of pain and facial swelling involving her mandible, in particular the mandibular left
quadrant. She described the discomfort as beginning approximately 3 to 4 weeks before
her appointment. She stated that several of her teeth were deemed unrestorable by
her referring oral health care provider and needed extraction. Her medical history
was significant for hypertension, arthritis, asthma, and a heart murmur. Clinical
examination revealed an edentulous area in the maxillary left molar region corresponding
to teeth nos. 14 and 15. Several teeth showing recurrent caries were also observed.
Extraoral examination revealed soft-tissue expansion of the mandibular left region
with slight involvement of the inferior aspect of the nasolabial fold (Figure 1). The mandibular left quadrant showed swelling in the vestibule compared with the
right side (Figure 2). Radiographic images were obtained, and multiple mixed radiolucent-radiopaque lesions
were identified. The central portions of these lesions consisted of sclerotic, hyperostotic
material. These central zones were surrounded by well-defined radiolucencies of various
sizes. The roots of some of the mandibular premolars and molars appeared broadened
and bulbous (Figure 3). Despite these lesions, all of the teeth tested vital with the exception of the
mandibular left first and second molars.
Figure 1Extraoral photograph showing a left-sided facial swelling involving the mandibular
soft tissue and inferior aspect of the nasolabial fold.
Figure 2Intraoral photograph showing expansion of the left mandibular alveolar ridge (A) when compared with the right mandibular alveolar ridge (B).
Figure 3Panoramic radiograph showing multiple mixed radiolucent-radiopaque lesions of the
mandible.
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Biography
Mr. Rosen is a student, Columbia University College of Dental Medicine, New York, NY.
Biography
Dr. Sarmiento is a clinical associate professor, Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, and in private practice, New York, NY.
Biography
Dr. Rosen is a clinical professor, Department of Periodontics, Rutgers University School of Dental Medicine, Newark, NJ, and in private practice, New York, NY.
Biography
Dr. Peters is an assistant professor, Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY.
Article Info
Publication History
Published online: December 19, 2022
Publication stage
In Press Corrected Proof
Footnotes
Disclosures. None of the authors reported any disclosures.
Diagnostic Challenge is published in collaboration with the American Academy of Oral and Maxillofacial Pathology and the American Academy of Oral Medicine.
Identification
DOI: https://doi.org/10.1016/j.adaj.2022.11.002
Copyright
© 2022 American Dental Association. All rights reserved.
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