Ellipsoid radiolucent lesion of the mandible

Abstract

A 76-year-old man was referred for evaluation of a mandibular lesion incidentally discovered in a panoramic radiograph. His medical history was remarkable for hypertension, gout, degenerative disk disease, and bilateral total hip replacement. The patient denied any pain or numbness. However, he reported that his mandibular right canine had been moving distally over the past several years. Oral examination revealed mild cortical expansion of the right mandibular residual ridge. The mucosa covering the ridge appeared normal. On questioning, the patient gave a long history of multiple tooth extractions for caries. Examination of the head and neck did not reveal any palpable lymph nodes. The panoramic radiograph showed a well-circumscribed, corticated, ellipsoid, unilocular, radiolucent lesion occupying the right mandibular body and symphysis region (Figure 1). A cone-beam computed tomographic examination showed the lesion extending from the left mandibular central incisor anteriorly to the edentulous area of the right mandibular second molar posteriorly. The lesion had caused some erosion and expansion of the buccal and lingual cortices (Figure 2). It also had caused distal tipping of the canine tooth and inferior displacement of the mandibular canal. The overall estimated dimensions were 17 millimeters (height) ✕ 14 mm (width) ✕ 47 mm (length). The patient subsequently underwent further investigation; after aspiration of a serosanguinous fluid from the lesion, an incisional biopsy was obtained (Figure 3). Figure 2Axial cone-beam computed tomographic scan shows thinning and expansion of the buccal and lingual cortices. View Large Image Figure Viewer Download Hi-res image Figure 3Microscopic examination of a cystic structure with lining epithelium and a fibrous connective tissue wall. The lining epithelium is composed of variably thickened, nonkeratinizing stratified squamous epithelium. Scattered inflammatory cells, hemosiderin deposits, and extravasated red blood cells are present in the fibrous wall (hematoxylin and eosin, ×40 magnification). View Large Image Figure Viewer Download Hi-res image Dr. Omami is an assistant professor, Department of Oral Health Practice, College of Dentistry, University of Kentucky, 800 Rose St., Lexington, KY 40536.