Breakthrough Clinical oral pathology case: No. 32

Nov. 1, 2017

A healthy 40-year-old male presents with a fluctuant mass approximately 12 mm x 24 mm on the lingual side of the left mandibular jaw, along the palatoglossal arch muscle. The mass is tender to palpation. Both the diagnosis and genesis for the origin of this soft-tissue mass are surprising. After reading the details of this oral pathology case, how would you proceed with treatment?

Stacey L. Simmons, DDS, Editorial Director of DE's Breakthrough Clinical e-newsletter

A healthy 40-year-old male presents with a fluctuant mass approximately 12 mm x 24 mm on the lingual side of the left mandibular jaw, along the palatoglossal arch muscle. The mass is tender to palpation. Both the diagnosis and genesis for the origin of this soft-tissue mass are surprising. After reading the details of this oral pathology case, how would you proceed with treatment?

Editor's note: This article first appeared in DE's Breakthrough Clinical with Stacey Simmons, DDS. Find out more about the clinical specialties newsletter created just for dentists, and subscribe here.

Presentation and chief complaint

A healthy 40-year-old male presents to the office with this chief complaint:

“I have some swelling on the lower left side toward the back of my mouth on my jawbone. It’s been there for two days and seems to be getting worse."

Clinical exam

Clinical assessment reveals a fluctuant mass that is tender to palpation on the lingual side of the left mandibular jaw, inferior and lingual to where No. 17 would be, along the palatoglossal arch muscle. The size of the mass is approximately 12 mm x 24 mm, the tissue in the surrounding area is normal in color, and there is no opposing dentition or history of trauma to the area (figures 1 and 2). Upon initial assessment, the panoramic radiograph is insignificant (figure 3).

Figure 1Figure 2

Figure 3

With this information, how would you proceed with treatment for this patient? I will tell you that both the diagnosis and genesis for the origin of this soft-tissue mass are surprising. Further, multiple complications have occurred while rendering treatment.

Send your answers to [email protected] or join our Facebook group to discuss this oral pathology case and more. Next month, we will discuss the final diagnosis and recommended treatment for this case.

Do you have an interesting oral pathology case you would like to share with Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to: [email protected]. We will let you know if we select your case.

For more oral pathology articles, click here.

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at [email protected].

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About the Author

Stacey L. Simmons, DDS | Editorial Director of DE's Breakthrough Clinical e-newsletter

Dr. Stacey Simmons grew up in Hamilton, Montana. She did part of her undergraduate work at Purdue University and then received her bachelor’s degree in exercise physiology from the University of Utah. After applying to both medical and dental school, she decided that dentistry was her career of choice. She received her DDS degree from Marquette University School of Dentistry in Milwaukee, Wisconsin, in 2004. In private practice, she focuses her care on prosthodontics and cosmetic dentistry. She is a guest lecturer in the Anatomy and Physiology Department at the University of Montana. Outside the office, she trains for triathlons and spends time with her family. You may contact Dr. Simmons by email at [email protected].

In 2015, Dr. Simmons became the editorial director of DE's Breakthrough Clinical with Stacey Simmons, DDS, an e-newsletter focused on breaking through plateaus in clinical practice. Subscription information may be found here.

Updated May 4, 2016