(75) An Incidental Finding of a Skull Base Lesion on Diagnostic Cone Beam Computed Tomography for Implant Planning: A Case Report

Introduction:

Objectives: To highlight the importance of comprehensive interpretation of cone beam computed tomography (CBCT) for dental implant planning

Methods: Case report: We present a 43-year-old female patient with a history of adult-onset left temporal lobe epilepsy and pseudotumor cerebri who reported to a university dental clinic for implant placement. A diagnostic CBCT was ordered for implant planning. Oral maxillofacial radiologist review revealed an incidental finding (IF) of a locally aggressive osteolytic lesion in the left side of the sphenoid bone with destruction of the left pterygoid process and associated expansion into the lateral aspect of the left sphenoid sinus. The patient and their neurologist were informed of the lesion and that medical examination, further imaging, and potential tissue biopsy would be needed for a definitive diagnosis. Our report highlights the importance of a comprehensive review of patient imaging that extends beyond the field of interest.

Results:

Discussion: CBCT is an increasingly essential diagnostic tool for dental implant planning that provides data on bone volume and quality in relation to surrounding anatomical structures. The increased use of CBCT imaging prompts the need to emphasize the significance of a comprehensive interpretation of the entire CBCT volume outside the maxillomandibular areas of interest. Traditional review of CBCT includes generating a panoramic view of regions of interest using automated techniques, risking overlooking non-maxillomandibular IFs. Review of our patient’s CBCT by an oral maxillofacial radiologist revealed an abnormality in the left skull base. IFs are common in the review of CBCT images with a prevalence of IFs ranging from 24.6 to 94.3% in the literature. However, potentially threatening findings are rare with a prevalence of 1.4%. This patient’s specific risk factors of tobacco use and prior neurological history of epilepsy make a close review of her CBCT even more critical as her lesion could represent a primary bone sarcoma or metastatic disease.

Conclusions:

Conclusion: CBCT interpretation beyond the areas of interest for implant treatment planning is essential and should not be overlooked. This case demonstrates the significance of reviewing the entire CBCT volume for IFs.

Clinical Significance: IFs prompt providers to make the necessary referrals for complete medical evaluation and final diagnosis. They play an integral role in the early detection of potentially malignant primary or metastatic lesions that could improve a patient’s outcome through early detection and treatment. A thorough interpretation of imaging, subsequent referrals, and follow-ups allow for the best possible care to be delivered to patients.

Lead Author's Contributions to the Research Project. : The Lead Author was responsible for the data collection and composition of the abstract.