Name: H. B. Gender: Male DOB: 11/12/1950 Age: 64 Date taken: 16/11/2015 Date reported: 19/11/2015 Clinical details: Reason for referral: Referred by: Investigate symptoms related to left TMJ. Reconstructed panoramic of jaws requested Dr xxx Details of scan: Machine: icat Voxel size: 0.25 mm (closed) FOV: 13 x 16 cm 0.40 mm (open) CONE BEAM CT REPORT: RECONSTRUCTED PANORAMIC: There is a generalised pattern of loss of crestal bone height and correlation with clinical measures would be of value in assessing the periodontal status. A large radiolucent lesion is associated with the roots of teeth 17 and 16. The lesion appears to be communicating with the oral cavity at the crest of the ridge distal to the 17. The lesion has resulted in remodelling of the floor of the adjacent maxillary sinus. There are large metallic restorations in many of the posterior teeth and this has created streak artefacts. These teeth would be best checked clinically and with intraoral film for decay. TMJs: There is evidence of advanced degenerative changes in the left temporomandibular joint. There is marked pitting and erosion of the corticated surface of the left condyle, resulting in remodelling of the left condylar head and osteophyte formation. There is also some evidence of subchondral cystic changes in the left condylar head. There is widening of the left anterior joint space, consistent with internal joint derangement. Page1
There is widening of the anterior joint space in the right TMJ, suggestive of anterior disc displacement. The bony anatomy of right temporomandibular joint appears within normal anatomical limits, although I cannot exclude the possibility that there may be early degenerative changes occurring in the right TMJ. The translation of both the left and right temporomandibular joints upon opening is within normal limits. Other findings: 17 16 region: Axial, cross-sectional and corrected sagittal images are provided of the lesion in the upper right molar region. The lesion encompasses the roots of 17 and 16 and the vitality of both these teeth should be checked clinically. The lesion has resulted in elevation and remodelling of the floor of the maxillary sinus, and thinning and destruction of bone palatal to teeth 17 and 16. There is also destruction of bone distal to tooth 17 and the lesion communicate with the oral cavity at this site. The surrounding bone has a sclerotic appearance consistent with long-standing chronic inflammation. The lesion has no appreciable internal structures, and the roots of the involved teeth do not appear to be undergoing resorption or displacement as a result of the lesion. The most likely differential diagnosis for this lesion is a long-standing periapical granuloma/abscess or a radicular cyst, associated with one or both non-vital upper right molars. This lesion may have formed as a combined endo-perio lesion. Although less likely, I cannot exclude a keratocystic odontogenic tumour as part of the differential diagnosis. Tonsilloliths are noted bilaterally. Sclerotic bone, with or without retained root fragments, is noted mesial to tooth 37. 19 November, 2015 Dr Louise Brown, Dentomaxillofacial Radiologist BDSc, MDSc (Perio), MPH, D Clin Dent (Dent Maxfac Radiol), PhD, MRACDS (Perio), FADI, FICD, FPFA Page2
Reconstructed panoramic view Page3
TMJ (closed) (1 mm slices) corrected sagittal views TMJ (closed) (1 mm slices) corrected coronal views Page4
TMJ (open) (1 mm slices) corrected sagittal views Page5
Axial sections showing maxilla 17-16 region (1 mm slices) Page6
Cross sections showing maxilla 17-16 region (1 mm slices) Page7
Corrected sagittal sections showing maxilla 17-16 region (1 mm slices) Page8