COM June 2010

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June 2010: Large radiolucency with scalloped border, right posterior mandible

Dolphine Oda, BDS, MSc
doda@u.washington.edu

Contributed by
Dr. Jae Hong
Washington Oral Surgery, Everett, WA

Case Summary and Diagnostic Information

This is a 14-year-old Japanese male who presented with a large radiolucency associated with tooth #32 (Figure 1).

Diagnostic Information Available

History of present Illness

This is a 14-year-old Japanese male who presented with a large radiolucency associated with tooth #32 (Figure 1). The lesion was 3-4 cm in size and was asymptomatic. It was of unknown duration and was not expansile. The radiograph revealed a large radiolucency with a scalloped border squeezing between the roots of teeth #s 30 & 31 (Figure 1). In very close proximity to this radiolucency lay the crown of tooth #32 with a well-defined dental follicle. The mesial aspect of this follicle appeared to be connected to the large radiolucency in the panoramic view but a line of separation was present in the CT scan (Figure 1).

Figure 1 Panoramic view at first presentation demonstrates a large radiolucency with a scalloped border squeezing between teeth #s 30 & 31. Note the coronal section demonstrating a fine line of separation between the large scalloped radiolucency and the dental follicle of tooth #32.

Medical History

The patient is otherwise healthy with no significant medical or family history.

Clinical and Radiographic Findings

The lesion was discovered on a routine panoramic radiograph to evaluate the patient’s third molars. At presentation there was no evidence of swelling or pain.  The panoramic radiograph showed a large radiolucency with a scalloped border squeezing between teeth #s 30 & 31. Mesially, this large radiolucency appeared as if it was connected to the crown of tooth #32. The cross-sectional images, however, demonstrated a very thin line of separation between the follicle of tooth #32 and the large radiolucency mesial.

Excisional Biopsy

Treatment

Under IV sedation, the area was surgically explored.  A buccal window was created around the lower right third molar and extended anteriorly towards the lesion.  Once the lesion was entered, an empty cavity, devoid of any fluid or solid mass was discovered.  The third molar was removed and the soft tissue around the lining of the bony crypt and the follicle was curetted and submitted for histopathological evaluation.   

Incisional Biopsy

Histologic examination revealed multiple pieces of hard and soft tissue made up of ribbons of loose and vascular connective tissue with early bone formation and clusters of fibrinoid material (Figure 2).   The latter comprised a significant portion of the specimen (Figure 3).  The connective tissue was loose and vascular and was surrounded by aggregates of erythrocytes.  The bone was reparative in type with viable osteocytes (Figure 4).

Figure 2 Low power (x100) H & E histology shows multiple pieces of hard and soft tissue made up of ribbons of loose and vascular connective tissue with early bone formation and clusters of fibrinoid material.

Figure 3 Higher power (x200) H & E histology shows amorphous fibrinous material with small strands of vascular connective tissue and small fragment of reparative viable bone.

Figure 4 Low power (x100) H & E histology shows strands of loose and vascular connective tissue and clusters of fibrinous material.

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