Multilocular radiolucency of the anterior mandible

Abstract

A 10-year-old boy sought care at the Department of Oral and Maxillofacial Surgery at the University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, with a large swelling in the anterior mandible and multiple loose teeth. The patient’s medical history was clinically significant for exercise-induced asthma. A panoramic radiograph (Figure 1) demonstrated a large well-defined, multilocular radiolucency with thin corticated borders in the anterior mandible extending between the premolars bilaterally. Fine, wispy septations were noted within the lesion, giving it a multilocular appearance. The lesion expanded the inferior border of the mandible. To determine the extent of the lesion, we prescribed a computed tomographic (CT) examination. A sagittal view (Figure 2) of the area demonstrated a multilocular lesion causing buccolingual expansion of the anterior mandible with thinning of the buccal and lingual plates, and root resorption. Axial bone window sections (Figure 3) showed the extent of the lesion in a buccolingual direction, as well as the extent of the lesion from the left mandible to the right, crossing the midline and extending into the bilateral molar areas, which was not clearly visible on a standard panoramic radiograph. The lesion was more extensive on the right side and extended to the right buccal vestibule and posteriorly to the molar area. The lesion was 4.6 × 2.7 × 2.3 centimeters. A soft-tissue window with contrast showed the lesion had areas of density compared with the nearby soft tissues within the septations and also scattered calcifications. It also showed the extent of the expansion, thinning of the cortices, and preservation of the cortices. Figure 2Sagittal view of the CT scan depicting the buccolingual expansion of the mandible, root resorption and the multilocularity of the lesion. View Large Image Figure Viewer Download Hi-res image Figure 3Axial bone window view of the CT scan showing anterior posterior and the buccal and lingual extent of the lesion. View Large Image Figure Viewer Download Hi-res image Dr. Buraczewski is the chief resident, Oral and Maxillofacial Pathology, University of Pittsburgh Medical Center, G-132 Salk Hall, 3501 Terrace St. Pittsburgh, PA 15261. Dr. Potluri is an associate professor, Oral and Maxillofacial Radiology, University of Pittsburgh School of Dental Medicine, G-119 Salk Hall, 3501 Terrace St. Pittsburgh, PA 15261. Dr. Costello is associate dean of Faculty Affairs and professor of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, G-32 Salk Hall, 3501 Terrace St. Pittsburgh, PA 15261. Dr. Bilodeau is an associate professor, Oral and Maxillofacial Pathology, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, 15261.