Incidental Mandibular Intraosseous Findings in Neurofibromatosis Type 1: CBCT and MRI Features Influencing Clinical Management.
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Neurofibromatosis type 1 (NF1) may involve the jaws without clinical symptoms and may affect orthodontic treatment planning. A 13-year-old female with NF1, diagnosed in childhood, was referred for orthodontic evaluation because of maxillary anterior crowding and Class III malocclusion. Routine panoramic radiography revealed incidental mandibular radiolucencies. Cone-beam computed tomography demonstrated multiple non-expansile intraosseous radiolucent findings in the anterior and posterior mandible, including a lesion close to an adjacent tooth root with mild buccal cortical thinning but no root resorption. Magnetic resonance imaging identified an intramedullary lesion in the right parasymphyseal region. As histopathological confirmation was not obtained, the exact nature of the findings remained uncertain. Following multidisciplinary consultation, mandibular orthodontic tooth movement and extractions were avoided as an individualized precautionary decision. Treatment was limited to skeletal anchorage-assisted maxillary expansion with facemask therapy, followed by fixed appliances in the maxillary arch. Follow-up imaging showed no aggressive changes and partial development of sclerotic changes. This case illustrates how clinically silent mandibular findings in NF1 may influence orthodontic treatment planning and supports individualized management based on multidisciplinary assessment and radiological surveillance.