case_images: PMC10550332_01
case_images: Panoramic radiograph of the maxillary. A radiolucent cystic and osteolytic lesion localised in the retromolar trigone can be seen in proximity to teeth 47 and 48.
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case_images: The panoramic radiograph of the maxillary bones showed a radiolucent lytic area in proximity to teeth 47 and 48 (Figure 1).
case_images: CT with intravenous contrast. Both the soft tissue window (a) and bone windows (b-c), shows an osteolytic lesion with right mandibular body and ramus involvement, localised in the retromolar space behind tooth number 48. The lesion features soft tissue components and presents lingual cortical disruption. It shows the involvement of the adjacent inferior alveolar nerve canal. It measures approximately 29 x 23 x 11 mm in size.
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case_images: The computed tomography (CT) (Figure 2) confirmed the presence of the 29 x 23 x 11 mm lesion described on the radiograph, which showed lingual cortical disruption and mandibular body and ramus involvement.
case_images: 3D Stereo-lithographic planning. (a) Lesion in red in relation to the inferior alveolar nerve and teeth. Cutting guides with adequate oncological margins and prefabricated angulation for their subsequent reconstruction were provided. (b and c) Cutting lines made on the right fibula for the incorporation of bone fragments, an accurate subsequent osteosynthesis and reconstruction of the new mandible.
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case_images: The resection range and the reconstruction of the length and angle of the fibula were prefabricated using 3D stereo-lithographic reconstruction models (Figure 3).
case_images: (a) Layout established for the free fibula flap approach. (b) Resected fibular fragment alongside the peroneal muscle and vascular bundle. The bone fragments were moulded and fixed to the titanium reconstruction plate. (c) Highlights the anastomosis of the peroneal veins to the facial artery, the external jugular vein, and the facial vein. It also shows its fixation to the remaining right mandible using a titanium reconstruction plate.
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case_images: Histopathology. Haematoxylin and eosin stain (10x). (a) Atypical epithelial proliferation consisting of mucinous, intermediate and squamous cells. The cells described form solid nests that line glandular spaces, some with cystic dilations and extracellular mucin. (b and c) Epithelial proliferation with similar characteristics and active compact bone tissue involvement.
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case_images: The intermediate-grade mucoepidermoid carcinoma diagnosis was confirmed based on histopathology (Figure 5).
case_images: Second post-operative month. Both figures (a) and (b) show the correct lateral and anterior projection of the reconstructed mandible. The patient has on-going masticatory function rehabilitation exercises.
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case_images: The patient does not have any major therapeutic procedure side effects and has on-going rehabilitation (Figure 6).