Kevin, C Franz
| Kevin, C Franz |
Kevin C Franz
Adeyinka, F Dayo
Division of Radiology, Oral Medicine, University of Pennsylvania School of Dental Medicine
Introduction
To demonstrate the importance of a complete and thorough evaluation of diagnostic imaging modalities. To emphasize the advantage of the multiplanar representation of cone beam computed tomography (CBCT) in the identification and description of aggressive osteolytic lesions in patients with compromised immune systems.
Methods
A 66-year-old Caucasian female presented to the University of Pennsylvania School of Dental Medicine with an asymptomatic periapical radiolucency noted as an incidental finding during the initial radiographic examination. Intraoral full mouth series was prescribed, and a large radiolucent lesion was noted in the mandibular anterior region apical to teeth #23-26. No bony expansion or swelling were noted clinically. However, after acquisition and analysis of a CBCT scan, an irregular shaped, homogenous, aggressive osteolytic lesion extending between teeth #23 to #26 with perforation of both lingual and labial cortical plates was detected. There was no sclerotic border, cortical expansion, resorption of roots or tooth displacement. Our report highlights the impact of 3-dimensional nature of the CBCT in the diagnosis of aggressive osteolytic lesions.
Results
Radicular cyst is an inflammatory periapical lesion originating from epithelial remnants in the periodontal ligament. The cystic process results as a response to inflammation or necrosis of the dental pulp. When secondary inflammatory processes are involved in long-standing cases, the corticated boundary is resorbed, and the characteristic circular shape may be lost mimicking other benign tumors. Differential diagnoses can also include odontogenic keratocyst and unicystic ameloblastoma. A diagnostic work-up including radiographic and histopathologic examination is critical to institute appropriate management. The selection of diagnostic radiographs and advanced imaging modalities is instrumental in the identification and subsequent treatment of cystic lesions. In medically complex population, a patient’s medical comorbidities may impact the body’s response to inflammatory processes in the jaws. The immunocompromised status may facilitate fast progression of the inflammatory process.
Conclusion
Appropriate selection of diagnostic imaging is critical to identifying, diagnosing, and treating lesions not clinically apparent. Additionally, HIV positive status may influence bony microarchitecture leading to osteolytic inflammatory lesions that are more aggressive in nature.