PMC5496487_01
Clinical view of the patient.
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Paediatric Surgery, Children's Hospital, ASST degli Spedali Civili, Brescia, Italy. Physical examination revealed only left mandibular swelling and pain with trismus (Fig. 1).
The preoperative orthopantomogram.
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Orthopantomography revealed mixed dentition with nothing of note in the mandible or maxilla (Fig. 2).
The CT axial view of the mandibular lesion.
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The seat of the cortical bone of the left mandibular branch was interrupted (maximum 1 cm extension) and the structure of the underlying cancellous bone appeared to be particularly inhomogeneous (2 cm craniocaudal extension) and showed the presence of multiple areas of osteolysis (Fig. 3, Fig. 4, Fig. 5).
The CT sagittal view of the mandibular lesion.
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The seat of the cortical bone of the left mandibular branch was interrupted (maximum 1 cm extension) and the structure of the underlying cancellous bone appeared to be particularly inhomogeneous (2 cm craniocaudal extension) and showed the presence of multiple areas of osteolysis (Fig. 3, Fig. 4, Fig. 5).
The MR axial view of the mandibular lesion with diffuse structural alteration of the left vertical mandibular branch and horizontal branch in the molar region.
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Two days later, on the suspicion of mandibular osteomyelitis, the patient underwent contrast-enhanced maxillofacial magnetic resonance imaging (MRI), which revealed diffuse structural alteration of the left vertical mandibular branch and horizontal branch in the molar region (Fig. 6, Fig. 7, Fig. 8).
The MR sagittal view of the mandibular lesion with diffuse structural alteration of the left vertical mandibular branch and horizontal branch in the molar region.
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Two days later, on the suspicion of mandibular osteomyelitis, the patient underwent contrast-enhanced maxillofacial magnetic resonance imaging (MRI), which revealed diffuse structural alteration of the left vertical mandibular branch and horizontal branch in the molar region (Fig. 6, Fig. 7, Fig. 8).
Intraoperative view.
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Local anaesthesia (mepivacaine 0.2% with 1:100,000 adrenaline) was then used in the left mandibular region and an intraoral approach was performed (Fig. 9).
Histological view of the lesion showing bone spicules that were largely necrotic, with disappearance of the osteoblastic contour and an absence of inflammatory infiltrate and bacterial or fungal colonies.
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An absence of inflammatory infiltrate and bacterial or fungal colonies confirmed the aseptic nature of the lesion (Fig. 10).