{"id":5693,"date":"2017-12-11T09:20:44","date_gmt":"2017-12-11T15:20:44","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=5693"},"modified":"2018-07-31T15:19:41","modified_gmt":"2018-07-31T20:19:41","slug":"case-challenge-december-2017","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/case-challenge-december-2017\/","title":{"rendered":"Case Challenge: December 2017"},"content":{"rendered":"<p>In an effort to include more interactive clinical content in their communications, the Resident and New Practitioner Committee is introducing the Case Challenge column. This recurring column will give readers the opportunity to review a case and select the correct diagnosis from a multiple-choice question. If you have a Case Challenge you would like to submit for publication, please contact Allison Houle at <a href=\"mailto:ahoule@aae.org\">ahoule@aae.org<\/a>.<\/p>\n<hr \/>\n<p><strong>By Eshwar Arasu, D.M.D.<\/strong><\/p>\n<p>A 73-year-old Caucasian male in no apparent distress presented with the chief complaint of spontaneous, remitting pain in the anterior maxilla around teeth #6-8. The patient reports that the pain is long-standing (&gt;12 months) and recalls extraction of tooth #7 over 5 years ago. To his recollection, a fixed partial denture was delivered shortly after the extraction.<\/p>\n<p><strong>Vitals<\/strong><\/p>\n<ul>\n<li>Blood Pressure: 142\/88 mmHg<\/li>\n<li>Heart Rate: 76 bpm<\/li>\n<\/ul>\n<p><strong>Medications<\/strong><\/p>\n<ul>\n<li>Lisinopril<\/li>\n<li>Metformin<\/li>\n<\/ul>\n<p>Patient has no known drug allergies. Past medical history is notable for diagnoses of hypertension, Type 2 diabetes, and glaucoma. Past surgical history is unremarkable. Patient has a 10-pack-year history of cigarette smoking and reports drinking between two to five alcoholic beverages per week.<\/p>\n<div id=\"attachment_5734\" style=\"width: 221px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5734\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/12\/mucosal_lesion.jpg\" alt=\"\" width=\"211\" height=\"250\" \/><p id=\"caption-attachment-5734\" class=\"wp-caption-text\">Clinical Photograph of Mucosal Lesion<\/p><\/div>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_17' ><form method='post' enctype='multipart\/form-data'  id='gform_17'  action='\/specialty\/wp-json\/wp\/v2\/posts\/5693' data-formid='17' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_17_1\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >A soft tissue biopsy of the lesion in the area of #7 was obtained. Given the historical, clinical, and radiographic findings of this case, which of the following diagnoses on the differential is most likely to reflect the patient\u2019s condition?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_1'>\n\t\t\t<li class='gchoice gchoice_17_1_0'>\n\t\t\t\t<input name='input_1' type='radio' value='A. Oral Squamous Cell Carcinoma'  id='choice_17_1_0'    \/>\n\t\t\t\t<label for='choice_17_1_0' id='label_17_1_0' class='gform-field-label gform-field-label--type-inline'>A. Oral Squamous Cell Carcinoma<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_1'>\n\t\t\t\t<input name='input_1' type='radio' value='B. Dentigerous \/ Periapical Cyst'  id='choice_17_1_1'    \/>\n\t\t\t\t<label for='choice_17_1_1' id='label_17_1_1' class='gform-field-label gform-field-label--type-inline'>B. Dentigerous \/ Periapical Cyst<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_2'>\n\t\t\t\t<input name='input_1' type='radio' value='C. Globulomaxillary Cyst'  id='choice_17_1_2'    \/>\n\t\t\t\t<label for='choice_17_1_2' id='label_17_1_2' class='gform-field-label gform-field-label--type-inline'>C. Globulomaxillary Cyst<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_1_3'>\n\t\t\t\t<input name='input_1' type='radio' value='D. Central Giant Cell Granuloma'  id='choice_17_1_3'    \/>\n\t\t\t\t<label for='choice_17_1_3' id='label_17_1_3' class='gform-field-label gform-field-label--type-inline'>D. 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The mucosal lesion can be probed, revealing a 9-mm internal defect and eliciting bleeding. Palpation of the mucosa in this area reproduces the patient\u2019s chief complaint. No response to cold thermal testing was elicited among any teeth in the anterior maxilla.<\/p>\n<p>The following annotated radiographs and cone beam CT images were gathered at the time of examination.<\/p>\n<div id=\"attachment_5740\" style=\"width: 202px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5740\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/12\/radiograph_6-8.jpg\" alt=\"\" width=\"192\" height=\"250\" \/><p id=\"caption-attachment-5740\" class=\"wp-caption-text\">PA radiograph: #6 (yellow arrow), #8 (red arrow)<\/p><\/div>\n<div id=\"attachment_5743\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5743\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/12\/cbct_coronal_8-300x213.jpg\" alt=\"\" width=\"300\" height=\"213\" \/><p id=\"caption-attachment-5743\" class=\"wp-caption-text\">CBCT Coronal View (#8 noted by yellow arrow)<\/p><\/div>\n<div id=\"attachment_5744\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5744\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/12\/cbct_sagittal_8-300x211.jpg\" alt=\"\" width=\"300\" height=\"211\" \/><p id=\"caption-attachment-5744\" class=\"wp-caption-text\">CBCT Sagittal View of #8<\/p><\/div>\n<div id=\"attachment_5741\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5741\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/12\/cbct_3d-300x210.jpg\" alt=\"\" width=\"300\" height=\"210\" \/><p id=\"caption-attachment-5741\" class=\"wp-caption-text\">CBCT 3D Reconstruction<\/p><\/div>\n<div id=\"attachment_5742\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-5742\" src=\"https:\/\/www.aae.org\/specialty\/wp-content\/uploads\/sites\/2\/2017\/12\/cbct_axial_8-300x211.jpg\" alt=\"\" width=\"300\" height=\"211\" \/><p id=\"caption-attachment-5742\" class=\"wp-caption-text\">CBCT Axial View (#8 noted by yellow arrow)<\/p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>This first installment of Case Challenge features a 73-year-old Caucasian male in no apparent distress presented with the chief complaint of spontaneous, remitting pain in the anterior maxilla around teeth #6-8. <\/p>\n","protected":false},"author":8,"featured_media":5741,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[266],"tags":[],"feature":[236],"class_list":["post-5693","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","feature-paperpoint"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - 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