Clinical  and Radiographic Findings

The patient was a thin, elderly man with a disheveled appearance. He was noted to have Hornerís syndrome on the right side of his face. An oral examination found multiple missing teeth and an upper complete denture (Fig 2). He had full mandibular range of motion. The left posterior alveolar ridge showed a large, ulcerated, necrotic and exophytic mass extending downward into the floor of mouth. The lesion was foul-smelling. A panoramic radiograph (Fig 2) demonstrated irregular bony destruction leading to the saucerization of the alveolar ridge. However, further irregular bone destruction is noted below this concavity, extending downward. In addition to the bony destruction, a large exophytic soft tissue mass is identified radiographically. Reactive bone is noted medial to the lesion and on both sides of the mandible where there appears to be a defect from the wisdom teeth.

Figure 2. Panoramic view demonstrating upper complete denture and mandibular multiple missing teeth. Left posterior mandible shows evidence of bone destruction and an exophytic soft tissue mass.