Left Mandibular Body Research Articles

New insights on the ecology and behavior of Machairodus aphanistus (Carnivora, Felidae, Machairodontinae) through the paleopathological study of the fossil sample from the Late Miocene (Vallesian, MN 10) of Cerro de los Batallones (Torrejón de Velasco, Madrid, Spain)

The Late Miocene natural traps of Cerro de los Batallones (Madrid, Spain) have yielded thousands of fossils of vertebrates, mostly carnivoran mammals such as hyaenids, amphicyonids, ailurids, mustelids, ursids, and felids, especially Batallones-1 and Batallones-3. Among these carnivorans, the tiger-sized saber-toothed felid Machairodus aphanistus was the top predator of the association, and one of the most abundant taxa, represented by thousands of fossils, including several examples of bone pathologies that have never been studied. In this work, we carry out a paleopathological analysis of some of these pathologies from the Batallones sample of this large early machairodontine, with a description of the pathological changes that occurred in the affected bones, a possible diagnosis, and the ethological and ecological consequences of the presence of these diseases in the living animal. The pathological sample of M. aphanistus studied here included a calcaneus and a Mc III from Batallones-1, and a mandible from Batallones-3. The fossils were X-rayed, and their pathologies were described and compared to non-pathological bones. The calcaneus showed a bone callus indicative of osteitis/osteomyelitis or a tumor; the mandible had evidence of the development of an abscess located in the left mandibular body; and the Mc III shows a marked osteosclerosis. These injuries affected the hunting ability of these individuals and gradually weakened them, very likely contributing to their final entrapment in the Batallones cavities, where they were attracted by the presence of previously trapped animals.

Case report: Spontaneous mandibular body regeneration following unilateral subtotal mandibulectomy in a 3-month-old French bulldog.

To document a case of spontaneous regeneration of the mandibular body following subtotal mandibulectomy in a juvenile dog. A 3-month-old male intact French bulldog was presented with papillary oral squamous cell carcinoma located at the dorsal aspect of the molar region of the left mandible. Initial biopsy of the mass was performed by the primary care veterinarian. Complete clinical staging revealed no signs of metastasis. Computed tomographic images of the head showed minimal contrast enhancement of the mass with no signs of periosteal or bone involvement. Subtotal mandibulectomy was performed. Histopathology indicated complete excision of the tumor. The patient returned 8-weeks later for follow up and cleft palate surgical repair, at which time bone was noted in the mandibulectomy area on palpation. Repeat computed tomography of the head revealed complete regeneration of the left mandibular body from the level of the ramus to the mandibular symphysis. No treatment for malocclusion was necessary due to the reformation of a functional mandible. The present case demonstrates that spontaneous regeneration of the mandibular body is possible following subtotal mandibulectomy in immature dogs. Subtotal mandibulectomy is a radical procedure that can lead to long term complications including mandibular drift, malocclusion, and oral pain. This case report provides evidence that these sequelae may be mitigated or eliminated in young patients undergoing this procedure.

Radiation‐induced osteosarcoma involving the mandible—Report of a rare diagnosis

AbstractBackgroundRadiation‐induced osteosarcomas of the jaws are a rare but often fatal consequence of radiation therapy in the head and neck region. Here we present a case of radiation‐induced osteosarcoma of the mandible.Case PresentationA male presented with severe trismus and marked left lingual alveolus expansion 1 year following extractions in the lower left quadrant. Four years previously, he had radical radiotherapy (70Gy) and chemotherapy for a p16‐positive T1N2cM0 squamous cell carcinoma of the left tonsil with a positive left level II node. Initial bone biopsies of the left mandible showed a bony sequestrum suggestive of osteoradionecrosis with the presence of abnormal osteoid suspicious of osteosarcoma. Imaging demonstrated an abnormal exophytic bone‐forming lesion in the left mandibular body and parasymphysis and ruled out a metastatic lesion. The patient underwent bilateral neck dissection, left mandibulectomy with fibula flap reconstruction and full‐thickness skin graft.ConclusionsOsteosarcoma should be considered if changes are seen in previously stable irradiated bone with bony destruction and a soft tissue mass. This case highlights the importance of synthesis of clinical, radiological and pathological findings in the diagnosis of such lesions, especially where the histology initially suggested a benign process.

Multifocal Tuberculosis Presenting as Mandibular Swelling in a 3-Year-Old Boy: A Case Report


 
 
 
 ABSTRACTObjective: To report a case of multifocal pediatric tuberculosis presenting with mandibular swelling and discuss its etiology, clinical findings, diagnosis, management, and outcome after treatment.
 
 
 
 
 Methods:
 Design: Case Report
 Setting: Tertiary Government Training Hospital
 Patient: One
 
 
 
 
 Results: A 3-year-old boy presented with progressive non-tender, right mandibular swelling for 11 months. Panoramic X-ray exhibited extensive multiple loculations with lytic changes on the mandible. CT Scans revealed a peripherally enhancing hypodense mass with lytic expansion of the right mandibular angle extending across the left mandibular body with an incidental finding of right lung mass. Other extrapulmonary lesions were also detected involving the scapula, pleura with lysis of the adjacent ribs at the level of T7 and T8. Biopsy of the mandibular and lung mass confirmed the presence of caseating and non-caseating granulomas consistent with Koch’s infection. The patient showed significant improvement by the 7th month of a 12-month course of anti-tuberculous therapy.
 
 
 
 
 Conclusion: Multifocal TB can present as simple mandibular swelling, and a thorough workup should look for other involved sites. Early diagnosis in children may prevent debilitating sequelae and improve long-term treatment outcomes.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

TCL-525 Salivary Myeloid Sarcoma: A Challenging Diagnosis.

A female in her late 30s from North Africa with no past medical history presented with four months of an expanding left face and neck mass that led to facial disfigurement (Viral screen HIV, HCV & HBV negative, EBV unknown). Ultrasound of the neck showed an enlarged left submandibular salivary gland with increased echogenicity with a surrounding inflammatory process and reactive lymphadenopathy, and no visible stone. Magnetic resonance imaging (MRI) of the neck revealed an infiltrating soft tissue enhancing mass surrounding the left side mandibular body, and it was locally infiltrating the left side submandibular, sublingual salivary gland left parotid, left side masseter muscle, myeloid muscle, and left side medial pterygoid muscle, and prominent bilateral cervical lymphadenopathy. Contrast tomography (CT) of the neck, chest, abdomen, and pelvis was unremarkable apart from cervical lymphadenopathy. Biopsy of the submandibular gland immunohistochemistry (LCA, BCL2, CD7 +VE, & focally for CD3 & CD5, while they are negative for PanCK. CD20, PAX5, CD79a, MUM1.BCL6.CD30, CD2, CD56, & TdT, Ki67 40%) suggested the diagnosis of high-grade T-cell lymphoma. Bone marrow biopsy was normal. The patient received five cycles of cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP). A follow-up CT scan and positron emission tomography (PET) scan showed stable disease size and hypermetabolism. Revision of immunohistochemistry was strongly positive for CD45, CD33, CD34, CD43 and CD107, and negative for CD3, CD4, CD8, CD30, CD68, CD11c, CD20, CD79a and MPO. The diagnosis was updated to myeloid sarcoma (granulocytic sarcoma). The patient received 7+3 doxorubicin and cytarabine with impressive results clinically, followed by 3 high-dose cytarabine consolidation. Three months following completion of treatment, facial swelling recurred, and a PET scan showed hypermetabolic activity consistent with recurrence. The patient is undergoing salvage therapy (cytosar & etoposide) in preparation for a bone marrow transplant. We present a challenging case of salivary gland myeloid sarcoma that was initially misdiagnosed as T-cell lymphoma; interestingly, her bone marrow was not involved at the time of diagnosis. A high index of suspicion is warranted in CD3 negative and CD20 negative lymphoma, and expanded immunohistochemistry earlier may improve diagnosis.

A RARE CASE OF JUVENILE OSSIFYING TRABECULAR FIBROMA IN THE MANDIBLE

A 12-year-old male patient reported to the oral medicine care unit complaining of an enlarged face. Clinical and radiographic examinations revealed a lesion in the left mandibular body causing expansion of the cortical bone. Laboratory blood tests showed high levels of eosinophils and lymphocytes. Computed tomography showed cortical bone remodeling in the body of the mandible due to an osteolytic lesion with areas of cortical discontinuity. Incisional biopsy revealed the diagnosis of juvenile ossifying fibroma trabecular. Conservative enucleation of the lesion was executed. Immunohistochemistry was performed on the surgical specimen, which ruled out the possibility of low-grade osteosarcoma and confirmed the previous diagnosis. One year and 2 months after the procedure, the panoramic x-ray of follow-up control showed bone neoformation; however, bone expansion was still detected. Juvenile ossifying fibroma is a rare lesion with an invasive behavior and, in most cases, occurs in the jaw. A 12-year-old male patient reported to the oral medicine care unit complaining of an enlarged face. Clinical and radiographic examinations revealed a lesion in the left mandibular body causing expansion of the cortical bone. Laboratory blood tests showed high levels of eosinophils and lymphocytes. Computed tomography showed cortical bone remodeling in the body of the mandible due to an osteolytic lesion with areas of cortical discontinuity. Incisional biopsy revealed the diagnosis of juvenile ossifying fibroma trabecular. Conservative enucleation of the lesion was executed. Immunohistochemistry was performed on the surgical specimen, which ruled out the possibility of low-grade osteosarcoma and confirmed the previous diagnosis. One year and 2 months after the procedure, the panoramic x-ray of follow-up control showed bone neoformation; however, bone expansion was still detected. Juvenile ossifying fibroma is a rare lesion with an invasive behavior and, in most cases, occurs in the jaw.

MANDIBULAR BROWN TUMOR AS A MANIFESTATION OF HYPERPARATHYROIDISM: CASE REPORT

Brown tumor (BT) is nonneoplastic giant cell lesion that appears in advanced stages of hyperparathyroidism. It represents a giant cell reparative cellular phenomenon that involves areas with intense bone resorption because of high circulating parathyroid hormone (PTH) levels. A 27-year-old woman was referred with presentation of left mandibular swelling, mobility of teeth 33 and 34, and bleeding for 10 months, with an anatomopathologic diagnosis of central giant cells lesion. Orthopantomography showed bone involvement with a radiolucent image in the left mandibular body. Laboratory tests showed human parathyroid hormone (HPTH) and increased alkaline phosphatase, creatinine, and urea. Referral was made to endocrinology, which started pharmacotherapy and referred the patient for surgical removal of the left superior parathyroid. A diagnosis of parathyroid adenoma was made. The final diagnosis was a BT with central involvement. After resolution of the hyperparathyroidism, osteoplasty of the altered region was performed. Eight-month follow-up was uneventful.

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.

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.

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.

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.

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.

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.

Severe mandibular osteomyelitis and exfoliation of a mandibular canine tooth in a Vietnamese potbellied pig

A 10-year-old male castrated Vietnamese potbellied pig presented for evaluation of a dermal mass present on the left cervico-mandibular region. The patient had a mass removed 6 years earlier from the same region, which was diagnosed as squamous cell carcinoma on histopathology. On physical examination, all vital parameters, including heart rate, respiratory rate and temperature, were within normal reference ranges, and the owner reported a normal appetite with no recent history of weight loss. Upon intubation for the dermal mass removal, a large heterogeneous mass of material was observed in the rostral aspect of the left mandible (Figure 1). Once removed, the mass appeared to be grossly composed of foodstuffs, hair, and a firm, mineralized segment of unknown material (Figure 2a). Within the contents of this debris, the left mandibular canine tooth (304) or tusk was identified. For the size of the mass of material, there was minimal inflammation associated with the gingiva and the mucosa (Figure 2b). There did not appear to be any evidence of displacement of the remaining teeth in the area. The periodontal attachment appeared to be normal in the remaining teeth. Computed tomography (CT) of the head was performed with the patient anaesthetized as previously described1 and positioned in sternal recumbency. Findings included severe, multifocal, chronic periodontal disease. The left mandibular canine tooth (304) or tusk was absent, and there was a large bony defect associated with the left mandibular body along the alveolar margin. The bony defect continued to affect the buccal aspect of the mandibular body (Figure 3). There was also extensive periapical lysis and evidence of external tooth resorption of the right mandibular canine tooth (404). The radiographic dental abnormalities were consistent with severe diffuse mandibular osteomyelitis characterized by multifocal moth-eaten bone lysis and irregular periosteal new bone formation, and multiple draining tracts from the right ventral mandible. Additional radiographic findings included absence of all premolar and molar teeth except the right first maxillary premolar (105), multifocal periapical lysis of the remaining teeth, bilateral medial retropharyngeal lymphadenopathy, and evidence of bilateral otitis externa and right otitis media. Miniature companion pigs (MCPs) are increasing in popularity as companion animal pets in North America.2 While data for exact numbers are limited, MCPs first appeared in the United States in the 1980s, with a dramatic increase in popularity over the past 17 years.3 With the increase in numbers, preventive care strategies are essential to improve animal health and welfare. Commonly reported dental pathologies in MCPs include missing teeth (most commonly the first mandibular premolar), periodontal disease, and tooth resorption.4 Early diagnosis of dental disease and mandibular osteomyelitis is important for companion animal pigs, considering their potentially long life span. Extraction of an infected tusk can be quite challenging. In cases of severe infection and disease, the integrity of the mandible can be affected to the point where it can be unstable after the extraction.5 Osteomyelitis can be managed with long-term antimicrobial therapy, including oral, injectable, and regional infusion of antibiotic-impregnated compounds, depending on lesion location.6 Removal of the infected nidus, in many cases the tooth, is critical for a positive long-term outcome. A complete oral assessment with inclusion of dental radiographs in MCPs should be considered for proper preventative dental care.4 As evidenced by our case, CT is also beneficial for a thorough oral evaluation and dental assessment. The authors declare no conflict of interest. This case represents a retrospective clinical case report and not a prospective study that requires institutional approval. The authors received no specific funding for this work. Open access funding provided by the Iowa State University Library.

Continuous mandibular nerve block as sole analgesia for postoperative pain management after a hemimandibulectomy in a French Bulldog

AbstractA 12‐year‐old French Bulldog presented for a mandibulectomy due to a large ameloblastoma in the left rostral mandibular body. Preoperative pain management consisted of methadone 0.2 mg/kg and a mandibular nerve block with ropivacaine 0.5%. Intraoperatively, an indwelling perineural catheter was placed through the mandibular canal, with the tip placed in the mandibular foramen for postoperative ropivacaine administration. Ropivacaine 0.2% was administered every 6 hours for the first 36 hours without need of any systemic analgesic administration, providing adequate analgesia and allowing for a rapid recovery. The dog was completely alert and responsive in the immediate postoperative period and started eating 12 hours after surgery without any sign of pain or discomfort. No complications were observed during the postoperative period. The perineural catheter was removed after 40 hours and the dog was administered metamizole every 8 hours for analgesia and was discharged 48 hours after surgery.

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

BackgroundThe postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability.Case presentationA 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required.ConclusionsThe treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

Cisto ósseo traumático: revisão da literatura e relato de um caso

The authors report a case of the traumatic bone cyst in the left mandibular body in a 17-year-old girl. The lesion was diagnosed radiographically as an accidental finding. The radiographic characteristics was unusual showing a image of traumatic bone cyst involving an unerupted third molar.

Mandibulectomy in feline with bacterial fibrosing osteomyelitis

Background: Fibrosing osteomyelitis is a chronic inflammatory process caused by infectious agents that lead to the destruction and replacement of bone tissue by fibroblasts. The diagnosis is based especially on histopathological and bacterial culture. In cases where extensive and irreversible injuries are observed, surgical treatment may be indicated. The objective of this work is to report the clinical, radiographic, histopathological, and microbiological aspects of a cat presenting fibrosing osteomyelitis.Case: A 10-year-old male feline, no defined breed, weighing 3.9 kg was referred to one Private Veterinary Clinic of Fortaleza, CE, Brazil with a history of left mandibular enlargement, presenting dysphagia, sialorrhea, an increase in firm consistency along of the left mandibular body, temporomandibular arthralgia and decreased joint motion range. On cranium radiograph, signs of proliferative osteopathy of irregular contours were observed in the branch and body of the left mandible and extending to the rostral region of the right mandible, suggesting a neoplastic process. After anesthesia, for better assessment of the oral cavity, a sample was collected by incisional biopsy, however, the histopathological result was nonspecific. In view of the inconclusive condition, it was decided to perform left hemimandibulectomy combined with right partial mandibulectomy. Tissue samples were obtained and sent for microbiological and histopathological analyses. The last test revealed an inflammatory reaction consisting of neutrophils and plasma cells, associated with a large amount of fibrous connective tissue, multifocal bacterial aggregates, necrosis and bone resorption. Based on the findings, the diagnosis of chronic bacterial osteomyelitis was concluded. The microbiological culture demonstrated the growth of the bacterium Pseudomonas aeruginosa, with sensitivity to cefovecin, which was administered to the treatment in doses of 8 mg/kg/SC, every 15 days, for 60 days. After 10 days of the surgery, the patient was able to start the process of swallowing and seizing pasty food.Discussion: Although radiography is a diagnostic method of choice to assess the extent of bone involvement, it hardly allows the distinction between neoplastic processes and osteomyelitis. Thus, in addition to the cranium radiographic examination, that revealed signs of proliferative osteopathy with irregular contours in branch and body topography of the left mandible were required biopsy and bacterial culture. After mandibulectomy, difficulty in retracting the tongue and anorexia were observed in the first days. Despite that, from the 12th day on, there was an improvement in food seizure, with the return to voluntary feeding. Mandibulectomy is indicated in cases where extensive and irreversible lesions are observed, although excision of the caudal mandible to the third or fourth premolar tooth is not recommended, because it compromises the sublingual musculature, with fall of the tongue and loss of function apprehension. In the present case, the caudal portion of the right mandibular branch was maintained, which facilitated the return of spontaneous feeding. The tissue removed was necessary to perform a microbiological culture with antibiogram, essential to determine the possible etiologic agent and choosing antimicrobial drugs. For the treatment of P. aeruginosa infection, cefovecin was prescribed due to the dosage and route of administration that collaborate with the mandibular surgery, once that the oral treatment is more difficult. Post-surgical complications related to mandibular resection, such as anorexia and difficulty in grasping food, are common. However, in the present case, the patient had an adequate reestablish after 15 days. Therefore, hemimandibulectomy is effective in treating fibrosing osteomyelitis, with maintenance of the patient's ingestive function.

ODONTOGENIC KERATOCYST: A CASE REPORT

This case report is about a 30-year-old brown male patient who, after radiographic examination for orthodontic documentation, showed a unilocular radiolucent lesion in a region of the left mandibular body that had a 20-mm diameter. Clinically, there were no local alterations, with satisfactory oral hygiene, stable occlusion, and vitality in the teeth (33-37) adjacent to the lesion. In the anamnesis, the patient denied local pain symptoms, systemic diseases, alcoholism, or smoking. The diagnostic hypothesis was odontogenic cyst. The treatment chosen was peripheral osteotomy with enucleation and curettage, with significant drainage of citrus yellow secretion in the intraoperative period. The specimen was referred for histopathologic examination, and the diagnosis was of odontogenic keratocyst (OK). The patient had satisfactory recovery without sequelae or infection and in follow-up. This case highlights the importance of radiographic evaluation for the early diagnosis of OK, considering its potentially aggressive and infiltrative behavior. This case report is about a 30-year-old brown male patient who, after radiographic examination for orthodontic documentation, showed a unilocular radiolucent lesion in a region of the left mandibular body that had a 20-mm diameter. Clinically, there were no local alterations, with satisfactory oral hygiene, stable occlusion, and vitality in the teeth (33-37) adjacent to the lesion. In the anamnesis, the patient denied local pain symptoms, systemic diseases, alcoholism, or smoking. The diagnostic hypothesis was odontogenic cyst. The treatment chosen was peripheral osteotomy with enucleation and curettage, with significant drainage of citrus yellow secretion in the intraoperative period. The specimen was referred for histopathologic examination, and the diagnosis was of odontogenic keratocyst (OK). The patient had satisfactory recovery without sequelae or infection and in follow-up. This case highlights the importance of radiographic evaluation for the early diagnosis of OK, considering its potentially aggressive and infiltrative behavior.

MANDIBULAR PLASMACYTOMA PRESENTING WITH EXTENSIVE ROOT RESORPTION

<h3>Clinical Presentation</h3> We report here an unusual case of a 67-year-old female who presented to the Faculty of Dentistry at the University of Toronto (Toronto, Canada) with a primary chief complaint of a 2-month history of dull pain in her left mandibular tooth. Clinical examination revealed percussion sensitivity and buccal palpation tenderness of the mandibular left first molar. Panoramic, intraoral, and cone beam computed tomography (CBCT) imaging showed a well-defined, irregularly shaped osteolytic lesion in the left mandibular body, with directional external root resorption of adjacent teeth. <h3>Differential Diagnosis</h3> The radiologic differential diagnosis of a well-defined osteolytic lesion resulting in extensive, directional external root resorption includes benign neoplasms and cysts. Malignant neoplasms, such as multiple myeloma, would be an unlikely consideration. In this case, the radiologic impression was of a benign neoplasm, in particular, central giant cell granuloma. Ameloblastoma and odontogenic myxoma were also considered. <h3>Diagnosis and Management</h3> A diagnosis of plasmacytoma was made through histopathologic examination. A subsequent systemic workup revealed multiple myeloma. <h3>Discussion and Conclusion</h3> Although the occurrence of root resorption in multiple myeloma is rare, it has been reported in a small number of cases in the literature. The radiologic features of this case are presented to highlight this uncommon presentation.