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Case 99487

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Referral category

Disease / syndrome / tumor / condition

Region of interest

38

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Canaray 99487

1. Osteomyelitis in posterior left mandible

There is an ill-defined region of bone loss in the posterior left mandible, which extends from the mesial root of tooth 36 distally to the base of the left mandibular ramus, and from the superior cortex of the left inferior alveolar nerve canal superiorly to the alveolar crest. The alveolar crest and superior cortex of the mandibular canal appear discontinuous in this region. The lingual cortical plate appears detached from the mandible, which suggests the presence of sequestrum. This defect is filled with soft tissue attenuation, but there is no evidence of a mass effect. There is subtle periosteal bone formation along the lingual aspect of the mandibular body. These findings are suggestive of a focus of osteomyelitis, which could have arisen secondary to bisphosphonate treatment and/or a history of head and neck radiation therapy.

2. Generalized radiolucencies in mandible: medical referral needed

There are multiple foci of well-defined, non-corticated, punctate radiolucencies present within the buccal and lingual cortices of the left and right mandible. This pattern of bone loss can arise secondary to a history of head and neck radiation therapy and/or the presence of an infiltrative malignancy, such as multiple myeloma. Correlation with the patient's medical history and biopsy with histopathologic analysis is advised. It is prudent to refer this patient to a medical professional for further assessment.

Axial views of the mandible

These axial cross-sectional images demonstrate the presence of multiple punctate radiolucencies within the buccal and lingual cortices of the mandible. Also evident in these cross-sectional images is the presence of a sequestered lingual cortical plate in the posterior left mandible.

4. Calcification of the C2-C3 intervertebral disc

The intervertebral disc between the C2 and C3 vertebrae appears calcified. This could be secondary to the presence of degenerative joint disease.

3. Multiple radiolucencies in the cervical spine

There are multiple well-defined, non-corticated radiolucencies present within the visible portions of the cervical spine. These findings are similar to those noted in the mandible, and referral to a medical professional should be considered for further assessment.

5. Periradicular bone loss + root resorption in tooth 36

There is extensive periradicular bone loss around the distal root and along the distal surface of the mesial root of tooth 36. There are also multiple foci of root resorption present along the mesial surface of the distal root and the distal surface of the mesial root of tooth 36. These findings suggest that tooth 36 has been secondarily affected by the focus of osteomyelitis in the posterior left mandible. Due to the extensive nature of bone loss, this tooth demonstrates a poor prognosis.

Abrasions on mandibular dentition

There are generalized abrasions involving the buccal surfaces of the mandibular dentition, at the levels of their cemento-enamel junctions.

6. Widened PDL space on tooth 46M

There is widening of the periodontal ligament space around the mesial root apex of tooth 46. There are no radiographic signs of root fracture in this tooth. The remaining periodontal ligament space and lamina dura appears normal. These findings suggest the presence of early pulpal inflammatory disease, and clinical vitality testing of this tooth is recommended.

7. Furcal bone loss on tooth 48: probable mesial root fracture

Furcal bone loss is present in tooth 48, which extends from the furcal floor to the apices of its mesial and distal roots. The lingual cortical plate appears partially dehiscent in this region. This region of bone loss appears to correspond with a fracture in the apical third of the mesial root of tooth 48.

8. Dense bone island apical to tooth 46

A dense bone island is present in the alveolar bone apical to tooth 46. This dense bone island demonstrates no effects on its surrounding structures. This is a non-significant incidental finding.

9. Lingual mandibular tori

Lingual tori composed of cortical bone are present in the alveolar process of the mandible adjacent to teeth 33, 34, 35, 43, 44, and 45. This is a non-significant incidental finding.