PMC5932521_01
(a) Patient with sebaceous adenoma. (b) Oral examination revealed a facial asymmetry with a nonmovable mass about 8 mm in diameter 873 (74 and 75). (c) The tumor size is measured in the tomography, which is 5.6 x 9.6 x 8.3 mm in the left mandible site.
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However, cone beam computed tomography (CBCT) showed multiple radioopacities throughout the brain, which were diagnosed by the neuropediatrician (Figure 1(a)). Radiographic examination of the mandible revealed a large, round, radiolucent lesion with edges well circumscribed (Figures 1(b) and 1(c)).
(a) The deciduous teeth 73 and 74 were removed. (b) A surgical enucleation was carried out. (c) The flap was repositioned and sutured with Vicryl 4-0.
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The biopsy was sent to the pathology department, and the following week, the patient attended to his follow-up appointment for stitches removal (Figures 2(a)-2(c)).
(a) The histopathological result was desmoplastic fibroma, which was constituted by a proliferation of connective tissue with the presence of fusiform fibroblasts. (b) Radiographic control after first surgery. (c) At the fourth month follow-up, it was observed in the radiograph a radiolucent area apically around the left mandibular canine (33).
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The histopathological showed a DF, constituted by a proliferation of connective tissue with the presence of fusiform fibroblasts deposited between dense hyalinized collagen bundles (Figure 3(a)). In the clinical follow-ups, radiographically was observed that the first premolar (34) during the first three months, and there was no visible lesion (Figure 3(b)). However, in fourth-month control appointment, the presence of tissue adjacent to the erupting teeth was observed radiographically, as well as an asymmetry in the left mandible, so a second intervention was decided (Figure 3(c)).
(a) At the fourth month, a surgical excision was performed, and the lesion was observed delimited and adhered to adjacent tissues. (b) The lesion was removed, and an osteotomy was performed. (c) A button was placed on the left mandibular canine, and a close orthodontic chain without traction was placed. (d) Histopathological result of 4 months of desmoplastic fibroma relapse.
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It was placed a closed chain without traction (Figure 4(a)). Finally, the flap was repositioned by using Vicryl Suture 4-0 (Ethicon, Polyglactin 910, USA), leaving the orthodontic chain free (Figure 4(b)).
(a) Two months after the last surgery. (b) The eruption of canine. (c) Five months follow-up.
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The Department of Oral Pathology reported the presence of desmoplastic fibroma recurrence with bundles of spindle-shaped, fibroblast-like cells in a collagen matrix (Figure 5(a)). The canine was erupted after 5 months (Figures 5(b) and 5(c)).