Spontaneous Bone Regeneration of the Mandible: In a Case of Osteosarcoma and Literature Review

Case Report

Austin J Dent. 2016; 3(1): 1031.

Spontaneous Bone Regeneration of the Mandible: In a Case of Osteosarcoma and Literature Review

Bataineh AB*

Department of Dentistry, Jordan University of Science & Technology, Jordan

*Corresponding author: Anwar B. Bataineh, Department of Dentistry, Jordan University of Science & Technology, Irbid, Jordan

Received: March 31, 2016; Accepted: May 05, 2016; Published: May 07, 2016

Abstract

There are rare cases reported in the literature that have demonstrated spontaneous bone regeneration after resection of the mandible in benign pathology. Mandibular defects may result from many conditions such tumors. The tumor presented radiographically as an osteolytic lesion, after biopsy, it was found to be an osteogenic sarcoma, a hemimandibulectomy was performed. Clinically and radiographically a very hard-formed bone could be palpated and seen, also a functional left temporal muscle, which had been completely detached from the resected mandible, could be palpated.

The purpose of this article was to report an unusual malignant case of complete spontaneous bone regeneration of the coronoid process ascending ramus and partial regeneration of the body of the mandible in a case of osteosarcoma.

Keywords: Spontaneous bone regeneration; Hemimandibulectomy; Osteosarcoma

Introduction

Osteosarcoma is a tumor that can occur in any bone and most commonly occurs in the long bones. Some studies found that osteosarcomas accounts for about 20% of all primary bone cancers and about 4%-6% occur in the maxillofacial region, while others found account for 6% to 9% [1,2].

Spontaneous bone regeneration is an uncommon form of bone healing where bone grows into critical size defects. In the mandible, spontaneous bone regeneration has replaced extensive defects up to the entire mandible and bilateral condyles [3-5]. The mechanism of spontaneous bone regeneration is not thoroughly understood, however, various factors have been suggested to influence this event [3,6,7]. The age of the patient, presence of infection, soft tissue protection of the bone defect, immobilization and genetic factors have been suspected as factors controlling spontaneous bone regeneration, but the exact are not yet to be identified [4-6,8-12]. In Sub-Saharan Africa reports of spontaneous bone regeneration are very rare; all previous accounts have come from Nigeria following jaw resection for ameloblastoma [3,4,6]. Spontaneous regeneration of the mandible has been rarely stated in previous studies [3-5,8]. Our review of literature showed only one report of spontaneous regeneration of the whole mandible [8]. This case report followed mandibular resection for Osteosarcoma in a 10-years-old female.

The purpose of this article was to report a complete spontaneous bone regeneration of the coronoid process ascending ramus and partial regeneration of the body of the mandible in a malignant case of osteosarcoma.

Case Presentation

In January 11, 1995 a 10-year-old girl with a 5 months history of hard non movable painless mass in the posterior region of the left mandible was referred to Oral and Maxillofacial clinic at the Jordan University of Science and Technology. Extra-oral examination showed an enlargement of the left mandible, with mild facial asymmetry. A tangible lymph node in the left sub mandibular region was also found. Intraoral examination revealed a minimal expansion of the body extending from the left first premolar to the angle, the buccal sulcus was obliterated. The overlying mucosa was normal, whereas the first, second premolars, the first and second molars were mobile, with no signs of inflammation or infection and without any exudation.

Orthopantomograph showed the presence of an osteolytic lesion in the left side of the mandibular body, extending from the left first premolar to the angle of the mandible and both medial and left lateral cortexes were scalloped (Figures 1). An aspiration biopsy revealed no presence of liquid or pus content into the lesion. Intra-oral incisional biopsy confirmed the diagnosis of osteosarcoma.