PMC5242084_01
Preoperative photograph showing diffuse swelling over the left side of the lower face
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F1
On examination, a firm, diffuse, nontender swelling of size 9 x 5 cm involving the left body of the mandible was observed [Figure 1].
Intraoral photograph showing missing permanent left mandibular molars and a calcified, toothlike structure protruding from the alveolar mucosa over the retromolar region
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F2
To our surprise, the left mandibular molars were missing [Figure 2].
Orthopantomogram revealsa large, well-defined radiopaque lesion with focal radiolucent areas occupying the whole left body of the mandible. An impacted tooth is also visible. This appearance suggests that the lesion is a complex odontoma
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F3
An impacted third molar was present below the mass just above the inferior border [Figure 3].
Intraoperative photograph after complete removal of the tumor
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F4
The lingual cortical bone was found to be intact [Figures 4 and 5].
The tumor specimen showing the presence of both calcified and epithelial components
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F5
The lingual cortical bone was found to be intact [Figures 4 and 5].
Reconstruction of the mandibular defect was done with iliac crest graft
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F6
The reconstruction of the defect was done with nonvascularized corticocancellous iliac crest bone, which was taken from the contralateral side [Figure 6].
Photomicrograph stained with H and E reveals the presence of dense fibrous tissue and a few odontogenic epithelial cell islands. Fibrous tissue is of a primitive type containing spindle-shaped fibroblasts, some areas of hyalinization signifying dentin formation, and some clear spaces of enamel formation. In addition, odontogenic epithelial cells follicles are visualized with a few stellate cells suggestive of AFO
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F7
To our surprise, histopathological examination revealed the tumoras an AFO [Figure 7].