An incidental finding

We present a curious case of a patient referred by the GDP to the local Oral and Maxillofacial unit. The patient had been urgently referred due to an exophytic growth in a post-operative LR6 extraction socket. Incidentally, he had been complaining of a more posterior discomfort to the ipsilateral side of his mouth. Initial examination showed a mild trismus and a small granulomatous lesion overlying the extraction socket.

An OPG was taken (Figure 1) that showed two anomalies. The first, within the extraction site, appeared to show a retained foreign body – likely a root-filling material. The second, in the region of the angle of the mandible, appeared densely radio-opaque and coiled or braided.

A biopsy was performed to the LR6 socket tissue and the socket explored and debrided. All tissue obtained was sent for histology, which later confirmed granulation tissue. Careful re-examination of the patient, focused to the right posterior lingual sulcus, revealed a large coiled brush with a central malleable metal process. Initially, it had been missed, as it lay between the palato-glossal arch and the base of the tongue. The object was removed without complication and quickly identified as a large interdental brush, whose handle had separated. The adjacent mucosa was examined and found to be mildly erythematous but with no ulceration. Immediate relief followed the removal of the brush.