C J Nortjé

A bulging swelling was observed in the anterior maxilla that resulted in displacement of nasal features and enlargement of the right nostril. Adjacent teeth tested vital and the contents radiodensity measured approximately 22 Hounsfield units (HU) on CT imaging

This 10-year-old boy presented with a main complaint of a carious painful primary molar in the third quadrant. A pantomograph revealed an incidental mass in the right posterior maxilla (Figure 1). No other symptoms were reported. What are the most important radiological features and what is your provisional diagnosis?

Objective Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region. Methods Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis. Results Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast. Conclusion Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals.

Six normal anatomical landmarks which could due to faulty angulation or lack of knowledge be diagnosed as undelying pathology or traumatic injury. Identify the anatomical landmarks illustrated and dicuss the reason(s) why a faulty diagnosis could be made.

Infection of the jaws that could be life-threatening within a few days due to spread of bacteria into perioral fascial spaces. Discuss the clinical and radiological features and what is your provisional diagnosis?

Cropped radiographic images of various lesions that may present in the jaws of a patient during a radiographic examination. What is the cardinal feature that are present in every case presented?

Clinical pictures and images of a very rare lesion presenting in the jaws at birth of a female. The patient spend some time in an incubator (Fig. 1). Tracheostomy was a lifesaving procedure in this patient. Repeated operations have removed the gross mass hamartomatous tissue but Figure 2 still shows noticeable recurrence of the lesion. Figure 3A and B are study models at two and a half years of age. The jawbones have grown in size. There is a pronounced shift in the midline of both jaws and their dentitions towards the right and away from the lesion. What are the important radiological findings?

A clinical picture of a thirty year old female who presented with a non-ulcerated swelling which has been present for the last eighteen months. The teeth in the region have been extracted ten months ago but the swelling in the left upper jaw increased in size causing nasal obstruction.