Successful mandibular reconstruction for a boy with Trabecular juvenile ossifying fibroma

mandibular reconstruction

This is a 10-year-old boy from Vadodara. He presented to our hospital with a large swelling on the right side of the face. This was first diagnosed as a ‘cyst’ elsewhere. He had already undergone enucleation of the cyst, but that surgery was unsuccessful. His father stated that the swelling returned with an increase in size and caused a great deal of pain.
The parents were very worried about his future due to recurrence. His parents had searched the Internet for the facial deformity correction surgeon. Their search had led them straight to our hospital.
Dr SM Balaji examined the patient. Radiographic investigations obtained at our hospital showed a mixed radiolucent and radiopaque lesion. This lesion was extending from the right ramus to the body of the mandible. It had a ground glass appearance. Histopathological examination confirmed it to be trabecular juvenile ossifying fibroma. Treatment planned for the patient included a right hemimandibulectomy. The parents were in complete agreement with the proposed treatment.
Preoperative digital OPG showing huge expansile osteolyticlesion involving right ramus, angle and body of the mandible
Preoperative 3DCT showing huge osteolytic lesion involving entire right side of the mandible
A Buccolingual expansile osteolytic lesion involving right side of the mandible
Preoperative facial view shows swelling in right side of the face
Rib graft obtained to reconstruct the affected portion of the mandible
A Huge expansile bony lesion involving the entire right ramus and body of the mandible
Mandible reconstructed with cc graft and reconstruction plate
Immediately after suturing
Postoperative digital OPG showing complete removal of the lesion and reconstruction using plate and rib graft
Resection of fibroma was first done followed by a right hemimandibulectomy. The defect was then reconstructed using a mandibular reconstruction plate and costochondral grafts. This resulted in symmetry of the patient’s face. The parents were very happy with the outcome of the surgery.
smbalaji:
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