[Oradlist] Oradlist Digest, Vol 82, Issue 24

Lennart Flygare Lennart.Flygare at nll.se
Wed Aug 11 05:03:17 PDT 2010

Dear Revan,

My recommendation of a 3D-follow up was largely based on the differentials originally given which I didn't think added up to the radiograph.
To be honest, my impression from the panoramic was clearly that there was a benign lesion of cystic nature, either cyst or tumour but I want to be cautious about offering diagnoses on single compressed jpg-images as this one.
However, in such a case as this 3D imaging is of course not necessary, according to my opinion, unless you need further information regarding relationship to the mandibular canal, cortical breakthrough and soft tissue involvement etc. etc. Having said as much I would still claim that 3D-imaging, if readily available, in almost all cases like this will add valuable information provided that the surgeon is skilled enough to take advantage of the information.  As you point out the decision is a balance depending on the availability of 3D-imaging and the environment in which you are working.

1)       In a case like this with an unknown or suspected lesion, consulting with surgical or radiological expertise at hand seems the right way to go.
2)       Radiographs will seldom give you the final diagnosis so yes; aspiration or open biopsy is a good way to narrow the list of differentials and get more information on the nature of the lesion.
3)       In this particular case I would still advocate surgical intervention or 3D-imaging, not least due to the considerable size of the lesion. In many cases when there are no clinical symptoms, period recalls with follow-up radiographs is sufficient, especially when dealing with fibro-osseous lesions. I would however be cautious to offer a general rule of thumb about when to "wait and see". The best advice I can give a junior colleague is that consulting a colleague when you are uncertain is never ever wrong. Having practiced DMFR including 3D-imaging for more than two decades know I confess that I have to consult colleagues on cases, if not every single day, at least once or twice a week. The older and hopefully more experienced I get - the less my resistance to consult with colleagues, both senior as well as junior ones.

Best wishes

Lennart  Flygare

Från: oradlist-bounces at lists.ucla.edu [mailto:oradlist-bounces at lists.ucla.edu] För Revan Joshi
Skickat: den 11 augusti 2010 11:20
Till: oradlist at lists.ucla.edu
Ämne: Re: [Oradlist] Oradlist Digest, Vol 82, Issue 24

Dear Ebtihal,

Sub: 16 yr old girl with asymptomatic periapical radiolucency irt 48

As Lennart says you have to definitely rule out the tumor aspect of this lesion.

But his opinion puts forth an ever confusing dilemma of what to do next? The obvious answers would be to go in for 3D imaging as he suggested.

I would like to know the opinion of those people in this community who have witnessed the growth and ease of availability of 3D imaging from the 2D imaging modality. I ask this  to those people specifically because they have experienced both the worlds (3D & 2D).

1. What should be the protocol for a dentist or a radiologist if he is in a place where the availability of 3D imaging is either scarce and/or is prohibitively expensive?

2. Is there a need to do an aspiration to rule out the tumor or the cyst part, though it is invasive or minimally invasive?

3. Is it good enough to keep the patient on a periodic recall as you see that the size of the lesion has remained dormant for 2 yrs?

The answers to this will go a long way in helping the young clinicians practicing in the old world 2D system.

Thanks in advance to everybody who responds to these queries..

Dr. Revan Joshi,
Foreign Research Scholar
Dept Of Oral & Maxillofacial Radiology
Showa University Dental school,
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