case_images: PMC4073470_01
case_images: Panoramic radiography showing a lesion on left temporomandibular joint involving ramus and coronoid process extending till sigmoid notch
case_images: AMS-4-85-g001.jpg
case_images: PMC4073470_01_AMS-4-85-g001.jpg
case_images: F1
case_images: Panoramic radiograph revealed a mixed lesion measuring about 4 cm x 3 cm with osteolytic and osteosclerotic changes on the medial aspect of left mandibular condyle extending until the sigmoid notch [Figure 1a]. Computed tomography (CT) scan confirmed a 5 cm x 3 cm osteolytic and osteosclerotic lesion with three areas of cortical perforation along the medial aspect of the lesion with soft-tissue mass extending in to the infratemporal fossa and cortical expansion on the lateral aspect of mandibular condyle along with intra lesional calcifications [Figure 1b].
case_images: Computed tomography scan showing a osteolytic and osteosclerotic lesion of 5 x 3 cm with cortical expansion on lateral side with three areas of cortical perforation on medial side with intra lesional calcifications
case_images: AMS-4-85-g002.jpg
case_images: PMC4073470_01_AMS-4-85-g002.jpg
case_images: F2
case_images: Through high cervical submandibular incision, subplatysmal flap was raised [Figure 2a]. The lower border of the mandible was identified and subperiosteal dissection was done until the lesion was exposed in glenoid fossa [Figure 2b]. Osteotomy cut was placed in the angle region with tumor clearance margins of 1.5 cm [Figure 2c]. Hemostasis of inferior alveolar vessels was achieved [Figure 2d]. The lingual attachments to the mandible were stripped along with the lateral pterygoid muscle and disarticulation of the condyle [Figure 2e and f] was done along with discectomy.
case_images: Marking of high cervical submandibular incision and dissection in layers
case_images: AMS-4-85-g003.jpg
case_images: PMC4073470_01_AMS-4-85-g003.jpg
case_images: F3
case_images: A 2.5 mm titanium reconstruction plate was fixed with 2.5 mm x 8 mm titanium screws to maintain the anatomical contour of the mandible [Figure 3].
case_images: Subperiosteal dissection of mandible to expose the lesion
case_images: AMS-4-85-g004.jpg
case_images: PMC4073470_01_AMS-4-85-g004.jpg
case_images: F4
case_images: The chondrocytes show enlarged nuclei with nuclear hyperplasia hyperchromatism [Figure 4a and b]. Myxoid matrix was strikingly prominent with foci of intra lesional calcifications [Figure 4c].
case_images: Osteotomy cut placed at the angle region with a clearance margins of 1.5 cm
case_images: AMS-4-85-g005.jpg
case_images: PMC4073470_01_AMS-4-85-g005.jpg
case_images: F5
case_images: Patient was free from locoregional occurrence for a follow-up of 1 year [Figures 5 and 6].
case_images: Completion of osteotomy and hemostasis of inferior alveolar vascular bundle
case_images: AMS-4-85-g006.jpg
case_images: PMC4073470_01_AMS-4-85-g006.jpg
case_images: F6
case_images: Patient was free from locoregional occurrence for a follow-up of 1 year [Figures 5 and 6].