PMC6018279_01
Preoperative view showing facial swellings and skin pigmentation
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F1
Pigmentation in the form of freckles was seen on his skin and especially so on the facial skin [Figure 1]. In addition, similar swelling was observed in the region of the right Maxilla [Figure 1].
Preoperative OPG showing the maxillary and mandibular lesions
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F2
Orthopantomographic examination revealed the presence of multiple, multilocular lesions in the symphysis, and left- and right body-angle region of the mandible with similar lesions in the right and left maxilla [Figure 2].
Computed tomography scan - Axial view
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F3
Plain and contrast-enhanced computed tomography (CT) of the paranasal sinuses, mandible, and maxilla was performed in the axial and coronal planes and color volume-rendered three-dimensional-CT images were obtained with audio video interleaved files [Figures 3 and 4].
Computed tomography scan - Coronal view
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F4
Plain and contrast-enhanced computed tomography (CT) of the paranasal sinuses, mandible, and maxilla was performed in the axial and coronal planes and color volume-rendered three-dimensional-CT images were obtained with audio video interleaved files [Figures 3 and 4].
Histopathology slide suggestive of Giant cell lesions
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F5
A biopsy procedure was carried out for the lesions of the maxilla and the mandible and was suggestive of multiple giant cell tumors with odontogenic keratocysts and Cherubism [Figure 5].
Lesions exposed for curettage
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F6
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Lesions exposed for curettage
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F7
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Decalcified freeze-dried bone powder used for filling the surgical defects
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F8
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Decalcified freeze-dried bone powder
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F9
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Mandibular defects filled with bone powder postcurettage
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F10
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Maxillary defects filled with bone powder postcurettage
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F11
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Postoperative OPG: At 2-week postenucleation
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F12
The lesions in the right and left maxilla, right, left half and anterior mandible were exposed [Figures 6 and 7] and curetted thoroughly, and the cavities in bone were filled with decalcified freeze-dried bone powder [Figures 8-12].
Six months postoperative view
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F13
Postoperative recovery of the patient was uneventful, and there was a significant improvement in the facial appearance 6 months postoperatively [Figure 13].
Postoperative OPG: At 15 months postcalcitonin therapy
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F14
There was a significant reduction in the size of the lesions postcalcitonin therapy as reflected in the postoperative OPG [Figure 14].