PMC8110395_01
(a) Facial asymmetry on the left side. (b) Swelling in the buccal side of the mandible. (c) Panoramic X-ray showing the radiopaque image englobing the dental germ of the permanent second premolar. (d) The course of the mandibular canal displaced buccally is shown on the axial image of the CBCT. (e) Axial image of the CBCT showing the expansion of the body of the mandible. (f) Para-axial images of the CBCT revealed the ossification of the lesion and the positions of the retained dental germ and the mandibular canal.
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Extraoral examination showed a mild facial asymmetry associated with a well-defined swelling on the left side of the mandible measuring 3 to 4 cm (Figure 1(a)). Intraoral examination displayed expansion of the buccal cortical plate, extending from the mandibular left incisal to the first molar, and the first deciduous molar was absent (Figure 1(b)). The cone-beam computed tomography (CBCT) axial images revealed a radiopacity lesion with an expansion and thinning of the buccal bone cortical with well-defined borders (Figure 1(d)). The dental germ was in the middle of the lesion (Figure 1(e)), and the para-axial images showed the mandibular canal displaced buccally and toward the lower border of the mandible (Figure 1(f)).
(a) Clinical view of the excess bone. (b) The excised bone with the dental germ. (c) HE x 10 showing irregularly shaped trabeculae of immature bone within proliferating fibroblastic tissue (B: bone; FT: fibrous tissue). (d) One-week panoramic radiograph. (e) Five-year panoramic radiograph.
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Under locoregional analgesia, a conservative surgical excision of the buccal bone was proceeded, with extraction of the dental germ and remodeling of the region disturbed by the asymmetry (Figure 2(a)). Macroscopically, the excised bone was soft with spongy aspects (Figure 2(b)). The hematoxylin-eosin staining revealed irregularly shaped trabeculae of immature bone within proliferating fibroblastic and vascularized stroma (Figure 2(c)).
(a) Facial asymmetry at 10 years. (b) Clinical view of the intraoral swelling. (c) Panoramic X-ray at 10 years. (d) Axial image of a CBCT showing the expansion of the lesion to the midline and discontinuity of the buccal cortex. (e) 3D reconstruction showed an increase in the volume of the left hemimandible.
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(a) Intraoperative view for the surgical approach. (b) The excised bone with respect to the mental foramen. (c) Healing of the soft tissue one month later. (d) Facial stability after 5 years following the second surgery and 15 years after the first surgery. (e) Clinical appearance of the soft healing after 15 years of the first surgery. (f) Panoramic X-ray after 15 years of the first surgery.
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Under locoregional analgesia, a wide osteoplasty was performed, and the buccal bone was reshaped until the limit of the mental nerve anteriorly and the position of the mandibular canal apically (Figures 4(a) and 4(b)).