Clival lesion incidentally discovered on cone-beam computed tomography: A case report and review of the literature

Dental malocclusions coupled with skeletal discrepancies usually require a combination of surgical and orthodontic interventions.Most common orthognathic procedures involved in facial, functional, and esthetic corrections are Le Fort-I osteotomy, mandibular bilateral sagittal split osteotomy (BSSO), and genioplasty.1 The recent introduction of cone-beam computed tomography (CBCT) into dentistry has given the surgeon the ability to perform real-time, virtual surgical planning.2 It also helps in the diagnosis and dento-facial evaluation of pre-surgical orthognathic cases. 2 Coupled with a relatively low radiation dose and a high spatial resolution, CBCT is rapidly becoming the imaging modality of choice in the pre-surgical evaluation of orthognathic surgical procedures.Most common incidental findings that appeared during the interpretation of CBCT volumes are associated with the sinonasal complex, pharyngeal wall and airway, temporomandibular joint (TMJ), and the jaws.3 This report is the first to describe a rare case of an osteolytic lesion found in the clivus of a patient with an otherwise unremarkable history, discovered during the pre-surgical interpretation of a CBCT volume. Case ReportA 27-year-old male patient visited the Department of Orthodontics in the University of Connecticut, School of Dental Medicine with the chief complaint of an "asymmetric face."The consulting orthodontist performed a facial and dental evaluation and arrived at a working diagnosis of facial asymmetry associated with skeletal malocclusion.An initial panoramic radiograph was taken to evaluate the maxillofacial complex.The panoramic image and posterior-anterior (PA view) showed an asymmetry of the mandible with deviation to the left side and slightly