PMC3809591_01
(a) Extraoral picture of the patient showing swelling in the left submandibular region. (b) Extraoral picture after 1 year of followup.
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Extraoral examination revealed a swelling in the lower left back tooth region of the jaw and on the angle of the mandible (Figure 1(a)).
OPG showing multilocular radiolucency in relation to left third molar involving the angle, ramus, and coronoid process of the mandible. Root resorption is evident in mandibular I, II, and III molar.
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The orthopantomograph revealed a multilocular radiolucency on the left side of the mandible extending from molar upto the condyle and coronoid area (Figure 2).
3D CT image showing the lesion in the body and ramus of the mandible, (a) left lateral surface, (b) lingual surface of left mandible, and (c) lingual surface of mandible from the posterior view.
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The solid tumor measured about 2.6 x 3.6 cm in axial plane with craniocaudal extension measuring 7.3 cm (Figure 3).
(a) Surgical photograph showing hemimandibulectomy and (b) condylar reconstruction plate.
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Hemimandibulectomy with disarticulation was performed, and condylar reconstructive plate was fixed in the area (Figures 4(a) and 4(b)).
Resected mandible sent for histopathologic examination, (a) lateral surface, and (b) medial surface of the mandible.
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The hemimandibulectomy specimen showed the resection margin till the mandibular left second premolar (Figures 5(a) and 5(b)).
H & E stained section showing cystic lining with ghost cells and stroma with dysplastic dentin, (a) magnification x40, (b) magnification x400.
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Few large eosinophilic, anucleated cells were seen with indistinct cell membrane suggestive of ghost cells (Figure 6). Juxta-epithelial hyalinization was seen suggestive of dysplastic dentin (Figures 6(a) and 6(b)).
Odontogenic island in the stroma showing ghost cells.
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Proliferative odontogenic islands with ghost cells were also seen in the connective tissue capsule (Figure 7).
Posttreatment OPG after 1 year.
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