Two tooth-like opacities are visible towards the left wall of the maxillary sinus.
One opacity is likely the 28, while the smaller one is likely a supernumerary tooth (as supernumerary teeth are generally smaller).
These teeth are described as ectopic, not displaced, as there is no visible lesion (such as a dentigerous cyst) pushing them.
Mandible and Condyles:
Asymmetry: There is a vertical dimension asymmetry between the right and left condyles.
Right Condyle: Longer and more rounded at the superior aspect (described as “thumb-like”). It is superimposed over the zygomatic process of the temporal bar.
Left Condyle: Shorter and flattened/sharp compared to the right side.
Left Ramus: The entire ramus is visually shorter than the right side.
Antigonial Notch: On the left side, the notch is more curved or “caved in.”
Other Structures:
Mastoid Process: Contains “soap bubble-like” appearances. These are mastoid air cells, which are normal anatomical structures (similar to ethmoid air cells) and not pathologic.
Differential Diagnosis
Unilateral Hypoplasia of the Left Mandible: Suggested by the shortened ramus, flattened condyle, and curved antigonial notch.
Childhood Trauma: Likely cause for the unusual condylar morphology. Trauma to the condyle (the growth center) during maturation can result in a structural change where the bone is smaller and flattened rather than showing degenerative changes (like sclerosis or beaking).
Ectopic Teeth: Specifically tooth 28 and a supernumerary tooth located in the maxillary sinus area.
Investigations==
CBCT or CT: Recommended to further investigate the ectopic teeth in the sinus. This is necessary to rule out the presence of a cyst (like a dentigerous cyst) within the airspace that might be displacing the teeth, which cannot be definitively seen on the OPG.
Diagnosis==
Unilateral Mandibular Hypoplasia (Left side): Secondary to blunt childhood trauma.
Ectopic Tooth 28 and Ectopic Supernumerary Tooth.
Management==
Referral to medical imaging clinics for advanced imaging (CBCT/CT) to evaluate the maxillary sinus and the position of the ectopic teeth.
