16 May 2024

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Multiple radiolucencies in a 12-year-old boy

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A healthy 12-year-old boy (The American Society of Anesthesiologists Physical Status Classification I) was initially referred by a general dentist to the University of Illinois Chicago oral and maxillofacial surgery clinic for evaluation of an incidentally found asymptomatic lesion associated with the apex of tooth no. 8. His medical record included a distant history of sports-related trauma to the anterior maxilla and a family history of jaw lesions in his father and sister.

He was also previously evaluated by a dermatologist for nonpainful, nonpruritic bumps on his extremities and desquamation of his feet. At the initial consultation at the oral and maxilloficial surgery clinic, radiographic imaging revealed enlarged follicles of teeth nos. 17 and 32 and a periapical radiolucency associated with tooth no. 8 without clinical signs of asymmetry (Figure 1). The father of the patient declined a plan to perform a biopsy of the apical lesion associated with tooth no. 8.

The patient was then lost to follow-up but returned a year and a half later with asymmetry in the lower facial one-third, with the right mandible larger than the left. On intraoral examination, the region of tooth no. 8 was not tender to palpation, without fluctuance, and the pulpal and periapical testing results for tooth no. 8 were normal. Asymmetric firm bony expansion of the posterior mandible was appreciated bilaterally, with more expansion being apparent on the right.

A cone-beam computed tomographic scan revealed large homogeneous, well-demarcated, pericoronal radiolucent lesions with hyperostotic borders associated with and displacing the follicles of teeth nos. 17 and 32 distally and inferiorly to the inferior border of the mandible (Figure 2A). A third similar-appearing lesion was visualized in the anterior maxilla apical to tooth no. 8 (Figure 2B). No cortical breakthrough was seen radiographically. Incisional biopsies were performed for the 3 lesions, revealing thick cheesy exudate surrounded by a friable cystic lining.

Authors: Osman Khan, DDS, Andrew Bertagna, DMD, MD, Douglas Damm, DDS, Ashleigh Weyh, MD, DMD, MPH, Nicholas Callahan, MPH, DMD, MD, FACS

Source: https://jada.ada.org/