PMC5069364_01
First visit: (a) extraoral frontal photography, (b) intraoral photography, and (c) panoramic and (d) periapical views.
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Iran, with the chief complaint of a mass in her palate (Figures 1(a) and 1(b)). Initially, she complained about the lesion a week prior to the referral. The color of the lesion was pink to purple with firm-to-hard consistency and nontenderness in palpation (Figure 1(b)). Also accidentally in panoramic and periapical radiography, a well-defined unilocular radiolucent lesion with scalloped border on the right quadrant of mandible from the central incisor to second premolar was observed (Figures 1(c) and 1(d)).  Table 1 shows the results of laboratory tests.
After 6 months, preoperative (a, b) extraoral frontal and lateral photography were carried out. (c) Intraoral photography. (d) Panoramic view. (e) Coronal contrast enhanced CT scan image. (f) Axial contrast enhanced CT scan image.
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Also, superior displacement of the right glob was seen (Figures 2(a) and 2(b)). Teeth displacement was seen in the right maxilla (Figure 2(d)). Also, in the buccal side, the alveolar process was destructed and a soft tissue mass was formed (Figure 2(e)). Expansion and thinning of the buccal cortex, thinning of the lingual cortex, and buccal movement of teeth were seen (Figure 2(f)).
Preoperative whole body scan.
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Regarding patient history, the scan pattern favored metabolic bone disease (hyperparathyroidism and renal osteodystrophy) (Figure 3).
Intraoperative photograph shows the (a) macroscopic appearance of the lesion. (b, c) Resected specimen. (d) Closure.
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Excisional biopsy by hemimaxillectomy under general anesthesia and Weber-Ferguson approach was done, also in the mandible, incisional biopsy with extraction of right lower canine was done (Figure 4).
Histopathology photomicrograph. (a) Hematoxylin and eosin stained tissue sections of the mandibular lesion [HPF x40]. (b) H&E stained tissue sections of the maxillary lesion show new bone formation, hemorrhage, giant cells, and sinusoid space in cellular fibrous connective tissue background [HPF x100].
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The features were consistent with an ABC (Figure 5).
Postoperative course (18 months after surgery). (a) Extraoral frontal photography. (b) CT scan coronal axis. (c) Panoramic view. (d) Periapical views.
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She visited with the aim of reconstructing the maxilla, after 18-month recall (Figure 6(a)). Areas of the right maxillary antrum, lower portion of the nasal cavity, and floor of the orbit were replaced with soft tissue and the glob structure was normal (Figure 6(b)). In radiographic evaluation of the mandibular region, the lesion area was healed and bone scar was seen (Figures 6(c) and 6(d)).