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Case 88507

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Referral category

Disease / syndrome / tumor / condition

Region of interest

34,35,36

Referral reason

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Canaray 88507

1. Ossifying fibroma in left mandible

A well-defined, corticated, mixed density lesion is present within the left mandible, with an epicenter apical to tooth 74. This entity extends between the the unerupted teeth 33 and 35, and from the alveolar crest to the inferior mandibular cortex. The internal structure is comprised primarily of diffuse granular bone. The contiguous buccal and lingual cortical plates are concentrically expanded and demonstrate a thinned, granular appearance. Tooth 34 has been displaced inferiorly, tooth 74 is displaced superiorly, and teeth 33 and 35 are splayed.

This radiographic appearance is most consistent with a benign neoplasm. The presence of internal bone formation suggests an ossifying fibroma is the most likely interpretation. The juvenile subtype is probable, given the patient's age and the aggressive radiographic features. Biopsy and histopathologic confirmation are required.

Impacted and displaced tooth 34

The ossifying fibroma in the left mandible has caused horizontal impaction of tooth 34. Tooth 34 is positioned at the level of the inferior mandibular cortex, and the crown is positioned apical to site 73. The root apex of tooth 34 is positioned apical to the distal aspect of tooth 74. No resorption is evident on tooth 34.

Axial views of mid-3rd quadrant

These axial cross-sectional images demonstrate the diffuse granular bone pattern within the central aspect of the ossifying fibroma in the left mandible. The presence of concentric buccolingual expansion is supportive of the diagnosis of a benign neoplasm.

Buccolingual views of mid-3rd quadrant

These buccolingual cross-sectional images demonstrate the thinned and granular appearance of the expanded buccal and lingual cortical plates of the left mandible. The inferior mandibular cortex is unaffected. Note the proximity of the left mandibular nerve canal and mental foramen to the lesion.

Mesiodistal views of mid-3rd quadrant

These mesiodistal cross-sectional images demonstrate mesial displacement of the unerupted tooth 33, distal displacement of the unerupted tooth 35, and inferior displacement of the impacted tooth 34 due to the ossifying fibroma in the left mandible. The alveolar crest is elevated, and tooth 74 is superiorly displaced. No resorption is present on the permanent dentition.