CDA Essentials 2019 • Volume 6 • Issue 4

S upporting Y our P ractice 38 | 2019 | Issue 4 I always recommend examining images in a deliberate, systematic way, making observations, and trying to discern from these observations what disease process we may be looking at.  Navigation to a differential interpretation • First fork in the road: normal or not normal? Not normal. • Second fork in the road: developmental or acquired? Acquired. From there we are going to rule out the following: 1. Cyst 2. Benign tumour 3. Systemic 4. Fibro-osseous We are left with the following possible acquired conditions: malignant tumour, infection/inflammation, and trauma. Both condylar heads have been fractured in the distant past and most likely are displaced medially. Since the osseous components of the right articular area (particularly) have adapted to this, I believe both condyles have been fractured (i.e. there is a traumatic cause behind the findings in the right and left condylar area). There is evidence of inflammation/infection in the right mandible and possible a pathologic fracture. We should integrate these findings with a clinical examination (Do the two mandibular segments move as one or can we see movement between the anterior and posterior segments indicating a fracture). In this case we have: 1. Old traumatic condylar head injuries. 2. Inflammatory/infection of the right mandible. Ask the patient if they had radiation for their base of tongue cancer and this will give you more, much- needed information. 3. Possible pathologic fracture (a fracture secondary to a pathologic entity) in the right mandible. This patient needs specialist care. a Dr. Wood presents this and other case studies on CDA Oasis. Test your radiographic interpretation skills at: oasisdiscussions.ca/2018/12/12/ test-your-radiographic-skills