Nasopalatine canal and periapical radiolucency fusion following dentoalveolar trauma: A CBCT-based case-control study

There is a lack of evidence regarding the radiological characteristics of a periapical radiolucency (PRL) fusion with the nasopalatine canal (NPC) following dentoalveolar trauma. The aim of this study was to assess the NPC enlargement resulting from fusion with a PRL and its relationship with the surrounding anatomical structures.

A total of 100 patients was retrospectively recruited and divided into two groups: case group and control group. The case group consisted of 50 cone-beam computed tomography scans of the maxilla of patients (32 males, 18 females; age range: 11-83 years) with a known history of dentoalveolar trauma in the maxillary anterior region and the presence of an undiagnosed and/or asymptomatic NPC and PRL fusion. An age- and gender-matched control group of 50 patients (32 males, 18 females; age range: 11-82 years) without trauma history to the upper anterior teeth, demonstrating normal maxillary scans, was recruited. A subjective scoring criterion was established for assessing the characteristics of the fused lesion and its relationship with the buccal/palatal alveolar cortex, nasal cavity cortex, NPC cortical border, and maxillary sinus floor.

The fused NPC and PRL was mainly lobular in appearance (88%) with non-corticated well-defined margins (80%). Male patients showed larger (68%) dimensions compared with female patients (32%). The NPC cortical bone was the most commonly perforated structure in relation to fusion (72%), whereas maxillary sinus cortical bone was the least effected (2%). A statistically significant difference was observed between the NPC dimensions in the control and test groups, with fused lesions having larger mesiolateral, craniocaudal, and buccopalatal dimensions (P < .001).

Periapical radiolucencies should be treated as soon as possible before they fuse with NPC. In case of fusion, surgical enucleation should be considered as the treatment of choice.