Left Body Research Articles

MULTIPLE CENTRAL GIANT CELL LESIONS IN MANDIBLE: A CASE REPORT

Although giant cell lesions occur as single lesions, they can occur multifocally and in association with syndromes. A 14-year-old male patient presented an asymptomatic swelling in the right mandible. Panoramic radiography and computed tomography (CT) showed a single, multiloculated, radiolucent/hypodense lesion in right mandibular body and ramus, affecting the coronoid process. Incisional biopsy confirmed the diagnosis of giant cell lesion, and parathyroid hormone, calcium, phosphorous, and alkaline phosphatase levels excluded hyperparathyroidism. The lesion was unresponsive to conservative treatment with intralesional corticoid injections, and total enucleation with peripheral osteotomy and Carnoy's solution was performed. A 10-month follow-up CT showed another lesion in the left mandibular body, which microscopically was confirmed as a giant cell lesion. These multiple giant cell lesions in a young patient are compatible with the diagnosis of a mild and atypical manifestation of cherubism or another syndromic condition. Further genetic analysis might help clarify such assumptions.

IMMEDIATE MANDIBULAR RECONSTRUCTION WITH MICROVASCULARIZED GRAFT IN A PATIENT WITH MRONJ

Medication-related osteonecrosis of the jaw (MRONJ) is a complication associated with certain groups of drugs that have a potential antiresorptive or antiangiogenic effect. In advanced stages, surgical treatment and vascularized fibular flaps are the first choice for mandibular reconstructions. The paper reports a case of immediate mandibular reconstruction with microvascularized graft in a patient with MRONJ. The patient presented with bone necrosis, progressing to pathologic fracture of the left mandibular body. With the aid of computed tomography, osteonecrosis of the jaw was diagnosed, possibly caused by bisphosphonates (MRONJ). Mandibular resection and immediate reconstruction with a vascularized osteomyocutaneous graft from the right fibula was performed. Since the aforementioned therapy, the patient has been under follow-up, clinically stable, and without recurrences. More advanced stages should be managed with mandibular resection followed by immediate reconstruction with a vascularized osteomyocutanous fibula graft.

CONSERVATIVE MANAGEMENT OF UNICYSTIC AMELOBLASTOMA—A CASE REPORT WITH 6 YEARS’ FOLLOW-UP

Unicystic ameloblastoma is a benign odontogenic tumor of the jaws. A 14-year-old female patient presented with a swelling located in the left jaw body. Panoramic radiograph disclosed a unilocular radiolucent lesion extending from midline mandibular to the left second molar tooth area. An exploratory punction revealed 4 mL of a yellowish fluid. Computed tomography demonstrated an extensive bone resorption tangent to the mandibular canal with expanded cortical bone, tooth displacement, and radicular resorption. The patient was initially submitted to incisional biopsy and a drain was installed. The histopathologic examination revealed unicystic ameloblastoma and with 4 months of decompression there was a decrease of lesion extension. Afterwards, under general anesthesia, the lesion was enucleated. A reconstruction plate was installed and removed after 1 year. After 5 years, 4 dental implants were installed, and the patient was rehabilitated with a fixed prosthesis. The patient is at 6-year follow-up with no signs of recurrence.

TREATMENT OF DEVELOPING ODONTOMA WITH IMMEDIATE BONE RECONSTRUCTION ASSOCIATED WITH L-PRF: CASE REPORT

Developing odontoma is a mixed benign odontogenic tumor in which the epithelial and ectomesenchymal components are considered neoplastic. An 18-year-old male patient was referred by his orthodontist because of the identification of a mandibular lesion observed in a routine radiographic examination. On tomographic examination, an intraosseous hyperdense image involving tooth 38 was observed, surrounded by a hypodense halo, well defined, involving the angle and the left mandibular body, in association with the mandibular canal, with bulging of the cortical bone. An incisional biopsy was performed, and the result of the anatomopathologic report was a developing odontoma. The surgical treatment of choice was excision of the lesion, removal of the involved tooth, and filling of the defect with exogenous, autogenous, and leukocyte and platelet-rich fibrin grafts. Thirty days after surgery, the region presented a satisfactory healing aspect and good clinical evolution and radiographically showed new bone formation.

ADENOMATOID ODONTOGENIC TUMOR OF THE JAW: CASE REPORT

A 35-year-old woman was referred to the oral and maxillofacial surgery service for excision of a benign intra-osseous lesion with histopathologic report of adenomatoid odontogenic tumor. On intraoral examination, the presence of a bulge along the bottom of the left mandibular body vestibule, with normal color and a smooth surface, was noted. Cone beam computed tomography showed an extensive hypodense image, with defined limits, comprising the region between teeth 31 and 35, expanding the buccal and lingual cortical bones with displacement of adjacent teeth and resorption of the 33-tooth apex root. Complete surgical excision of the lesion was performed under general anesthesia. At 1 year postoperative follow-up, the surgical site region showed a completely healed mucosa with no signs of recurrence and complete bone repair on the control radiograph.

A CASE REPORT OF AGGRESSIVE AMELOBLASTIC FIBRODENTINOMA IN AN 11-YEAR-OLD BOY

Ameloblastic fibrodentinoma (AFD) is a rare and benign odontogenic mixed tumor, composed of odontogenic epithelium, immature connective tissue, and formation of dysplastic dentin. We present a rare case of AFD in a 11-year-old boy, with the chief complaint of swelling in the left face region. There was no history of associated pain or fever and the time of the lesion was undefined. The swelling was firm-hard, extending from the left body to right parasymphysis region of the mandible. The swelling was noncompressible, nonfluctuant, and nontender, with a normal color of overlying skin and oral mucosa. An orthopantomogram revealed an extensive multilocular radiolucent lesion with the 35 impacted. The clinical diagnosis was benign odontogenic tumor. An incisional biopsy confirmed the diagnosis of AFD. Based on histologic diagnosis, exeresis with osteotomy of the lesion and teeth extraction was done under general anesthesia. The patient is being kept under regular follow-up. Ameloblastic fibrodentinoma (AFD) is a rare and benign odontogenic mixed tumor, composed of odontogenic epithelium, immature connective tissue, and formation of dysplastic dentin. We present a rare case of AFD in a 11-year-old boy, with the chief complaint of swelling in the left face region. There was no history of associated pain or fever and the time of the lesion was undefined. The swelling was firm-hard, extending from the left body to right parasymphysis region of the mandible. The swelling was noncompressible, nonfluctuant, and nontender, with a normal color of overlying skin and oral mucosa. An orthopantomogram revealed an extensive multilocular radiolucent lesion with the 35 impacted. The clinical diagnosis was benign odontogenic tumor. An incisional biopsy confirmed the diagnosis of AFD. Based on histologic diagnosis, exeresis with osteotomy of the lesion and teeth extraction was done under general anesthesia. The patient is being kept under regular follow-up.

Abnormal left atrial body stiffness is predicted by appendage size: impact of appendage occlusion on left atrial mechanics assessed by pressure-volume analysis.

Atrial cardiomyopathy has been recognized as having important consequences for cardiac performance and clinical outcomes. The pathophysiological role of the left atrial (LA) appendage and the effect of percutaneous left atrial appendage occlusion (LAAO) upon LA mechanics is incompletely understood. We evaluated if changes in LA stiffness due to endocardial LAAO can be detected by LA pressure-volume (PV) analysis and whether stiffness parameters are associated with baseline characteristics. Patients undergoing percutaneous endocardial LAAO (n = 25) were studied using a novel PV analysis using near-simultaneous three-dimensional LA volume measurements by transesophageal echocardiography (TEE) and direct invasive LA pressure measurements. LA stiffness (dP/dV, change in pressure with change in volume) was calculated before and after LAAO. Overall LA stiffness significantly increased after LAAO compared with baseline (median, 0.41–0.64 mmHg/mL; P ≪ 0.001). LA body stiffness after LAAO correlated with baseline LA appendage size by indexed maximum depth (Spearman’s rank correlation coefficient Rs = 0.61; P < 0.01). LA stiffness change showed an even stronger correlation with baseline LA appendage size by indexed maximum depth (Rs = 0.70; P < 0.001). We found that overall LA stiffness increases after endocardial LAAO. Baseline LA appendage size correlates with the magnitude of increase and LA body stiffness. These findings document alteration of LA mechanics after endocardial LAAO and suggest that the LA appendage modulates overall LA compliance.NEW & NOTEWORTHY Our study documents a correlation of LA appendage remodeling with the degree of chronically abnormal LA body stiffness. In addition, we found that LA appendage size was the baseline parameter that best correlated with the magnitude of a further increase in overall LA stiffness after appendage occlusion. These findings offer insights about the LA appendage and LA mechanics that are relevant to patients at risk for adverse atrial remodeling, especially candidates for LA appendage occlusion.

Postural orthostatic tachycardia syndrome explained using a baroreflex response model.

Patients with postural orthostatic tachycardia syndrome (POTS) experience an excessive increase in heart rate (HR) and low-frequency (∼0.1 Hz) blood pressure (BP) and HR oscillations upon head-up tilt (HUT). These responses are attributed to increased baroreflex (BR) responses modulating sympathetic and parasympathetic signalling. This study uses a closed-loop cardiovascular compartment model controlled by the BR to predict BP and HR dynamics in response to HUT. The cardiovascular model predicts these quantities in the left ventricle, upper and lower body arteries and veins. HUT is simulated by letting gravity shift blood volume (BV) from the upper to the lower body compartments, and the BR control is modelled using set-point functions modulating peripheral vascular resistance, compliance, and cardiac contractility in response to changes in mean carotid BP. We demonstrate that modulation of parameters characterizing BR sensitivity allows us to predict the persistent increase in HR and the low-frequency BP and HR oscillations observed in POTS patients. Moreover, by increasing BR sensitivity, inhibiting BR control of the lower body vasculature, and decreasing central BV, we demonstrate that it is possible to simulate patients with neuropathic and hyperadrenergic POTS.

Body Composition Asymmetries in University Ice Hockey Players and Their Implications for Lower Back Pain and Leg Injury.

Resta, T, Frenette, S, Rizk, A, and Fortin, M. Body composition asymmetries in university ice hockey players and their implications for lower back pain and leg injury. J Strength Cond Res 36(10): 2830-2836, 2022-Right to left asymmetries in body composition have been examined across many sports, suggesting possible implications for lower back pain (LBP) and decreased level of performance. However, we are not aware of any study that has examined the presence and implications of morphological asymmetries in ice hockey players. The purpose of this study was to (a) investigate body composition asymmetries in female and male university-level ice hockey players and (b) examine whether the degree of body composition asymmetry is associated with the history of LBP and lower-limb injury (LLI). A total of 32 players (female = 18, male = 14) were included in this cross-sectional study (e.g., university research center setting). Dual-energy X-ray absorptiometry (DEXA) was used to acquire body composition measurements. The parameters of interest included bone mass, lean body mass, and fat mass, for the right and left sides and body segments (e.g., arm, leg, trunk, and total), separately. The history of LBP and LLI was obtained using a self-reported demographic questionnaire. The statistical significance for the study was set at p < 0.05. Our findings revealed significant side-to-side asymmetry in arm and total bone mass in females, with higher values on the right side. Both males and females also had significantly greater trunk lean body mass on the left side. With the exception of greater arm bone mass asymmetry being associated with LBP in the past 3 months, there was no other significant association between the degree of asymmetry with LBP and LLI. This study provides novel data regarding the presence of asymmetry in body composition in university-level ice hockey players. Monitoring body composition in athletes provides information that can be used by athletic trainers and strength and conditioning coaches to develop injury prevention, performance optimization, and targeted rehabilitation programs.

Does Motor Symptoms Asymmetry Predict Motor Outcome of Subthalamic Deep Brain Stimulation in Parkinson's Disease Patients?

BackgroundIn Parkinson's disease (PD), the side of motor symptoms onset may influence disease progression, with a faster motor symptom progression in patients with left side lateralization. Moreover, worse neuropsychological outcomes after subthalamic nucleus deep brain stimulation (STN-DBS) have been described in patients with predominantly left-sided motor symptoms. The objective of this study was to evaluate if the body side of motor symptoms onset may predict motor outcome of bilateral STN-DBS.MethodsThis retrospective study included all consecutive PD patients treated with bilateral STN-DBS at Grenoble University Hospital from 1993 to 2015. Demographic, clinical and neuroimaging data were collected before (baseline condition) and 1 year after surgery (follow-up condition). The predictive factors of motor outcome at one-year follow-up, measured by the percentage change in the MDS-UPDRS-III score, were evaluated through univariate and multivariate linear regression analysis.ResultsA total of 233 patients were included with one-year follow-up after surgery [143 males (61.40%); 121 (51.90 %) right body onset; 112 (48.10%) left body onset; mean age at surgery, 55.31 ± 8.44 years; mean disease duration, 11.61 ± 3.87]. Multivariate linear regression analysis showed that the left side of motor symptoms onset did not predict motor outcome (β = 0.093, 95% CI = −1.967 to 11.497, p = 0.164).ConclusionsIn this retrospective study, the body side of motor symptoms onset did not significantly influence the one-year motor outcome in a large cohort of PD patients treated with bilateral STN-DBS.

Morphometric characteristics and histotopography of the left atrium walls

Background. Knowledge of the anatomical features of the left atrium walls will minimize complications during the Cox-Maze surgery.&#x0D; Aim. To clarify common features and local anatomical specificities of the anterosuperior, lateral and inferior walls of the left atrial body of the heart of an adult.&#x0D; Material and methods. From 60 preparations of the hearts of men and women aged 3589 years who died from non-cardiac causes, 61 histotopograms and 180 anatomical sections of the left atrium walls were made. A stereoscopic microscope (4.715 magnification), a histological microscope (40 magnification), and an image recognition program were used. Nonparametric dispersion, correlation, one-way regression analysis were applied. The significance of differences was assessed by the MannWhitney U-test. The results were presented as medians.&#x0D; Results. Anatomical markers of the anterosuperior wall were a compact group of transverse myocardial fibers (anterior interatrial Bachmann bundle) and a thinned section of the lower third of the medial half of the wall. A feature of the lateral wall was a group of oblique myocardial fibers (left lateral ridge). The inferior wall was characterized by well-developed subepicardial tissue. Anteroposterior wall in the medial area (5130 m) and lateral wall (5243 m) were thin. The epicardium with subepicardial tissue in the medial part of the inferior wall was thicker (4750 m) than in the lateral (2651 m) and anterosuperior (2535 m) walls. The myocardium of the anteroposterior wall (2714 m) was thicker than the myocardium of both the lateral (2213 m) and inferior wall in its central (1947 m) and lateral (1913 m) sections. The median thickness of the endocardium of different walls varied from 335 to 426 m. The wall thickness in the upper third mostly depended primarily on the myocardium thickness, and in the inferior third on the epicardium and subepicardial tissue thickness.&#x0D; Conclusion. For the walls of the left atrium, their thickening towards the coronary sulcus was common due to the subepicardial adipose tissue. The peculiarities were the differences of the left atrium walls in thickness and their unique pattern of myocardial anatomy.

MEDIASTINAL PARAGANGLIOMA OF THE AORTOPULMONARY SUBTYPE: A SURGICAL CHALLENGE

TYPE: Abstract TOPIC: Disorders of the Mediastinum PURPOSE: To report a rare occurance of a paraganglioma in a young male which occupied a critical space in the mediastinum and to discuss literature associated with similar cases. METHODS: The case report was transcribed by using the patient's file to review their data, and surgical notes were reviewed to report significant actions and observations during the procedure. Lastly, a thorough literature review was done to ensure relevant discussion. RESULTS: A 30 year old male, with no significant past history, presented with complaints of a left neck swelling for the last 5 years. A biopsy of cervical lymph node showed a metastatic paraganglioma. The diagnosis of a left carotid body tumor was made after doing a full work up, and was resected by the vascular surgery department. He presented again, 6 months later for evaluation of his thoracic disease, which showed a hypermetabolic mass (4.7x4.6cm) in the right precarinal region adjacent to critical vascular structures. He was diagnosed with a mediastinal paraganglioma, which was resected in a challenging procedure without the use of Cardiopulmonary Bypass that was kept on standby given the risks of the procedure. CONCLUSIONS: The surgery done to resect the mass was successful, without the need of Cardiopulmonary Bypass. The histopathology report that followed confirmed the presence of a recurrent paraganglioma. CLINICAL IMPLICATIONS: This report adds value to the existing limited literature on the cases of paraganglioma, as well as, describes a very rare scenario in which a highly vascular mass in a critical area that was resected without the use of Cardiopulmonary bypass. DISCLOSURE: Nothing to declare. KEYWORD: paraganglioma

Effectiveness of Yoga versus Exercise for Reducing Falling Risk in Older Adults: Physical and Psychological Indices.

Our purpose in this study was to examine the effectiveness of yoga to address multiple risk factors of falling in active and low active older adults. Community-dwelling older adults (N = 35) over the age of 65 actively participated in either a yoga program, an exercise program, or a no-program control. Participants completed measures associated with falling risks. Physical measures included lower body strength, static balance, and lower body flexibility. Psychological measures included perceived self-efficacy with respect to falls and health-related quality of life. We determined between-group differences using planned comparisons, effect size, confidence intervals, and probability of superiority. Results of planned comparisons and practical significance testing indicated that yoga participants scored higher than the exercise and control participants on both right and left lower body flexibility tests. Yoga participants also scored higher than the control participants on right leg static balance, and the right and left lower body flexibility tests. The exercise participants scored higher than yoga participants on the RAND-36 Quality of Life subscales of Energy/Fatigue, Pain, and General Health. The probability of superiority results indicated that the no-program older adult participants would benefit by enrolling in the yoga rather than the exercise program to reduce physical risks of falling. These findings were discussed in relation to promoting physical activity programs to reduce risks of falling, and the roles of the protocol, practical significance, and measures employed when determining program effectiveness.

Дивертикул уретры у мужчины с двумя конкрементами после комплексного лечения рака простаты с метастазом в левое кавернозное тело полового члена

Urethral diverticula are sac-like dilatations of the urethra that communicate with its lumen. They may be congenital or acquired. In males, urethral diverticula are rare and classified as congenital (true) and acquired, which are associated with trauma, abscess, strictures, surgical procedures, in particular in patients with hypospadias. A clinical observation of urethral diverticulum with two stones in a man after complex treatment of prostate cancer with metastasis to the left cavernous body of the penis is presented in the article. At the first stage, the patient underwent endoscopic lithotripsy with a biopsy of the diverticulum wall and laser ablation of the stricture of urethrovesical anastomosis. At the second stage the excision of the diverticulum with urethroplasty was performed. The team of authors considers this clinical observation to be unusual. Previously, postoperative urethral diverticula with two stones in patients after complex treatment of prostate cancer with metastasis to the left cavernous body of the penis was not described in the scientific literature.

Removal of a Left Upper Lobar Bronchial Foreign Body Using Fogarty Catheter and Rigid Bronchoscope

Airway foreign body aspiration in children can lead to accidental death, due to the foreign body itself or the removal procedure. Depending on its location, removal of the foreign body can be challenging. Here, we present a case of successful removal of a foreign body from the left upper lobar bronchus via ventilating bronchoscopy with a rigid bronchoscope and Fogarty arterial embolectomy catheter. Tracheobronchial foreign bodies in locations that are difficult to reach with forceps, due to an acute angle or the small diameter of the pediatric bronchial tree, can be effectively removed with a Fogarty arterial embolectomy catheter.

Gunshot Fracture of the Mandible

A 51-year-old male was transferred to the hospital with a gunshot injury of the lower face. Three-dimensional scan of the multislice computed tomography (MSCT) revealed a severely comminuted fracture (Panel A: arrow) of the left mandibular body at the inferior margin area (what corresponds to the gunshot marginal mandible fracture diagnosis among 12 variants of gunshot mandibular fractures)1. Also, the implantation of multiple different shape radiopaque foreign bodies (arrowhead) was also visualized along with metal artifacts. A rotated coronal scan of the MSCT (Panel B) showed linear continuation (waved arrow) of the fracture to the ramus (visualized as incomplete fracture)2, partially splitting it into medial and lateral fragments. Although the incomplete fractures are more common for the pediatric jaw fractures, in this gunshot injury the MSCT data also indicates an incomplete fracture. In this particular case, it was a gunshot compound fracture (also known as open fracture) of the mandible. 3 Intermaxillary fixation (also known as maxilla-mandibular4 or maxillomandibular fixation5) was performed for 3 weeks without open intervention in the mandible margin area. Antibiotic therapy (Ceftriaxone 1.0 g 2 times daily applying intramuscular administration) was done during 7 days after trauma.

Individual automatic detection and identification of big cats with the combination of different body parts.

The development of facial recognition technology has become an increasingly powerful tool in wild animal individual recognition. In this paper, we develop an automatic detection and recognition method with the combinations of body features of big cats based on the deep convolutional neural network (CNN). We collected dataset including 12244 images from 47 individual Amur tigers (Panthera tigris altaica) at the Siberian Tiger Park by mobile phones and digital camera and 1940 images and videos of 12 individual wild Amur leopard (Panthera pardus orientalis) by infrared cameras. First, the single shot multibox detector algorithm is used to perform the automatic detection process of feature regions in each image. For the different feature regions of the image, like face stripe or spots, CNNs and multi-layer perceptron models were applied to automatically identify tiger and leopard individuals, independently. Our results show that the identification accuracy of Amur tiger can reach up to 93.27% for face front, 93.33% for right body stripe, and 93.46% for left body stripe. Furthermore, the combination of right face, left body stripe, and right body stripe achieves the highest accuracy rate, up to 95.55%. Consequently, the combination of different body parts can improve the individual identification accuracy. However, it is not the higher the number of body parts, the higher the accuracy rate. The combination model with 3 body parts has the highest accuracy. The identification accuracy of Amur leopard can reach up to 86.90% for face front, 89.13% for left body spots, and 88.33% for right body spots. The accuracy of different body parts combination is lower than the independent part. For wild Amur leopard, the combination of face with body spot part is not helpful for the improvement of identification accuracy. The most effective identification part is still the independent left or right body spot part. It can be applied in long-term monitoring of big cats, including big data analysis for animal behavior, and be helpful for the individual identification of other wildlife species.

Efficacy of locking miniplate in the treatment of mandibular fractures without intermaxillary fixation

Background: The introduction of locking plate/screw miniplate and reconstruction plating systems for the treatment of mandibular fractures and continuity defects has offered advantages over other plating systems. The present study was conducted to assess the efficacy of locking miniplate in the treatment of mandibular fractures without intermaxillary fixation. Materials & Methods: 56 patients with undisplaced or minimally displaced mandibular fractures of both genders were treated by open reduction and internal fixation using the 2.0 mm locking plates. Parameters such as cause of injury, site of fracture, complications etc. was recorded. Results: Out of 56 patients, males were 30 and females were 26. Causes of injury was RTA in 34, sports injury in 10, fall in 8 and miscellaneous in 4 cases. The site was right body in 12, left body in 15, right angle in 10, left angle in 8 and parasymphysis in 11 cases. Common complications was non- union seen in 2, infection in 5 and delayed union in 1 case. Conclusion: The locking miniplate system was found to be effective in management of mandibular fractures.

LENGTH FREQUENCY DISTRIBUTION, ALLOMETRIC GROWTH AND MORPHOMETRIC CHARACTERISTICS OF Oreochromis niloticus FROM OVIA RIVER

Oreochromis niloticus is one of the most widespread species in Africa. Its introduction around the world is of economic and social benefit especially in rural communities where they are caught from the wild or cultured in captivity. Length frequency distribution was used to estimate the age of this commercial fish species between May to October, 2012. A year old (1+) specimen had a total length in the size class of 100-121 mm. Other size classes whose total length measurements are (133-165 mm, 166-176 mm and 188-220 mm) corresponded to ages of (2+, 3+ and 4+) as stated. Significant relationships existed between total length and body weight measurements resulting in 'r' value of (0.88) for male and (0.813) for female. The regression coefficient ‘b’ for males was (1.903) while that for females was (1.887). Both values were less than three, indicating negative allometric growth. Characterization of lengths of body parts, otherwise known as morphometric measurement, revealed that there was a significant relationship between total length and lengths of other body part including: length of scales (0.599), right eye diameter (0.883), left eye diameter (0.571), otoliths (0.881) and body weight (0.594) for males. Likewise in female specimens, the opercula bone (0.666) and otoliths length (0.814) showed significant relationships with total length of the fish. This study has shown that it is possible to age Nile Tilapia using length frequency distribution. Therefore length frequency distribution, in conjunction with other methods could also be investigated in further studies for the aging of same fish species in other water bodies as well as their investigation in other fish species, for a better understanding and management of the lives of fishes and fish populations.

Recurrent osteomyelitis with proliferative periostitis after segmental resection and reconstruction of the mandible: a case report

A 50-year-old patient presented with a two-year history of chronic osteomyelitis of the left mandibular body. It was treated by wide segmental resection of the left hemimandible and reconstruction with a free vascularized fibular graft. Six months after surgery, the patient returned with pain, swelling, and moth-like lesions in the transplant in combination with appositional bone formation surrounding the ossified fibular bone. Radiographic and histological examination led to the diagnosis of a recurrent osteomyelitis with proliferative periostitis affecting the resected and reconstructed mandible. Application of ibandronate led to a significant symptom decrease.