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Clinical Challenge
Radiology
May 2015

A Painless Right Facial Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Virginia, Charlottesville
  • 2Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Medical Center, Charlottesville
JAMA Otolaryngol Head Neck Surg. 2015;141(5):485-486. doi:10.1001/jamaoto.2015.0272

A healthy nonsmoking woman in her 30s presented with a 6-year history of a nontender mass on the right side of the inferior face, overlying the mandible. She first noticed the mass following an uncomplicated dental procedure. It grew slowly for a few years but then stabilized. She stated that it was sensitive to cold liquids but was otherwise asymptomatic. Results from routine laboratory tests and hematologic markers were normal. Examination revealed a roughly 4 × 2.5-cm, nontender, firm mass anterior to the right mandibular parasymphysis. The mass was fully mobile relative to the underlying mandible and could be seen bulging into the gingivolabial sulcus. There were no overlying skin or mucosal changes, and the skin and mucosa moved freely over the mass. Computed tomographic (CT) imaging demonstrated a well-defined, hyperdense, mildly heterogeneous mass with few focal areas of fat attenuation along the inferior aspect of the lesion (Figure, A-C). The mass was separate from the right mandibular parasymphysis without evidence of periosteal reaction or erosion into the underlying bone. The surrounding soft tissues appeared unremarkable. No additional lesions were noted. The patient was taken to the operating theater, where a firm, multilobulated, yellow mass was excised through a gingivolabial incision (Figure, D). The mass was not fixed to any adjacent structures.

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