[Oradlist] Differential Diagnosis for mandibular ossifications/calcifications

Leif Kullman leikul at yahoo.com
Wed Dec 15 04:03:56 PST 2010

Yes very interesting, thanks! You don't have a skull radiograph to look at also?

And it could be interesting to know about the level of serum alkaline phosphatase for this patient in order to know about the bone turnover rate?

Regards Leif

Leif Kullman DDS, PhD

Assoc. Professor

Oral and Maxillofacial Radiology

Faculty of Dentistry

Kuwait University

--- On Wed, 12/15/10, Lennart Flygare <Lennart.Flygare at nll.se> wrote:

From: Lennart Flygare <Lennart.Flygare at nll.se>
Subject: Re: [Oradlist] Differential Diagnosis for mandibular ossifications/calcifications
To: "'Oral Radiology Discussion Group'" <oradlist at lists.ucla.edu>
Date: Wednesday, December 15, 2010, 3:18 AM

Dear Aruna

Thanks for supplying this very interesting case and I don't feel like I can add much to you accurate description and thoughts. 
But I have a question for you and other ORADLISTERS. 
I don't interpret these features as pathognomonic, but do you think it would be worthwhile to include the possibility of Gardner's syndroma considering the risk involved or do you think it can be ruled out based on these radiologic features?

Best wishes


Lennart Flygare DDS, Odont Dr
Senior Consultant
Dept of Radiology
Sunderby Hospital
SE-971 80 Luleå
Ph: +46-920-282000
Moble: +46-70-6743858
-----Ursprungligt meddelande-----
Från: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] För Ramesh, Aruna
Skickat: den 14 december 2010 21:40
Till: oradlist at lists.ucla.edu
Ämne: [Oradlist] Differential Diagnosis for mandibular ossifications/calcifications

 Hello all,

This case was referred to our oral path department for a consult, and sent to me by them. 

This panoramic is of a 24 year old asymptomatic female involved in a MVA two weeks ago, with some soft tissue injuries but no facial bone fractures.  The radiopacities in the anterior mandible and very thick inferior cortex of the mandible were incidental findings.  She denies any history/clinical diagnosis.

My thoughts: idiopathic osteosclerotic islands/enostoses/osteomas as the patient does not report any existing diagnosis. However as many of the cortical osseous landmarks, like external oblique ridge, zygomatic process of maxilla, posterior Wall of the maxillary sinus, inferior mandibular cortex, all show thicker than typical borders, hypercorticalis generalisata is a possibility, if the same features are present in rest of the skeleton. Craniofacial fibrous dysplasia, juvenile pagets would not be included, as these areas are focal with defined borders, no teeth displacement or other effects in the trabecular bone noted. 

In the absence of any clinical symptoms, I am unsure if prescribing a CBCT scan would help in any way, other than help us better characterize these areas.

I would appreciate your thoughts/input. 

Aruna Ramesh
Tufts University School of Dental Medicine
Oradlist mailing list
Oradlist at lists.ucla.edu

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