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INTRA-ORAL PERIAPICAL RADIOGRAPH AS PRIMARY IMAGING IN DETECTING
INTRABONY MALIGNANCY CHANGES: SEEING IS BELIEVING
CASE REPORT

Saari MH, Apipi M, Sofee MSM, Mamat MR, Kohir S

Case report: A 72-year-old lady presented at Department of Oral and Maxillofacial Surger
Tuanku Ja’afar Hospital with gingival swelling. She was diagnosed with hypertension and
Type II diabetes mellitus. Patient denied any history or risk factors predisposing to
malignant tumors. The patient previously had an upper right lateral incisor (12) removed
in 2013 due to periodontal issues followed by fabrication of denture. Patient complained
of poorly-fitting upper denture due to gingival swelling at anterior upper jaw which she
noticed 5 years ago. Afterwards, the growth started to appear over the tooth socket and
increased in size throughout the years. The patient visited the nearest dental clinic to
where a prompt referral was made to Oral Maxillofacial Surgery Department, Hospital
Tuanku Ja’afar (OMFS). On presentation, well- defined lesion with 2 obvious nodules were
seen; the first nodule was firm to hard in consistency with a dimension of 2.0 x 2.0 cm (A),
pale in colour; while the second nodule was firm in consistency with the size 1.0 x 0.9 cm
(B), reddish in colour over the residual ridge of anterior maxilla region. The texture of the
nodules appeared smooth but non-tender on palpation. The attached intraoral periapical
radiograph (IOPA) showed an erosion of underlying bone over the growth site with no
apparent radiopaque lesion as to exclude bony lesion. Following clinical protocol, an
excisional biopsy was planned and made for a thorough histopathological examination to
establish the definitive diagnosis. Biopsy result reported as well-differentiated
chondrosarcoma of the maxilla. Currently, patient is awaiting Computed Tomography (CT)
scan for further imaging extension of lesion. Availability of IOPA radiographs in primary
care dental clinics makes it a first line of imaging modalities which should be optimized in
recognizing suspicious lesion specifically in the dentoalveolar region. Conclusion: This
case report highlights an IOPA cannot be underestimated as it is capable of detecting
intrabony malignant changes especially in the case of bony malignancy.

st
Virtual poster presentation at the 1 International Conference on Digital Solution for Education and Clinical Dentistry
(ICDSECD) 2019 on 18-19 November 2019 at Research Management & Innovation Complex, University of Malaya
th
Dr Muhammad Hamidie bin Sa'ari Dr Mohammad Suhayl bin Mohd Sofee
Tampin Dental Clinic Dr Sutina binti Kohir
Negeri Sembilan Malaysia Dr Mohamad Ropi Bin Mamat
Department of Oral and Maxillofacial Surgery
Dr Muzaffar bin Apipi Tuanku Ja’afar Hospital
Department of Oral and Maxillofacial Surgery Negeri Sembilan Malaysia
Slim River Hospital
Perak Malaysia

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