An Anterior Maxillary Radiolucency : Differential Diagnosis
By Andrew Herr BS , Elizabeth Ann Bilodeau DMD , MD , MSEd , and Anitha Potluri , BDS , DMD , MDS , School of Dental Medicine , University of Pittsburgh
The case :
A 72-year-old male presented to the University of Pittsburgh School of Dental Medicine for endodontic consultation . The patient reported mild pain in the anterior maxillary region of his mouth . Examination revealed slight inflammation of the anterior maxillary palate , which was tender to palpation . The periapical radiograph ( Figure 1 ) taken during the initial visit revealed a well-defined , round , unilocular , faintly corticated radiolucency periapical to # 8 and # 9 .
After viewing the radiograph the patient was referred to oral surgery for excisional biopsy . Excision of the lesion resulted in a pink-tan , soft tissue lesion measuring 0.7 x 0.5 x 0.3 cm , which was submitted for histological analysis . Microscopically , the lesion was comprised of variably dense fibroadipose tissue and haphazardly arranged small nerve bundles .
Can you make the diagnosis ?
A . Keratocystic odontogenic tumor / Odontogenic keratocyst ( KCOT / OKC ) B . Traumatic neuroma C . Periapical ( radicular ) cyst D . Nasopalatine duct cyst ( NPDC )
Figure 1 : A well-defined , round unilocular , faintly corticated radiolucency periapical to teeth # 8 and # 9 .
Diagnosis
B . Traumatic neuroma
These lesions are a result of damage or injury to a peripheral nerve ; however , are not considered true neoplasms . 1 , 2 The proximal ends of the nerve attempt to reconnect to the distal ends of the cut nerve . When the scar tissue interferes with this process the nerves heal and stabilize in an aberrant fashion forming a haphazard ball of nerve fibers . 3 Traumatic neuromas present at any age , but are most common in middle-aged adults with a slight female predilection . 1 , 3-6 Traumatic neuromas typically are asymptomatic ; however , if symptoms are present , pain is the most common ( 25-30 percent of cases ). 5 , 6
These lesions are most commonly seen forming in the mental foramen region , but sites may also include : the lower lip , buccal mucosa , and tongue . 1 , 3-5 Intraosseous traumatic neuromas are extremely rare , but , if seen , are most likely to be found in the mandible . 7 Radiographically , if visible , intraosseous traumatic neuromas present as well-demarcated radiolucent defects . 3 , 4 Surgical excision is the standard treatment in order to fully remove the mass of nerve tissues that form . Recurrences with traumatic neuromas are infrequent . 3
JANUARY / FEBRUARY 2018 | PENNSYLVANIA DENTAL JOURNAL 21