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Case 242478

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Canaray 242478

1. Large cystic lesion in left maxilla and maxillary sinus: possible secondarily infected

A large unilocular cystic lesion is present the left maxillary alveolar process and the left maxillary sinus. This entity has displaced and expanded the walls of the left maxillary sinus. The posteriorlateral and lateral walls of the left maxillary sinus are siginficantly, thinned, expanded, and are partiially lost, which suggests that the cystic lesion may be draining into the buccal space at this region. Air space is present within the lumen of the cystic lesion, which represents a history of biopsy or surgical intervention. The borders of the lesion within the alveolar process appears non-corticated and the remaining alveolar bone adjacent to the lesion appears sclerotic. This feature suggests that the lesion may be secondarily infected. The epicenter of this lesion appears to be originating within the left posterior alveolar process apical to teeth 24 and 25. The roots of teeth 24, 25, and 26 have been resorbed. These radiographic features are highly suggestive of a large, partially marsupialized/secondarily infected cystic lesion with the most likely diagnosis of a keratocystic odontogenic tumour. MDCT may be recommended to better substantiate the diagnosis. Biopsy and histopathologic evaluation are recommended.

2. Double-border sign in the maxillary sinus

The walls of the maxillary sinus exhibit a double-border appearance, which confirm the diagnosis of the cystic lesion originating at the alveolar bone that extends to the sinus. The remaining maxillary sinus cavity exhibits mucositis with air bubble formation.

Axial views of the left maxilla

These axial cross-sectional images demonstrate that the large cystic lesion in the left maxilla has caused extensive expansion and thinning of the lateral and posterior walls of the left maxilla. These walls appears partially dehiscent, and the cystic lesion extends to the soft tissue overlying the maxilla. The medial wall of the sinus appears intact despite the thinning and mild expansion.

Coronal views of the left maxilla

These coronal cross sectional images demonstrate the expansion of the lateral wall of the left maxillary sinus by the cystic lesion in the left maxilla. The dehiscence in the lateral aspect of the maxillary sinus is present, which is likely the site of marsupilization or biopsy of the cystic lesion. Note the presence of the air as well as air-fluid level in the in the lumen of the cystic lesion, which is likely secondary to the history of the biopsy or surgical intervention.

3. Pseudo soft tissue window: thin remaining buccal cotical plate

CBCT is not the ideal imaging modality for visualization of soft tissue structures. These orthogonal cross-sectional images demonstrate the soft tissue expansion of the cystic lesion into the left buccal space.

Panoramic image of left maxilla

This reconstructed panoramic image demonstrates the extension of the lesion from the along the roots of teeth 22, 23, 24, 25,26 and 27. Note the scalloping of the lesion between the roots and significant resorption of the roots of teeth 24 and 25 and apical resorption of teeth 23, 36, and 27.

Generalized periodontal bone loss

There is generalized moderate to severe horizontal bone loss involving the imaged dentition. Furcation involvement is noted on tooth 26, 27, and 36.