PMC9527840_01
(a) Frontal view demonstrating swelling over the right side of the face, (b) Lateral view showing swelling over the right preauricular region (arrow)
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The swelling measured 6 cm x 5 cm in the greatest dimension extending anteroposteriorly from the tragal pointer to a line perpendicular to the lateral canthus of the eye and superoinferiorly from the root of the helix to the inferior border of the mandible [Figure 1a and b] with no cutaneous sinuses.
(a) Coronal view of MRI head showing lesion in the right condyle and masseter region. (b) Axial section of CT head demonstrating bony destruction of the right mandibular condyle. (c) Coronal section of CT head showing medullary destruction of the right mandibular condyle.
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T2W1 magnetic resonance imaging of the head demonstrated a hyperintense area over the right masseteric region extending up to the lateral pterygoid muscle with osteolytic configurational changes of the right mandibular condyle [Figure 2a]. Computed tomogram (CT) of the head revealed an osteolytic lesion in the right condyle measuring 6 cm x 4 cm x 2.3 cm, suggestive of suppurative osteomyelitis [Figure 2b and c].
Chest X-ray of the patient showing no pulmonary lesions
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Chest radiograph [Figure 3] and high-resolution computed tomography of the thorax were unremarkable.
(a) Preauricular incision, (b and c) Surgical exploration and sequestrectomy with high condylectomy, (d) Tissue approximation with placement of corrugated rubber drain, (e) Resected tissue specimen, (f) Histopathology demonstrating Langerhans giant cell, surrounded by lymphocytic infiltration suggestive of chronic granulomatous infection and formation of tuberculous granuloma (Leishman staining, x40 magnification) (arrows).
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Considering the aetiology to be infectious, the patient was subjected to surgical exploration requiring decortication of bone (sequestrectomy) resulting in medullary destruction and cortical perforation followed by placement of corrugated rubber drain [Figure 4a-e]. This made us to suspect the presence of tuberculous granuloma which is a consistent finding in a diagnosis of TBO [Figure 4f].
(a) Postoperative frontal view after 9-month follow-up, (b) Postoperative lateral view after 9-month follow-up showing healed scar
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The patient was advised of monthly follow-up [Figure 5a and b].
(a) Postoperative axial section of CT head demonstrating surgical defect (arrow), (b) Postoperative coronal section of CT head showing surgical defect (arrow), (c) Postoperative orthopantomograph showing surgical defect after condylectomy (arrow).
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The outcome was satisfactory showing regeneration of bone at nine months, the surgical site healed completely, and CT (head) demonstrated a healthy remnant bone structure [Figure 6a-c].