[Oradlist] Another interesting case/reply

[M. Mupparapu]

Hi Sharon:

I agree with Jie. After viewing the limited scan sets, it appears to be more
closer to the diagnosis of a fibro-osseous lesion, perhaps fibrous
dysplasia. The expansion of the  zygomatic bone with its mixed radiodens and
hypodens lesions along with the presence of what seems like"simple bone
cyst" reminds me of the association of simple bone cyst with the
fibroosseous lesions that we saw a few times. Although in both of our cases,
the association was seen in the mandible, there is no reason why it can not
be seen in other facial bones.

Mupparapu et al.Simultaneous presentation of focal cemento-osseous dysplasia
and simple bone cyst of the mandible masquerading as a multilocular
radiolucency.Dentomaxillofacial Radiol (2005) 34*,* 39-43

Singer SR, Mupparapu, Rinaggio J. Clinical and radiographic features of
chronic monostotic fibrous dysplasia of the mandible. JCDA 2004;70:548-52

Here's what I would characterize the appearance:

Hypoplastic right maxillary sinus with density changes in the right
zygomatic arch suggestive of a fibroosseous lesion in association with a
simple bone cyst. A monostotic fibrous dysplasia  of the right zygomatic
arch can not be ruled out. A radiographic exam within a year is recommended
as a follow-up if no clinical changes are noticed or a repeat CBCT scan
immediately if an when clinical changes are noticed ( which I doubt given
the age of the patient). I too thought of the ZACD, but the given the
density of the lesion, air cells can be ruled out as you initially stated.
Moreover, with the air cells, there would be no apparant expansion of the
area of interest.

cheers,

Mel Mupparapu
Newark, NJ

On Thu, Apr 1, 2010 at 2:53 PM, Brooks, Sharon <slbrooks at umich.edu> wrote:

> As long as we are sharing interesting cases, I have one that I would like
> some opinions on.
>
> The patient is a 66 year old Chinese male. The CBCT scan of the maxilla was
> done for implant planning purposes. I noted an incidental lesion in the
> right zygoma, round, very well defined. There is also an asymmetry in the
> maxilla and maxillary sinus on the same side, with that side being smaller
> than the left. There is no similar lesion in the left zygoma.
>
> I have no history on this patient, other than that he wants implants in the
> maxillary anterior. Clinically I did not notice a facial asymmetry but he
> has a very full face with all muscles of mastication very prominent due to
> a
> serious bruxing habit. A facial asymmetry was not obvious either on a 3D
> rendering showing skin.
>
> The lesion does not appear to be an air cell, given its density. However,
> my
> impression is something developmental or a result of some (unknown) trauma,
> rather than a cyst or neoplasm. However, I don't see anything like it in
> any
> of the references I have.
>
> As an interesting aside in this case, the patient was referred for the
> maxillary scan by our graduate prosthodontic program. They do all their
> implant cases with the Nobel Biocare process, which requires that the
> patient wear a specially marked imaging stent during the scan. A second
> scan
> is made of the stent alone.
>
> Two months ago he had been referred to our dental school oral surgery
> department for "implants". The surgeon who saw him referred him to the
> hospital dentistry clinic for a CBCT. (no imaging guide, no idea about the
> Nobel Biocare system, big miscommunication between departments since the
> prosthodontist was interested in having the surgeon do soft-tissue grafting
> only, not the implants).
>
> I had a chance to see that hospital scan today and the lesion looks
> identical (only two months difference so no surprise there). What was a
> surprise is that they did a gigantic scan, from above the top of the head
> well down into the neck - for maxillary implants!
>
> The hospital dentistry program is also having their CBCT scans read by
> medical radiology. I saw the report on this fellow:
>
> "Clinical indication: bone evaluation for teeth #8 and 9 implant placement.
>
> Technique: Utilizing the low radiation dose MiniCAT scanner (actually an
> E-Woo), noncontrast axial images through the maxillofacial bones were
> obtained.
>
> Impression: The paranasal sinuses are clear. Absent anterior maxillary
> teeth, with bone loss/thinning of the anterior alveolar ridge. Right
> mandibular premolar is absent.
>
> Note: as this study was performed on a low radiation dose scanner
> (radiation
> dose reduced by 80-90% vs conventional Ct scanning), evaluation of
> structures outside the paranasal sinuses (including orbits, brain, deep
> face, neck, subcutaneous and skin regions, et al) is non-diagnostic; if a
> pathologic process is of concern in any of those regions, scanning on a
> conventional CT scanner should be performed."
>
> They did not comment on the lesion in the zygoma. Granted that they had
> only
> the axial images, the axial plane is the one where I first saw the lesion
> and the facial asymmetry.
>
> Any comments? I have to make a recommendation about what we do next, if
> anything).
>
> Thank you.
>
> Sharon
>
> *****************************
> Sharon L. Brooks, DDS, MS
> Diplomate, American Board of Oral and Maxillofacial Radiology
> University of Michigan School of Dentistry
> Department of Periodontics and Oral Medicine
> Ann Arbor, MI 48109-1078 USA
> Tel: +1 734-764-1595   Fax +1-734-764-2469
> slbrooks at umich.edu
>
>
>
> _______________________________________________
> Oradlist mailing list
> Oradlist at lists.ucla.edu
> http://lists.ucla.edu/cgi-bin/mailman/listinfo/oradlist
>
>


-- 
Prof. M. Mupparapu, DMD, MDS, Dip.ABOMR
Professor & Director
Oral & Maxillofacial Radiology
UMDNJ - New Jersey Dental School
110, Bergen Street
NEWARK- New Jersey 07101-1709
USA
Tel: Office: 973-972-0348
Tel: Clinic: 973-972-4118
http://www.umdnj.edu
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.ucla.edu/cgi-bin/mailman/private/oradlist/attachments/20100402/d6087c65/attachment.htm>