R. NICKBRYANMDS. JAMESZINREICHMD
A 20-YEAR-OLD white man presented with a slowly growing mass overlying the right mandible. He had been kicked in the jaw during a martial arts exercise just before he noticed the mass. The patient reported trismus as the mass increased to the size of a golf ball over a 6-month period. He denied pain, numbness, dysphagia, odynophagia, or weakness of the facial nerve. His medical history was unremarkable. He had no history of radiotherapy or surgery and was taking no medications. Physical examination revealed a healthy young man with a 3.0-cm mass overlying the lateral surface of the right mandibular ramus. The parotid gland had no palpable lesions. The mass was palpable deep to the parotid gland, however, and was intrinsically involved with the masseter muscle. There were no intraoral mucosal lesions and no swelling of the peritonsillar area. Facial nerve function was normal. A T1-weighted magnetic resonance imaging scan revealed a 2 × 3-cm hypodense mass in the right masseter muscle, arising from the lateral cortex of the mandibular ramus (Figure 1). The cortex of the mandible appeared to be intact, and there was no signal abnormality within the marrow space. The mass demonstrated complex striations and heterogeneous enhancement. The parotid gland was displaced posteriorly and laterally, and the mass was clearly not of parotid origin. Two independent fine-needle aspirations did not yield a definitive diagnosis.
Sorensen DM, Gokden M, El-Naggar A, Byers RM. Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2000;126(4):550. doi:10.1001/archotol.126.4.550