Observation
This is a 52-year-old woman, living in Ambalavao Fianarantsoa
Madagascar, who came to the Maxillofacial Surgery Department of the
Tambohobe University Hospital in Fianarantsoa for a large right
mandibular swelling. Her disease has been evolving for 4 months with
progressive and rapid appearance of the swelling in an apyretic context
without any notion of trauma but notion of right lower molar pain.
She is neither an alcoholic nor a smoker. She has no particular defects.
She has no personal or family history of malignant neoplasia.
Exobuccal examination found a well-limited mandibular tumor that was
body to bone, mobile cutaneously, painless, and nonbleeding (Figure 1).
The consistency was partly hard and partly firm. The size was
approximately 15 cm long. There was no palpable cervical adenopathy.
Endobuccal examination found a tumor of the same characteristic with
invasion of part of the oral floor and mobility of all right mandibular
teeth and teeth 31, 32.
Cranial X-ray (Figure 2) showed a large, mallimited, heterogeneous
mandibular opacity of the entire ramus with a ”grass fire” image in the
periphery and osteolysis of the right mandibular horizontal. Cervical
ultrasound did not reveal any cervical adenopathy. The biological workup
was unremarkable.
We proceeded to an extended surgical excision consisting of a right
interrupting hemimandibulectomy extending back to 33 (Figure 3) and a
right submandibulectomy. She did not undergo reconstruction.
Pathological examination revealed an epithelial type osteosarcoma with a
focus of squamous differentiation, complete excision and the
submandibular gland was free of the tumor process. One month
postoperatively, the evolution was favorable with good healing, no signs
of recurrence were observed (figure 4).