PMC4429953_01
Panoramic radiograph taken 6.6.12.
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Clinically there was no evidence of infection or discharge but radiographically there remained a clearly demarcated radiolucency over the right posterior mandible (Fig. 1).
Panoramic radiograph taken 27.9.13.
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Radiographic examination revealed a much more extensive area of necrosis at the right body and ramus of the mandible spreading to involve the coronoid process and the appearance of a pathological fracture (Fig. 2).
CT coronal section showing pathological fracture of the right coronoid process.
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The CT images and 3D reconstruction are shown below (Figs. 3-5).
3D reconstruction of the CT image showing pathological fracture of the right coronoid process and the extent of bony necrosis.
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The CT images and 3D reconstruction are shown below (Figs. 3-5).
3D reconstruction of the CT image showing pathological fracture of the right coronoid process and the extent of bony necrosis.
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The CT images and 3D reconstruction are shown below (Figs. 3-5).
Pus draining from the non-healing mucosa overlying the ascending ramus.
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Intraoperative examination revealed pus draining from the right posterior mandible (Fig. 6).
The coronoid process was gripped with forceps and gently removed.
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The coronoid process was gripped firmly to prevent the temporalis pulling the fragment superiorly, and gently removed (Fig. 7).
Necrotic bone carefully removed until healthy bone seen.
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Necrotic bone was removed leaving a margin of bleeding bone with normal appearance thus indicating sufficient metabolic potential for healing to take place (Fig. 8).
Shows the fractured coronoid process and shape conforming to that on the panoramic radiograph.
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The removed fragment is shown in Fig. 9.