A 24-year-old woman complained of facial palsy and progressive growth of mental illness over a 2-year period.
In addition to the aesthetic impact, the patient had difficulty chewing and even constipation.
It had been evaluated in several specialized centers, being rejected for treatment, given the dimensions and location of the lesion.
Extraoral clinical examination revealed a large chin tumor with severe aesthetic repercussions.
This tumor protruded in a very striking way to the floor of the anterior mouth and associated mobility of the lower jaws, without pain at palpation.
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Orthopantomography showed a poorly defined, poorly defined, glassy lesion in the mandibular body ranging from 4.6 to 3.8.
CT with 3D reconstruction confirmed the presence of a 6.5 x 4.5 x 4.5 cm lesion that affected practically the entire mandibular body, with expansive growth to the floor of the mouth.
Biopsy samples were compatible with fibrous dysplasia.
Systemic evaluation with cranial SPECT, with bone scan and vascular bone scintigraphy ruled out extracranial involvement.
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The dimensions of the lesion, the patient's age and the progressive nature of the disease, dismissed due to inappropriateness and contraindication, justifying the adoption of a radical attitude.
From the 3D CT a stereolithographic model of the jaw was obtained by planning the resection and preforming the reconstruction plate.
An angle-to-angle mandibulectomy was performed with a low cervical incision for aesthetic reasons.
The reconstruction was performed using a microvascularised fibular graft fixed on a preformed reconstruction plate.
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The lesion was anatomopathologically described as a solid nodular tumor, apparently well-defined, of 6.8 x 5.7 x 5.1 cm, which in the section had an indurated consistency, a macroscopically homogeneous white bone plate.
Nobelactive Internal RP implants were placed, and 6 months later the second surgery was performed.
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Controls performed 12 months after implant insertion showed adequate osteosynthesis.
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Two years after surgery, masticatory function has been rehabilitated with implant-supported prostheses.
The patient maintains a very satisfactory aesthetic appearance, with complete recovery of swallowing function and voiding.
