PMC3303501_01
Extra oral view shows large mandible
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F1
Intra oral examination showed increased size and altered shape of the mandibular alveolar ridge, pseudo micrognathia of the maxillary arch [Figures 1 and 2], and partially edentulous, thickened cortical plate.
Large size partially edentulous mandible
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F2
Intra oral examination showed increased size and altered shape of the mandibular alveolar ridge, pseudo micrognathia of the maxillary arch [Figures 1 and 2], and partially edentulous, thickened cortical plate.
OPG shows hypercementosis of the teeth roots.
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F3
Orthopantomograph shows hypercementosis with displacement of involved teeth, cortical thickening of the body of the mandible, and mixed radiolucent and radio opaque areas [Figure 3] on both sides of the mandible.
3D scan shows thickened mandibular cortical plate
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F4
Whole-body X-rays and scans were taken to ascertain the involvement of other bones [Figure 4], confirming that the lesion was restricted to mandible only.
(a) Irregular reversal line, (b) mosaic bone pattern histologically
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F5
Marrow spaces were filled with fibro vascular connective tissue, confirming osteitis deformans [Figure 5].
Biochemical report
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F6
Biochemical analysis showed abnormal increase of alkaline phosphatase (ALP) enzyme level (1368.1 U/l) [Figure 6] while comparing with the normal values of 30-120 U/l (above 17 years) and 74-390 U/l (below 17 years).