Left Ramus Research Articles

ODONTOGENIC MYXOMA: A SUNBURST RADIOGRAPHIC APPEARANCE MIMICKING A MALIGNANT LESION

Odontogenic myxoma (OM) is a benign tumor derived from the odontogenic ectomesenchyme. This report describes a case of OM mimicking a malignant lesion. A 21-year-old female patient was referred for diagnosis of a swelling with 5 months of duration. Panoramic radiograph revealed a multilocular, mixed lesion, which involved the left mandibular body and ramus. On cone beam computed tomography, the lesion caused thinning and rupture of the buccal and lingual cortical bone. Root resorption and sunburst appearance were also observed. Malignant neoplasms were the main hypotheses of diagnosis. Under local anesthesia, an incisional biopsy was performed. Microscopically, there was a loose myxoid tissue, with scarce spindle cells without atypia. The diagnosis of OM was established. The patient was submitted to surgical resection, confirming the diagnosis of OM. Recurrence was not observed after 12 months. Although rare, OM should be considered in the differential diagnosis of lesions with sunburst radiographic appearance.

Dysuria: An unusual complication of pubic exostosis in a child 10 years

Abstract Exostosis or osteochondromas are benign bone tumors frequently.These benign tumors may be symptomatic or be manifested on the occasion of a complication. We report the case of a child boy 1O years, admitted to our training multiple exostosis, with a location iliopubic left that proved by painful induration left of the base of the penis. Induration the increasing volume, it bothered the child during urination. Conventional radiography and CT were in favor of a pedunculated osteochondroma of the left iliac ramus compressing the urethra. The child underwent surgical tumor resection and pathological examination confirmed the diagnosis of osteochondroma. The evolution was good with disappearance of urinary symptoms down two years without recurrence.

PRIMARY XANTHOMA OF THE MANDIBLE: A CASE REPORT OF A RARE ENTITY.

Objective Central xanthoma of the jaw is an extraordinarily rare entity with less than 30 cases reported in the English literature so far. This benign lesion is often associated with endocrine and metabolic diseases (e.g. hyperlipidemia, diabetes mellitus, etc.). When those conditions are ruled out, primary xanthoma of the jaw is the appropriate diagnostic term. Adult males are most commonly affected, and the lesion is most frequently reported in the mandible. The classic microscopic features include the presence of histiocytic-like cells with foamy cytoplasm that stain positive by immunohistochemistry for CD68, but are negative for S100 and CD1a. Due to the microscopic similarities of histiocytic-like cells in H/E slides, Erdheim-Chester disease and Rosai-Dorfman disease are two systemic conditions that should be considered in the work-up. Findings We present a case of a 15 years-old male patient with multiple, ill-defined, non-corticated, radiolucent entities in the left ramus of the mandible. The lesions appear to be coalescing in some views. There is no evidence of bucco-lingual expansion and cortical destruction of bone. An excisional biopsy is performed. Microscopic examination reveals mixed soft and hard tissues. The hard tissue is composed of reactive vital bone. Sheets of foamy cells with dark, centrally placed vesiculated nuclei, prominent nucleoli and well-defined cytoplasmic membrane are noted between the bony trabeculae. In some areas, epithelioid cells with more amphophilic cytoplasm and less distinct cytoplasmic membrane are identified. Chronic inflammatory infiltrate with extravasated erythrocytes within the background of the connective tissue is also observed. Conclusion The appropriate diagnosis of central xanthoma of the jaw requires the work-up for systemic diseases in association with immunohistochemical profile. The recommended treatment is excision and curettage, which has been associated with excellent prognosis and extremely low recurrence rate.

SUN-497 Atypical Parathyroid Adenoma- Is There More Than What Meets the Eye ?

Background: Parathyroid adenoma with severe hyperparathyroidism and parathyroid carcinoma can have similar clinical presentations. Atypical cases should prompt suspicion for parathyroid carcinoma. We report such a case of an atypical parathyroid adenoma in a young woman. Case: A 22 year old woman without any past medical history presented with an inability to bear weight on her left leg after ascending stairs. X-rays showed lytic lesions of the left femur and pubic ramus, and an intertrochanteric fracture of the left femur. Suspicion for a pathologic fracture prompted further imaging. CT imaging demonstrated an asymmetric enlarged mass originating from the inferior aspect of the right thyroid lobe and bilateral medullary nephrocalcinosis. MRI showed a pathologic fracture with multiloculated cystic lesions with multiple fluid levels in the left femur and multiple solid lesions in bilateral pubic rami. Labs: corrected calcium 14.9 mg/dL, phosphorus 1.8 mg/dL, ALP 208 U/L, PTH 1450.0 pg/mL, 25-hydroxy vitamin D 29 ng/mL, and creatinine 0.90 mg/dL. Endocrinology was consulted for management of hypercalcemia. Patient was managed with aggressive IV hydration, sq calcitonin, and a dose of IV pamidronate. The possibility of metastatic disease prompted a biopsy of the right pubic ramus, which demonstrated interstitial hemorrhage and numerous giant cells consistent with osteitis fibrosa cystica. A sestamibi scan revealed uptake suggestive of a large right parathyroid adenoma (measuring 3.0 x 2.7 x 5.7 cm) that corresponded to the mass found on CT. She underwent an ORIF of the left femur and right parathyroidectomy with resection of adjacent paratracheal lymph nodes after her calcium levels stabilized. The parathyroid mass was grossly described as being a well-circumscribed, well-encapsulated, yellow-tan, hemorrhagic lesion measuring 3.0 x 2.0 x 5.0 cm. Biopsy of the mass also indicated that the tumor was encapsulated and comprised of monotonous parathyroid cells without increase in mitosis. The final diagnosis was an atypical parathyroid adenoma. Post surgery, calcitriol and calcium supplements were initiated. Her PTH decreased to 19.3 pg/mL upon discharge from the hospital. Conclusion: This is an unusual presentation of severe hypercalcemia in a young woman due to primary hyperparathyroidism. Concerning features for possible parathyroid carcinoma included the patient’s young age, a corrected calcium level >14 mg/dL, a markedly elevated PTH, a parathyroid mass >3 cm, and the combination of renal and bone involvement.1 These factors prompted the resection of adjacent lymph nodes with the parathyroid mass. Pathology was suggestive of an atypical parathyroid adenoma. These aggressive clinical features warrant close Endocrine follow up. 1. Marcocci C, Cetani F, Rubin MR, Silverberg SJ, Pinchera A, Bilezikian JP. Parathyroid carcinoma. J Bone Miner Res. 2008;23(12):1869-80.

The study of anthropometry of human mandibles in Wardha region

Background: The knowledge of different measurements of mandible is important to the dental surgeons in maxillofacial surgeries, reconstructive surgery of mandible, and plastic surgeries of face. The study of mandible is also important for individual identity such as age, sex, race, and stature. Objective: The objective of this study was as follows: Determination of sex, identification of individual for medicolegal purpose, and craniofacial reconstruction. Materials and Methods: In the present study, 140 cadaver mandibles including 100 male and 40 female mandibles of Wardha regions were studied. I have measured the bicondylar width, bigonial diameter, and mandibular symphyseal height of the left ramus with the help of spreading caliper (Vernier). Results: The calculated range for 100% accuracy is measured by mean ± 3.5 standards deviation. Conclusion: On the basis of percentage beyond demarking point, these parameters are found to be very useful in sex determination.

Post Traumatic Multi-Injured patients. To wait, to operate or to use Damage Control Orthopedic template? A case report

Abstract Purpose. Damage Control Orthopedics (DCO) is a surgical concept used in the recovery of seriously injured patients. Given that the leading cause of death among trauma patients remains uncontrolled hemorrhage, DCO emphasizes on preventing the "lethal triad” of acidosis, coagulopathy and hypothermia, rather than correcting the anatomy immediately. Thereby, we are presenting the crucial importance of using this technique in severe trauma cases. Methods. A 23-year-old female was admitted in the Emergency Room as a multi-trauma patient. Following the Advanced Trauma Life Support protocol, fully exposure examination showed bilateral forearm and femur deformities, with bilateral open femur fracture, left ankle deformity and pelvic ecchymosis. X-rays confirmed fractures of the ribs, bilateral pulmonary contusion, fracture of the left ankle fracture, bilateral superior and inferior pubic ramus, and bilateral femur fractures with both bone midshaft fracture on the right leg. DCO was proceeded immediately, during which external fixators were placed on the fractures, while splinting both forearms. After 11 days in the Intensive Care Unit (ICU), the patient underwent the definitive surgeries. Results. Managing the patient with the DCO protocol first and not rushing with the definitive surgical procedures resulted in a proper stabilization. After two years follow up, the patient fully recovered and returned to a normal life style. Conclusion. Performing a definitive operation on severely injured patients results in deleterious effects that could lower life expectancy. Short-term physiological recovery should be prioritized over definitive management and DCO should be proceeded in order for the best outcomes to be achieved.

Finite element analysis of the pelvis including gait muscle forces: an investigation into the effect of rami fractures on load transmission

BackgroundThe objective of the study is to investigate the load transmission within the pelvic ring under physiological loading during gait and to correlate these results with clinical findings. In a second approach, we analysed how load distribution is altered by fractures of the anterior pelvic ring.MethodsMuscle forces and joint reaction forces are calculated by inverse dynamics and implemented in a finite element pelvis model including the joints.ResultsWith the intact configuration and according to the moment of the gait, left and right superior and inferior rami show the highest stresses of the model, corresponding to the typical location of an anterior pelvic ring fracture. A superior ramus fracture induces larger stresses to the lower ramus and a slight increase of stresses on the posterior structures. A total disruption of anterior rami redirects the loads to the back of the pelvis and introduces significantly higher stresses on the posterior structures.ConclusionsThis investigation enhances the understanding of the biomechanics of the pelvis and highlights the important role of the rami in load carrying and in maintaining integrity of the pelvic ring.

Three Dimensional Osteometric Analysis of Mandibular Symmetry and Morphological Consistency in Cats.

Objectives: The aim of this study was to describe a number of anatomical reference points which can be used to measure mandibular morphology and assess the degree of mandibular symmetry in a group of normal cats. Comparisons were then made between cats to evaluate correlations between morphological measurements and degree of inter-cat variation. This will provide data valuable evaluating and developing techniques for caudal mandibular fracture repair.Methods: Twenty-seven mixed breed cats (26 Domestic Shorthaired and 1 Domestic Longhaired) with no history of head trauma, intact undamaged mandibles, both mandibular fourth premolars and first molars present which had a full skull CT scan were included in this study. Anatomical reference points were defined on maximum intensity projections of multiplanar reconstruction of the mandibles and measurements taken. The ratios between paired right and left measurements, and the ratio of jaw widths at the coronoid process and mandibular foramen were calculated. All analyses were performed using R version 3.3.3 and the multcomp library.Results: None of the right:left ratios were detected as being significantly different from 1 and the coefficient of variation values were all very small showing that when cats deviate from the mean ratio they do so by only a small amount. Measurements analyzed to determine how consistent individual measurements were between cats showed that the most consistent measurement was the lateral ramus inclination angle. The least consistent measurements were ramus height and jaw width at the mental foramen. The correlation between pairs of measurements of the right and left ramus was analyzed and demonstrated a strong correlation between the height, width and length of the ramus.Conclusions: This study has demonstrated a low level of asymmetry between contralateral mandibles in cats, a high level of consistency in the dimensions of mandibles between cats and a strong correlation between the height, width and length of the ramus.

Squamous Cell Carcinoma in Chinese Hamsters (Cricetulus griseus)

Background: The companion animal market has changed over the years. The number of people living in small apartments has increased; as a result, the demand for small pets such as exotics, fish, and small rodents has also increased due to their smaller space requirements and ease of handling and care. Pets help relieve anxiety and stress in people suffering from social issues. Small rodents are usually bred in specific cages with cellulose or wood shaving bedding, and fed with commercially available diets. Small rodent clinics struggle due to the lack of scientific reports on some diseases and therapies. To date, the oncology literature is too limited to develop better diagnosis and treatment methods. Here, we report three cases of squamous cell carcinoma in the mandibular region of Chinese hamsters (Cricetulus griseus).Case: Three adult male hamsters averaging 1.5 years old, from different pet stores, bred under home conditions by different owners in Sergipe, Brazil, were brought to the Dr. Vicente Borelli Hospital at Pio X University for exotic veterinary care. Each animal had been bred alone in a specific breeding cage. Each had a history of apathy, loss of appetite, andrapid deformity of the facial region. Radiographs showed areas of bone involvement and extensive injury, with partial resorption of the left ramus and angle of the mandibular region. Due to the location of the tumor mass, the clinical status, and limitations in systemic treatment, euthanasia was recommended for each animal. After anamnesis, the animals weresubjected to clinical assessment. A firm and well-circumscribed mass was identified on palpation. In case A, it compromised the left mandible from the angle to the body and extended to the maxillary soft tissues and left superior lips. In case B, it extended from the ramus to the symphysis on the left side and to the maxillary region, similar to case A. In case C,it extended on both sides of the mandible symphysis, with no alterations in the maxillary soft tissues. Following clinical examination, each animal underwent laterolateral and dorsoventral radiographic examination; no images were suggestive of pulmonary metastasis. However, an expansive mandibular lesion with partial resorption, suggestive of bone neoplasia,was detected. The animals were dehydrated and in clinical distress, and euthanasia was recommended. Histopathological examination of samples from the tumor sites revealed moderate cellular and nuclear pleomorphism and proliferation of neoplastic keratinocytes, suggestive of squamous cell carcinoma, a malignant tumor of epidermal keratinocytes with a highly invasive and aggressive nature.Discussion: The number of reports in the literature of cancer in small rodent companion animals has lead us to believe that neoplasms in these animals are misdiagnosed and/or that their prevalence is underreported. The literature describes that the tumor incidence in hamsters is 3-40%, and that the incidence is higher in male rodents. This incidence range increases the analysis of cancer in these animals from rare to middle-frequent what do not contribute to the animals’ clinics and to small rodent therapeutics. Differential diagnosis of squamous cell carcinoma and other tumor types should be addressed, especially osteosarcomas. Histopathological examination is essential to clarify the etiopathogenesis.Keywords: rodents, neoplasm, keratinocytes.

Selection of a lectotype for Brachycrus laticeps mooki Schultz and Falkenbach (Mammalia, Artiodactyla, Merycoidodontidae)

In 1968 Schultz and Falkenbach described a new oreodont subspecies, Brachycrus laticeps mooki, from a locality 11 km (7 miles) southeast of Fort Logan, Meagher County, Montana. As a holotype for this new taxon, Schultz and Falkenbach (1968:369) designated both American Museum of Natural History (AMNH) specimen number 21321 (a skull) and AMNH 21322 (a left ramus). Although the citation of two separate catalog numbers as a holotype is highly unusual, Schultz and Falkenbach believed that the specimens cataloged under both numbers represent only a single individual. The use of the term ‘holotype’ was appropriate, therefore, although it would have been more common practice to place elements believed to represent a single individual under a single catalog number. Schultz and Falkenbach did not give a justification for their opinion that AMNH 21321 and AMNH 21322 represent the same individual, although they stated this belief in two publications (1941 and 1968).

First record of Toxodontidae (Mammalia, Notoungulata) from the late Miocene–early Pliocene of the southern central Andes, NW Argentina

AbstractA new species of toxodontid notoungulate, Xotodon maimarensis n. sp., is described from the Maimará Formation (late Miocene–early Pliocene), Jujuy Province, northwestern Argentina. This is the first record of a toxodontid from the Eastern Cordillera. The specimen is housed at the Museo de Geología, Mineralogía y Paleontología, Instituto de Geología y Minería de la Universidad Nacional de Jujuy. It consists of an incomplete mandible preserving the right mandibular ramus with part of the dental series, partially preserved symphysis with all the incisors, and a small portion of the left ramus without teeth. The following characters distinguish it as a new taxon: symphysis long and narrow with slight divergence of its lateral borders; strong procumbence of lower incisors and deeply implanted i3; chin angle lower than in X. major and X. cristatus and bulging labial keel limiting strong lateral concavities. Comparative analysis in the context of the recently revised Neogene Toxodontidae indicates that the Maimará specimen shares mandibular features and dental characters with Xotodon and Mixotoxodon, differing from the latter by the more upraised symphysis. The phylogenetic position of Xotodon maimarensis n. sp. supports the taxonomic interpretation of the studied specimen as a new species of Xotodon. This new Toxodontidae increases the knowledge of the diversity and radiation of this group of notoungulates in northwest Argentina.

Mandibular symmetry in participants with a unilateral cleft lip and palate

Context: Facial asymmetry has been reported to be a typical morphological characteristic of unilateral cleft lip and palate (UCLP). Posteroanterior cephalometric radiographs have shown that in addition to an asymmetrically developed nasomaxillary complex, children with UCLP may also have distorted mandibles. Aims: The aim of this retrospective study was to evaluate mandibular symmetry in participants with a complete unilateral left cleft lip and palate (ULCLP) using panoramic radiographs. Subjects and Methods: Pretreatment records of 163 participants (84 ULCLP, 79 Angle Class I without a cleft; mean age: 12.9 ± 3.5 years) were retrieved from the orthodontic department archives. A total of ten anatomic landmarks were marked on panoramic radiographs, and measurements were performed using the PORDIOS software. Statistical Analysis Used: Intra- and inter-group differences were analyzed using Student's t-test. Results: Mandibular right and left ramus, total ramus, condylar, and mandibular molar alveolar heights were significantly shorter in the ULCLP group when compared to controls (P < 0.05 to P< 0.001). In the ULCLP group, mandibular and corpus lengths were shorter on the left side (P < 0.05), whereas in the control group, mandibular and corpus lengths and ramal, condylar, and molar alveolar heights were shorter on the right side when compared to the left side. In addition, ramus/corpus angles were significantly larger in the ULCLP group when compared to the control group (P < 0.001). Conclusions: Mandibular asymmetry exists to varying extents in ULCLP patients and is characterized mainly by smaller cleft-side dimensions. Discrepancies in left-right mandibular dimensions also occur in normal participants.

Stafne’s Bone Defect in Atypical Location: Between the Subcondylar Region and Neck of the Mandible Ramus

CONTEXT: Stafne’s bone defect is a benign lesion appearing on the image as a round radiolucent lesion within a cortical defect on the mandible. CASE REPORT: We attend one 46-year-old male patient came for diagnostic evaluation of a rounded and radiolucent lesion in the transition of the subcondylar region and neck of the left mandible ramus incidentally found by a dentist. Computed tomography and magnetic resonance imaging were performed in medical radiology and a Stafne’s cyst was diagnosed in an atypical location. CONCLUSION: We emphasize that Stafne’s bone defect is a benign lesion, whose imaging diagnosis can be conclusive, avoiding unnecessary surgical procedures.

Coronary cameral fistulae symptomatic with unstable angina

Coronary arterial fi stula is a rare defect characterized by a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. Complications include ‘steal’ from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fi brillation, rupture, endocarditis/endarteritis and arrhythmias. Here we report the case of a 73-year-old female that was admitted for unstable angina. Coronary angiography revealed the presence of multiple large coronary-cameral fi stula. CT scan confi rmed the presence of ecstasis of the left main artery, associated with coronary-cameral fi stulae between left ventricle and ramus intermedius artery and the circumfl ex artery.

Radiographic Blind Test of Curvature of the Posterior Border of the Mandibular Ramus as a Morphological Indicator of Gender.

Curvature ofthe posterior border of the mandibular ramus at the occlusal plane has been described as a morphological trait for males. Controversy over the accuracy of this method remains among researchers; studiesemploying similar methodsreportaccuracy rates for successful genderidentification ranging from 59% to 99%. This blind study assessedevaluators'ability to determinegenderbased on the presence or absence ofcurvatureof the posterior margin of the mandibular ramus through panoramic radiographs. Randomly selected panoramic radiographs were obtained from The Ohio State University College of Dentistry for 413 adult male (M) and female (F) subjects. Two evaluators separately assigned ratingsusing a similar method to the Loth and Henenberg methodology to each subject on the right and left sides of mandibular rami.The ratings were based upon three criteria: (1) presence ofcurvatureat the occlusal plane (M), (2) presence ofcurvaturebut not at the occlusal plane (F), and (3) lack of curvature (F). Pearson exact chi-squared test was used to evaluate the statistical strength of the ratings. The evaluators were only in agreement for both the right and left rami in roughly two-thirds (66.8%) of cases when there was no excessive tooth loss (ETL); however, the inter-observer agreement improved to 82.1% for those rami associated with ETL. Inter-observer agreement occurred in 72.9% of female rami and in only 64.4% of male rami. The results of this studyindicatedthat assessment of posterior bordercurvature of mandibular rami through panoramic radiographswas not a reliable indicator ofgenderandwasfurther plagued by unacceptably high levels of inter-observer disagreement.

Pelvis Injury - Running

HISTORY: A 41-year-old female presented with new left pelvic and left ischial tuberosity pain after recreational distance running. Pain was localized to the left groin and described as “aching” without radiation or numbness. The patient, a former collegiate 800m track athlete, was diagnosed with left athletic pubalgia two years prior and managed conservatively with return to full pain-free running one year prior to consult. She was running 40 miles per week, ranging from 5-15 miles per day and had recently transitioned running shoe models 2-3 weeks prior. Pain had progressively increased to inability to tolerate running. PHYSICAL EXAMINATION: Examination revealed a symmetric, non-antalgic walk, equal leg lengths and ability to perform full squat. Resisted left hamstring flexion in the supine position with knees at 90 degrees reproduced left ischial tuberosity pain. Left hamstring tendon was palpable and intact. Range of motion was full throughout the bilateral lower extremities. Strength, reflexes, sensation and pulses were normal throughout. DIFFERENTIAL DIAGNOSIS: 1. Hamstring tendinosis 2. Pelvic stress fracture 3. Pelvic floor injury TESTS AND RESULTS: Anterior-posterior pelvis x-ray with two oblique views and lateral view: — Healing, non-displaced, periosteal reaction at the inferior ramus of the left pubic bone consistent with stress fracture not demonstrated on previous AP pelvis done one year prior. FINAL/WORKING DIAGNOSIS: Left inferior pubic ramus stress fracture TREATMENT AND OUTCOMES: 1. Immediate cessation of land-based running with pool running as tolerated for 2 months. 2. Initiated 800 IU Vitamin D and 2000 mg Calcium supplementation. 3. DEXA scan performed and negative for osteopenia. Subsequent Vitamin D level within normal limits. 4. 3 months from initial consult, patient tolerated treadmill evaluation and commenced a walk-to-run protocol with initiation of physical therapy. 5. Repeat AP pelvis x-ray demonstrated healed undisplaced fracture of left inferior pubic rami with solid bone union. Further imaging with MRI was not needed. 6. After 4 months, she tolerated land-based running without pain. Gait analysis was performed to ensure proper running mechanics with increased running frequency and duration in the prescribed walk-to-run protocol.

Massive Intrapelvic Hematoma after a Pubic Ramus Fracture in an Osteoporotic Patient

Figure 1: Displaced left pubic ramus fracture. Figure 2: Massive intrapelvic hematoma (axial size, 11 cm by 5 cm) around the fracture site. An 88-year-old female presented with a left thigh pain and dysuria. She visited our hospital 2 week after she noticed her symptoms. She stated that she might have a low-energy fall, but she could not identify the exact onset. Her radiograph of the pelvis (Figure 1) showed displaced left pubic ramus fracture. Her computed tomographic scanning of the pelvis (Figure 2) showed massive intrapelvic hematoma (axial size, 11 cm by 5 cm) around the fracture site, although she did not use any anticoagulants. Because her bone mineral density was 0.357 g/cm2 , and T score was -4.8 SD, she started a bisphosphonate therapy. She received a bed-rest physical therapy for 6 weeks, and the hematoma regressed spontaneously. She started full weight bearing after 6 weeks, and walked by a walker after 8 weeks. Although it is extremely rare to develop massive chronic intra-pelvic hematoma after a lowenergy pubic ramus fracture without any use of anticoagulants, it may occur in elderly and severely osteoporotic patient.

A Case Report of Aneurysmal Bone Cyst of the Mandible

Aneurysmal bone cyst (ABC) is a rare benign lesion of bone, which represents less than 1% of all the bone cysts biopsied. It is generally noted in long bones and spine and is less common in the craniofacial skeleton including maxilla and mandible. These rare jaw lesions are encountered mostly in the body and ramus of the mandible in the second or third decades of life. This case report describes a rare case of ABC in a 48 year old male patient involving the left body and ramus of the mandible. Clinically, it presented as an extra-oral swelling of 3 months duration with occasional mild pain and paraesthesia of the lip which are rare features of the lesion. Both conventional and CT imaging were suggestive of a multilocular (soap-bubble) lesion. An incisional biopsy was done and the histopathological report was suggestive of an Aneurysmal Bone Cyst. The patient was planned for hemimandibulectomy with free fibula reconstruction graft.

Panoramic Radiographic Appearance of Giant Bilateral Tonsilloliths.

A 52-year-old male patient reported with a chief complaint of pus discharge from left mandibular posterior region, with an associated history of extraction of tooth 36 one year ago. Past medical history of patient was not significant in relation to patient’s current complaint. Draining sinus was observed near the left body region of the mandible extraorally [Table/Fig-1]. Intraorally associated region disclosed a mobile root remnant [Table/Fig-2]. A provisional diagnosis of chronic suppurative osteomyelitis was made because of mobile root remnant of mandibular left first molar. A periapical radiograph showed extensive radiolucent bony changes surrounding the root remnant and hence a panoramic radiograph was advised. Interestingly, the panoramic radiograph showed the presence of two ovoid shaped radiopaque areas superimposed one on either side of the ramus of mandible measuring of size approximately 2.5cm x 2.8cm and 1.3cm x 1.6cm respectively on right and left side [Table/Fig-3] and large radiolucent lesion associated with periapical to root piece of lower left first molar. A lateral oblique view of left ramus showed the large ovoid shaped radiopacity above the sigmoid notch excluding intraosseous radiopaque lesion [Table/Fig-4], right lateral oblique view of ramus showed small calcified radiopaque area superimposed on sigmoid notch [Table/Fig-5]. On comparison with panoramic image radiopacity on right side ramus area appears larger in size giving an impression of “Ghost Image” formation. To rule out the size and determine the exact anatomical location patient was advised Computed Tomography (CT) Scan. Radiographic diagnosis of osteomyelitis of left body mandible and soft tissue calcification was given with a differential diagnosis of calcification of phleboliths, calcified lymph node, foreign bodies, an elongated styloid apparatus, large maxillary tuberosity, displaced mandibular third molar and calcified tuberculous lymphadenitis was made. His blood and serological investigations was normal.

Odontogenic Myxoma of Mandible: Report of A Rare Case.

Odontogenic Myxoma of Mandible: Report of A Rare Case.