Oral Surgery · patient case question
On a different patient's routine panoramic, a large destructive lesion is discovered in the ramus of the mandible. The patient has no symptoms. What is the appropriate action?
Patient case: Incidental radiographic finding on a routine panoramic
Patient: Male, 26 years old
Chief Complaint: Attends for a routine check-up. No symptoms whatsoever.
Background: No relevant medical history. Has never had a panoramic radiograph before.
Current Findings: The panoramic shows tooth #17 retained and impacted against tooth #18. A well-defined unilocular radiolucency with a corticated border surrounds the crown of #17, attaching at the cementoenamel junction. There is no root resorption of adjacent teeth and no cortical expansion.
Show answer and explanation
Correct answer: D. Refer to an oral and maxillofacial surgeon
- A. Watchful waiting on an undiagnosed destructive lesion allows continued growth and, if it is neoplastic, a worse outcome and more extensive surgery.
- B. A periapical film cannot capture a ramus lesion adequately and does nothing to establish a diagnosis.
- C. Antibiotics treat infection. There is nothing here to suggest an infective aetiology, and a trial of antibiotics simply delays diagnosis.
- D. CORRECT. A large lesion in the ramus is outside the scope of general practice and needs specialist assessment — advanced imaging, biopsy and definitive management. The absence of symptoms is not reassuring; many significant jaw lesions, including ameloblastoma and other neoplasms, grow silently until they are large. Referral is prompt regardless.