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Case 71166

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Disease / syndrome / tumor / condition

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24

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Canaray 71166

1. Odontogenic tumor in anterior left maxilla: biopsy recommended

There is a well-defined, non-corticated, radiolucent defect present in the anterior left maxilla, which extends from the palatal aspects of teeth 21 and 22 to the mesial root surface of tooth 25. This defect appears to be lined with soft tissue, and has not caused any expansion or displacement of the adjacent structures. This entity appears to scallop around the roots of teeth 22, 23, 24, and 25, and may have caused mild external root resorption in teeth 23, 24, and 25. The palatal cortex adjacent to this region is mostly dehiscent, but a thin margin of palatal cortex is still present palatal to tooth 22. The periapical periodontal ligament spaces lining the roots of teeth 22, 23, 24, and 25 appear intact, which suggests that this lesion did not arise secondary to pulpal inflammatory disease in these teeth. These findings suggest the possibility of an odontogenic tumor in the anterior left maxilla, with the most likely interpretation being that of a central odontogenic fibroma. Biopsy with histopathologic correlation is necessary for a definitive diagnosis.

Axial views of the anterior left maxilla

These axial cross-sectional images demonstrate the presence of a well-defined osseous defect in the anterior left maxilla, which extends from the palatal aspects of teeth 21 and 22 to the mesial root surface of tooth 25. This defect appears to be lined by a relatively uniform margin of soft tissue. The palatal aspect of this defect appears to have collapsed, and an air-filled cleft in evident palatal to teeth 23 and 24. Note the presence of a thin margin of palatal cortex remaining palatal to tooth 22, and the absence of a space-occupying effect in association with this lesion. These features support the interpretation of a central odontogenic fibroma.

Coronal views of the anterior left maxilla

These coronal cross-sectional images demonstrate the extension of the osseous defect into the palatal process of the left maxilla. Although this defect encroaches the floor of the nasal fossa and anterior floor of the maxillary sinus, their cortical boundaries remain intact. The palatal cortex adjacent to this region appears dehiscent, and this defect appears to be filled with soft tissue and air. The buccal cortex adjacent to the interradicular region between teeth 23 and 24 appears thinned and partially dehiscent.

Sagittal views of the anterior left maxilla

These sagittal cross-sectional images demonstrate that the periapical periodontal ligament space lining the roots of teeth 22, 23, 24, and 25 appears relatively normal and intact, which suggests that this lesion did not arise secondary to inflammatory disease involving these teeth.

Secondarily affected tooth 22

The osseous defect in the anterior left maxilla abuts the distopalatal aspect of the apical third of the root of tooth 22, but its apical periodontal ligament space appears intact. The remaining periradicular bone surrounding tooth 22 appears normal. These findings suggest that tooth 22 has been secondarily affected and is not the source of this lesion.

2. Mild external resorption in tooth 23

The radiolucent entity in the anterior left maxilla abuts the mesial, palatal, and distal aspects of the coronal two-thirds of the root of tooth 23. Mild external resorption may be present along the distal root surface of tooth 23, at the mid-root level. Tooth 23 appears normal otherwise, and its apical periodontal ligament space appears thin and uniform, which suggests that this tooth is likely not the source of the lesion.

3. External resorption in tooth 24

The radiolucent entity in the anterior left maxilla abuts the mesial, palatal, and distal aspects of the roots of tooth 24, and has caused external resorption along the mesial and distal aspects of the middle thirds of these roots. These resorptive defects are not yet continuous with the root canal system. The periapical periodontal ligament space of tooth 24 appears normal, which suggests the absence of periapical inflammatory disease.

4. External resorption in tooth 25

The radiolucent entity in the anterior left maxilla extends distally to abut the mesial root surface of tooth 25. This lesion may have caused mild external resorption of the mesial aspect of the middle third of the root of this tooth. The remaining periapical and periradicular bone appears normal, which suggests the absence of periapical inflammatory disease in tooth 25.

5. Mucositis or sinusitis in the left maxillary sinus

The left maxillary sinus is partially captured in this imaging volume. The visible portion of the left maxillary sinus is completely opacified, which suggests the presence of moderate-severe mucositis or sinusitis.