Radiology · patient case question
For the well-defined radiolucency between the roots of the maxillary central incisors, all of the following belong in the differential EXCEPT:
Patient case: Ossifying Fibroma and Anterior Maxillary Radiolucency
demo: 31-year-old female
chief: Asymptomatic lesion noted on routine imaging.
history: Non-contributory.
meds: None
findings: A well-circumscribed lesion of mixed density is present in the posterior mandible (images below). On a separate periapical film of the maxillary central incisors, a well-defined radiolucency is seen between the roots of #8 and #9.
Show answer and explanation
Correct answer: B. Buccal bifurcation cyst
- A. An OKC can occur anywhere in the jaws and is a legitimate, if less likely, differential.
- B. Correct — this is the exception. A buccal bifurcation cyst is an inflammatory cyst on the buccal aspect of an erupting mandibular first or second molar in a child. It has no relationship to the anterior maxilla.
- C. A prominent incisive foramen is normal anatomy and is the first thing to exclude before treating.
- D. The nasopalatine duct cyst is the most common non-odontogenic cyst of the jaws and sits exactly here, classically heart-shaped.
Note: The practical rule: an incisive foramen wider than about 6 mm, or one that enlarges over time or is symptomatic, moves from normal variant toward nasopalatine duct cyst.