Abstract
BackgroundMandibular pseudocarcinomatous hyperplasia is a rare and generally benign pathology. We report on one of these rare cases.Case presentationThe case history of a 73-year-old white man stated that he had a carcinoma of the oropharynx, which was primarily treated with radiotherapy and chemotherapy 4 years prior. As a result of radiotherapy he developed an osteoradionecrosis of his mandible and a consecutive pathological fracture of his left mandibular angle. Subsequent osteosynthesis was performed with a reconstruction plate. When we first saw him, his reconstruction plate was partially exposed with intraoral and extraoral fistulation. The resected bone of his defect-bordering jaw showed the typical pathohistological findings of an intraosseous mandibular pseudocarcinomatous hyperplasia. After a first reconstruction attempt with an iliac crest graft failed, definitive reconstruction of his mandible with a microvascular anastomosed fibula graft was achieved.ConclusionsIntraosseous pseudocarcinomatous hyperplasia of the mandible is a rare differential diagnosis in maxillofacial surgery. Besides other benign epithelial neoplasms, such as calcifying epithelial odontogenic tumor, squamous odontogenic tumor, or different forms of ameloblastoma, the far more frequent invasive squamous cell carcinoma needs to be excluded. A misinterpretation of pseudocarcinomatous hyperplasia as squamous cell carcinoma must be avoided because it can lead to a massive overtreatment.
Highlights
ConclusionsIntraosseous pseudocarcinomatous hyperplasia of the mandible is a rare differential diagnosis in maxillofacial surgery
Mandibular pseudocarcinomatous hyperplasia is a rare and generally benign pathology
A misinterpretation of pseudocarcinomatous hyperplasia as squamous cell carcinoma must be avoided because it can lead to a massive overtreatment
Summary
Mandibular PH is a disease pattern which is only rarely reported in the common literature, its appearance in the maxillofacial area is probably due to the proximity of the oral squamous epithelium to the alveolar bone. That is why mandibular PH should be taken into consideration, especially when the clinical suspicion of oral SCC arises, to prevent unnecessary diagnostics and therapy, such as resection of larger parts of the mandible, extended lymphadenectomy, and unnecessary chemoradiotherapy or radiotherapy
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