PMC6374874_01
Intraoral view showing a swelling in the buccal fold of the left maxillary posterior region.
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Intraoral examination revealed, in the buccal fold of the left maxillary posterior region, a swelling extending from behind the canine up to the tuberosity, covered by normal oral mucosa (Figure 1).
Panoramic radiograph showing in the left maxillary posterior region a radiolucent, unilocular lesion, resorptions of 2.6 roots and 2.7 mesial root, and presence of unerupted third molar.
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Computed tomography scan: (a) panorex view: unilocular, well defined, hypodense area extending from the mesial root of 2.4 up to the distal root of 2.7 and in the apicocoronal direction from the sinus floor to the alveolar ridge; (b) axial view: limited expansion and thinning of the buccal and palatal cortical plates, erosion of the buccal wall, and some small foci of radiopacity; and (c) coronal view: root resorption of the first molar.
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Tomography (CT) revealed a hypodense intrabony, unilocular lesion circumscribed by radiopaque border, extending from the mesial margin of the first premolar to the distal margin of the second molar and apicocoronally from the sinus floor to the alveolar ridge. The resorption of the first molar roots and the second molar mesial root and the unerupted third molar not related to the lesion were also detectable (Figure 3(a)).
Incisional biopsy: (a) incision in the buccal fold and (b) retrieved specimen.
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Histopathological sections of incisional biopsy specimen: (a) characteristic of nodular epithelial proliferation composed of polyhedral to spindle cells with lobular or syncytial arrangement of cells (hematoxylin and eosin, 20X) and (b) foci of PAS-positive material and some.
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The stroma was poorly cellular, either intensely eosinophilic or amorphous like dentin, with some calcifications (Figure 5).
Surgical treatment: (a) a full-thickness intrasulcular trapezoidal buccal flap, (b) detaching of the flap, (c) ostectomy and dissection of the lesion from the bony walls, (d) bony cavity, (e) suture, and (f) surgical specimen.
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Surgical access was obtained through a full-thickness trapezoidal intrasulcular buccal flap, extending from the mesial aspect of the canine to the distal aspect of the second molar (Figure 6(a)). The flap was detached, and the cortical bone was exposed (Figure 6(b)). The fibrotic capsule surrounding the tumor was dissected from the bony wall, and the mass was completely enucleated (Figures 6(c) and 6(d)).
Twelve-month follow-up: (a) intraoral view, (b) ortopantomography, (c) CT sagittal view, and (d) CT axial view.
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