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