CLINICAL Q&A – QUESTION 1

Clinical Q+A in Oral Medicine

Test your knowledge with this issue's first oral-medicine challenge.

Drs Jacinta Vu & Alissa Jacobs | Oral Medicine Specialists

Question 1

Figure 1

Pete, a 17-year-old male, was referred with a complaint of several weeks’ history of recurrent right facial swelling over the right angle of the mandible. The non-painful swelling lasts for about a week before resolving. Pete denies any fever, malaise, or other systemic symptoms. He does note that his right third molar (48) is erupting. His medical history is unremarkable, and he did not have any known allergies. He has never smoked and does not consume alcohol. Extra-oral examination demonstrates a mild soft swelling over the right angle of the mandible. There is no redness nor heat. Intraoral examination demonstrates deep linear ulcers along the right buccal sulcus and gingival tissues of the right mandibular first and second molars. The right third molar is partially erupted, and the operculum does not appear to be inflamed. Figure 1. Intra-oral photograph of the right mandibular buccal sulcus CT of the mandible does not demonstrate any pericoronal or periapical pathology associated with the third molar, but a diffuse non-specific soft tissue swelling is reported in the buccal sulcus and mucosa adjacent to the right mandibular molars. Figure 2. Coronal CT image demonstrating (arrows) soft tissue swelling in the buccal sulcus and mucosa adjacent to the right mandibular molars.

Figure 2

WHAT IS THE BEST CLINICAL DIFFERENTIAL DIAGNOSIS?

Pericoronitis of the left mandibular third molar Recurrent aphthous ulcers Angioedema Orofacial granulomatosis

KNOW THE ANSWER?

Turn to page 39 to see if you're right.

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