Breakthrough Clinical pathology case: No. 4—Two patients with the same diagnosis

Dr. R.F. John Holtzen, an oral and maxillofacial surgeon, describes two cases he encountered involving young teens who ultimately received the same histopathologic diagnosis, but were treated following different protocols.

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This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

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Pan for patient No. 1

Patient No. 1
A 14-year-old female presented to her general dentist complaining of pain in the right posterior mandible and mobility of tooth No. 31. Her medical history was otherwise unremarkable. A panoramic radiograph revealed a large, multilocular radiolucent lesion within the entire ramus and posterior body of the right mandible. Tooth No. 32 was within the lesion. Cortical expansion in the area of the lesion was notable. All adjacent teeth were vital. A panoramic radiograph taken at the completion of orthodontic treatment 18 months previously showed no evidence of the lesion.

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Pan for patient No. 2

Patient No. 2
A 13-year-old male was noted by his orthodontist to have an expanding radiolucency encompassing impacted tooth No. 11. The patient was without complaint, and his medical history was otherwise unremarkable. The extent of the lesion was not clear on traditional 2-D radiography so a cone beam CT scan was obtained. This revealed a multilocular radiolucency extending from the maxillary midline to the area of the left permanent second molar, and expanding into the left maxillary sinus. Cortical expansion in the area of the lesion was notable and all adjacent teeth were vital.

Both of these patients ultimately received the same histopathologic diagnosis, but were treated following different protocols. What is the differential diagnosis, and what treatment options should be considered for the most likely diagnosis?

Send your answers to DEbreakthrough@pennwell.com or join our Facebook group for more discussions.

Do you have an interesting pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to: DEbreakthrough@pennwell.com. We will let you know if we select your case!

This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

R.F. John Holtzen, DMD
, is a board certified oral and maxillofacial surgeon with private practices in Missoula, Montana, and Las Vegas, Nevada. He is a graduate of Temple University School of Dentistry, and completed internship and residency programs at Johns Hopkins University, St. John’s Mercy Medical Center, and MCP-Hahnemann University Medical Centers. He is a previous associate clinical professor at the University of Nevada School of Medicine, and has lectured on a variety of topics related to his specialty.

ADDITIONAL READING …
Breakthrough Clinical pathology case: No. 3
Answer to April’s Breakthrough Clinical pathology case: No. 3

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