Forum for Clinical and Surgical Oral Pathology

Case BBOPF 04-3-1

This is the first in a series of five cases submitted by Dr. Jerry Bouquot. Please enter your comments in the form at the bottom of the page. This case was posted from March 26 to April 2, 2004. A summary of the responses will be available in BBOP.

Clinical History

46 year old female with 13 year history of idiopathic facial pain, diagnosed previously as atypical trigeminal neuraglia. Treatment with Tegretol, Neurontin, and radiofrequency rhizotomy failed. Teeth in the mandible were pulled more than 11 years ago because of pain, with no improvement of symptoms. All pain disappears with local anesthesia to the third molar region (positive diagnostic anesthesia test).

Images

Radiography

Additional photo below shows Grade IV sound attenuation in the right mandibular molar region (see note below for interpretation of quatitative ultrasound (QUS) images:

The QUS image (made from the FDA-cleared Cavitat 4000) represents sound transmission across alveolar bone to 64 separate sensors. At the frequency used sound traverses normal bone better than water or any other body tissue. Amount of sound hitting each sensor is represented by a single column (8 columns per row, 8 rows). Full transmission, as in normal bone, is represented by a tall column with a green tip. Attenuated sound, representing either low bone density or desiccated bone, is seen as short columns with yellow, orange or red tips. Grade IV indicates that more than half of the bone severely stops sound transmission.

Histology

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