ANATOMIC VARIATIONS OF THE MANDIBLE MIMICKING RADIOLUCENT LESIONS IN THE JAW

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): S. PALACIOS, A. LAMFON, D. KASHTWARI, S. BARGHAN

Background

The mandible can present marked anatomic variations that mimic lytic lesions radiographically. Most of the variations are well known in the posterior region but can represent diagnostic challenges when located in the unusual anterior area. We present 2 cases of anterior morphologic variants of the mandible incidentally identified after evaluation of panoramic radiographs. Previous multidetector computed tomography (MDCT) images were utilized for the confirmation of our interpretations.

Clinical and Radiologic Findings

First case: A 65-year-old man came to our department for dental treatment. A panoramic radiograph of the patient revealed a well-defined, corticated, unilocular, oval-shaped, radiolucent entity inferior to teeth #27 to #28, mimicking an apical radicular cyst, traumatic bone cyst, or keratocystic odontogenic tumor. However, the vitality of the involved teeth and the thick cortical border of this entity led to our interpretation of the lesion as an anterior Stafne defect, which was confirmed with a prior MDCT made from a previous oral cancer screening. Second case: A 34-year-old male came to the hospital for extraction of infected retained roots. A panoramic radiograph was made, and it demonstrated a large cyst-like radiolucent area in the anterior mandible, with apparent scalloping margins, possible root resorption, and divergence of the involved teeth. However, the prior MDCT image revealed that the radiolucent area in the mandibular anterior region was a result of marked facial and lingual undercuts, with no evidence of pathosis.

Differential or Definitive Interpretation

Case #1: anterior Stafne bone defect. Case #2: facial and lingual anterior undercuts.

Discussion/Conclusions

Panoramic radiographs can demonstrate that any localized marked anatomic depression in the mandible could mimic a cystic lesion and, in some cases, more aggressive pathosis. It is important to recognize the specific radiographic features and the location of the morphologic variants of the mandible and utilize other available imaging studies before making any interpretation and/or initiating unnecessary invasive diagnostic procedures.

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