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Case 215790

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Referral category

Disease / syndrome / tumor / condition

Region of interest

4th quadrant

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Canaray 215790

1. Recurrent odontogenic keratocyst in posterior right mandible

There is a diffuse granular bone pattern within the right mandible distal to tooth 44, within which there are four well-defined, variably-corticated radiolucencies.

The largest radiolucency extends from the distal root surface of tooth 43 to the anterior aspect of the mandibular ramus, and from the alveolar crest to the superior cortex of the inferior alveolar canal. There is a sharp, straight septation located between the roots of teeth 45 and 46. There is a perforation of the alveolar crest buccal to the mesial root of tooth 46. Adjacent to this perforation, within the radiolucency, several focal radiopacities are observed. These likely represent foreign objects. This radiolucency scallops between the roots of the teeth. There is endosteal thinning and mild hydraulic expansion of the buccal and lingual cortical plates.

The second radiolucency is located lingual and distal to the roots of tooth 48. Here, there is another dehiscence of the alveolar crest. The third and fourth radiolucencies are located within the anterior aspect of the middle third of the mandibular ramus.

These appearances are suggestive of a recurrent odontogenic keratocyst. Biopsy and histopathologic correlation are recommended.

2. Secondarily affected tooth 47

One of the radiolucencies in the posterior right mandible abuts the lingual and distal aspects of the roots of tooth 47. Another one of the radiolucencies abuts the apices of the roots of tooth 47. No displacement or resorption is present on tooth 47. This tooth appears normal otherwise and does not exhibit any signs of endodontic pathology.

3. Secondarily affected tooth 46

The largest radiolucency in the posterior right mandible abuts the mesial root and the mesial aspect of the distal root of tooth 46. No displacement or resorption is present on tooth 46. This tooth appears normal otherwise and does not exhibit any signs of endodontic pathology.

4. Secondarily affected tooth 45DB

The largest radiolucency in the posterior right mandible surrounds the mesial, lingual, and distal surfaces of the root of tooth 45. Part of the lamina dura may be intact on the mesial root surface of tooth 45. No displacement or resorption is present on tooth 45. This tooth appears normal otherwise and does not exhibit any signs of endodontic pathology.

5. Secondarily affected tooth 44

The largest radiolucency in the posterior right mandible abuts the lingual and distal surfaces of the root of tooth 44. No displacement or resorption is present on tooth 44. This tooth appears normal otherwise and does not exhibit any signs of endodontic pathology.

6. Secondarily affected tooth 43

The largest radiolucency in the posterior right mandible abuts the distal surface of the root of tooth 43. No displacement or resorption is present on tooth 43. This tooth appears normal otherwise and does not exhibit any signs of endodontic pathology.

7. Palatal exostosis adjacent to teeth 17 and 18

An exostosis composed of cortical and trabecular bone is present palatal to teeth 17 and 18. This is a non-significant incidental finding.

8. Palatal torus

A palatal torus is present in the midline of the hard palate. This is an incidental finding with no clinical significance.

9. Mild mucositis of right maxillary sinus

The right maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.