Radiolucent Halo Research Articles

DILATED ODONTOMA ASSOCIATED WITH A DENTAL ROOT: A CASE REPORT

Dens invaginatus is an anomaly resulting from the enamel organ invagination into the dental papilla. When the invagination is extreme, it can dilate the crown and root, generating a so-called dilated odontoma, which is rare in the posterior mandible. A 47-year-old female presented an asymptomatic radiopaque mass attached to the distal root of the second lower molar, surrounded by a radiolucent halo. Computed tomography revealed a hypodense image within the mass. With the hypothesis of fusion, concrescence, and odontoma, the tooth and the lesion were removed. After demineralization, the material was hemisectioned, and a cavity within the calcified mass could be seen. Microscopic examination revealed that the mass consisted of tubular dentin, containing a cavity filled with empty clefts and irregular calcified tissue, consistent with the diagnosis of dilated odontoma. The radiological appearance of a dilated odontoma may vary, when the histological analysis is key to the final diagnosis. Dens invaginatus is an anomaly resulting from the enamel organ invagination into the dental papilla. When the invagination is extreme, it can dilate the crown and root, generating a so-called dilated odontoma, which is rare in the posterior mandible. A 47-year-old female presented an asymptomatic radiopaque mass attached to the distal root of the second lower molar, surrounded by a radiolucent halo. Computed tomography revealed a hypodense image within the mass. With the hypothesis of fusion, concrescence, and odontoma, the tooth and the lesion were removed. After demineralization, the material was hemisectioned, and a cavity within the calcified mass could be seen. Microscopic examination revealed that the mass consisted of tubular dentin, containing a cavity filled with empty clefts and irregular calcified tissue, consistent with the diagnosis of dilated odontoma. The radiological appearance of a dilated odontoma may vary, when the histological analysis is key to the final diagnosis.

COMPOUND ODONTOMA ASSOCIATED WITH A DENTIGEROUS CYST

Dentigerous cysts (DCs) and odontomas are lesions of odontogenic origin and are relatively common in the oral cavity, with rare recurrence after treatment. The purpose of this study is to describe a case of association of odontoma with DC of a young patient. A 16-year-old male patient presented with a well-defined unilocular radiolucent lesion associated with an impacted mandibular right canine. Mesially, there was another lesion, mixed with small radiopaque structures similar to dental structures, surrounded by a radiolucent halo. Microscopic examination revealed a fragment of fibrous connective tissue partially covered by stratified squamous epithelial tissue exhibiting the suprabasal layer loosely arranged and fragments of pulp-like tissue surrounded by dentinoid tissue. The diagnosis of DC associated with compound odontoma was made. This case report highlights that DC associated with odontoma is rare and further studies are needed to investigate the probable etiology of this association. Dentigerous cysts (DCs) and odontomas are lesions of odontogenic origin and are relatively common in the oral cavity, with rare recurrence after treatment. The purpose of this study is to describe a case of association of odontoma with DC of a young patient. A 16-year-old male patient presented with a well-defined unilocular radiolucent lesion associated with an impacted mandibular right canine. Mesially, there was another lesion, mixed with small radiopaque structures similar to dental structures, surrounded by a radiolucent halo. Microscopic examination revealed a fragment of fibrous connective tissue partially covered by stratified squamous epithelial tissue exhibiting the suprabasal layer loosely arranged and fragments of pulp-like tissue surrounded by dentinoid tissue. The diagnosis of DC associated with compound odontoma was made. This case report highlights that DC associated with odontoma is rare and further studies are needed to investigate the probable etiology of this association.

CENTRAL OSSIFYING FIBROMA IN JAW: A CASE REPORT

Central ossifying fibroma is considered a benign, slow-growing fibro-osseous lesion with a predilection for middle-aged women. On imaging exams, the lesion can be uni- or multilocular, radiolucent, mixed, or radiopaque. The aim of this study is to report a case of central ossifying fibroma. A 57-year-old Black sought consultation for increased volume in the mandibular right region. On examination, a slight bulging in the bottom of alveolar mucosa near tooth 47, without changes in the mucosa. On radiographic examination, the presence of a hyperdense mass with a radiolucent halo of approximately 2 cm in the mandibular body associated with the apex of tooth 47 was observed. Incisional biopsy confirmed the suspicion of central ossifying fibroma. As a form of treatment, surgical excision and curettage were performed under general anesthesia. The patient is being followed up and has no pain and functional complaints at the moment. Central ossifying fibroma is considered a benign, slow-growing fibro-osseous lesion with a predilection for middle-aged women. On imaging exams, the lesion can be uni- or multilocular, radiolucent, mixed, or radiopaque. The aim of this study is to report a case of central ossifying fibroma. A 57-year-old Black sought consultation for increased volume in the mandibular right region. On examination, a slight bulging in the bottom of alveolar mucosa near tooth 47, without changes in the mucosa. On radiographic examination, the presence of a hyperdense mass with a radiolucent halo of approximately 2 cm in the mandibular body associated with the apex of tooth 47 was observed. Incisional biopsy confirmed the suspicion of central ossifying fibroma. As a form of treatment, surgical excision and curettage were performed under general anesthesia. The patient is being followed up and has no pain and functional complaints at the moment.

A Rare Case of Myoid Hamartoma Masquerading As Invasive Breast Carcinoma

Breast Myoid Hamartoma (MH) is a rare type of neoplasm with a poorly understood pathogenesis. Very few literatures have reported such disease with an unclear prognosis and malignant potentiality. Some isolated studies have shown that breast Myoid Hamartoma (MH) may be genetically related to other types of tumours with the involvement of HMGA2 gene. We reported a case of a 64-year-old post-menopausal lady with an underlying chronic idiopathic axonal polyneuropathy (CIAP) that was referred to our centre for a suspected right breast tumour. Clinical and imaging proved the disease to be malignant, however, core biopsy results showed otherwise. Ultrasound of the right breast showed a solid mass with a hypoechoic heterogeneous echotexture and posterior shadowing. A Mammogram highlighted a dense lesion in the right breast with radiolucent halo and macrocalcification. It was reported as BIRADS 4 category. Managing breast Myoid Hamartoma (MH) is proved to be of great challenge to clinicians as meticulous clinical acumen is needed to strategize a proper plan and management, most importantly, not to overlook the disease as the malignant transformation has been reported before.

Vertical Root Fracture in Non-Endodontically and Endodontically Treated Teeth: Current Understanding and Future Challenge.

A vertical root fracture (VRF) is a complex complication that usually leads to tooth extraction. The aim of this article is to review the prevalence, demography, distribution, diagnostic methods, etiology and predisposing factors, clinical features, radiographic characteristics and treatment strategies of VRFs in non-endodontically treated teeth (VRFNETT) and endodontically treated teeth (VRFETT). Search terms for each subject related to VRFNETT and VRFETT were entered into MEDLINE, PubMed and Google Scholar. Systematic reviews, retrospective cohort studies, demographic research, clinical studies, case reports and case series were reviewed. Most of the VRFs were found in patients older than 40 years old. Older populations were discovered in the non-endodontically treated VRF group when compared to the endodontically treated VRF group. Male patients were found at a greater prevalence than females in the non-endodontically treated VRF group. The initial occurrence of a VRF may accompany radiolucent lines within the root canal, unusual space between the canal wall and intracanal material, a widening of the PDL space along the periradicular surfaces, angular bony destruction, step-like bone defects, V-shaped diffuse bone defects, or root resorptions corresponding to the fracture line before the clear separation of the fractured fragment. The indicative clinical and radiographic signs of VRF included a coronally positioned sinus tract, deep-narrow periodontal defects, the displacement of a fractured fragment, periradicular radiolucent halos and the widening of the root canal space. Interestingly, VRFNETT are more often observed in the Chinese population. Some patients with multiple VRFs were observed, suggesting possible predisposing factors in genetics and tooth development. The management of a VRF usually involves a multidisciplinary approach. The common distribution and features of VRFNETT and VRFETT were elucidated to facilitate recognition and diagnosis. Besides extraction, variable therapeutic schemes, such as the repair of the VRF, root amputation and others reported in earlier literature, are available. A long-term prognosis study of the various therapeutic strategies is needed.

Case Report: Incidental Finding of an Osteoblastoma of the Mandible

Osteoblastoma is a rare, benign primary neoplasm of the bone. The reported incidence rate of osteoblastomas is 1% of all whole body bone neoplasms. According to radiologic literature, this entity is most commonly reported in the vertebral skeleton. Of these reported lesions, 15% arise in the gnathic skeleton, 36% occur in the vertebrae with the remaining in the long bones of the extremities.1 Osteoblastomas have a predilection for presenting in the second or third decade. Seldom these lesions occur at a more advanced age.2 This entity appears to affect males more frequently than females, with a gender predilection of 2:1. Among reported cases arising in the gnathic skeleton, medullary bone is the primary location. The hypothesized pathogenesis involves benign neoplastic proliferation of osteoblasts.1Clinically, osteoblastomas often present as a painful swelling of the mandible. Imagining of this entity may be variable with a differential diagnosis spanning both benign and malignant neoplasms. Often radiographic features include ossification with an increase in radiodensity.2 Additional radiographic characteristics may include sclerotic bone with a radiolucent halo. This presentation is similar to an osteoid osteoma. Histopathology of this entity includes anastomosing trabeculae set within a loose fibrovascular stroma.2 Key histologic features include osteoblastic rimming with varying degrees of calcification. Definitive diagnosis may be challenging because of the similar histological features seen with primary malignant bone neoplasms, especially osteosarcoma.2Traditionally, the treatment involves surgical intervention, which ranges from aggressive curettage to en-bloc resection. Reported surgical intervention is dependent on size and anatomic location. Recurrence of the entity is reported to be uncommon with a 20% recurrent rate. Malignant transformation secondary to radiation therapy has been reported.1The authors present the clinical course and treatment of a 68-year-old male who presented to the St. Barnabas Hospital Oral and Maxillofacial Surgery Clinic for evaluation and treatment of a painful mobile carious tooth. On review of his panoramic radiograph, an incidental finding of a lesion was noted in the lower left mandible. The patient complained of no pain in the left mandible, and clinical examination showed a mild lateral expansion of the lower left mandible. The radiographic examination was consistent with a well-defined radiolucent/radiopaque lesion of the left mandible below the inferior alveolar nerve canal. The patient underwent an incisional biopsy in the operating room and was subsequently diagnosed with an osteoblastoma.

Efficacy of Antibiotic-Loaded Cement Augmentation for Correcting Low Grade Pedicle Screw Loosening.

ObjectiveAltered biomechanics and bone fragility can contribute to pedicle screw loosening. This study aimed to evaluate the efficacy of antibiotic-loaded cement augmentation for correcting symptomatic screw loosening as a minimally invasive alternative to open revision surgery.MethodsTen consecutive patients who underwent percutaneous cement augmentation for pedicle screw loosening were included in this study. Low grade pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with significant radiolucent halo zones at a vertebral level without screw backing out or stripping. We analyzed the screw loosening at the main location of halo formation. All patients were treated by fluoroscopy-guided antibiotic-loaded cement augmentation of the loosened pedicle screws. Patient demographics and pre- and postoperative data were also assembled and analyzed.ResultsMost (80%) halo formation locations were the inferior type. Augmentation was technically feasible in all but one patient, in whom the procedure was unsuccessful due to access difficulty. This patient ultimately underwent percutaneous screw re-implantation via a different trajectory. The other nine patients in whom cement filling was satisfactory reported significant pain relief at the final follow-up. Moreover, no severe complications such as wound infection or repeated screw loosening occurred during the follow-up period.ConclusionThe most common halo formation location was the inferior type. In cases without access difficulty, antibiotic-loaded cement augmentation for the treatment of low grade pedicle screw loosening can relieve pain and avoid extensive open surgery.

S1850 Septal Wall Divides Esophagus Into Double Lumen: Successful Endoscopic Septotomy

INTRODUCTION: Intraluminal esophageal diverticulum is a rare condition identified by a collection of intraluminal barium with surrounding radiolucent halo on barium swallow. To our knowledge, only seven cases have been reported in the literature. In those cases, management consisted of proton pump inhibitor (PPI) therapy, lifestyle modifications and esophageal dilation. Limited literature exists on the endoscopic management of this condition. Our case highlights the use of endoscopic septotomy and myotomy as minimally invasive techniques in treating symptomatic intraluminal esophageal diverticulum. CASE DESCRIPTION/METHODS: A 27-year-old male with a history of gastroesophageal reflux disease and gastric ulcer presented with progressive dysphagia leading to a 50-lb weight loss over three months. Medical therapy with PPI provided mild symptomatic improvement. Initial upper endoscopy revealed an esophageal stricture with a double lumen. Repeat endoscopy showed true and false lumens divided by a septal wall located at 25 cm from the incisor, with multiple diverticula seen within the false lumen. These endoscopic findings were confirmed by esophagram. Due to persistent symptoms, the patient was referred for further endoscopic evaluation and management. Various endoscopic submucosal dissection knives were used to perform septotomy, guided by yellow and black guidewires placed in the true and false lumens, respectively. A nasogastric tube placed over the yellow guidewire further defined the true lumen. A distal cap attachment was used simultaneously to improve visibility and maintain hemostasis. Septotomy began 25 cm from the incisor and terminated 39 cm from the incisor, for a total length of 14 cm in the mid- to distal esophagus. Intermittent endoscopic mucosal resection was performed with redundant tissue removed via hot snare. One endoclip was deployed at the distal end of the esophagus to prevent mucosal division and achieve hemostasis. At the end of the procedure, a single lumen was visualized endoscopically. DISCUSSION: Endoscopic septotomy and mucosal resection offer a minimally invasive approach to treat intraluminal esophageal diverticulum. The procedure was well-tolerated and follow-up esophagram confirmed a single esophageal lumen. Further reporting and research are needed to determine optimal endoscopic management of this rare condition.

Managment of the mandibular dentigerous cyst plus rigid bone fixation, Presentation of a case

The objective of this article is to present the management of a patient diagnosed with a mandibular dentigerous cyst. The present case deals with a 14-year-old male patient, without relevant antecedents who attended the SERODU dental clinic, a radiolucent shadow between the dental pieces 42, 44 and 45 was included in the computerized axial tomography with the part piece No. 43 included in the symphysis of the mandibular region, horizontal position of the dental piece, the crown towards the distal and its root towards the medial with complete formation. At the crown level, a well-defined radiolucent shadow can be observed with a radiopaque halo, compatible with a dentigerous cyst. Therefore, it was decided to carry out the endodontic treatment in the dental pieces 43,44,45, subsequently the enucleation of the lesion, elimination of the dental piece, curettage and rigid bone fixation were performed, to avoid pathological complications of adjacent structures such as fracture mandibular due to the size of the lesion. A histopathological diagnosis of dentigerous cyst was obtained. At the thirty-day control, a radiopaque area compatible with bone regeneration was observed radiographically, with a radiolucent halo separating with the original basal bone. Enucleation and rigid bone fixation is an effective treatment technique to eliminate the lesion that turned out to be benign.

PERIAPICAL BONE DYSPLASIA: A CASE REPORT

Periapical bone dysplasia (PBD) is a benign fibro-osseous lesion that involves apex of vital teeth. Single lesions can occur; however, the multiple foci are more common, affecting anterior regions of the mandible. PBD affects more black women, between 30 to 50 years old, and mainly are discovered during radiographic routine examinations because of usual asymptomatic signs. This is a case of a 48-year-old white female patient referred to the dental service for periodontal condition evaluation. Routine periapical radiographic examination observed numerous radiopaque calcified masses involved by radiolucent halo in apical region of teeth 31, 41, and 42. Sensitivity test showed pulp vitality. After clinical and radiographic evaluation, final diagnosis of the PBD was made. Biopsy was not necessary in this case, which is an invasive procedure in the involved areas and can lead to osteomyelitis. This report emphasis the importance of a correct diagnosis of PBD, avoiding unnecessary and incorrect treatments. Periapical bone dysplasia (PBD) is a benign fibro-osseous lesion that involves apex of vital teeth. Single lesions can occur; however, the multiple foci are more common, affecting anterior regions of the mandible. PBD affects more black women, between 30 to 50 years old, and mainly are discovered during radiographic routine examinations because of usual asymptomatic signs. This is a case of a 48-year-old white female patient referred to the dental service for periodontal condition evaluation. Routine periapical radiographic examination observed numerous radiopaque calcified masses involved by radiolucent halo in apical region of teeth 31, 41, and 42. Sensitivity test showed pulp vitality. After clinical and radiographic evaluation, final diagnosis of the PBD was made. Biopsy was not necessary in this case, which is an invasive procedure in the involved areas and can lead to osteomyelitis. This report emphasis the importance of a correct diagnosis of PBD, avoiding unnecessary and incorrect treatments.

EXTENSIVE AMELOBLASTIC FIBRO-ODONTOMA IN MANDIBLE-ASSOCIATED IMPACTED TOOTH

The ameloblastic fibro-odontoma (AFO) is a subtype of odontoma according to the World Health Organization (2017). It is considered a mixed benign odontogenic tumor with specific clinical, radiographic, and histopathologic features. We report a case of the AFO in an 11-year-old boy with complaints of not erupting the lower first right molar and slight increase of mandible volume. The patient presented discrete facial asymmetry, hard swelling, and painlessness in posterior region of mandible in right side. The imaging examinations showed an extensive radiopaque mass with delimited circumscribed radiolucent halo with cortical bone expansion of 3.0 × 2.5 cm × 2.0 cm, preventing eruption of permanent tooth U46. Histopathologic examination revealed presence of odontogenic epithelium and of ectomesenchyme associated with dental structures. Enucleation of the lesion was performed, preserving the impacted permanent tooth and allowing its eruption process. No recurrence was observed during follow-up of 6 months. The ameloblastic fibro-odontoma (AFO) is a subtype of odontoma according to the World Health Organization (2017). It is considered a mixed benign odontogenic tumor with specific clinical, radiographic, and histopathologic features. We report a case of the AFO in an 11-year-old boy with complaints of not erupting the lower first right molar and slight increase of mandible volume. The patient presented discrete facial asymmetry, hard swelling, and painlessness in posterior region of mandible in right side. The imaging examinations showed an extensive radiopaque mass with delimited circumscribed radiolucent halo with cortical bone expansion of 3.0 × 2.5 cm × 2.0 cm, preventing eruption of permanent tooth U46. Histopathologic examination revealed presence of odontogenic epithelium and of ectomesenchyme associated with dental structures. Enucleation of the lesion was performed, preserving the impacted permanent tooth and allowing its eruption process. No recurrence was observed during follow-up of 6 months.

Bilateral mandibular dentigerous cyst in non-syndromic patient: technical strategy and literature review

Bilateral mandibular dentigerous cyst in non-syndromic patient: technical strategy and literature review

Gambaran sementoblastoma tahap awal pada cone beam computed tomography (CBCT) 3D

Objectives: The purpose of this study was to report a case of mandibular cementoblastoma with radiologic approach and describe its characteristics.
 Case Report: A 32-year-old female came to the Hospital and complained of swelling of the left side of the lower jaw. Clinical examination showed a strong swelling in the buccal region of teeth 44-45, with the same soft tissue color as the surrounding tissue. In the picture cone beam computed tomography appears as a rounded lesion, the internal structure of the radiointermediet with clear and firm boundaries, surrounded by a halo radiolucent. Cementoblastoma radiodiagnosis is established. The patient was referred for surgery.
 Conclusion: Cementoblastoma was a benign tumor with radiographic characteristics in the form of clearly demarcated radiopaque lesion with radiolucent halo. Some early-stage lesions can show lower density.

GIANT COMPLEX ODONTOMA OF MAXILLA WITH EXPOSURE INTO ORAL CAVITY

A 32-year-old female patient was referred with a painful swelling on the right side of the maxilla. Medical history, trauma experience, and drug prescriptions were not significant. Clinically, the patient presented with asymmetry of the face with an extensive necrotic bone exposed into the mouth. The overlying skin was normal with no tenderness with normal mouth opening. The orthopantomogram revealed a large, well-defined radiopacity with radiolucent halo with corticated margin extending from the alveolar bone to zygomatic bone. An incisional biopsy was performed, and the microscopic analysis revealed an odontoma. The surgical approach with complete excision and the microscopic analysis of surgical sample revealed an odontoma associated with odontogenic cyst, and the patient is very well since the surgery. The dentists must be well aware of the clinical and radiologic findings of such lesions to provide prompt treatment with better prognosis.

NASOPALATINE DUCT CYST WITH SECONDARY INFECTION AND SULFUR LITHIASIS

The present study aims to report an interesting case of secondary actinomycosis infection of a nasopalatine duct cyst, with a radiopaque surfur granule and calculus formation. The patient, a 30-year-old female with light-brown color skin, was referred to the oral medicine service with spontaneous pain in the region of upper central incisors. During anamnesis, an endodontic treatment in tooth 21 was found. Periapical radiographic examination revealed a radiolucent, unilocular, well-defined, heart-shaped lesion in the midline. Scanning tomographic examination revealed a radiodense round substance surrounded by a radiolucent halo. A hypothesis of nasopalatine duct cyst with a foreign body was raised. Excisional biopsy of the lesion was performed revealing the presence of a brownish, granular, calcified material within the cystic lumen. Histopathologic examination elucidated the diagnosis with histochemical characterization of the actinomycosis infection. Postoperative follow-up of 12 months was uneventful. The microscopic characterization of sulfur lithiasis is discussed.

PHLEBOLITHS ASSOCIATED WITH VASCULAR MALFORMATION IN THE JUGAL MUCOSA

Stagnation of blood flow and thrombosis in vascular malformation (VM) have been known to cause phlebolith formation. The symptoms of VM with phleboliths are pain, stasis, swelling, and foreign body sensation. A 48-year-old white woman was referred to an oral diagnostic service presenting with swelling and pain in the face close to the right parotid gland. Clinical examination showed the presence of multiple nodules with poorly defined limits, with a mobile and rigid consistency in the region of the right buccal mucosa. Panoramic radiography demonstrate multiple lesions which were well delimited and of different sizes; further, they were radiopaque with a radiolucent halo area extending from the coronoid process area to the mandibular base. An x-ray with periapical film of the buccal mucosa on the right side was performed and the image was similar to panoramic view. Ultrasonography examination was requested and revealed a low-flow vascular abnormality in the region. The patient was referred to the vascular surgeon. Support: FAPEMIG.

Compound odontoma associated with a dentigerous cyst

Dentigerous cysts (DCs) and odontomas are lesions of odontogenic origin relatively common in the oral cavity with a rare recurrence after treatment. The purpose of this study is to present a case of association of odontoma with DC in the mandible of a young patient and to describe all cases published in English literature to date. A 16-year-old male patient presented with a well-defined unilocular radiolucent lesion associated with impacted mandibular right canine. Mesially, there was another lesion, mixed with small radiopaque structures, similar to dental structures surrounded by a radiolucent halo. The diagnosis of DC associated with compound odontoma was made. This case report associated with the literature review of other reports highlights that the association of DC with odontoma is rare and further studies are needed to investigate the probable etiology of this association.

True Cementoblastoma: a Case Report

A 24-year-old male patient, W.C.F., with melanoderma complained of a lump in the mandible. In the anamnesis, the patient reported that the lesion of 6 months' evolution had a slow growth and had been subject to trauma resulting in the formation of edema and hematoma. Extraoral examination revealed facial asymmetry, with increased volume in the body region and mandibular angle. Intraoral examination revealed a volumetric increase of 2 cm in diameter in the buccal vestibule near the lower molars, covered with a slightly hyperemic mucosa. Radiographic examinations were requested; these showed a radiopaque lesion well delimited by a radiolucent halo. Incisional biopsy was performed, and the specimen was sent for histopathologic examination; the results indicated a cementoblastoma. Subsequently, the patient was referred for resection of the tumor together with the structures involved. The patient is under clinical and radiographic follow-up and has made excellent progress.

Progress in the diagnosis of florid cemento-osseous dysplasia

Florid cemento-osseous dysplasia (FLCOD) is a rare, extensive bone metabolism disorder, which occurs only in the jaw bone. It is usually asymptomatic for a long time and discovered incidentally during a radiological examination. The characteristics of FLCOD in the initial stages are similar to those of periapical granuloma or jaw cyst, which may lead to misdiagnosis. After the lesion is mature, the imaging findings show that radiopaque with a thin radiolucent peripheral halo, which is crucial for the diagnosis of FLCOD, but other jaw lesions have similar imaging findings. Due to the poor blood supply of the lesion, the alveolar bone of root apices of vital teeth is slow to heal after trauma, increasing the chance of infection, which can lead to the osteomyelitis of the jaws and emerge sequestrum. This paper reviews the aspects of pathogenesis, clinical characteristics, diagnosis, differential diagnosis and treatment.

Hemimandibulectomy of an extensive complex odontoma in the mandible: a case report

Objective: Odontomas are the most common form of odontogenic tumors of the jaw, represent a benign hamartoma rather than a true neoplasm. They constitute 22% of all odontogenic tumors. Odontomas are consist of two types, compound and complex. The compound odontomas contain recognizable enalmel, dentin and sometimes cementum, shaped in toothlike structures; whereas complex odontomas are composed of irregular masses of dentin and enamel and have no anatomic resemblance to a tooth.Methods: A17-year-old female patient came to Department of Oral and Maxillofacial Surgery with a slow growing and asymptomatic swelling in her left mandible. The panoramic radiograph showed a radioopacity and radiolucent lesion, with well-corticated limits. The radioopaque area was amorphous, circumscribed by a thin and irregular radiolucent halo. An inscisional biopsy confirmed the lesion as a complex odontoma. The surgery performed was hemimandibulectomy followed by a reconstruction using a plate under general anaesthesia.Results: Complex odontomas are most likely to be found in the posterior region of the maxilla or the mandible and can be treated with a simple enucleation and curettage. In this case report the hemimandibulectomy was performed due to the extensiveness of the mass.Conclusion: Surgical removal of large complex odontoma with hemimandibulectomy is a rare clinical scenario. The extensiveness of the lesion contributed to its removal technique.