死后法医影像中显著的颌骨隆突与多灶性上颌骨性突起：一例病例报告

文献信息

中文摘要

背景： 显著的口腔骨性突起可能有助于法医身份识别，但也可能造成诊断上的不确定性。本报告记录了一例显著的颌骨隆突，并伴有多灶性上颌表面骨性突起，同时评估其法医学意义。方法：一名71岁男性被发现死于一辆停放的车辆内，处于高度腐败状态，接受了法医尸检和全身死后计算机断层扫描（PMCT）。评估了大体所见、轴位PMCT图像和三维容积渲染重建。作为身份识别过程的一部分，另行回顾了既往生前影像。结果：PMCT显示双侧大型多小叶状颌骨隆突和多灶性前庭上颌骨性突起。上颌病变显示成熟的皮质结构，无破坏性骨溶解、髓腔侵犯、侵袭性骨膜反应或相关软组织肿块。PMCT或尸检均未发现提示第三方参与的创伤性损伤。通过生前/死后颅脑计算机断层扫描比对确定了身份。上颌骨性突起在生前影像上可见，并作为辅助的一致个体识别特征；而颌骨隆突因生前采集未包括下颌骨而无法进行对比评估。结论：颌骨隆突在形态学上为典型显著的良性解剖变异，而上颌突起在影像学上最符合良性外生性或肥厚性重塑，但未经组织病理学证实。在具备有记录的生前对应关系时，其形态可为身份识别提供有用的辅助信息。若无临床、影像学、尸检或组织病理学的一致证据，此类发现不应归因于恶性肿瘤、系统性疾病或死因。

英文摘要

Prominent oral osseous outgrowths may be useful for forensic identification but may also create diagnostic uncertainty. This report documents marked mandibular tori associated with multifocal surface-based maxillary osseous outgrowths and evaluates their forensic significance. A 71-year-old man, found deceased in a parked vehicle in an advanced state of decomposition, underwent medicolegal autopsy and whole-body post mortem computed tomography (PMCT). Macroscopic findings, axial PMCT images, and three-dimensional volume-rendered reconstructions were assessed. Previous ante mortem imaging was reviewed separately as part of the identification process. PMCT demonstrated large bilateral multilobulated mandibular tori and multifocal vestibular maxillary osseous outgrowths. The maxillary lesions showed mature cortical architecture without destructive osteolysis, medullary invasion, aggressive periosteal reaction, or an associated soft-tissue mass. No traumatic injury suggesting third-party involvement was identified on PMCT or autopsy. The identity was established by ante mortem/post mortem cranial computed tomography comparison. The maxillary osseous outgrowths were visible on ante mortem imaging and contributed as ancillary concordant individualizing features, whereas the mandibular tori could not be assessed comparatively because the mandible was not included in the ante mortem acquisition. The mandibular tori were morphologically typical of prominent benign anatomical variants, whereas the maxillary outgrowths were radiologically most consistent with benign exostotic or hyperostotic remodeling but were not histopathologically confirmed. Their morphology may provide useful ancillary information for identification, provided that documented ante mortem correspondence is available. Such findings should not be attributed to malignancy, systemic disease, or cause of death without convergent clinical, radiologic, autopsy, or histopathological evidence.