PMC3304341_01
Panoramic radiograph at first visit, showing a ground-glass appearance (yellow arrows) from the left premolar to the mandibular ramus region and enlarged canals of the left mandible (red arrow).
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Panoramic radiography showed osteosclerosis from the left premolar to the mandibular ramus region (Figure 1).
Plain computed tomography at first visit revealed increased density of cancellous bone.
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Computed tomography of the head and neck showed enlarged canals of the left mandible and increased density of cancellous bone, which seemed to be reactive bone remodeling (Figure 2).
Magnetic resonance imaging at first visit.. Note: The left side of the ascending ramus of the mandible shows heterogeneous intermediate-to-high signal intensity on fat-suppressed T2-weighted images.
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On magnetic resonance imaging, jaw lesions showed low signal intensity on T1-weighted images and heterogeneous intermediate-to-high signal intensity on fat-suppressed T2-weighted images (Figure 3).
Bone scintigram (99mTc-labeled methylene diphosphonate) at first visit, showing extremely intense tracer uptake in the left side of the mandible, the sternum, and the sternocostal and sternoclavicular joints.
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Bone scintigram (99mTc-labeled methylene diphosphonate) showed extremely intense tracer uptake in the left mandible, the sternum, and the sternocostal and sternoclavicular joints (Figure 4).
CT and MRI at 4-month follow-up after the first visit: (A) plain CT showing diffuse cortical bone resorption of the left condyle of the mandible; (B) MRI, with the left condyle of the mandible in part showing low-high signal intensity on a T1-weighted image; (C) MRI, with soft tissue around the left side of the ascending ramus of the mandible showing heterogeneous high-signal intensity on a fat-suppressed T2-weighted image.. Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.
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However, radiographic examination showed development of inflammation in the soft tissue around the left mandibular condyle and resorption of condylar bone (Figure 5).
Bone scintigram 6 months after administration of antibiotics.. Note: Radioisotope uptake in the left mandible is unchanged, while radioisotope uptake in the sternum and in the sternocostal and sternoclavicular joints is increased, compared with the images of the first visit.
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Six months later, scintigraphic examination showed almost the same level and range of uptake in the left mandible, and stronger and wider uptake in the sternum and the sternocostal sternoclavicular joints, compared with the findings obtained 1 year earlier (Figure 6).