This month's case is a little different than our usual cases that we present, it will be presented as a story directly from the clinicians mouth.

"Patient was presented to the endodontic clinic at KAU with a chief complain of swelling on the lower anterior teeth. She was advised to seek endodontic surgery because of the large size of the lesion associated with the lower anterior teeth.

Clinically, clinical examination revealed intact teeth of the lower anterior sextants. However, this area was associated with mild to moderate hard swelling. Clinical examination revealed negative response to percussion and palpation. Sensitivity tests revealed negative response also to cold test indicating necrotic non vital 6 lower anterior teeth(from canine to canine). Periodontal examination revealed normal periodontium with normal gingival texture and of pocket depths within normal limits

Though the lesion did not seem to be symptomatic; radiographic examination shows larger periapical radiolucency Figure. These osseous changes were accompanied with mild root resorption.

Patient denied any medical problem. There is a history of old trauma long time ago as a result of car accident.


NSRCT was done to the lower anterior teeth first followed by a minor surgical procedure by maxillofacial surgeon(multidisciplinary surgery was suggested by contribution of endodontic consultant)
surgery involved surgical removal of the lesion followed by end root resection with bevels and heat treatment of apical G.P.

Biopsy was sent to histopathology and the reported result was as shown " Mural Ameloblastoma" .

Patient is under follow up and periodic examination as recurrence is expected and if so another surgical intervention is recommended with a valuables degree of safety margin involvement."

Note: We had 2 years old Panoramic Radiograph showing the progression of the lesion before it was noticed and the patient came to the clinic with swelling related to the area.

"The Take away message here is that we clinicians should give attention to all details not to neglect any early signs of any disease in the Oral Cavity as well as in the Head & Neck area"

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