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.