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Reminder of important clinical lesson
CASE REPORT
Primary intraosseous mucoepidermoid carcinoma of the mandible: radiographic evolution and clinicopathological features
  1. Nicholas B Abt1,
  2. Matthew E Lawler2,
  3. Joseph Zacharias2 and
  4. Edward T Lahey2
  1. 1 Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  2. 2 Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Nicholas B Abt, nicholas_abt{at}meei.harvard.edu

Abstract

Mucoepidermoid carcinoma (MEC) can be rarely found as a primarily intraosseous lesion and mistaken for other intraosseous or odontogenic pathology. A 65-year-old man had a poorly defined radiolucency distal to the left mandibular second molar root. Periapical radiographs demonstrated a minor radiolucency from 2.5 years prior. An oral and maxillofacial surgeon felt the radiolucency represented periodontal disease, extracting tooth #18. The differential diagnosis of mixed radiolucent/radio-opaque mandibular lesions includes: (1) fibro-osseous lesion, (2) odontogenic and non-odontogenic cyst, (3) infection and inflammatory lesion, or (4) benign or malignant neoplasm (odontogenic, non-odontogenic, or metastatic). Histological analysis revealed low-grade MEC. A composite resection was performed with a 1 cm margin from first molar to ascending ramus. A buccal fat pad advancement flap covered the defect with an iliac crest bone graft placed later for a resulting osseous defect. Careful examination and diagnostic work-up for odontogenic cysts should be provided as they may harbour malignant tumours.

  • otolaryngology / ENT
  • oral and maxillofacial surgery
  • dentistry and oral medicine
  • head and neck cancer

https://doi.org/10.1136/bcr-2018-224612

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    Footnotes

    • Contributors NBA, MEL, JZ and ETL: Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published . Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.