Aneurysmal bone cyst of the mandibular condyle

INTRODUCTION: Aneurysmal bone cyst (ABC) is a pseudotumor of bone consisting of a septated cystic cavity filled with blood. CASE: We report a case of aneurysmal bone cyst of the left mandibular condyle discovered in a 10-year-old child with a history of mandibular trauma which had occurred one year earlier. The treatment consisted in surgical excision of the lesion and reconstruction using a chondro-costal graft. The post operative development led to a chondral hyperplasia. DISCUSSION: We discuss the pathogenesis of the ABC centered on three theories, traumatic, vascular and tumoral of primary lesion. There are several complementary examinations to establish the diagnosis of ABC but the histopathological examination is the only way to confirm the diagnosis. The differential diagnosis of ABC is not an easy task. Surgical management with removal followed by immediate reconstruction is preferred.     

Mandibular hemangiopericytoma, a malignant vascular tumor

INTRODUCTION: Hemangiopericytoma is a rare tumor, arising from pericytes, which are perivascular cells belonging to the capillar walls. OBSERVATION: A 41 year old man consulted for a mandibular tumor. The clinical and radiographic diagnosis was difficult. The biopsy performed in the operative room led to an embolization decided in emergency, and proved the definitive diagnosis. Despite the embolization, bleeding during surgical excision of the tumor compelled us to perform an external carotid artery ligature. The mandibular reconstruction was performed using a trapezium osteo-muscular flap. DISCUSSION: As reported in the literature, the radiographic diagnosis of hemangiopericytoma is difficult, the malignant potential is variable and the recommended treatment is surgical excision.     

Teratoid cyst: a rare tongue tumor in children

BACKGROUND: Dermoid cysts are rare benign tumours (only 20 cases have been reported) with 3 different histological types. Only 5 cases of teratoid cyst of the tongue have been described in the world literature, characterized by a respiratory cilied epithelium. OBSERVATION: We report the sixth case, in a one-year-old boy with a macroglossia and permanent protrusion of the tongue. Ultrasonography showed a kystic, ovoid, homogeneous cyst. Treatment was a surgical resection. DISCUSSION: This case is similar to the other cases reported in the literature.     

Kyste osseux anévrismal de la mandibule

The aneurysmal bone cyst is a rare, expansive, osteolytic, pseudocystic lesion with an unknown etiology. It usually affects long bones and the spine. Two to 5 % of cases have mandibular localization (between 75 and 100 % present on the mandible) accounting for 1 % of all mandibular cysts. Less than 200 cases have been reported in English and French literature.     

Metastatic prostate carcinoma mimicking a parotid tumor: a case report

We report a case of prostate carcinoma metastatic to the mandible that had been initially suspected as being a primary tumor of the parotid. The initial symptom was hard swelling in the left parotid region. No pathologic fracture was diagnosed. The metastatic lesion was diagnosed 4 years after diagnosis of the carcinoma of the prostate. This is a very interesting event because of its unusual localization.     

Adenomatoid odontogenic tumor mimicking a dentigerous cyst

Adenomatoid odontogenic tumor (AOT) is a slow-growing, asymptomatic and uncommon lesion that arises from odontogenic epithelium with inductive effects on connective tissue. The more common variant is the follicular type, which involves an unerupted tooth and is often mistaken for a dentigerous cyst. Histopathologic examination demonstrates cuboidal or spindle-shaped epithelial cells forming aggregates or rosette-like structures with minimal connective tissue, and cuboidal or low columnar cells forming glandular duct-like structures. Treatment is complete enucleation, and recurrences are rare. We presented a case of AOT in a 14-year-old male presenting as a cystic mass around an unerupted tooth.     

Mandibular asymmetry in plagiocephaly without synostosis

SUBJECT: The number of plagiocephalies without synostosis (PWS) strongly increased in the last decade. Its impact on the mandible remains badly understood, the more so as there are various forms of PSS. The purpose of this study was to analyze mandible deformation according to the deformation of PWS. MATERIAL AND METHODS: The study was carried out retrospectively starting from three-dimensional scans of children presenting with a PWS. They were classified in 2 groups according to the deformation of the cranium. There were 51 frontal plagiocephalies (PF) and 19 occipital plagiocephalies (PO) for which the cephalic index was calculated. The position of the mandible compared to the base of cranium and its intrinsic asymmetry were analyzed (paired parametric Student test). RESULTS: The mandible was symmetrical in PO whereas it was asymmetrical for PF. This asymmetry was present at the level of the corpus and developed in 2 ways: that is to say asymmetry compensated for that of the base of the cranium (68.6%); or it worsened it (23.5%). The degree of brachycephaly was more important in PO than the PF with a cranial index of 0.93+/-0.07 and 0.85+/-0.07 respectively (P<0.05). In both cases the position of the mandibular condyle followed the asymmetry of the base of cranium and the asymmetry of the temporomandibular joint (TMJ) was secondary with that of the base of cranium. DISCUSSION: In addition to the asymmetry of TMJ position there was an intrinsic mandibular asymmetry in PF which was not found in PO. This asymmetry of the mandible was variable but in most cases it tended to compensate for the asymmetry of the base of the cranium which was more important in PF. The risk to have asymmetry of dental occlusion seems more important in PF than in PO, and an orthodontic follow-up appeared to be justified for these children.     

A rare aneurysmal bone cyst of the maxillary sinus: a case report

Aneurysmal bone cyst (ABC) is a non-neoplastic expansile bone lesion that is common in the long bones; only 2% occurs in the head and neck. We present a case of ABC in a 23-year-old male and describe the clinical and radiological features, histopathology and treatment. Magnetic resonance imaging (MRI) demonstrated multiple internal septations, cysts with fluid-fluid levels of varying intensity, and an intact rim of low-intensity signal completely surrounding the lesion. The tumor was removed by enucleation with resection of the lateral nasal cavity. Histopathologic diagnosis was ABC and fibrous dysplasia. We suggest that MRI is very useful for the diagnosis of ABC. ABC is thought to follow other lesions, and thus when treating ABC, it is important to determine whether any pre-existing lesion has preceded or not; in particular, if the lesion site is in the head and neck region.     

Aggressive aneurysmal bone cyst of the maxilla confused with telangiectatic osteosarcoma

Aneurysmal bone cyst (ABC) is a benign, expansile lesion typically affecting the long bones and vertebrae of patients younger than 20 years. Approximately 2% of ABCs occur in the head and neck region, most commonly affecting the mandible. Although the most common co-existing lesion associated with ABCs is the giant cell tumor, ABCs can be radiologically confused with telangiectatic osteosarcoma in cases of aggressive behavior and rapid growth. Here, we report a case of an aggressive ABC of the maxilla confused with telangiectatic osteosarcoma in a patient who underwent several operations for an osteoblastoma that was diagnosed histopathologically. This case highlights the need for a differential diagnosis both radiologically and histopathologically, because ABCs can easily be interpreted as a giant cell tumor or an osteoblastoma, and, on occasion, can be mistaken for osteogenic malignancies.     

Clinical pathological analysis of nine cases of aneurysmal bone cyst of the jaws in a Brazilian population

Aneurysmal bone cysts (ABCs) are benign osteolytic lesions that occur rarely in the jaws. The aim of this study was to investigate the clinical, radiographical and pathological features of ABCs of the jaws. A retrospective analysis of the content of a 39-year database, including nine cases of ABCs of the jaws diagnosed from the archives of the Oral Pathology Service. Nine patients (3 males and 6 females), ranging in age from 5 to 33 years were included. Seven (7/9) lesions were located in the mandible and two (2/9) in the maxilla. A painful swelling was the most common clinical finding (n = 4, 4/9). Radiologically, the lesions frequently presented as multilocular (5/9), well defined (4/9), bone expansion and perforation (2/9). Pathological analysis revealed that two cases were associated with central ossifying fibroma and one case with central giant cell lesion. Histomorphology showed a predominance of the solid type (5/9) and of sinusoidal pseudocystic spaces (4/9). Giant cells, osteoid material, calcified material, blood vessels and hemosiderin deposits were observed in 6/9, 7/9, 8/9, 9/9 and 7/9, respectively. The patients with ABCs presented clinical and radiographical features, which often posed a diagnostic dilemma. Knowledge about the most common characteristics of ABCs may contribute to the establishment of a more accurate diagnosis.     

Primary aneurysmal bone cyst of the maxillary sinus in a child: case report and review of the literature

Our case report describes a primary aneurysmal bone cyst (ABC) of the maxillary sinus in a 12-year-old girl. The young patient presented with progressive diplopia, strabismus, and rapidly growing painless swelling of the left cheek. Imaging studies showed a heterogeneous contrast enhancing mass expanding the left maxillary sinus. The lesion was completely resected endoscopically and histological examination reported it as an ABC. The patient recovered well and is free of recurrence 9 months following surgery. ABC is a benign lesion usually associated with other bone pathology (fibrous dysplasia). It may behave aggressively and invade the orbit; so resection is necessary. Minimally invasive techniques such as endoscopic sinus surgery can be performed successfully in select cases. Long follow up is important because recurrence may occur, in which case further resection is warranted.     

Lymphoma mimicking a thyroglossal duct cyst in an adolescent

Mass lesions of the head and neck in infants and children can be either developmental, inflammatory or neoplastic. Lymphomas (Hodgkin's or Non-Hodgkin's) commonly present as neck lumps in children. Although malignancy is not the commonest aetiology of paediatric cervical lumps, a high index of suspicion is critical to facilitate early diagnosis and treatment of cervical lesions. We present the case of a 15-year-old boy who presented with a solitary midline cervical lesion, which simulated a thyroglossal cyst on clinical examination. However, histopathological examination revealed it to be a Hodgkin's lymphoma. Related literature is also reviewed.     

Mandibular osteomyelitis in children mimicking juvenile recurrent parotitis

Objective

To describe pediatric cases with mandibular osteomyelitis initially diagnosed and treated as juvenile recurrent parotitis.

Methods

We reviewed the patient data of all our pediatric patients treated at Helsinki University Central Hospital, a tertiary care hospital, between 1998 and 2010 who had the initial diagnosis of recurrent parotitis which in fact was osteomyelitis.

Results

Over a period of 12 years, six children (aged 5-17 years, five girls) presented with mandibular osteomyelitis primarily diagnosed as recurrent parotitis. Diagnostic delay ranged from 1.5 months to 6.0 years before the final diagnosis of mandibular osteomyelitis confirmed in MRI. Of the six cases undergoing biopsies, bacterial culture showed Actinomyces or Streptococcus viridans in four cases. All patients received antimicrobial treatment. Two received hyperbaric oxygen therapy with no resolution of symptoms. Debridement was performed in these two cases as well, and in the second case persistent symptoms led to bisphosphonate treatment.

Conclusions

Juvenile parotitis is in most cases a clinical diagnosis, and treatment is symptomatic. In contrast, mandibular osteomyelitis is a severe disease requiring lengthy treatment. Because symptoms of these two entities may mimic each other, unclear cases require MRI.     

Foreign body mimicking a nasal bone fracture

Nasal foreign bodies are common in young children and are typically the result of intranasal placement by the child. The authors report a case of an extranasal foreign body in an adult, which presented as a nasal fracture following trauma to the nose. This uncommon presentation, previously unreported in the literature, highlights the importance of careful history taking in cases of nasal trauma and of thorough wound exploration if any penetrative injury is found.     

Melanotic schwannoma of the neck mimicking a malignant melanoma

We report a case of a 42-year-old female patient who presented with a 5-month history of a right cervical swelling. A fine-needle aspiration biopsy performed elsewhere led to the diagnosis of malignant melanoma. Clinical examination revealed pigmented skin and mucous-membrane lesions of the pharynx. Diagnostic exstirpation of the cervical tumor resulted in the intraoperative diagnosis of a malignant melanoma. Subsequent pathological examination including ultrastructural analysis allowed the revision of the diagnosis to that of melanotic schwannoma, a rare, pigmented nerve sheath tumor. Further analysis of the tissue obtained from neck dissection revealed additional melanotic schwannomas. With regard to prognostic and therapeutic issues, it is necessary to differentiate these tumors from the more common metastatic malignant melanoma. The preoperative differential diagnosis is very difficult, as light microscopy and immunocytochemistry allow no discrimination in small biopsies. Although the occurrence of multiple schwannomas points to a hereditary syndrome, our patient did not fulfill the criteria of Carneys syndrome or other known syndromes, suggesting a so far unknown genetic background.     

Submandibular approach to anterior C2-C4 disc space in the management of an aneurysmal bone cyst

We report a case of a ten-year-old girl with a large posterior neck mass, an aneurysmal bone cyst involving the upper cervical spine.Patient underwent tumor resection through a posterior approach and required subsequent anterior fusion and instrumentation of C2-C4 for stability. We describe a challenging transcervical submandibular approach that allowed anterior cervical discectomy with placement of interdisc spacer using pre-contoured allograft and plating to achieve anterior fusion. We demonstrated that this approach is safe and effective in children, and provides excellent visualization for direct access with a surprisingly large operative field for instrumentation.     

Transnasal endoscopic surgery for the treatment of fibrous dysplasia of maxillary sinus associated to aneurysmal bone cyst in a 5-year-old child.

Fibrous dysplasia (FD) and aneurysmal bone cyst involving the facial skeleton are rare but their synchronous association in other parts of the body is well-known. The most common treatment for these lesions has been based on surgical resection using an external approach. Only recently has the endonasal endoscopic approach been utilized for the partial or complete removal of these lesions. In this report, we attempt to outline the effectiveness of the endonasal endoscopic approach for the treatment of a 5-year-old child affected by a fibrous dysplasia associated with an aneurysmal bone cyst of the right maxillary.