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Case 261927

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Mandible

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Canaray 261927

1. Large odontogenic cyst in posterior left mandible

There is a well-defined, corticated radiolucent entity located within the posterior left mandible, which extends from the periapical region of tooth 37 to the anterior aspect of the left mandibular ramus. The superior extent of this lesion is not captured in this imaging volume. This entity exhibits a multi-locular appearance, and appears to scallop along the endosteal surfaces of the cortical plates, as well as around the roots of teeth 37 and 38. The internal attenuation of this lesion appears mostly radiolucent, but small calcifications are observed within the inferior aspect of the lesion, interradicular and apical to teeth 37 and 38, which are likely dystrophic in origin. The buccal and lingual cortical plates overlying this lesion appear thinned, but remain intact, and there is no significant evidence of intraosseous expansion. The anterior margin of base of the left mandibular ramus appears partially dehiscent just distal to tooth 38, which could suggest communication with the oral cavity. The left inferior alveolar nerve canal appears to have been slightly displaced in an inferior and buccal direction, and mildly compressed by the cystic lesion. The canal cortices appear intact, despite this finding. There is no significant evidence of root resorption involving teeth 37 and 38.

These findings suggest the presence of a large odontogenic cyst or cystic tumor, and its radiologic features favor an interpretation of a keratocystic odontogenic tumor. However, histopathologic correlation is needed to reach a definitive diagnosis. Complete radiographic imaging of the left mandibular ramus is also recommended to fully appreciate the superior extension of this lesion.

Additional orthogonal views of posterior left mandible: without the nerve overlay

The same cross-sectional images are provided without the nerve overlay so as to provide better visualization of the cortices of the nerve canal.

2. Abrasions on teeth 24, 25, 26

Abrasions are present along the buccal surfaces of teeth 24, 25, 26, at the levels of their cemento-enamel junctions.

3. Left palatine tonsilloliths

Tonsilloliths are present in the left palatine tonsil. This is an incidental finding with no clinical significance.