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Case 102076

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Canaray 102076

1. Progressive worsening of osteomyelitis in anterior maxilla

Sequestered bone fragments are present in the anterior maxilla at sites 21 and 22. This is pathognomonic for osteomyelitis. Surgical removal of the sequestra is indicated. The bone defect in the region surrounding the sequestra extends superiorly to the nasal floor, medially to the nasopalatine duct, and distally to site 23. The patient has a history of bisphosphonate use, which may be a contributory factor to the formation of these sequestra.

When compared to the prior scan of the same region (case 84411 dated 12 May 2015), the sequestration of the bone in the anterior second quadrant appears to have progressed. A wider radiolucent band of soft tissue surrounds the sequestered bone. In addition, the bone appears more sclerotic. This suggests that the antibiotic treatment has not been successful, and that the lesion would likely require surgical exploration in order to facilitate resolution.

Axial views of anterior maxilla

These axial cross-sectional images demonstrate the well-defined sequestra that are present in the anterior second quadrant. The buccal cortical plate has been lost adjacent to the sequestra. The left lateral border of the nasopalatine duct has also been lost

Sagittal views of anterior second quadrant

These sagittal cross-sectional images demonstrate the extension of the bone defect surrounding the sequestra through the floor of the nasal cavity.

Coronal views of anterior maxilla

These coronal cross-sectional images demonstrate the well-defined sequestra that are present in the anterior second quadrant. A radiolucent bone defect surrounds these sequestra.

2. Rarefying osteitis at teeth 41 and 42

Teeth 41 is 42 exhibit periapical rarefying osteitis this rarefying osteitis extends through the buccal cortical plate, and is suggestive of a failing endodontic treatment at tooth 41 and a possible loss of vitality of tooth 42.

3. Degenerative joint disease in the left TMJ

Subchondral sclerosis and erosions are visible on the superior surface of the left condylar head. In the mandibular closed position, the condylar head is posteriorly positioned in the glenoid fossae and the joint space is reduced. This overall appearance is suggestive of the presence of mild degenerative joint in the left temporomandibular joint.

4. Calcified cornua of thyroid cartilage

Both cornua of the thyroid cartilage are partially calcified. This is an incidental finding with no significance.

5. Intracranial calcification of internal carotid arteries

Focal calcifications are visible lining the walls of the cavernous parts of the left and right internal carotid arteries. These findings may represent signs of cerebral atherosclerosis, which could potentially increase the risk of future cerebrovascular events. The significance of this finding cannot be determined based on CBCT imaging alone.

6. Mild cervical degenerative joint disease

Small osteophytes, a reduced joint space, and mild subchondral sclerosis are present in the articular regions of the atlas and dens of the cervical vertebrae. This is a common incidental finding with no clinical significance that is suggestive of mild cervical degenerative joint disease.