PMC3258555_01
Front view of the patient's lower face.
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F1
An initial clinical examination showed a nodular formation that was palpable along the mesial portion of the right mandibular angle (Figure 1).
Panoramic view of the patient presenting multiple osteomas. A particularly large lobulated osteoma is present in the right condyle and coronoid process that impacted both permanent and deciduous teeth.
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F2
A panoramic radiograph and an anteroposterior radiography showed the presence of multiple round radiopaque lesions in both the maxilla and mandible, multiple impacted teeth (upper right first, second premolar, upper right third molar, upper left canine, upper left first and second premolar, upper third molar, lower left canine, first and second premolar, and lower right canine, first and second premolar), and multiple odontomas, each measuring approximately 0.5 to 2 cm in diameter (Figure 2).
Osteomas at the left mandible angulus, mental protuberance and below the mandibular notch (white arrows)
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F3
Dental volumetric tomographic (DVT) images showed multiple osteomas of the buccal cortex of the right mandibular angle and left mandibular angle (Figure 3,4).
Coronal and sagittal section view of the right condyle showing large lobulated osteoma (white arrows)
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F5
Additionally, in the coronal and sagittal sections of the mandible condyle, a huge osteoma that limited mouth opening was diagnosed (Figure 5).
Tracing lateral cephalometric radiograph of the patient. Ricketts' analysis is illustrated. G = glabella; N = the anterior point of the intersection between the nasal and the frontal bones; Or = the lowest point of the inferior margin of the orbi; Pn = pronasale; Po = the midpoint of the upper contour of the external auditory canal; Pns = posterior nasal spine; Ans = anterior nasal spine; A = the innermost point on the contour of the premaxilla between anterior nasal spine and the incisor tooth; Pg = the most anterior point on the contour of the chin; Gn = the most anterior and inferior point on the mandibular symphysis; Me = the most inferior point on the mandibular symphsis; Go = the midpoint of the contour connecting the ramus and body of the mandible; Ba = the lowest point on the anterior margin of the foramen magnum, at the base of the clivus; Ar = the point of the intersection between the shadow of the zygomatic arch and posterior border of the mandibular ramus.
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According to the Steiner's S line his lips were in normal position (Figure 6).
Compact tissue within a loose connective tissue containing apposition and resorption lines(X100, H&E).
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F7
Histopathologic examination revealed that the specimens displayed a normal-appearing dense compact lamellar bone with minimal marrow spaces and rare irregular Haversian canals that did not show osteoclasts or osteoblasts (H&E X100)(Figure 7).