PMC4073467_01
Preoperative photograph of case 1 showing expansile swelling over the left anterior maxilla
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F1
This paper reports a case of a 21-year-old male patient who reported to our department with the complaint of a painless, rapidly growing swelling, over the left side of mid-face since 4 months [Figure 1].
Orthopantomograph showing a well-defined unilocular radiolucent lesion affecting left maxilla with multiple displaced teeth
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F2
Orthopantomograph showed a unilocular radiolucent lesion affecting the left maxilla displacing lateral incisor, canine, both premolars and molars [Figure 2].
Intraoperative photograph showing the tumor involving the left maxilla exposed via modified Weber-Ferguson incision
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F3
The patient was planned for wide resection of tumor with normal margins through the modified Weber Ferguson approach under general anesthesia [Figure 3].
Resected tumor after sub-total maxillectomy
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F4
The resected specimen was sent for histopathologic examination [Figure 4].
Photomicrograph showing odontogenic epithelial island with peripheral ameloblast-like cells (pre-ameloblasts) and centrally stellatereticulum like cells. Also seen is acanthomatous change (squamous metaplasia with keratin pearl formation) within the follicle, which also shows comedo necrosis (H and E, x40 objective)
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F5
Furthermore seen was acanthomatous change (squamous metaplasia with keratin pearl formation) within the follicle, which also showed comedo necrosis [Figure 5].
Photomicrograph showing nuclear yperchromatism and pleomorphism. Arrowheads point out mitotic figures (H and E, x40 objective)
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F6
These cells showed nuclear hyperchromatism, nuclear pleomorphism, increased nuclear-cytoplasmic ratio and mitotic figures or abnormal mitosis [Figure 6].
Postoperative photograph after 6 months
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F7
Presently, after the 15 month postoperative period, there has been no recurrence at the primary site and no distant metastasis or regional lymphadenopathy has been observed. Patient is regular to his follow-up and maintaining his oral hygiene [Figure 7].
PMC4073467_02
Preoperative photograph of Case 2 showing swelling over left mid and lower face
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F8
This was a case of a 70-year-old male patient who reported to our department with the complaint of rapidly growing painless swelling of the left side of lower jaw with difficulty in chewing, multiple mobile teeth over left side of both jaws and progressive loss of teeth for last 6 months [Figure 8].
Case 2: Intraoral view showing the swelling involving left mandibular alveolus, obliterating the vestibule with buccal cortical expansion
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F9
Intraoral examination revealed a painless firm proliferative growth from midline up to the left anterior border of ramus with an obliterated left side buccal sulcus and extended lingually with expansion of the lingual cortex and a medially displaced tongue [Figure 9].
Orthopantomograph showing multiple ill-defined radiolucencies over the angle and ramus region of left side of mandible with displaced adjacent teeth
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F10
Orthopantomogram showed a multilocular radiolucent lesion involving left angle and ramus of mandible with multiple areas of resorption over anterior border of ramus and maxillary alveolus distal to premolar region [Figure 10].
Operated site after the resection of tumour (hemimandibulectomy) done followed by placement of 2.4 mm titanium reconstruction plate
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F11
After hemi-mandibulectomy, the defect was reconstructed with the placement of 2.4 mm titanium reconstruction plate with condyle and surgical wound was closed primarily in layers [Figure 11].
Resected hemi-mandible with 2 cm margin
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F12
The resected specimen was sent for histopathologic examination [Figure 12].
Case 2: Recurrence with marked swelling over left side lower face extending to the neck after 8 months of surgery
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F13
After about 8 months, the patient again turned up with a firm, tender swelling over the left side mid and lower face extending to the neck [Figure 13].