Oral and Maxillofacial Diagnosis, Imaging and Treatment Planning
This domain tests structured history, clinical examination, appropriate imaging and a defensible treatment plan. The safe answer is usually the least invasive step that answers the clinical question.
Core rules
- Start with chief complaint, history of present illness, medical history, medications, allergies, social history and previous treatment.
- Examine extraorally for symmetry, lymph nodes, TMJ and cranial nerves; intraorally for mucosa, teeth, periodontal status, occlusion and range of movement.
- Panoramic radiography is a screening view with magnification, ghost images and poor detail in the anterior maxilla and soft tissues. CBCT is indicated when 3D information changes management: impacted teeth near the canal, root resorption, implant bone volume or fractures.
- Use ALARA and justify every exposure. MRI is preferred for soft-tissue lesions; CT for bone and acute trauma.
- Biopsy: incisional for large or suspicious lesions, excisional for small discrete lesions. Do not biopsy a suspected vascular lesion without imaging.
- The plan should list problems, options, risks, consent and review.
Worked example
A 45-year-old has a painless expansile radiolucency at the mandibular angle. Panoramic view shows a multilocular lesion. The next step is CBCT to define cortical expansion and tooth relations, then incisional biopsy if the lesion is large; do not enucleate before histology because ameloblastoma or keratocyst changes the operation.
Traps
Treating a panoramic ghost image as a real lesion; missing a second fracture or second lesion; planning implants from a panoramic alone; failing to record baseline sensation and occlusion.