PMC5824508_01
Clinical picture
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F1
An 82-year-old female patient, was reported to the department of Oral Medicine having history of facial pain which was right sided, electric shock like, and confined to the right half of the lower lip and also lower half of the face on same side with duration of 10 months [Figure 1]. The CBCT reports revealed the involvement of the nerve [Figures 6-8 and Table 1].
Intraoral examination revealed missing teeth in relation to 46, 47 and 48 with no buccal and lingual plate cortical expansion. Attrition and cervical abrasion present in relation to 44 and 45
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F2
The patient had previously visited 3 dentists who were unable to relieve patients pain later for which she underwent extraction of decayed lower right back molar thinking it to be the root of cause [Figures 2 and 3].
Intraoral examination revealed missing teeth in relation to 46, 47 and 48 with no buccal and lingual plate cortical expansion. Attrition and cervical abrasion present in relation to 44 and 45
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F3
The patient had previously visited 3 dentists who were unable to relieve patients pain later for which she underwent extraction of decayed lower right back molar thinking it to be the root of cause [Figures 2 and 3].
An orthopantomogram revealing a well-defined radiolucency in the right body of the mandible that surrounds impacted supernumerary teeth. Presence of 2 more supernumeraries in the maxillary 1st quadrant and 3rd quadrant.
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F4
The patient was advised to get an OPG done to rule out if any residual infection was present within the alveolus, but to our surprise, the OPG revealed an impacted supernumerary tooth within the body of the mandible, that was surrounded by an well-defined unilocular radiolucency, with a sclerotic border, that was measuring approximately 2.5 cm x 1.5 cm in size and seemed to be encroaching on the mandibular canal; supernumeraries were also present in the 1st and the 3rd quadrants [Figure 4].
Mandibular cross-section view
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F5
To rule out any cortical plate expansion, a mandibular cross-sectional occlusal radiograph was taken, which did not reveal any expansion [Figure 5].
Panoramic view on cone-beam computed tomography
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F6
The CBCT reports revealed the involvement of the nerve [Figures 6-8 and Table 1].
Axial view on cone-beam computed tomography
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F7
The CBCT reports revealed the involvement of the nerve [Figures 6-8 and Table 1].
Cross-section view on cone-beam computed tomography
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F8
The CBCT reports revealed the involvement of the nerve [Figures 6-8 and Table 1].
Soft-tissue incision placed distal to 45
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F9
The patient was given antibiotics and anti-inflammatory drugs for 5 days [Figures 9-14].
A bony trough was placed on the alveolus
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F10
The patient was given antibiotics and anti-inflammatory drugs for 5 days [Figures 9-14].
The lesion was retracted and here we can see the attachment of the lesion to the mandibular nerve
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F11
The patient was given antibiotics and anti-inflammatory drugs for 5 days [Figures 9-14].
Complete removal of the lesion and the impacted tooth with thorough irrigation
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F12
The patient was given antibiotics and anti-inflammatory drugs for 5 days [Figures 9-14].
Excised specimen
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F13
The patient was given antibiotics and anti-inflammatory drugs for 5 days [Figures 9-14]. The excised specimen [Figure 13] was sent for histopathologic examination which revealed fibrocollagenous tissue lined by stratified squamous epithelium exhibiting palisading of basal epithelium and luminal surface containing wavy parakeratotic epithelial cells.
Sutures placed
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F14
The patient was given antibiotics and anti-inflammatory drugs for 5 days [Figures 9-14].
H&E picture, odontogenic keratocyst
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F15
Subepithelium shows mixed inflammatory cell infiltrate along with congested blood vessels [Figure 15].