Mandibular osteoradionecrosis with pathological fracture

Case contributed by Dr Henry Knipe

Presentation

Jaw pain.

Patient Data

Age: 75
Gender: Male

Fracture through the right angle of the mandible. The surrounding bone is abnormal with increased sclerosis and bone resorption. Extensive caries. Crown of 47 is destroyed. 

Mixed sclerosis and lucency affecting both the cortical and trabecular bone of the angle of the right mandible extending from the coronoid process superiorly into the body of the mandible inferiorly.

More focal lucent region incorporating the roots of the 47 tooth (with destroyed crown) and about the roots of 46 is traversed by a pathological fracture running through the second molar tooth socket.

Evidence of previous right neck dissection. Linear scarring and traction bronchiectasis in the right apex.

Case Discussion

The patient had a history of radiation therapy for squamous cell carcinoma of the right tonsil. The patient proceeded to biopsy prior to consideration of free flap reconstruction.  

MACROSCOPIC DESCRIPTION: 1. "Distal 47 mandible bone": Four irregular fragments of hard tan bone 18x15x3mm in aggregate. Placed into decal. A1. 2. "46 site mandible bone": An irregular fragment of hard tan bone up to 4mm. Placed into decal. A1. 3. "Soft tissue from mandible fracture line": Multiple pieces of rubbery to soft tan tissue 16x10x3mm in aggregate. A1.

MICROSCOPIC DESCRIPTION: 1. The sections show fragments of necrotic cortical lamellar bone. The osteocytes have lost their nuclear staining. There is granular material, bacterial colonies and occasional clusters of neutrophils on the surface. No tumour is seen. The features are consistent with osteoradionecrosis. 2. The sections show some fragments of viable cortical lamellar bone. There is no evidence of osteoradionecrosis. Focal fibrosis is present. No tumour is seen. 3. The sections contain thickened squamous mucosa with some calcified bony trabeculae and connective tissue. The squamous cells show reactive changes. Scattered neutrophils are seen in the epithelium, along with clumps of bacteria. No evidence of dysplasia or malignancy is identified. The bony trabeculae appear viable.

DIAGNOSIS: 1. Distal 47 mandible bone: Osteoradionecrosis. 2. 46 site mandible bone: Viable bone with focal fibrosis. 3. Soft tissue from mandible fracture line: Reactive and inflamed squamous mucosa. No evidence of dysplasia or malignancy.

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Case Information

rID: 39583
Case created: 10th Sep 2015
Last edited: 21st Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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