The cortical borders of the canal are not visualized in this area.

Buccolingual views of the cystic lesion without nerve tracing

These buccolingual cross-sectional images demonstrate the inferior displacement of the mandibular canal and the loss of the borders of the canal within the lesion. Note the mild expansion of the buccal lingual cortices of the mandible at this site as well as effacing of the lingual cortex

2. Mild mucosal thickening in left maxillary sinus

Mild mucosal thickening is evident in the left maxillary sinus, which may be suggestive of mucositis. This is a common incidental finding with no clinical significance.

3. Calcified stylohyoid ligament

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