Treatment

Under IV sedation and in a transoral approach along the lateral left mandible, the area was subperiosteally dissected to the inferior border of the mandibular ramus. The lateral cortex bone was removed where dense fibrous tissue with a gritty consistency was encounter. There was no evidence of a bony cavity; the area was filled with solid material. Small fragments of this tissue were removed and submitted for histological evaluation. The surgical area was thoroughly irrigated and the soft sutured with 3.0 chromic gut suture. The patient was placed on Vicodin and a week of amoxicillin. At two week follow-up, patient complained of moderate discomfort. The area was healing well and the patient was placed on three-month follow up visit for repeat CT and panoramic radiographs.

Incisional and excisional biopsy

The incisional biopsy demonstrated multiple fragments of decalcified hard and soft tissue made up of a benign fibro-osseous (figures 3 & 4). It is composed of irregularly shaped woven-type bony trabeculae surrounded by slightly cellular fibrous connective tissue stroma. The bony trabeculae are of variable shapes and sizes, some are curvilinear. They show very little osteoblastic rimming. In focal areas, the connective tissue stroma is artifactually mildly retracted from the bony trabeculae (Figure 4).

 

Figure 3 Low power (x100) histology shows a benign fibro-osseous type lesion with small and irregular bony trabeculae, some with curvilinear morphology. The connective tissue stroma is moderately cellular.

Figure 4 Higher power (x200) histology shows the irregular shaped bony trabeculae lacking osteoblastic rimming and directly lined by fibroblasts of the surrounding connective tissue stroma. Note the slight retraction of the connective tissue from the bony trabeculae.