PMC7264005_01
Extraoral and intraoral views. (A) Note an asymmetry in the left lower third of the face. (B) Expansion of the lingual and buccal cortical bones in the region of the left mandibular body and angle with involvement of soft tissues.
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Extraoral clinical examination showed an asymmetry in the left lower third of the face (Fig. 1A). Intraoral examination identified marked expansion of the lingual and buccal cortical bones in the region of the left mandibular body and angle with involvement of soft tissues (Fig. 1B).
Panoramic radiograph. (A) Note two well-delimited osteolytic lesions, unilocular in the left maxilla and multilocular in the mandible (asterisk). Computed tomography. (B) Note larger diameter lesion involved the mandibular body, angle and ramus, sometimes with a characteristic of hyperdensity, which suggests areas of mineralization. (C) Note lesion in the maxilla associated with hyperdense foci and extended to the maxillary sinus.
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Imaging scans revealed signs suggestive of two well-delimited and osteolytic lesions, unilocular and multilocular in the left maxilla and mandible, respectively (Fig. 2A). The lesion involved the mandibular body, angle and ramus and resulted in displacement of the affected teeth. (Fig. 2B) In the maxilla, the lesion measuring approximately 2.0 cm was associated with root resorption of the affected teeth and extended to the maxillary sinus (Fig. 2C).
Trans-surgical approaches. (A) Curettage and peripheral osteotomy of the maxilla. (B) Resection with a safety margin in the mandibular lesion.
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In view of the aggressive features of the lesions, treatment planning consisted of surgical resection with safety margins for the mandibular lesion and curettage and peripheral osteotomy for the maxillary lesion (Fig. 3A and B).
Histological sections of the mandibular JOF stained with hematoxylin-eosin. (A) Fragments exhibiting intensely cellularized fibrous connective tissue with irregular bone trabeculae at different stages of mineralization (400x, HE); (B) Spherical structures with osteoid margins (asterisk). Note trabeculae exhibiting an osteoid margin that fused with the underlying connective tissue and with brush border appearance (arrow) (400x, HE); (C) Myxoid areas intermingled with more fibrous areas in the connective tissue (400x, HE).
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Fig. 4 shows fragments of the mandibular lesion exhibiting intensely cellularized fibrous connective tissue that contained numerous irregular bone trabeculae at different stages of mineralization (Fig. 4A) and spherical basophilic structures with osteoid margins, sometimes with a brush border appearance (Fig. 4B). Some trabeculae also had an osteoid margin that fused with the underlying connective tissue (Fig. 4B). In the connective tissue, some myxoid areas intermingled with more fibrous areas were observed (Fig. 4C).
Histological sections of the maxillar JOF stained with hematoxylin-eosin. (A) Note intensely cellularized fibrous connective tissue with calcified areas (200x, HE); (B) Bone trabeculae at different stages of mineralization, exhibiting an osteoid margin (arrow) (400x, HE).
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The maxillary lesion exhibited characteristics similar to those described above (Fig. 5A and B).