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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Luca Volpi, MD; Fabio Ferreli, MD; Apostolos Karligkiotis, MD; Andrea Pistochini, MD; Francesco Meloni, MD; Paolo Castelnuovo, MD
Arch Otolaryngol Head Neck Surg. 2012;138(10):973. doi:10.1001/2013.jamaoto.57.
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A 36-year-old black woman presented with swelling of the right cheek that was associated with pain in the ipsilateral maxillary region and right nasal obstruction. Examination of the oral cavity revealed a swelling of the right alveolar process covered by normal oral mucosa with unstable 1.6 and 1.7 dental elements. The right upper third molar (1.8) was absent. No other symptoms were reported. No surgical dental procedures had previously been performed.

A dental panoramic radiograph was the first-line investigation, revealing evidence of erosion of the alveolar bone of the right maxilla, with thinning and interruption of the right maxillary sinus floor. The apical roots of the right upper molars appeared eroded (Figure 1). A computed tomogram revealed an expansile lesion with erosion of the right inferior and lateral maxillary sinus walls and erosion of the alveolar bone of the right maxilla. There were no signs of calcifications or presence of teeth inside the sinus. There was no invasion of the orbit, and the bony walls of the orbit were intact (Figure 2). A T2-weighted magnetic resonance image (MRI) revealed a hyperintense expansile right maxillary lesion, which is typical of phlogistic lesions such as mucoceles or cysts (Figure 3). A postcontrast T1-weighted MRI demonstrated peripheral enhancement, suggestive of a capsule (Figure 4).

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