Soft Tissue Infection from Non-Healing Endodontic Lesions on Submental Mass Evaluation

An 87-year-old female presented with a large firm mass under her chin in the midline. A medical ultrasound had been inconclusive, and the physician requested a dental evaluation. The patient had prior root canal therapy on teeth #26 and #27, which were asymptomatic, and the referring dentist noted associated apical lesions with some apparent bone fill. The dentist questioned whether there was evidence of incomplete osseous healing from the previous root canal therapy contributing to the mass. Upon full-volume review, the radiologist determined that both apical lesions showed no apparent radiographic signs of osseous healing, with adjacent perforation of the facial cortex and adjacent soft tissue swelling both facially and inferiorly. While CBCT is not ideal for soft tissue assessment, the radiologist noted that these findings suggest cellulitis, phlegmon, or abscess, which are varying degrees of soft tissue inflammation requiring prompt treatment to prevent further spread of infection through the soft tissues. This case demonstrates the oral radiologist's ability to bridge the gap between the general dentist's and physician's expertise and to accurately guide the dentist's radiological interpretation when uncertain, facilitating quick and decisive treatment.