Periapical Lesion Differentiated from Nasopalatine Duct Cyst on Endodontic Evaluation

A 74-year-old female was referred by a periodontist after an endodontist noted a periapical radiolucency at the apex of tooth #9. The referring clinician observed that the nasopalatine canal appeared enlarged and wanted to differentiate between a nasopalatine duct cyst and an apical lesion originating from #9, as the two differential diagnoses require different treatment approaches. Based on the shape of the lesion and detailed evaluation using radiology software to view the pathology from multiple angles, the radiologist determined the primary differential to be a persistent periapical inflammatory lesion associated with #9. The radiologist noted that this case highlights the value of an oral and maxillofacial radiologist in identifying nuances that differentiate one diagnosis from another, providing a perspective that multiple specialists had been unable to determine.