Do not neglect jaw swellings, clinical and radiological view

The paradox of benign jaw tumors is they are often asymptomatic¹ and might instigate worry in patients only in the presence of a swelling which often case is quite tardive.

Jaw tumors can be classed as either benign or malignant. Benign jaw tumors or tumor-like swellings of the jaws can be classed as odontogenic (originating from odontogenic tissues) or non-odontogenic. Odontogenic tumors are the most prevalent type of jaw neoplasm. There are several varieties, with the majority being rare.²

These odontogenic tumors have been reported to be more frequent in the mandible than the maxilla.³ In addition, geographical variations in their incidence have been reported4, 5, 6, 7, 8, 9, 10 despite a conventional range of 1–9 %.³

Benign jaw tumors are generally asymptomatic and are discovered fortuitously in the early stages. Benign jaw tumor-like swellings of the jaws occur clinically as swellings, however, radiologically they present as osteolytic lesions and are hence referred to as “pseudo tumors.”

This 20-year-old, male otherwise healthy patient presented with a painless jaw swelling accompanied by mobile and slightly displaced teeth (Figure 1). The patient was a student and had no contributive past history, his family history was without particularity. The patient noticed the jaw swelling about a year ago later accompanied by a localized tooth mobility 3 months ago which prompted the present consultation.

Figure 1.

Clinical view showing jaw swelling.

On the surface it did not seem exceptional but the orthopantomogram told us a different story. Radiologically, the patient presented a large osteolytic lesion (Figure 2) which was disproportional to the clinical visible swelling and associated with root resorption. To better comprehend this discrepancy we superposed the width visible clinical swelling on the radiological osteolytic lesion (Figure 3).

Figure 2.

Radiological view showing extensive mandibular osteolysis and root resorption.

Figure 3.

The difference between the clinical view of the swelling (blue) and the radiological presentation of the same osteolytic lesion(black).

This notion of tardive presentation is accentuated in developing countries with little awareness of benign jaw tumors, very little resources and where the field of dentistry and maxillofacial surgery is in its infancy or absent in some regions¹¹

Late clinical manifestations of benign jaw tumors have been reported in developing countries¹² which may have far-reaching consequences such as increased morbidity and DALYs (Disability adjusted life years), given that these tumors are often silent. In addition, there is a high risk of developing a nosocomial disease due to increased hospitalization time, higher expenditure due to the high cost of treatment in low-income developing countries where patients bear the majority of healthcare fees¹³ and, a possibility of malignant transformation in the advent of a jaw tumor recurrence as a complication.¹²

Additionally, the development of radicular resorptions, which are typically “knife-edge” in appearance, is related with advanced tumor presentation in some benign jaw tumors.

These resorptions could be explained by a tumor-induced mass effect on periodontal ligament vasculature, followed by hypoxia, then anoxia, and finally the death of cementoblasts necessary for root integrity preservation. This is followed by the death of odontoblasts, which exposes the mineralized radicular structure, causing chemotaxis in the periodontal region of osteoclasts and initiating root rhizalysis, which tends to be parallel and adjacent to the tumor surface closest to the root, and the regular surface generated gives this ``knife-edge'' shape observed.¹⁴

What this further demonstrates is the significant disproportionality between the radiological osteolysis and the clinical visible swelling, hence not neglecting jaw swellings and its potential impact on the patient’s wellbeing if not considered early through prompt diagnosis and treatment is essential.

Consent statement

We received voluntary consent from the patient to publish this report.

Informed consent

We received voluntary consent from the patient.

Ethical approval

Ethical approval was obtained for this study.

Funding

None.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.