PMC10499283_01
(a and b) Extra-oral clinical picture
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She was relatively asymptomatic for one year when she noticed the swelling, which slowly increased to present size causing obvious facial asymmetry [Figure 1].
Intraoral clinical picture
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Intraoral examination revealed the obliteration of vestibule and normal overlying mucosa [Figure 2].
(a) Pre- and (b) Post-treatment Orthopantomographs
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Panoramic radiograph showed a well-defined oval radiolucent lesion in the left body of the mandible [Figure 3a]. At one year follow up, resolution of 'punched out lesions' can be observed on plain radiographs i.e. orthopantomograph [Figure 3b] and lateral skull x-ray [Figure 5b] respectively.
(a) Microscopic image, (b) 'M' spike on graph after protein electrophoresis and immunofixation
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The oral pathologist diagnosed the lesion as a chronic inflammatory lesion [Figure 4a]. The patient was advised for serum electrophoresis that showed a characteristic spike of M band [Figure 4b].
(a) Pre- and (b) Post-treatment Lateral skull radiograph
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Radiographs of the skull were then advised, which showed multiple punched-out lesions in the cranial vault [Figure 5a]. At one year follow up, resolution of 'punched out lesions' can be observed on plain radiographs i.e. orthopantomograph [Figure 3b] and lateral skull x-ray [Figure 5b] respectively.
Pre-treatment CT scan. CT = Computed tomography
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A subsequent computed tomography scan [Figure 6] revealed a hypoattenuated lytic lesion extending from the left body to the angle of the mandible, as well as many minor lytic lesions over the ramus, zygoma and cranial vault indicating an unknown underlying pathogenic aetiology.