PMC6580315_01
Cone beam computed tomography with image of the lesion and hypodense image in the chin region.
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A - Axial cut of the computed tomography showing medullary and cortical bone destruction, not affecting the inner mandibular cortical surface. B - Computed tomography with 3D reconstruction, showing the alloplastic material in the chin region. Because the patient concealed such information, the image identified suggested a bone tumor lesion, either malignant or with aggressive local behavior, of odontogenic or non-odontogenic mandibular origin.
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It also infiltrated the anterior myoadipose surfaces in the chin and oral space regions, suggesting a bone tumor lesion either malignant or with local aggressive behavior (e.g., osteosarcoma) (Fig. 2A and B).
A - Incisional biopsy procedure. B - Fragment of tissue removed during the incisional biopsy procedure. C - Microscopy of the previous biopsy. HE: dimension 100x. The field shows several fragments of white and contoured tissue with irregular and friable consistency, as well as giant multinucleated cells, macrophages, and bone neoformation, suggesting giant tumor cells. D - HE: 400x. Presence of clear vacuoles compatible with fragments of previous silicone with giant multinucleated cells in the edges.
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Considering this condition, an incisional biopsy of the lesion was performed under local anesthesia, in surgical block, which result showed a central giant cell granuloma (Fig. 3A-D).
A and B - During the surgical procedure, the silicone prosthesis was identified and removed. C - Curettage and removal of the granulation tissue. D - The extension of the lesion ended up reaching the external bone flap of the mandible.
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Intraoperation revealed the presence of abundant granulation tissue and, overall, identified the presence of foreign body compatible with silicone prosthesis, which excluded clinically the radiographic hypothesis of osteosarcoma or central giant cell granuloma (Fig. 4A-D).
A - After 12 months of clinical control, bone repair and the absence of signs of mandibular lesion were detected at the site. B - Axial cut of the postoperative computed tomography, with discrete change in the trabecular bone in the mandible.
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After 12 months of clinical and imaging control, bone repair and the absence of any sign of mandibular lesion were confirmed (Fig. 5A and B).