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Radiology forum

ORAL SURG ORAL MEW ORAL PATHOL July 1992

sharply defined, its walls were undercut but continuous, and the lingual cortex was eroded nearly to the extent of perforating the buccal plate. A 1.5 mm portion of bone separated the posterior margin of the defect and the most posterior margin of the ramus. There was no radiographic evidence of sclerosis. Discussion

Lingual cortical defects of the mandible are usually classified under one of two categories: anterior and posterior defects. Anterior defects are situated inferior to the incisor and premolar region, and posterior defects are always in the retromolar area, inferior to the mylohyoid ridge. A search of the literature revealed only one report of bone cavities situated high on the mandibular ramus, cavities similar to those reported here.7 The ovoidal defects (i.e., bone cavities or lucencies) were found in five Finnish men (mean age 46 years) during routine radiographic examination. Three of the defects were on the left mandibular ramus and two were on the right. Radiographically the defects ranged in size from 7 X 3 mm to 1.5 X 7 mm, and four defects were surrounded totally or partially by a dense radiopaque line. Follow-up examinations for up to 6 years 4 months revealed that none of the patients had symptoms and no changes were observed in the size or circumference of the defects. We concluded that the location and radiographic appearance of these asymptomatic defects near the parotid gland supported the theory that developmental bone cavities are salivary gland depressions of bone. In conclusion, the two lingual defects presented here are radiographically similar in appearance and location to the five cases reported by Wolf.7 The present defects are situated near the parotid gland,

lack evidence of sclerosis or inflammation,

and grossly

resemble developmental bone cavities (Stafne’s) commonly seen in the retromolar region. To date, lingual defects on the mandibular ramus have only been found in men. The absence of similar defects in children supports the hypothesis that the defects are developmental and not congenital. We hope that other researchers may have encountered similar defects and can offer insight regarding their cause, frequency, and sex-relatedness in modern and ancient populations, Robert W. Mann, MA Anne Keenleyside, MA Department of Anthropology Smithsonian Institution NHB, Mail Stop I 12 Washington, DC 20560 Department of Anthropology MeMaster University Hamilton, Canada REFERENCES 1. Correll RW, Jensen JL, Rhyne RR. Lingua1 cortical mandibular defects. ORAL SURC ORAL MED ORAL PATHOL 1980:50: 287-91. 2. Chen CY, Ohba T. An analysis of radiological findings of Stafne’s idiopathic bone cavity. Dentomaxillofac Radio1 1981;10:18-23. 3. Shiratsuchi Y, Tashiro H, Yuasa K, Kanda S. Posterior lingua1 mandibular bone depression. Int J Oral Maxillofac Surg 1986;15:98-101. 4. Smith NJD, Looh FC, Todd JM, Whaites EJ. Stafne’s bone cavity: a review of the literature and report of two cases. Clin Radio1 1985;36:297-9. 5. Simpson W. A Stafne’s mandibular defect containing a pleomorphic adenoma: report of case. J Oral Surg 1965;23:553-6. 6. Pogrel MA, Sanders K, Hansen LS. Idiopathic lingual mandibular bone “depression”. Int J Oral Maxillofac Surg 1986; 15:93-7. 7. Wolf J. Bone defects in mandibular ramus resembling developmental bone cavity (Stafne). Proc Finn Dent Sot 1985;8 I : 215-21.

IMPACTED MANDIBULAR SECOND MOLAR

29-year-old white man was referred by his denA tist to our department for evaluation of unerupted molars. Clinical examination revealed the right and

left mandibular third molars to be partially bony impacted. Panoramic radiography showed the right mandibular second molar to be horizontally impacted and in close proximity to the mandibular canal (Fig. 1). This was confirmed by coronal computed tomographic scans,which better illustrated the buccolingual relationship of the impacted teeth to the mandibular canal (Fig. 2).

Fig. 1. Panoramicradiographshowshorizontally i secondmolar near mandibularcanal.

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Surgical removal of the impacted teeth was performed with the patient under general anesthesia. He was examined 2 weeks later and showed no signs of paresthesia. We advocate the use of adjunctive computed tomography where the precise relationship between an impacted tooth and the mandibular canal is important for surgical treatment planning.

Antoine Berberi, DDS Department of Oral and Maxillofacial Surgery Saint Antoine Hospital School of Dental Medicine University of Paris VI Paris, France

Fig. 2. Computedtomographicscanshowsbuccolingual relationshipof impactedteeth to mandibularcanal.

GOLDEN NEEDLES

A 62-year-old Korean woman was seen at our clinic

for an annual examination. Her medical history was unremarkable. Dental history revealed extensive crown and bridge restorations in the form of full mouth reconstruction. This treatment was performed in the Republic of South Korea. Pantomographic (Fig. 1) and full mouth series of radiographs were obtained and reviewed. The radiographs revealed approximately 20 regular radiopacities in the right mandibular area and left maxilla. Some appeared in the adjacent soft tissue spaces. The patient said that she had no history of trauma or osseous surgery to these areas. The patient related that 2 years previously she had chronic pain in those areas. She

explained that she sought treatment from a local doctor in Korea. His treatment consisted of surgically implanting gold needles into the soft tissue adjacent to the areas of concentrated pain. According to the patient, this was a form of acupuncture treatment. The patient reported that implantation of the gold needles relieved the pain in the affected areas. She was directed by her doctor that the needles were to remain in place and not to be removed. John Heimke, CPT, DC Robert B. Reichl, MAJ, DC USA DENTAC, Box 269 APO, NY 09069

Fig. 1. Note regular radiopacitiesin right mandibularareaand left maxilla.

Impacted mandibular second molar.

126 Radiology forum ORAL SURG ORAL MEW ORAL PATHOL July 1992 sharply defined, its walls were undercut but continuous, and the lingual cortex was er...
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