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A, Sagit tal T1-weighted MR image shows B and C, A xial fast spin-echo T2-weighted MR images
heterogeneously low-intensit y lesion (asterisk) in show multiloculated heterogeneously hyperintense
right maxillary sinus largely isointense to skeletal lesion (asterisk) and expansile remodeling of sinus
muscle. walls
Scenario 2
Clinical history
34-year-old man underwent a routine dental examination that included
a Panorex image.
3 4-year-old man with follicular cyst. Panorex image shows
radiolucent, well-defined, ovoid lesion (arrows) adjacent to crown of Drawing shows development odontogenic cysts. 1 =
unerupted right third molar and associated mandibular cortical
thinning follicular cyst, 2 keratocyst, 3 = lateral periodontal
cyst
Conclusion
The diagnosis was follicu- lar cyst, also called dentigerous cyst.Follicular
cysts are slow growing and develop when fluid accumulates between
the follicu- lar epithelium and the crown of a developing or unerupted
tooth.
16-year-old girl with mandibular odontogenic keratocyst.
A, Panorex image shows large lucent lesion with scalloped B, Sagit tal T1-weighted MR image shows expansile lesion
border (arrows). (asterisk) with intermediate signal intensit y in posterior
mandible.
C.Sagit tal contrast-enhanced T1- weighted MR image shows
peripheral rimlike enhancement of lesion around third molar.
C–F, A xial T1-weighted (C), FL AIR (D), contrast-enhanced fat-saturated T1-weighted E), and fast spin-echo T2-weighted (F) MR images show expansile
enhancing intermediate-signal-intensit y lobulated mass (asterisk)
involving right mandibular ramus and right masticator space.
Conclusion
This patient had a remote his- tory of Clark level III melanoma resected
by wide local excision from the right cheek. Biopsy confirmed the lesion
was metastatic melanoma.In a study by Patten et al. 17% of patients
with metastatic melanoma had osseous lesions. Of these patients, 12%
had osseous lesions as the only sign of metastatic disease. .
Infectious Processes
Scenario 1
Clinical history
A 38-year-old man pre- sented with fever, facial swelling, and
tenderness.
A, Clinical photograph at presentation shows inflammatory
changes involving right lower lateral teeth and gingival
discharge (arrow A xial CT images show foci of air in crescentic subfascial
fluid collections, associated inflammatory changes in
subcutaneous and intermuscular regions, and skin
thickening.
Conclusion
The diagnosis was necrotiz- ing fasciitis, a rapidly progressive and often
fatal infection of the fascia. That there are no natural barriers to the
spread of this type of in- fection allows its rapid spread and fulminant
clinical cois often nonspecific. Extreme pain followed by anesthesia
suggests the diagnosis. Patients also may have systemic manifestations
such as fe- ver, malaise, and vague, localizing symptoms. The classic
findings are warm overlying skin and indurated, so-called wooden, skin
with mottled purple patches urse. The clinical presentation
Scenario 2
Clinical history
A 73-year-old man with diabetes presented with persistent right-sid- ed
jaw pain, which he had experienced since the extraction of two right
posterior mandib- ular teeth (teeth 29 and 30) 6 months earlier. He had
poor healing and repeated visits be- cause of pain.
A, Panorex reconstruction of mandibular CT scan shows destruction of E–H, Blood-flow (E), blood-pool (F), and delayed anterior (G)
superior cortex (arrows) of right mandibular body with associated and lateral (H) images from three-phase bone scan show
sclerosis and gas. B–D, A xial (B and C) and collimated coronal (D) CT
images show ly tic destructive changes (asterisk, B) of right mandibular increased radiotracer uptake in right mandibular ramus in all
body with lamellated periosteal reaction (arrows, D). three phases.
Conclusion
The diagnosis was osteo- myelitis, which is rare in persons with nor-
mal immune function because they typical- ly undergo early treatment
with antibiotics. Possible causes of mandibular osteomyelitis include
direct extension of pulpal infection, acute exacerbation of a periapical
lesion, and a surgical procedure or penetrating trauma.
Conclusion