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Case 207009

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Mandibular

Referral reason

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Canaray 207009

1. Fibrous dysplasia in right mandibular body

A relatively homogeneous region of high density granular bone formation is present within the right mandibular body. The mandibular body exhibits buccolingual expansion in this area, and the right mandibular nerve canal is deflected superiorly. This appearance is consistent with the presence of fibrous dysplasia. Note that a focal concavity along the buccal aspect of the mandible apical to the premolar region may reflect an area of prior surgical intervention.

2. Simple bone cyst in left mandible

A well-defined, delicately corticated radiolucency is present within the left mandibular body and alveolar process, which extends from a point apical to tooth 33 to the apical region of the distal root of tooth 36 and from the apical third of the roots to the inferior mandibular border. This entity has caused small foci of endosteal scalloping within the contiguous buccal and lingual cortical plates, and exhibits a scalloping appearance around the root apices. The left mandibular nerve canal is inferiorly displaced and compressed apical to the premolar region.

These radiographic features are most consistent with a simple bone cyst in the left mandible. However, the displacement and compression of the neurovascular bundle is an atypical finding. A biopsy and histopathologic evaluation is recommended for a definitive diagnosis.

Axial views of mandible

These axial cross-sectional images demonstrate expansion of the right mandibular body adjacent to the region of high density granular bone formation, an appearance consistent with fibrous dysplasia. The simple bone cyst in the left mandible has not resulted in any expansion, but the buccal and lingual cortices are focally thinned due to endosteal scalloping.

Coronal views of mandible

These coronal cross-sectional images demonstrate the mandibular asymmetry arising from the presence of fibrous dysplasia within the right mandibular body. Note the superior deflection of the right mandibular nerve canal by this region of dysplastic bone, in contrast to the inferior deflection of the left mandibular nerve canal associated with the simple bone cyst.

Mesiodistal views of right posterior mandible

These mesiodistal cross-sectional images demonstrate the presence of high density granular bone formation within the right mandibular body, and the superior deflection of the right mandibular nerve canal in the premolar region. These findings are consistent with fibrous dysplasia.

Mesiodistal views of left posterior mandible

These mesiodistal cross-sectional images demonstrate a scalloping pattern adjacent to the root apices of teeth 34, 35, and 36 associated with the simple bone cyst in the left mandible. A faint, low density pattern of granular bone formation appears to be present within this radiolucency. The inferior mandibular border is intact and unaffected.

3. Widened PDL space on tooth 45D

The periodontal ligament space on the distal surface of the apical third of the root of tooth 45 is widened. This may reflect a site of persistent endodontic pathology arising from an unfilled lateral canal.

4. Retained root fragments at site 37

Two small root fragments are embedded within the apical aspect of site 37. No associated pathology is present.

5. Calcified cornua of thyroid cartilage

Both cornua of the thyroid cartilage are partially calcified. This is an incidental finding with no significance.