Radiopaque Mass of the Posterior Mandible With Lingual Expansion

A 26-year-old Caucasian male visited a private dentalclinic complaining about a painful swelling in the periapicalregion of the second lower left molar. Following a briefexamination, with no radiographs taken, the tooth wasextracted with the presumptive diagnosis of periapical in-flammatory lesion.The pain in the lower left mandible region remainedstrong, more severe at night, disturbing the patient’s sleep.The patient related that the pain was only relieved throughthe use of analgesics.Asthepainremainedafter1yearoftreatment,thepatientwas referred to the Oral Pathology Department, School ofDentistry, Federal University of Rio Grande do Sul.Clinical examination showed a firm mass in the lingualside of the space left by the extracted tooth measuring 1 cmin diameter and with intact overlying mucosa. Panoramicradiograph (Fig 1) showed a round clear lesion with centralradiopacity, surrounded by a sclerotic layer in the periapicalposition of the extracted second lower molar. The ra-diopaque mass altered the anatomy of the mandibular nervecausing condensation in the surrounding bone trabeculae.The patient’s medical history and general examinationrevealed no other pathologic conditions. Hematological pa-rameters, such as blood count, coagulation time (9 minutes;reference value 2 per 12 minutes), prothrombin time (in SIvalues: 13.17 seconds, 92%; reference value 12.2 seconds,100%), activated partial thromboplastin time (36 seconds;reference value up to 45 seconds) and bleeding time (4minutes; reference value 1 per 7 minutes) were normal atthe time of examination.