Forum for Clinical and Surgical Oral Pathology

Case BBOPF 04-3-2

This is the second 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

33 year old white female with moderately severe, constant "ache" of the right midface. The pain began within a dry socket after third molar extraction when she was 20 years old. Soft tissues healed over nicely and now the mucosa looks normal in the area. Tuberosity is tender to palpation and quantitative ultrasound (QUS) shows low bone density/desiccated bone in all four third molar regions, although only the maxillary right is painful. The mandibular retromolar pad areas are moderately tender to palpation. All right midface pain disappears with local anesthesia to the tuberosity area (positive diagnostic anesthesia test).

Images

Radiography

Additional photo below shows QUS scan images of all four quadrants. Explaination of images is given below the photo.

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 ("green bone"). Attenuated sound, represented either low bone density or desiccated bone, is seen as short columns with yellow, orange or red tips. GradeIV indicates that more than half of the bone severely stops sound transmission.

Histology

[Click for a larger image]	[Click for a larger image]	[Click for a larger image]
[Click for a larger image]

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).