PMC5543691_01
Extra oral profile of the patient with facial asymmetry.
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F1
Extra-oral examination revealed asymmetry on the left side of the face involving the maxilla, mandible, frontal and temporal bone (Fig.1A). Patient was subjected to conventional radiographs (Fig. 1B) including submentovertex view which revealed expansion of the left side of mandible. On computed tomography with bone window (Figs. 1C-1E), there was evidence of spongy bone with ground glass appearance of bone with lytic regions. Further there was evidence of involvement of temporal, zygomatic, frontal and ethmoid bones (Fig. 1C). Lesion was crossing the midline in frontal region (Fig. 1D). Sphenoid bone was also involved with narrowing of the optic canal as well as orbital fissures (Fig. 1C).
Submentovertex radiograph revealing expansion of the mandible of left side.
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F1B
The problem started with slight swelling on the right side of the face (Fig. 2A). On general physical examination there was evidence of swelling along the left shin of tibia (Fig. 2B). The initial screening involved conventional radiography including PNS and Submentovertex view which showed expansion of the right side of the craniofacial structures including maxilla, mandible and temporal bones (Figs. 2C, 2D). AP view of Tibia showed evidence of sclerosis of upper and mid shaft of tibia. Also there were lytic areas in the sclerotic irregularity of the bone (Fig. 2E). TMJ, glenoid fossa, temporal bone, frontal bone and maxilla with ground glass appearance of bone (Figs. 2F-2I). The maxillary sinus of right side was deviated antero-superiorly. Furthermore there was evidence of a cystic lesion in the right maxilla along with mandible extending from body of the mandible to the ramus of right side (Figs 2H, 2I).
Axial CT slice with bone window revealing involvement of temporal, zygomatic, frontal and ethmoid bones. Sphenoid bone was also involved with narrowing of the optic canal as well as orbital fissures.
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The CT scan showed the involvement of right side of the maxilla including the maxillary sinus, right zygoma, right sphenoid, zygomatic arch, pterygoid plates of right side along with the cranial base with ground glass appearance of bone (Figs. 3A-3D). Further there was evidence of narrowing of the right side of optic canal (Fig. 3D).
Coronal CT section revealing the lesion crossing the midline in frontal region with involvement of Crista Gali.
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F1D
CT scan revealed involvement of maxillary alveolus and tuberosity along with the maxillary sinus and base of the left pterygoid plate with ground glass appearance of bone (Figs. 4A-4C). The TMJ and the ostiomeatal complex were normal (Fig. 4D).