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Case 86854

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Referral category

Disease / syndrome / tumor / condition

Region of interest

(L) mandible

Referral reason

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1 Files Info

Canaray 86854

1. Odontogenic or cystic tumor in left mandibular ramus

There is a well-defined, oval shaped radiolucency located within the anterior aspect of the left mandibular ramus. This lesion abuts the left inferior alveolar nerve canal, and appears to be draining through a dehiscence along the alveolar crest just distal to tooth 38, which suggests that it may be partially marsupialized. The contiguous buccal and lingual cortices of the ramus appear thinned, and the lingual cortical plate may be partially dehiscent. The left inferior alveolar nerve canal appears to have been displaced in an inferior direction by this lesion. The periphery of this entity is lined with a margin of granular bone, which likely arose secondary to marsupialization.

These findings suggest the presence of a partially marsupialized odontogenic cyst or cystic tumor in the posterior left mandible, such as a keratocystic odontogenic tumor. However, biopsy with histopathologic correlation is necessary to reach a definitive diagnosis.

Orthogonal measurements of the cystic lesion

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the cystic entity in the left mandibular ramus.

Axial views of the left mandibular ramus

These axial cross-sectional images demonstrate the presence of a well-defined, oval shaped radiolucency located within the left mandibular ramus. The periphery of this lesion is lined with a margin of granular bone, which likely arose secondary to marsupialization.

Buccolingual views of the left mandibular ramus

These buccolingual cross-sectional images demonstrate that, although the lesion in the left mandibular ramus abuts the contiguous buccal and lingual cortical plates, there is minimal evidence of osseous expansion. These cortices appear thinned, and the lingual cortical plate may be partially dehiscent. The left inferior alveolar nerve canal passes immediately inferior to this lesion.

Mesiodistal views of the left mandibular ramus

These buccolingual cross-sectional images demonstrate that the cystic lesion in the left mandibular ramus appears to be draining through a dehiscence in the alveolar crest just distal to tooth 38. Note the presence of granular bone along the margins of this lesion, which likely arose secondary to marsupialization. The left inferior alveolar nerve canal has been displaced in an inferior direction by this lesion.

2. Periodontal-endodontic lesion on tooth 18

There is extensive circumferential bone loss around the root circumference of tooth 18, which extends from the alveolar crest to involve its periapical region. These findings suggest inflammatory disease arising from a combined endodontic and periodontal origin. This tooth exhibits a poor prognosis.

3. Caries + rarefying osteitis on tooth 16

A carious lesion is evident along the distal aspect of tooth 16, at the level of the cemento-enamel junction. Rarefying osteitis is evident periapical to the mesiobuccal, distobuccal, and palatal roots of this tooth, which suggests that it is likely devitalized. Clinical vitality testing of this tooth is necessary to substantiate this interpretation.

4. Recurrent caries + rarefying osteitis on tooth 15

Recurrent caries are evident along the distal aspect of the crown of tooth 15. The caries extend into dentin and encroach the pulp canal system of this tooth. There is also rarefying osteitis located periapical to tooth 15. These findings suggest that this tooth is devitalized. Clinical vitality testing is recommended to substantiate this interpretation.

5. Rarefying osteitis on tooth 12

There is rarefying osteitis located periapical to tooth 12. These findings could suggest that this tooth is devitalized, but clinical vitality testing is necessary to substantiate this interpretation.

6. Rarefying osteitis around retained roots of tooth 38

The crown of tooth 38 is absent. The roots of this tooth are retained within the alveolar process. There is rarefying osteitis located periapical to these retained roots, which indicates the presence of periapical inflammatory disease. Extraction of these retained roots is indicated.

7. Caries on tooth 37M

A carious lesion may be present along the mesial aspect of the crown of tooth 37. The caries extend into dentin but do not yet encroach the pulp canal system of this tooth. Clinical examination and intraoral radiography are recommended to substantiate this interpretation. This tooth appears otherwise normal, and there are no signs of endodontic pathology.

8. Rarefying osteitis on tooth 34

There is rarefying osteitis located periapical to tooth 34. This bone loss extends mesially to abut the root apex of tooth 33. These findings suggest the presence of inflammatory disease in association with a devitalized tooth 34, but clinical vitality testing of this tooth is necessary to substantiate this interpretation.

9. Secondarily affected tooth 33

The rarefying osteitis associated with tooth 34 extends mesially to abut the root apex of tooth 33. The remaining periapical and periradicular bone surrounding tooth 33 appears normal. This pattern of bone loss suggests that tooth 33 has been secondarily affected as opposed to a contributing source of inflammation. Clinical vitality testing of tooth 33 is recommended to substantiate this interpretation.

10. Healing extraction socket at site 43

Granular bone is present within the extraction socket at site 43, which indicates healing. The density of this granular bone is slightly lower than that of the surrounding trabecular bone. Correlation with the patient's dental history is recommended.

Generalized periodontal bone loss + calculus

There is generalized moderate to severe horizontal bone loss involving the imaged dentition. A combined periodontal-endodontic lesion is evident in tooth 18. Calculus deposits are evident in the interproximal regions of these teeth.

11. Mild mucositis of right maxillary sinus

The right maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.

12. Right palatine tonsillolith

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

13. Mild cervical degenerative joint disease

Small osteophytes and mild subchondral sclerosis are present in the articular regions of the atlas and dens of the cervical vertebrae. This is a common incidental finding with no clinical significance that is suggestive of mild cervical degenerative joint disease.

14. Cervical pneumatocysts in C3, C4

Small gas filled cavities are present in the bodies of the third and fourth cervical vertebrae. These represent pneumatocysts, which are suggestive of the presence of cervical degenerative joint disease.

15. Calcified stylohyoid ligaments

The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.