PMC8642013_01
A slight bulge is observed from the left cheek to the lower jaw.
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The maximum painless opening is 13 mm. The facial appearance was asymmetrical, and a slight bulge was observed from the left cheek to the lower jaw, but no major abnormalities were observed in the oral cavity (Figure 1).
The panoramic radiograph showing absorption changes in the left mandibular condyle (arrowhead).
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The panoramic radiography findings showed absorptive changes of the left mandibular condyle (Figure 2).
Computed tomography showing a bulge with an osteosclerosis was observed from the left mandibular branch to the mandibular condyle (arrowhead).
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Computed tomography (CT) findings showed swelling in the buccal side of the mandibular bone and sclerosing changes in the bone marrow from the body to the ramus of the left mandible (Figure 3).
(a) Bone scintigraphy showing abnormal accumulation in the bilateral thoracic rib joints and sternum (arrowhead). It presents with the so-called bull's head sign. (b) Abnormal accumulation is observed in the temporal bone, cheekbone, sphenoid bone, and mandible (arrowhead).
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Bone scintigraphy showed accumulation of technetium-99m hydroxymethylene diphosphonate (99mTc-HMDP) in the left mandible, including the TMJ (Figure 4(a)), and accumulation in both thoracic rib joints and sternum (Figure 4(b)).
H-E staining showing sclerosing changes and bone cell defects in the trabecular bone.
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Pathological findings showed sclerotic changes in the trabecular bone, inflammatory granulation tissue, and fibrous connective tissue with lymphocyte infiltration (Figure 5).
Image showing facial asymmetry with bulging of the left mandible of the patient in 2010.
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Since then, the patient continued to visit our department regularly, and although his facial asymmetry remained (Figure 6), her symptoms did not recur.