Retrospective Longitudinal Radiographic Evaluation of Non-Surgically Managed Jaw Lesions Using Panoramic Radiography

Background and Objectives: The aim of this study was to evaluate the radiographic progression of non-surgically managed jaw lesions that remained untreated due to patient deferral or refusal of surgery. Radiographic changes were assessed using two panoramic radiographs obtained at different time points, with a focus on dimensional progression, morphological characteristics, and anatomical involvement. Materials and Methods: A total of 85 non-surgically managed intraosseous cystic and cyst-like jaw lesions were evaluated on two panoramic radiographs obtained at least one year apart. Histopathological confirmation was available for 26 of the lesions (30.6%), while the remaining cases were evaluated radiographically due to the absence of surgical intervention or accessible pathology records. Assessments included localization, size, shape, internal structure, borders, association with non-erupted teeth, root resorption, tooth displacement, involvement of anatomical structures, and cortical changes such as thinning, expansion, or destruction. Nonparametric statistical comparisons were used to assess time-dependent changes and differences between follow-up groups. Results: A total of 57 lesions occurred in the mandible and 28 in the maxilla, predominantly in the posterior regions. The mean vertical/horizontal measurements of the intraosseous lesions was found to be 10.9 ± 4.6 mm/12.2 ± 6.5 mm (Mean ± SD) on the initial panoramic radiographs (Med: 10.0-IQR: 6.50/Med: 12.0-IQR: 8.75) and 14.8 ± 5.3 mm/17.5 ± 8.3 mm (Mean ± SD) on the second panoramic radiographs (Med: 14.5-IQR: 6.75/Med: 16.0-IQR: 10.75), respectively. Both vertical and horizontal dimensions showed a statistically significant increase between the two time points (p < 0.05). Initially, 41 lesions exhibited corticated margins; at follow-up, an additional 33 non-corticated lesions developed cortication. Lesions without corticated margins on the initial images exhibited significantly greater vertical and horizontal growth than those with corticated borders (p < 0.05). Lesions followed for 3-5 years showed significantly greater dimensional changes compared with those observed for shorter or longer intervals (p < 0.05). Lesion shape, internal structure, and multilocularity remained largely stable. Conclusions: Within the limitations of this retrospective study, non-surgically managed jaw lesions showed a tendency to increase in size over time. While the development of corticated borders may be associated with reduced growth activity, panoramic radiography alone is insufficient for definitive assessment, and regular radiographic follow-up should be considered within a broader clinical context.