W4.2 Case 13_integrated

Case 13

# Analysis

• Lesion Description:
  • A round, soft tissue density superimposed over the sinus.
  • The lesion has elevated and displaced the sinus floor.
  • Location: Mesial to the 18, extending to the periapical region of the 17 and 16.
  • There is possible communication with the oral cavity.
• Mandibular Observations:
  • Condyles: Both condyles are very small (hypoplastic) with minimal condylar neck. The left side is flattened, while the right side remains somewhat round.
  • Mandible: Hypoplastic mandible (both hemi-mandibles are very small).
  • Occlusion: Potential anterior open bite with posterior contact only, which is associated with the mandibular hypoplasia.
• Sinus Observations:
  • The left maxillary sinus is very small (hypoplastic), sitting at or slightly above the level of the nasal floor/hard palate.
  • This is noted as a developmental finding rather than a pathologic one.

# Differential Diagnosis

1. Dentigerous Cyst:
   • The primary differential.
   • Large dentigerous cysts can “fold over” the tooth.
   • Communication with the oral cavity may disrupt its natural characteristics.
2. Odontogenic Keratocyst (OKC) / Odontogenic Parakeratosis:
   • Often associated with impacted teeth.
   • Usually a pericoronal lesion but can occur in any part of the tooth.
   • Considered less common than a dentigerous cyst.

# Diagnosis

• Primary Finding: Large cyst related to the 18 (most likely a dentigerous cyst).
• Secondary Findings:
  • Hypoplastic mandible and condyles.
  • Hypoplastic left maxillary sinus.