Incidental Findings in Oral Maxillofacial Surgery- Expect the Unexpected

Objective and methods: The evaluation of patients in oral and maxillofacial surgery will frequently indicate performing different imaging modalities which can reveal incidental lesions not suspected at first. These findings will sometimes mandate altering the final diagnosis, treatment and prognosis of the patient. The aim of this study was to report the variability of malignant and nonmalignant conditions in a sample of patients diagnosed in the Baruch Padeh Medical Center-Poriya Oral and Maxillofacial Surgery Department. Full workup diagnosis and proposed clinical guidelines are also presented.

Results: This study presents 15 unique cases of incidental atypical diagnosis found on imaging studies in patients who were referred to our department due to distinct reasons as trauma and orofacial pain. Sarcoma, salivary gland tumors (acinic cell carcinoma, pleomorphic adenoma), nasopharyngeal carcinoma, metastasis of lung signet cell carcinoma, sialolithiasis, ectopic thyroid gland, Eagle syndrome and more were diagnosed in a period of 4 years. The presented study exhibits how overlooking incidental findings can lead to life-threatening/ disabling conditions and challenges the clinician to always expect the unexpected.

Conclusions: incidental findings vary in their importance from trivial lesions to findings that may have a great impact on the health and prognosis of the patient. Special awareness is to be dedicated to patients with persistent or atypical orofacial pain which mandates a meticulous interdisciplinary investigation in order to eliminate misdiagnosis.