Manadee, Peter, Zenon Kossak, Paul Edwards, and Takako Tanaka
Cone-beam computed tomography (CBCT) has been increasingly utilized in dentistry to assist the diagnosis and treatment planning of lesions in hard tissue by providing a three-dimensional view of the anatomy. We present a case of ameloblastoma in which CBCT was used to provide crucial information beyond that which conventional imaging can provide.
A 47-year-old African-American woman came to our emergency dental clinic complaining of constant, throbbing pain over the right lower jaw and radiating to the right ear and chest. She stated that she had noticed swelling in her lower right jaw for approximately one month, accompanied by numbness in the right side of the mandible and lower lip. She had been taking Amoxicillin, which had been prescribed at a medical emergency visit one month prior to her dental visit. This provided minimal relief of symptoms. Extraoral examination revealed mild facial swelling. Intraoral examination revealed fullness of the mucobuccal fold near tooth #31. Bloody exudate discharged from the buccal gingival sulcus of tooth #31. The tooth was extremely painful on percussion. A panoramic radiograph showed a well demarcated, irregular radiolucent lesion in the right side of the mandible, extending from the molar region into the ramus. An incisional biopsy was performed and ameloblastoma was diagnosed. CBCT revealed destruction of the lingual cortex in the mandibular body, but no periosteal reaction or extension of the lesion beyond the mandible. Resorption of the inner surface of the buccal cortical plate was also noted. The tumor displaced the mandibular canal inferiorly. Partial mandibulectomy was performed with the aid of information obtained from CBCT.
This case illustrates the importance of multiplanar views in CBCT to aid in treatment planning by providing information in three planes of space. CBCT allows accurate determination of the extent and growth pattern of the tumor.