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Clinical Challenge
October 2015

A Mandibular Mass With Maxillary Erosion

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Emory University, Atlanta, Georgia
  • 2Department of Pathology, Emory University, Atlanta, Georgia
JAMA Otolaryngol Head Neck Surg. 2015;141(10):939-940. doi:10.1001/jamaoto.2015.1648

A woman in her 60s was referred for a large, left-sided, progressively enlarging mandibular mass, present for approximately 7 months. She had no pain or neurosensory disturbances related to the lesion; however, she did have difficulty tolerating a regular diet owing to the bulk of the mass. She had no significant medical history, had quit smoking cigarettes 4 year prior to presentation, but had a 20 pack-year smoking history. Findings from the physical examination were notable for a 4.9-cm exophytic, nodular, slightly mobile mass of the left lower posterior alveolar ridge, involving the buccal and lingual gingiva. Teeth 20 to 24 were mobile. She had no cervical lymphadenopathy. Previous biopsy demonstrated squamous mucosa with ulceration and chronic inflammation. Contrasted computed tomography revealed an exophytic complex mass with areas of calcification and ossification inferiorly and a necrotic, cystic irregularly enhancing portion superiorly (Figure, A-C). An additional biopsy was performed (Figure, D). The mass was excised, and teeth 20 to 26 were removed. The alveolar ridge was recontoured, and the incision was closed primarily.

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