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A Non-expansile Radiolucency of the Posterior Mandible
Diagnostic Information

Case Author(s): James W. Rokos, DDS; Ricardo J. Padilla, DDS

History of Present Illness

The patient is asymptomatic and in good general health, has no known drug allergies, and does not take any medications daily. The lesion was an incidental finding on the radiographic survey at the initial orthodontic consultation.

Clinical and Radiographic Findings

The patient was evaluated for a radiolucent lesion at the right mandibular second molar area associated with impacted tooth #31. No bony expansion was noted clinically. The rest of her intraoral and head and neck examination was unremarkable.

A panoramic radiograph revealed a unilocular radiolucency adjacent to but not associated with the impacted #31 (Figure 1).

radiolucency distal to roots of tooth #30
Figure 1. Note the radiolucency distal to roots of tooth #30 (arrow).
A cone-beam CT examination revealed a 1.5-cm well-defined radiolucent area located lingual and distal to the roots of tooth #30 and mesial to the crown of the impacted tooth #31 (Figure 2). There was some expansion and thinning of the lingual cortical plate but no root resorption.
expansion adjacent to impacted tooth #31
Figure 2. Cone beam CT showing expansion adjacent to impacted tooth #31.

Histopathological Findings

An incisional biopsy was performed revealing an odontogenic neoplasm composed of a myxomatous connective tissue stroma containing nests and cords of cuboidal to columnar epithelium arranged in a pattern suggestive of early enamel organ development (Figures 3 and 4).

nests of odontogenic epithelium in a myxomatous stroma
Figure 3. Numerous nests of odontogenic epithelium in a myxomatous stroma.
appearance of the epithelium
Figure 4. The appearance of the epithelium is reminiscent of the developing enamel organ.
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