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OCCULT DISEASE- A CHALLENGE TO DIAGNOSTICIAN
-DR SHUDDHODHAN GAIKWAD
INTRODUCTION
Diagnosis of any disease is achieved after detailed clinical evaluation and the necessary radiographic and laboratory investigation. There are very few lesions in the oral cavity which are said to have pathognomic clinical radiographic findings.
However most of the disease present with some obvious or striking clinical features which paves way for the diagnosis.
But at times there may be a major lesion or disease which may not present in ususal expected manner, in such cases the clinician has to be alert and pick up some important clues from subtle signs and symptoms which then lead to further investigation and diagnosis.
CASE 1
Age – 38 years
Sex – male
Chief complaint – pain in the upper left back region of jaw since 25 days.
Past medical history :- nothing significant
Past dental history:- nothing significant
Habit history:- habit of smoking, pan and tobacco since 9 years.
• Palatal swelling
• Surface of the swelling
• Swelling is firm and tender on palpation
• Grade I mobile maxillary left second molar
INTRA-ORAL EXAMINATION
INTRA-ORAL PERIAPICAL RADIOGRAPH
• Floor of the sinus was not traceable
• Altered bony trabecular pattern of maxilla
• Mild root resorption in certain areas
• Loss of lamina dura
PANORAMIC RADIOGRAPH
CBCT SECTIONS
AXIAL
CORONAL
SAGITTAL
PROVISIONAL DIAGNOSIS
Malignant lesion
DIFFERENTIAL DIAGNOSIS
Inverted papilloma of maxillary sinus
Lymphoma
Minor salivary gland tumor
CASE 2
Age – 38 years
Sex – male
Chief complain – Pain and pus discharge from upper left back region of jaw
Past medical history :- nothing significant
Past dental history:- nothing significant
Habit history:- habit of smoking since 10 years
EXTRA-ORAL AND INTRA-ORAL EXAMINATION
PANORAMIC RADIOGRAPH
CBCT SECTIONS
PROVISIONAL DIAGNOSIS
Gorlin goltz syndrome.
DIFFERENTIAL DIAGNOSIS
Pseudohypoparathyroidism
Fibrous papule of face
CHEST RADIOGRAPH & 3D RECONSTRUCTION VIEW
KEY FEATURES OF GORLIN GOLTZ SYNDROME
CONCLUSION
As a radiologist we should be very vigilant in the interpretation of radiograph even the minor things like the normal anatomical landmarks should be evaluated critically which pave the way for the diagnosis of occult diseases.
REFERENCES
Shafer’s, 6th edition oral pathology.Oral and maxillofacial infections, 4th edition, Topazian.Stuart C.White Michael J. Pharoah,oral Radiology. Shear M, Speight P. Cysts of the Oral and Maxillofacial Regions.Oral and maxillofacial pathology, 3rd edition, Neville.Pathologic basis of disease, Robbins & Coltran.