The appearances are of a single well defined unilocular lucent lesion with a fine cortical rim in the mandibular ramus. The patient is adult and there are no unerupted teeth in the vicinity of the lesion. By definition this is, therefore, considered a non-aggressive lesion. Despite this there is medial deficiency of the mandibular cortex. In this medial location a well defined lesion appearing to invaginate into the osseous cortex is reminiscent of a Stafne’s cyst. Stafne’s cysts are intraosseous herniated inclusions of the submandibular or sublingual glands into the mandible. In this case there is no connection to the submandibular gland and the attenuation of the cystic component is less than that of the submandibular gland. However, Stafne’s cysts can arise from accessory glands and their attenuation can vary from that of the remainder of the salivary glands. Indeed this would be a typical location occurring between the first molar and the angle of the mandible. Typically Stafne’s cysts are asymptomatic discoveries rather than presenting with pain as in this case. However, more critically Stafne’s cysts occur below the inferior alveolar nerve canal. Reviewing the orthopantomogram and the curved planar reformat it is evident that this lesion lies above the inferior alveolar nerve canal. In addition one can identify that there is a connection to the empty nerve root of a removed molar. This suggests that the findings are far more likely to be due to a radicular cyst, synonymous with a periapical cyst. These lesions arise initially as an apical (near the apex of the roots) periodontitis related to chronic careous change or dental root treatment. A subsequent granulomatous response results in a small (<1cm) round or ovoid cyst with a thin walled cyst that like most dental related lesions arise above the inferior alveolar nerve canal in the mandible.
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