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Clinical Problem Solving: Radiology
October 20, 2008

Radiology Quiz Case 1

Author Affiliations
 

PATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2008;134(10):1112. doi:10.1001/archotol.134.10.1112

An 18-year-old man presented with a 6-week history of pain in the right mandible in 2004. Clinical examination revealed slight expansion of bone on the buccal side of the mandible. The patient was receiving orthodontic treatment, and his last panoramic radiograph revealed a slightly radiopaque lesion, surrounded by a radiolucent halo, that was related to the roots of the first mandibular molar. A radiograph obtained 1 year earlier did not show any abnormalities (Figure 1). The symptoms improved with anti-inflammatory therapy, and the patient was periodically followed up for 8 months. Another panoramic radiograph, obtained in 2005, showed a well-circumscribed, radiopaque, round mass obliterating the radiopaque details of the involved roots and surrounded by a thin, well-defined, radiolucent border (Figure 2). A computed tomogram revealed a well-defined, high-density mass in the right molar region. The lesion was attached to the roots of the first molar (Figure 3). It was easily enucleated from the surrounding bone (Figure 4[postoperative image]) with the patient under general anesthesia.

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