A four-year-old boy was referred from the diagnostic service of the Universidad Mayor to Dr Luis Calvo Mackenna Pediatric Hospital for evaluation of an asymptomatic increase in volume in the right mandibular zone.
The mother reported not having noticed an increase in volume until the moment of referral, and that the child never complained of pain or functional impotence.
The patient had no relevant morbid or surgical history.
Extraoral examination revealed a firm, painless swelling in the right mandibular body and ramus, without skin involvement.
No lymphadenopathy was recorded.
There was no associated sensory compromise and the mandibular functional examination was normal.
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Upon intraoral examination, the patient presented complete temporal dentition and a large volume increase that compromised the right side of the body and branch. The mucosa was painless and hard tough.
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In the panoramic view of the Beam Cone, an extensive unilocular unilocular well-defined radiolucent lesion could be observed, with variable radiopacities content similar to dental structures distally extending from the mandibular ramus.
The lesion caused displacement towards the basilary edge of the germ of the first permanent molar, while the second permanent molar was not observed.
Compromise of the anterior edge of the branch, alveolar ridge and basilar edge was observed.
In the coronal section, the expansion of the buccal bone plate and the inferior displacement of the inferior dental canal could be especially appreciated.
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An incisional biopsy of the lesion was performed.
Histopathological examination stained with hematoxylin-eosin showed fibrous connective tissue with areas of dental tissue with varying degrees of calcification similar to dentin or dentinoid tissue, all in relation to odontogenic epithelium.
In addition, areas similar to dental papilla with epithelial proliferation arranged in cords and islots with peripheries similar to ameloblasts were observed, and towards the center tissue that recalled the stellate reticulum.
The histopathological diagnosis was FOA.
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With this diagnosis, definitive surgery was planned.
Under general anesthesia, the approach was performed at the level of the anterior edge of the right mandibular ramus.
Bone exposure showed significant expansion in the mandibular buccal bone table, on which an osteotomy was performed which allowed access and subsequent complete enucleation, followed by cavity conditioning and suturing with Vycril 4.0.
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In the postoperative management of the patient was used antibiotics and conventional analgesia in conjunction with revulsive and soft diet.
The latter lasted for one month.
The patient remains under regular monitoring in the immediate and late postoperative period and, currently, after one year postoperatively, is in very good condition.
