PMC5433314_01
(A) Panoramic radiographic before the surgery. A radiolucent injury, unicystic pattern, unilocular, transition zones defined by thin sclerotic border, discreet insufflation extending from mandibular body to left ascending ramus, near to sigmoid notch associated with radicular reabsorption of teeth 36 and 37, and displacement tooth 38 for mandibular basis. (B) Computed tomography, axial cut. It is possible to observe a cystic injury of uniloculated aspect with homogenous and hypodense density in relation to muscle tissues with extension of body to left ascending ramus with signals of rupture of alveolar cortical and displacement of tooth 38. (C) Computed tomography, sagittal cut. A cystic injury of uniloculated aspect and radicular reabsorption of teeth 36 and 37 are also observed
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The diagnosis exam, the panoramic radiographic and computed tomography of the face showed suggestive images of injury involving the body and left mandibular ascending ramus (Figures 1A to C).
(A) Aspect of the injury in the surgery. Intraoral access of surgical removal of the lesion. (B) enucleation and curettage of the lesion with simple dissection because the tumor was encapsulated, , well-defined limits and cleavage plan, characteristics that enable its complete surgical removal
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An osteotomy was need using a 701 drill for higher exposure of the injury (Figure 2A). The dissection was simple because the tumor was encapsulated (Figure 2B).
(A) Prepared recipient site. The bone grafting technique defined with the use of rhBMP-2. Adaptation of titanium mesh 1.0 system
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AG, Wolhusen, Switzerland) and fairly adapted to surgical site with subsequent adaptation of titanium mesh 1.0 system that promoted a mechanical barrier. A plate 2.0 system was used on external oblique line to obtain higher stability (Figures 3A and B).
Macroscopic aspect of the lesion
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Material obtained was forwarded for anatomopathological examination, and the definitive diagnosis was unicystic ameloblastoma, intraluminal variant with plexiform pattern (Figure 4).
(A) Panoramic radiography. Recipient site can be observed with satisfactory adaptation of rhBMP-2 associated with Bio-Oss . (B) Computed tomography. Axial cut is shown with satisfactory adaptation of grafting material in the recipient site. (C) Computed tomography. Coronal cohort is observed, showing satisfactory adaptation of grafting material and recipient area fixation. (D) Computed tomography. Observe a sagittal section, evidencing satisfactory adaptation of the grafting material and the titanium mesh in the receiving area. (E) Computed tomography. Tri-dimensional reconstruction for follow-up after the surgery
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Clinical and radiographic follow-up was done after 1, 3 and 6 months with satisfactory aesthetic and functional result (Figures 5A and E).