PMC6585216_01
(a) Frontal view of a 37-year-old male with unilateral swelling over the left masseter region (arrow) extending superoinferiorly from the level of the zygomatic arch to the inferior border of the mandible and anteroposteriorly extending from the malar region to the tragus. (b) Panoramic radiograph demonstrating unilateral homogeneous sclerosis (ground-glass appearance) of the left hemimandible
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F1
Extraoral examination revealed facial asymmetry with a diffuse swelling over the left masseter region, approximately 7 cm x 5 cm in size [Figure 1a], afebrile, nontender, firm too hard on palpation, and overlying skin appeared taut. Panoramic radiography revealed unilateral diffuse sclerosis of the left hemimandible with ground-glass appearance, extending from distal aspect of the left canine region to the ipsilateral condyle, involving the body, ramus, condyle, and coronoid process with prominent condylar head resorption [Figure 1b].
(a) Axial computed tomography image showing extensive medullary sclerosis of the left hemimandible (arrow), unilateral thickening of the cortex, and mild periosteal new bone formation on posterior aspect of the left ramus (arrowhead). (b) Image showing Increased marrow density of the left condyle (arrow) with loss of demarcation of the cortical-medullary border
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F2
CT examination detected left hemimandibular extensive endosteal sclerosis, a well-preserved intact anatomy with cortical thickening and mild periosteal bone formation. Condylar head resorption and loss of demarcation of the cortical-medullary border were also noted [Figures 2 and 3].
Coronal computed tomography (cropped) images showing sclerosis and resorption of the left condyle (arrows)
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F3
CT examination detected left hemimandibular extensive endosteal sclerosis, a well-preserved intact anatomy with cortical thickening and mild periosteal bone formation. Condylar head resorption and loss of demarcation of the cortical-medullary border were also noted [Figures 2 and 3].
Axial magnetic resonance imaging sections showing left hemimandible (arrow) appearing (a) hypointense on TI-weighted image and (b) hyperintense on T2-weighted image
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F4
MRI revealed an altered marrow signal intensity of the left hemimandible appearing hypointense on TI-weighted images and hyperintense on T2-weighted images [Figure 4].
Postgadolinium T1-weighted images showing unilateral intramedullary enhancement, along with ill-defined enhancement of the overlying soft tissues (a) hypertrophic and hyperintense appearance of the left masseter and mylohyoid muscles (arrows) and (b) hyperintensity of the left buccinator and hyoglossus muscles (arrows)
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F5
Postgadolinium contrast images demonstrated unilateral intramedullary enhancement, with enhancement of overlying musculature such as the left buccinator, masseter, medial and lateral pterygoid, mylohyoid, and hyoglossus muscles [Figure 5].