case_images: PMC4556817_01
case_images: Computer simulation of patient with a large swelling on the lower right side of his face.
case_images: CRIM2015-567543.001.jpg
case_images: PMC4556817_01_CRIM2015-567543.001.jpg
case_images: fig1
case_images: Oral Oncology at the University of Mississippi Cancer Institute with the chief complaint of swelling in his right mandible that had been present for approximately one year (Figure 1). Oral exam revealed a 5.0 x 7.0 cm bulbous mass arising from the mandible and obliterating the right side of the oral cavity.
case_images: (a) Axial CT image. (b) CT scan, sagittal view.
case_images: CRIM2015-567543.002.jpg
case_images: PMC4556817_01_CRIM2015-567543.002.jpg
case_images: fig2
case_images: A computed tomography (CT) scan (Figures 2(a) and 2(b)) showed an expansile osseous lesion, involving the entire height of the mandible and extending from the right first premolar all the way posteriorly to involve the ramus and coronoid process.
case_images: Photomicrograph of the mandibular brown tumor showing numerous multinucleated giant cells dispersed in a highly cellular stroma (H&E, magnification x200).
case_images: CRIM2015-567543.003.jpg
case_images: PMC4556817_01_CRIM2015-567543.003.jpg
case_images: fig3
case_images: Microscopically, the lesion was composed of a highly cellular proliferation of bland spindle-shaped fibroblastic cells with numerous multinucleated giant cells (Figure 3) and spicules of woven bone.
case_images: Photomicrograph showing brown tumor of hyperparathyroidism. Multinucleated giant cells surrounding a spicule of bone are visible amidst a proliferative fibroblastic stroma (H&E, magnification x400).
case_images: CRIM2015-567543.004.jpg
case_images: PMC4556817_01_CRIM2015-567543.004.jpg
case_images: fig4
case_images: The osteoclastic giant cells were scattered throughout the cellular stroma and surrounded small spicules of bone (Figure 4).
case_images: Photomicrograph showing osteoclastic bone resorption and fibrosis in secondary hyperparathyroidism (H&E, magnification x200).
case_images: CRIM2015-567543.005.jpg
case_images: PMC4556817_01_CRIM2015-567543.005.jpg
case_images: fig5
case_images: The native bone showed evidence of intense bone resorption secondary to osteoclast hyperactivity and marrow fibrosis, consistent with secondary hyperparathyroidism (Figure 5).
case_images: Medical model demonstrating the extent of the expansion of this lesion.
case_images: CRIM2015-567543.006.jpg
case_images: PMC4556817_01_CRIM2015-567543.006.jpg
case_images: fig6
case_images: This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6 -8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543).
case_images: (a) Access to large brown tumor via lip split mandibulotomy approach. (b) Reconstruction bar placement.
case_images: CRIM2015-567543.007.jpg
case_images: PMC4556817_01_CRIM2015-567543.007.jpg
case_images: fig7
case_images: This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6 -8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543).
case_images: Final surgical specimen.
case_images: CRIM2015-567543.008.jpg
case_images: PMC4556817_01_CRIM2015-567543.008.jpg
case_images: fig8
case_images: This was done via a transcervical lip splitting approach due to limited access from the extensive size of the tumor (Figures 6 -8 and supplemental video in Supplementary Material available online at http://dx.doi.org/10.1155/2015/567543).
case_images: Simulated surgical procedure.
case_images: CRIM2015-567543.009.jpg
case_images: PMC4556817_01_CRIM2015-567543.009.jpg
case_images: fig9
case_images: Virtual surgical planning was utilized to help plan the mandibular resection as well as the reconstruction bar placement (Figure 9).