PMC6487125_01
(a) Orthopantomogram of the presenting case illustrating the ill-defined radiolucent lesion associated with impacted right mandibular third molar. (b) Immediate postoperative imaging showing postextraction of the right mandibular third molar and biopsy of the right mandible. Note that the mandibular inferior border remained intact.
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Imaging of the patient's facial bones via orthopantomogram and computed tomography (CT) was also obtained (Figures 1 and 2). A vertically impacted right mandibular third molar was present in the posterior right mandible, with an associated ill-defined radiolucency (Figure 1). Histopathological analysis showed multiple fragments of soft tissue that were nearly completely replaced by moderately differentiated invasive keratinizing squamous cell carcinoma (Figures 3(a) and Supplemental Figure 1A). Figure 1B). Focal mild dysplasia was noted in the retromolar mucosa, suggesting an origin from this area rather than an intraosseous origin.
Coronal (a), axial (b), and sagittal (c) views on CT scan of facial bones illustrating the impacted right mandibular third molar with the associated radiolucent lesion and its relationship to the surrounding remaining mandibular bone. Note the cystic appearance of the lesion. White arrow in each panel indicates the impacted right mandibular third molar in association with the radiolucent lesion.
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Imaging of the patient's facial bones via orthopantomogram and computed tomography (CT) was also obtained (Figures 1 and 2). CT imaging revealed destruction of the right posterior mandible by the radiolucent lesion described above, which measured 12 x 7.3 mm in dimension (Figure 2).
Histopathology from initial biopsy of lesion and final resected specimen. (a) High-power (200x, H&E stain) magnification illustrating fragments of keratinizing conventional SCC from incisional biopsy of lesion. (b) Low-power (40x, H&E stain) magnification of tissue from final resected specimen showing SCC invasion into mandibular bone (lower left) with central tumor necrosis.
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Histopathological analysis showed multiple fragments of soft tissue that were nearly completely replaced by moderately differentiated invasive keratinizing squamous cell carcinoma (Figures 3(a) and Supplemental Figure 1A).
Orthopantomogram illustrating the fibular bony segment of the free flap, plated to the adjacent native mandible as part of the reconstruction. This was obtained on postoperative day 7.
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The defect was reconstructed with a right fibula free flap, with a 6 x 8 cm laterally-based skin paddle (Figure 4).