History of the present illness

This is a 26-year-old female with some swelling and radiolucency of the anterior mandible (Figure 1) of approximately four years' duration. The swelling is described to be four cm in size and causing slight tooth mobility. The patient complained of mild pain, especially with movement of the incisor teeth. There was no parenthesia. One month prior to this presentation, tooth #24 was endodontically treated and was found to be non-vital by the referring dentist.  Clinical examination revealed slight expansion of the anterior buccal and lingual vestibules. With the exception of tooth #24, all of the anterior teeth tested vital. A sectional CT showed some expansion of the anterior mandible with significant thinning of the cortices, especially on the lingual aspect where there were areas in which the cortex could not be visualized.

 

Figure 1 This radiograph was taken in first clinical presentation.  Note the relatively well-demarcated and partially corticated radiolucency anterior mandible.  It is in the vicinity of the endodontically treated tooth #24.