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Case 24577

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Disease / syndrome / tumor / condition

Region of interest

Mouth

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Canaray 24577

1. Odontogenic keratocyst around tooth 37

A large unilocular radiolucent cyst has formed around the crown of tooth 37. The periphery of this entity is continuous with the cementoenamel junction of tooth 37. Tooth 36 has been mesially displaced by the cyst and the left mandibular nerve has been inferiorly displaced. Tooth 37 has been buccally displaced and horizontally oriented. The developing roots of tooth 37 are malformed.

These findings are suggestive of a large odontogenic cyst around the crown of tooth 37. The presence of multiple cysts is suggestive of odontogenic keratocysts related to nevoid basal cell carcinoma syndrome.

Sagittal views suggestive of self-marsupialization of keratocyst in 3rd quadrant

The sagittal cross sectional images demonstrate the unilocular cyst associated with the crown of tooth 37. Granular bone formation is occurring at the periphery of this cyst, which suggests that the cyst has recently marsupialized into the oral cavity, and may exhibit a progressive reduction in size.

Axial views of posterior third quadrant

These axial cross sectional images demonstrate the buccal displacement of tooth 37 by the keratocyst. Note the mild buccolingual expansion of the mandibular alveolar process relative to the overall dimensions of the keratocyst. The mesial extent of the cyst is the distal surface of the distal root of tooth 36.

2. Odontogenic keratocyst associated with follicle of tooth 47

A unilocular radiolucent cystic entity is present around the crown of tooth 47. The periphery of the entity is associated with the cementoenamel junction of tooth 47. No root resorption or damage has occurred to tooth 46. The entity has displaced the right mandibular nerve inferiorly, and has displaced tooth 47 buccally. The mandibular alveolar process exhibits buccolingual expansion. This radiographic appearance is suggestive of an odontogenic keratocyst associated with the follicle of tooth 47.

Sagittal views of posterior fourth quadrant

These sagittal cross sectional images demonstrate the inferior displacement of the right mandibular nerve by the keratocyst, as well as the horizontally oriented long axis of tooth 47. The mesial extent of the cyst is the periapical region of tooth 46.

Axial views of posterior fourth quadrant

These axial cross sectional images demonstrate the mild buccolingual expansion of the mandibular alveolar process, as well as the buccal position of the tooth 47 relative to the keratocyst. Note the dilacerated root apices on tooth 47.

Axial views of mandible

These axial cross sectional images demonstrate the symmetric bilateral keratocysts associated with teeth 37 and 47.

3. Odontogenic keratocyst associated with tooth 17

A large well-defined unilocular cystic entity is present around the crown of tooth 17. The entity extends to the crest of the maxillary alveolar process and has displaced the sinus floor superiorly. The mesial extent of the entity is the distal surface of tooth 15. This entity has displaced tooth 17 posteriorly into the posterior wall of the right maxillary alveolar process. Tooth 16 has been displaced mesiobuccally. The roots of tooth 16 exhibit distal curves and are positioned buccally to the root of tooth 15. No root resorption has occurred on any of the teeth in the first quadrant. . These radiographic findings are suggestive of an odontogenic keratocyst associated with the crown of tooth 17.

Axial views of posterior first quadrant

These axial cross sectional images demonstrate the displacement of the sinus floor by the odontogenic keratocyst, as well as the posterior displacement of tooth 17 and the dilacerated roots of tooth 17.

Sagittal views of posterior first quadrant

These sagittal cross sectional images demonstrate the round shape of the cyst, and the mesiobuccal displacement of tooth 16. Note the intact, but superiorly displaced, sinus floor.

Coronal views of first quadrant

These coronal cross sectional images demonstrate the absence of displacement of the lateral nasal wall or the lateral wall of the right maxillary sinus.

4. Orthogonal views of tooth 16

These orthogonal cross sectional images demonstrate the curved roots of tooth 16, as well as the buccal position of the roots of tooth 16 relative to the root of tooth 15. Tooth 15 has been palatally displaced by the roots of tooth 16.