PMC4073470_01
Panoramic radiography showing a lesion on left temporomandibular joint involving ramus and coronoid process extending till sigmoid notch
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F1
Panoramic radiograph revealed a mixed lesion measuring about 4 cm x 3 cm with osteolytic and osteosclerotic changes on the medial aspect of left mandibular condyle extending until the sigmoid notch [Figure 1a]. Computed tomography (CT) scan confirmed a 5 cm x 3 cm osteolytic and osteosclerotic lesion with three areas of cortical perforation along the medial aspect of the lesion with soft-tissue mass extending in to the infratemporal fossa and cortical expansion on the lateral aspect of mandibular condyle along with intra lesional calcifications [Figure 1b].
Computed tomography scan showing a osteolytic and osteosclerotic lesion of 5 x 3 cm with cortical expansion on lateral side with three areas of cortical perforation on medial side with intra lesional calcifications
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F2
Through high cervical submandibular incision, subplatysmal flap was raised [Figure 2a]. The lower border of the mandible was identified and subperiosteal dissection was done until the lesion was exposed in glenoid fossa [Figure 2b]. Osteotomy cut was placed in the angle region with tumor clearance margins of 1.5 cm [Figure 2c]. Hemostasis of inferior alveolar vessels was achieved [Figure 2d]. The lingual attachments to the mandible were stripped along with the lateral pterygoid muscle and disarticulation of the condyle [Figure 2e and f] was done along with discectomy.
Marking of high cervical submandibular incision and dissection in layers
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F3
A 2.5 mm titanium reconstruction plate was fixed with 2.5 mm x 8 mm titanium screws to maintain the anatomical contour of the mandible [Figure 3].
Subperiosteal dissection of mandible to expose the lesion
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F4
The chondrocytes show enlarged nuclei with nuclear hyperplasia hyperchromatism [Figure 4a and b]. Myxoid matrix was strikingly prominent with foci of intra lesional calcifications [Figure 4c].
Osteotomy cut placed at the angle region with a clearance margins of 1.5 cm
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F5
Patient was free from locoregional occurrence for a follow-up of 1 year [Figures 5 and 6].
Completion of osteotomy and hemostasis of inferior alveolar vascular bundle
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F6
Patient was free from locoregional occurrence for a follow-up of 1 year [Figures 5 and 6].