Carotid aneurysms: unusual referrals from general dental practice

Oral and maxillofacial surgeons carry out the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck. They provide a critical referral service for dentists in general practice, with the most suspicious of these being sent as 'urgent suspected cancer', or 'USC'. According to national guidelines, such cases must be seen within 14 days. In January and February 2017, the oral and maxillofacial team in Morriston hospital received two such referrals from separate GDPs in the locality. Both were prioritised and seen within the two week window on consultant clinics. These two cases presented as enlarging, firm and painful neck swellings in otherwise relatively healthy adults, with no classical risk factors for malignancy, such as smoking, high alcohol intake or HPV virus. There was no dental pathology noted in either. Following clinical examination and special investigations within the OMFS department in Morriston Hospital, both patients were diagnosed, and treated under the vascular surgical team via surgical repair for carotid aneurysms. This is a condition rarely considered by dentists, and an uncommon differential diagnosis of a neck lump.