PMC3220179_01
Pre-operative extra-oral photograph showing right mandibular swelling and facial asymmetry
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F1
Extraoral examination revealed a smooth superfacial swelling of about 3 x 2.5 cm extending from the corner of mouth to the angle of mandible and from the infraorbital margin to the lower border of mandible [Figure 1].
Pre-operative intraoral view showing vestibular obliteration and extraction socket related to the mandibular right first molar
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F2
Intraorally, the extraction socket of the mandibular right first molar [Figure 2] was present and remaining first molars were grossly carious. Vestibular obliteration and buccal and lingual plate expansion was observed in the area of right body of mandible [Figure 2].
Preoperative orthopantamograph showing periapical unilocular radiolucencies in mandibular right and left first molar regions
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F3
The mandibular canal was obliterated inferiorly [Figure 3]. A unilocular, well-defined radiolucency with a sclerotic border was accidentally found on the left side of mandible involving the roots of first and second molars [Figure 3].
Intraoperative view of enucleation of a cyst and intact neurovascular bundle on the right side
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F4
There was an intact inferior alveolar neurovascular bundle [Figure 4].
Intraoperative view of enucleation of a cyst on the left side
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F5
On the left side, a crevicular incision was made from the distal of the mandibular second premolar to the distal of the second molar, the mucoperiosteal flap was raised, mandibular first and second molars were extracted, and the cyst was removed in toto [Figure 5].
Photograph showing the tissue specimen of the right side
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F6
The surgically excised lesion of right side was about 4.5x3 cm in size [Figure 6] and left side was about 2x1 cm in size [Figure 7].
Photograph showing the tissue specimen of the left side
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F7
The surgically excised lesion of right side was about 4.5x3 cm in size [Figure 6] and left side was about 2x1 cm in size [Figure 7].
Microscopic image of the right side lesion (H and E stain x40)
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F8
Histopathological examination of the surgical specimens showed nonkeratinized stratified squamous epithelial lining with chronic inflammatory cells infiltration, discontinuous arcading pattern of epithelial lining, hemosiderin pigmentation, and hyaline bodies [Figures 8 and 9]. In connective tissue, there were moderate amount of collagen bundles and blood vessels with infiltration of chronic inflammatory cells [Figures 8 and 9].
Microscopic image of the left side lesion (H and E stain x40)
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F9
Histopathological examination of the surgical specimens showed nonkeratinized stratified squamous epithelial lining with chronic inflammatory cells infiltration, discontinuous arcading pattern of epithelial lining, hemosiderin pigmentation, and hyaline bodies [Figures 8 and 9]. In connective tissue, there were moderate amount of collagen bundles and blood vessels with infiltration of chronic inflammatory cells [Figures 8 and 9].
Postoperative photograph showing the facial asymmetry corrected
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F10
The patient was recalled after 7 days for removal of sutures; the extraoral swelling was resolved [Figure 10].
Postoperative orthopantamograph taken 7 months after surgery
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F11
Seven months after surgery, OPG exhibited good amount of bone formation [Figure 11].
Intraoral view showing removable partial prosthesis
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F12
So, the stent was replaced by removable partial prosthesis for oral rehabilitation [Figure 12].