Multilocular radiolucency of the mandibular condyle in a 19-year-old woman

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A 19-year-old woman presented to the orthodontic department of our institution for evaluation of maxillary excess and mandibular deficiency. On routine cephalometric and panoramic images, an asymptomatic multilocular radiolucent lesion was incidentally noted in the left mandibular condylar area (Fig. 1). The patient was subsequently referred to oral and maxillofacial surgery for a consultation regarding both orthognathic surgery and treatment of the condylar lesion. After the consultation, the patient elected to undergo presurgical orthodontic treatment. Follow-up imaging of the condylar lesion (Fig. 2) was performed 7 months after the first images were obtained. Although the lesion was found to be approximately the same size, the orthognathic surgeon referred the patient to an oral and maxillofacial surgeon who specializes in diseases of the temporomandibular joint (TMJ) for further examination. On examination by the second surgeon, the patient denied any history of trauma. The patient described the left TMJ as “tight,” and mild crepitus was noted. These symptoms were noteworthy because they had not been reported previously. The patient denied any pulsation, paresthesia, or pain. Joint sounds from the bilateral