Article
As surgeons, the authors, like many readers, are keen to address any problem seen with a scalpel/drill/scaler, rather than adopting a more conservative approach. Here we present two cases when the ‘wait and watch approach’ was indeed the right option.
A 58-year-old male was referred to the local maxillofacial department by his general medical practitioner with temporomandibular joint pain. An incidental finding of an asymptomatic impacted LR3 with an apparent dentigerous cyst formation was seen on routine imaging (Figure 1). A CBCT confirmed the presence of a unilocular cystic lesion, benign in appearance, associated with the crown of the unerupted LR3, which had no intervening bone with the inferior alveolar canal (Figure 2). After discussing conservative versus surgical management, including the associated risks and benefits of each, particularly inferior dental nerve injury, the patient opted for a watch and wait approach. His subsequent review was delayed owing to the COVID-19 pandemic, and at 2 years he remained asymptomatic, and surprisingly, surveillance imaging revealed resolution of the cystic lesion (Figure 3). A further review 2 years later showed no evidence of recurrence (Figure 4), and he was subsequently discharged for continued surveillance in primary dental care.
A 58-year-old female was referred to the local maxillofacial department by her general dentist with an asymptomatic lump on the lower jaw. Plain film imaging suggested the presence of a dentigerous cyst associated with the unerupted LL3 (Figure 5). CBCT imaging confirmed the presence of a unilocular cystic lesion associated with the cemento-enamel junction of LL8, benign in its appearance. In areas, there was no intervening bone between the inferior alveolar canal and the cystic lesion (Figure 6). The options for conservative versus surgical management were again discussed, along with their relevant risks and benefits. The patient requested a watch and wait approach owing to her lack of symptoms and the potential risk of inferior dental nerve injury involved with surgery. Subsequent annual review again appeared to show resolution of the lesion (Figure 7), with no sign of recurrence another year later (Figure 8). At this point, the patient was discharged back to her dentist's care for continued review.
The authors acknowledge the need for continued surveillance with regular review and prompt action should there be signs of changes or advancement of the lesion; however, for these two cases the conservative ‘watch and wait’ approach meant that the patients avoided surgery with the very real risk of inferior dental nerve injury.