Zebra XX, Part 1

JOURNAL OF ENDODONTICS Copyright © 2001 by The American Association of Endodontists

Printed in U.S.A. VOL. 27, NO. 5, MAY 2001

ZEBRA HUNT Zebra XX, Part 1 Giovanna Iezzi, DDS, Giovanna Orsini, DDS, Giovanna Petrone, DDS, and Adriano Piattelli, MD, DDS

A 67-yr-old woman was referred to our department for a dull, persistent pain of 6-month duration. A clinical intraoral examination showed the presence of a draining sinus tract with purulent discharge in the region of the right first mandibular molar. The patient had undergone an extraction in this area 4 months before. A panoramic X-ray showed the presence of several, multiple,

bilateral lesions of the mandible (Fig. 1). Periapical intraoral radiographies showed the presence of a mixed radiolucent-radiopaque lesion in the right mandible (Fig. 2) and a dense periapical radiopaque lesion located around the roots of the first left mandibular molar (Fig. 3). A CAT scan demonstrated the presence of multiple foci of radiopacity distributed in the mandible (Fig. 4). Due to the persistence of the pain and purulent discharge from the sinus tract the right lower quadrant lesion was entirely removed.

FIG 1. Panoramic radiography. Mixed radiolucent-radiopaque lesions are present bilaterally in the mandible.

FIG 3. Intraoral periapical radiography. A radiopaque mass is located at the roots of the first left mandibular molar.

FIG 2. Intraoral periapical radiography. Mixed area of radiopacity and radiolucency in the mandible.

FIG 4. CAT scan. Multiple radiopaque lesions are present bilaterally in the mandible.

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Zebra Hunt

The patient also received a cycle of antibiotic therapy. The pain and the purulent discharge disappeared. You are asked to consider the differential diagnosis for this case during the next month. In the next issue of the Journal, the possibilities will be discussed and the most likely interpretation given. The following pathologies are suggested in the differential diagnosis: cemento-ossifying fibroma, Paget’s disease, chronic scle-

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rosing osteomyelitis, hypercementosis, fibrous dysplasia, cementoosseous dysplasia, and florid cemento-osseous dysplasia. Drs. Iezzi, Orsini, and Petrone are research fellows, Dental School, University of Chieti, Chieti, Italy. Dr. Piattelli is a professor of Oral Medicine and Pathology, Dental School, University of Chieti, Chieti, Italy. Dr. Piattelli is also an honorary senior lecturer, Eastman Dental Institute for Oral Health Care Sciences, London, UK. Address requests for reprints to Professor Adriano Piattelli, Via F. Sciucchi 63, 66100 Chieti, Italy.

The Way It Was Rowan tree is another name for the mountain ash that many people plant about their homes for its bright red berries that attract birds in autumn. Years ago, the rowan was also planted in dooryards, but for a very different reason. It was widely held to be a talisman against evil— devils, witches, and the like who were supposedly deterred by the color red. The old verse was: Rowan-tree and red thread Hold the witches a’ in dread. Bruce McMaster