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Case 239607

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Right side lingual mandibular bone protrusion and inflammation

Referral reason

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Canaray 239607

1. Extensive osteomyelitis/MRONJ in mandible

There is severe sclerosis of the mandible and poorly-defined region of osteolytic area extending from the mandibular midline to the right and left mandibular molars along the lingual aspect of the alveolar bone. The lingual cortical plate is partially sequestrated along the this region and there are multiple irregularly shaped islands of bone within this region, which represent sequestra. Dense periosteal bone formation is observed along the inferior and lingual aspects of the alveolar process. The genial tubercles are completely detached from the mandible. There are no radiographic signs of displacement or root resorption on the involved teeth. These findings are suggestive of osteomyelitis. Given the patient's history of bone density injections, medication-related osteonecrosis of the jaw should be considered. However, the possibility of superimposed infections on the metastatic tumour should also be considered secondary to the history of purported multiple recurrent breast cancer.

Axial views of the mandible

These axial cross sectional images demonstrate the sclerotic appearance of the mandibular body, as well as the slit-like osteolytic region along the lingual aspect of the mandible. The lingual mandibular cortex appears sequestrated. Note that the genial tubercles are also completely sequestrated.

Mesiodistal views of the right mandible

These mesiodistal cross-sectional images demonstrate the normal path and caliber of the mandibular canal as well as significant periosteal bone formation along the inferior mandible. Also note the presence of a mixed sclerotic and lytic area in the bone.

Mesiodistal views of the left mandible

These mesiodistal cross-sectional images demonstrate the normal path and caliber of the mandibular canal as well as significant periosteal bone formation along the inferior mandible. Also note the presence of a mixed sclerotic and lytic area in the bone.

Buccolingual views of the right mandibular body

These buccolingual cross-sectional images demonstrate that the lingual cortex of the right mandibular body has partially sequestrated. Note the presence of periosteal bone formation along the inferior and lingual cortices. The genial tubercle is completely detached.

Buccolingual views of the left mandibular body

These buccolingual cross-sectional images demonstrate that the lingual cortex of the left mandibular body has partially sequestrated. Note the presence of periosteal bone formation along the inferior and lingual cortices. The genial tubercle is completely detached.

2. External resorption on tooth 17MB

The apical third of the mesiobuccal root of tooth 17 exhibits external resorption, which extends to abut the MB1 canal. Severe bone loss is present on the mesial surface of the tooth, which extends apical to the resorptive defect

Generalized periodontal bone loss+ widened PDL space

Generalized moderate to severe horizontal bone loss is present around the remaining maxillary teeth as well as periodontal ligament space widening on the teeth.

4. Mild mucosal thickening in right maxillary sinus

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

3. Moderate mucosal thickening in left maxillary sinus

Moderate mucosal thickening is evident along floor of the left maxillary sinus, which exhibits a slightly polypoid contour. This could represent mucositis, but clinical correlation is recommended to rule out signs and symptoms of sinusitis.

5. Sphenoid sinus mucositis

Mild mucositis is present in the left locule of the sphenoid sinus. This is a non-significant incidental finding.

6. Right palatine tonsillolith

A tonsillolith is present in the right palatine tonsil. This is an incidental finding with no significance because tonsilloliths exfoliate spontaneously.