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Case 170168

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Canaray 170168

Central giant cell lesion in the left mandible

There is a well-defined and multilocular entity present in the left mandible, which extends from the mesial root of tooth 36 to the root apices of teeth 31 and 32. The entity is predominantly low attenuation with the presence of multiple granular and right angles septae. There has been expansion and thinning of the mandibular buccal and lingual cortical plates. The expanded cortical plates adjacent to this area appear to be granular and may be partially dehiscent. There is also thinning and endosteal scalloping of the endosteal surfaces of the mandibular cortical plates. The lamina dura and periodontal ligament space of the involved teeth adjacent to this entity have been lost. There is mild external resorption on the lingual surface of the root of tooth 34. The left mental foramen passes along the distal surface of this lesion and has not been affected by the lesion. This radiographic appearance is compatible with a benign tumour with the most likely diagnosis of a central giant cell lesion. Biopsy and histopathologic examination should be considered to confirm the diagnosis.

Orthogonal measurements of the lesion

These orthogonal cross-sectional images demonstrate the approximate mesiodistal, buccolingual, and coronoapical dimensions of the lesion in the left mandible. Note that the lingual and buccal cortical plates may be partially dehiscent overlying the lesion.

Roots of teeth 32, 33, 34, and 35 extend into the lesion: root displacement

The roots of teeth 32, 33, 34, and 35 extend into the benign lesion in the left mandible, The roots of teeth 33 and 34 are buccally displaced, and the root of tooth 32 is mesially displaced. The roots of teeth 32/33 and teeth 34/35 appear divergent due to the lesion, which is a characteristic sign for central giant cell lesion.

1. Abrasions on teeth 44, 45, 46

Abrasions are present along the buccal surfaces of teeth 44, 45, and 46, at the levels of their cementoenamel junctions.

2. Dense bone island distal to tooth 37

A dense bone island is present in the alveolar process in the region distal to the middle third of the distal root of tooth 37. This dense bone island has not had any effect on the surrounding structures, and is a non-significant incidental finding.

Healed extraction socket at site 48

The extraction socket at site 48 has healed normally. The density of the bone within this healed socket is lower than that of the adjacent trabecular bone.

3. Retained radiopaque fragment at site 48

A small retained fragment of radiopaque restorative material is present near the alveolar crest at site 48. This is a non-significant incidental finding.

4. Lingual mandibular tori

Lingual tori composed of cortical bone are present along the alveolar process of the mandible adjacent to the canine-premolar region of the fourth quadrant. This is a non-significant incidental finding. Note the lingual cortical expansion adjacent to the giant cell lesion has caused thinning of the lingual cortex at the left mandible.