A 36-year-old woman, with no morbid history, presented with asymptomatic increase in left posterior mandibular volume of 2 years of evolution.
Clinical examination revealed a slight increase in volume in the left mandibular angle area.
Inspection and consolidation intraoral showed bicortical expansion of the edentulous left molar zone, extending posteriorly, with hard consistency, defined limits and mucosa that covers it with a healthy appearance.
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A study was conducted with Cone Beam, in which a mixed radiologic lesion with defined edges and corticalized was observed, with expansion of both bone tables, in the area of the body and left mandibular angle.
Its approximate dimensions were: length: 3.5 cm; height: 2.5 cm; width: 2 cm. The anterior radiolucent aspect and posterior radiopaque stand out, with formation of hard tissue distal dentin density presence towards third molar base, together with
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With the background obtained, as initial diagnosis, mainly from the radiographic point of view, two mixed lesions were considered: ameloblastic fibroodontoma and calcifying epithelial odontogenic tumor.
An aspiration puncture was performed, without obtaining a positive result, and then an incisional biopsy was taken, through which tissue of firm consistency belonging to the most anterior part of the tumor was obtained.
The histopathological study determined the presence of lax fibrous connective tissue with an important fibrotic myxoid area which led to determining a variety of odontomorphous lesions. In addition, a thorough review of the literature was made of the histologically available.
It was then decided to perform, under general anesthesia, the enucleation of the tumor with curettage of the residual cavity (to minimize the possibility of recurrence) and the placement of a plate of osteosyntesis at the basal border fracture.
The operation was performed using a submandibular extraoral approach, which facilitated the manipulation and placement of the osteosyntesis plate.
A wide vestibular window was opened in order to perform the complete exeresis of the tumor, which was finally achieved in two stages: first the anterior part of the tumor, with more fibrous consistency, and then the posterior calc (posterior part).
There were no intraoperative complications, but the alveolar nerve was practically contained in the calcified posterior mass, which marked its separation in order to preserve it in its entirety.
Although the defect was extensive and produced a significant decrease in the mandibular ridge, the lingual bone plate was already preserved in placement of a bone graft, as well as the mesial and distal limits of the tumor, so the regeneration was not considered healthy.
The final histopathological study confirmed the presence of calcified material, reported as dental structure and laminillar bone tissue, and the definitive diagnosis of odontogenic fibroma type WHO was obtained.
The patient presented with transient hypoesthesia and there was no recurrence of the lesion in 18 months of follow-up.
