PMC2666483_01
Slight left parasymphisis and mandibular body enlargement
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On extraoral clinical examination, a slight crowning was observed in the left mandibular body region (Figure 1) and the patient described local pain.
Discrete loss of definition on the left inferior vestibular fornix. The oral expansion of the mandibular bone was due to slowly increase in the size of the central lesion
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There were no tooth displacements or rotations and no related sensory disturbances (Figure 2).
Image of a extensive multilocular radiolucency from the lower left molar region to the right premolar region. The radiographic appearance resemble soap bubble patterns
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The panoramic radiograph was not pathognomonic, and revealed an extensive radiolucent, multilocular area with imprecise borders that extended from the left posterior mandibular body to the anterior contralateral mandibular body, and exhibited a "soap bubble" appearance (Figure 3).
Computed axial tomography scan showing the lesion with thin residual bony trabeculae or septa dividing the lesion in various compartments and slight expansion of mandibular external cortical
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Thus, the lesion did not penetrate the periosteum, and was not contiguous with the alveolar mucosa (Figure 4).
Photomicrograph showing rounded, stellate and spindle-shaped mesenchymal cells arranged in abundant loose myxoid stroma with few collagen fibrils (hematoxylin-eosin, original magnification X100)
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These results confirmed the clinical hypothesis of odontogenic myxoma (Figure 5).
Frozen bone after liquid nitrogen application
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Lesion excision was performed under general anesthesia, followed by vigorous curettage of the bone lodge and three 1 min liquid nitrogen sprayings with a defrosting interval between applications (Figure 6).
Panoramic radiograph 10 weeks after the surgery. Image suggesting pathological fractures in the left molar region. Teeth within the lesional area were extracted
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A pathologic fracture occurred in this area 2 1/2 months postoperatively (Figure 7).
Ten-year postoperative aspect showing preserved mandible contour and clear chin form without any enlargement. There were no sensitive or motor nerve impairment
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An intraoral ten-years postoperative view showing an implant-supported denture over a health attached alveolar mucosa
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Panoramic radiograph taken after 10 years of follow-up showing absence of lesion recurrence
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