Diagnostic conundrum in an ambiguous posterior mandibular osseous lesion: Case report and radiological review

Non-odontogenic osseous lesions of the mandible are relatively uncommon entities compared to odontogenic lesions. Although the posterior mandible is not a usual site, it is not rare either for these osseous lesions, making the diagnosis ambiguous, and if misdiagnosed leading to different treatment protocols. A 43-year-old female presented with a hard tissue lesion of the posterior mandible, misdiagnosed as a sialolith of the submandibular salivary gland in two other centers due to overlapping of symptoms, anatomic complexity, and inadequate investigations. The lesion was later diagnosed to be an osteoma of the posterior mandible with added investigations, and surgically excised. Histopathology confirmed the diagnosis. A variety of hard tissue lesions are known to occur in the posterior mandible like Submandibular sialolith, Osteomas, Calcified Submandibular lymph nodes, Phlebolith, and Tonsillolith. However, due to the region's structural complexity, localization of a hard tissue lesion may not always be forthright, even with radiographs. Moreover, in cases with conflicting symptoms, as was in this case there are more chances of misdiagnosis. The reasons for such diagnostic challenges are deliberated with radiological review of posterior mandibular osseous lesions. Recommendations are also suggested for proper investigations, thereby management of these posterior mandibular osseous lesions. Misdiagnosis of these posterior mandibular lesions may lead to the patient undergoing unnecessary surgical procedures as different lesions require different management. Differential diagnosis and adequate protocol for investigations are required. •The posterior mandible is not a rare site for osseous lesions.•Anatomical complexity of posterior mandibular osseous lesions makes localization and diagnosis difficult.•Vital to know differences between bony, salivary, soft tissue or other vascular osseous lesions as management varies.•Adequate investigations and awareness overlapping of clinical symptoms should be taken into consideration.