PMC4556817_01
Computer simulation of patient with a large swelling on the lower right side of his face.
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Oral Oncology at the University of Mississippi Cancer Institute with the chief complaint of swelling in his right mandible that had been present for approximately one year (Figure 1). Oral exam revealed a 5.0 x 7.0 cm bulbous mass arising from the mandible and obliterating the right side of the oral cavity.
(a) Axial CT image. (b) CT scan, sagittal view.
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A computed tomography (CT) scan (Figures 2(a) and 2(b)) showed an expansile osseous lesion, involving the entire height of the mandible and extending from the right first premolar all the way posteriorly to involve the ramus and coronoid process.
Photomicrograph of the mandibular brown tumor showing numerous multinucleated giant cells dispersed in a highly cellular stroma (H&E, magnification x200).
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Microscopically, the lesion was composed of a highly cellular proliferation of bland spindle-shaped fibroblastic cells with numerous multinucleated giant cells (Figure 3) and spicules of woven bone.
Photomicrograph showing brown tumor of hyperparathyroidism. Multinucleated giant cells surrounding a spicule of bone are visible amidst a proliferative fibroblastic stroma (H&E, magnification x400).
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The osteoclastic giant cells were scattered throughout the cellular stroma and surrounded small spicules of bone (Figure 4).
Photomicrograph showing osteoclastic bone resorption and fibrosis in secondary hyperparathyroidism (H&E, magnification x200).
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The native bone showed evidence of intense bone resorption secondary to osteoclast hyperactivity and marrow fibrosis, consistent with secondary hyperparathyroidism (Figure 5).
Medical model demonstrating the extent of the expansion of this lesion.
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This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6 -8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543).
(a) Access to large brown tumor via lip split mandibulotomy approach. (b) Reconstruction bar placement.
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This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6 -8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543).
Final surgical specimen.
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This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6 -8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543).
Simulated surgical procedure.
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Virtual surgical planning was utilized to help plan the mandibular resection as well as the reconstruction bar placement (Figure 9).