Clinicopathologic conference| Volume 115, ISSUE 4, P431-435, April 2013

A rapidly enlarging mandibular swelling

Published:April 30, 2012DOI:
      A 12-year-old boy presented to the Department of Oral and Maxillofacial Surgery with a 2-week history of a mass in the lower right molar region. Over that period it had rapidly enlarged, but was not associated with any discomfort. The first molar tooth had been extracted 18 months before presentation for unrestorable dental decay. There was no history of trauma or further dental symptomatology. His past medical history was unremarkable, he was systemically well, and there was no family history of note. Intraorally, there was a 4 × 2-cm nontender ulcerated mass centered at the first molar socket (Figure 1) . The upper teeth occluded with the mass, and, extraorally, there was mild fullness in the region, but no erythema. There was no palpable lymphadenopathy, and systemic examination was normal. A full blood count, urea, electrolytes, liver function tests, and calcium were all within the normal range. Panoramic radiography (OPG) demonstrated developing dentition with absence of the lower right first molar tooth. There was evidence of a soft tissue mass arising from this region, with an apparent underlying lucency of the mandibular bone. A computed tomography (CT) scan of the region confirmed destruction of the lingual cortex of the mandible with some periosteal new bone formation. The soft tissue mass was poorly delineated, with evidence of calcification (Figure 2, A and B, Figure 3) . A 6-mm right submandibular lymph node and several small submental nodes were evident.
      Figure thumbnail gr1
      Fig. 1Clinical presentation of a well-defined nontender ulcerated mass centered on the lower right first molar socket.
      Figure thumbnail gr2
      Fig. 2A and B, Axial CT scan demonstrating a mass in the lower right quadrant, with erosion of lingual cortex. There is a Whitehead's varnish pack (antiseptic solution) in the tooth socket, giving rise to an appearance of a calcified mass.
      Figure thumbnail gr3
      Fig. 3Three-dimensional reconstructed CT image with irregular nature of the lingual cortex bony erosion.
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