PMC9527836_01
Bilateral bony hard swelling in the mandible
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On extraoral examination, a bony hard swelling of size 3.5 cm x 4.8 cm on the right side and 3.3 x 5.1 cm on the left side approximately was evaluated, which was nonmobile, nonpulsatile, nontender, and nonulcerative in nature [Figure 1].
Orthopantomograph showing irregular bag of calcified mass bilaterally
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The orthopantomogram radiographic picture appeared as a bag of multiple irregular masses of calcified material surrounded by a thin radiolucent area with smooth periphery of size 4 cm x 4.5 cm approximately, involving the posterior base and angle of the mandible bilaterally, along with many other well-formed impacted permanent teeth [Figure 2].
Coronal and sagittal sections of computed tomography depicting bilateral multiple large nonspecific, disorganised, irregular radio-opaque mass with varying densities, unable to be recognised as a dental tissue
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The coronal and sagittal sections of contrast-enhanced computed tomography revealed bilateral multiple large nonspecific, disorganised, irregular radio-opaque masses with varying densities, unable to be recognised as dental tissue [Figure 3].
Risdon's extraoral surgical approach was planned and bilateral hard tissue mass was explored
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Extended Risdon's extraoral surgical approach was utilised and bilateral hard tissue mass was explored [Figure 4].
Surgical sites after removal of irregular hard mass. An iatrogenic fracture of the mandible occurred on the left side which was reduced and fixed with a titanium miniplate
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The hard tissue masses were gently chiseled from buccal and lingual sites bilaterally, and on the left side, while removing the hard tissue mass, an iatrogenic mandibular body fracture occurred, which was reduced and fixed with a titanium miniplate [Figure 5].
Specimen showing large chunks of hard tissue masses with ill-defined tooth-like structures in it
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Specimen collected was large chunks of hard tissue masses with tooth-like structures in it, which on fine separation yielded nearly 82 small teeth-like structures [Figure 6].
Histopathological section revealed multiple small tooth-like structures with haphazardly arranged central fibrofatty pulpal stroma surrounded by well-formed dentin showing dentinal tubules and empty areas representing decalcified enamel matrix surrounded by fibrovascular stroma at the periphery
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The histopathological section revealed multiple small teeth-like structures with haphazardly arranged central fibrofatty pulpal stroma surrounded by well-formed dentin showing dentinal tubules and empty areas representing decalcified enamel matrix surrounded by fibrovascular stroma at the periphery, and a diagnosis of complex composite odontoma was made [Figure 7].
Facial appearance after 3 months without any jaw deformity, and radiologically intact shape of the mandible with healed fracture site on the left side body of the mandible
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A 3-month follow-up showed uneventfully healed surgical site without any jaw deformity and radiologically intact shape of the mandible with healed fracture site on the left side body of the mandible [Figure 8].