Mandibular pain and deformation as a presentation of fibrous dysplasia of the mandible

Czech version

Authors: Tomáš Křiva ¹; Zdeněk Adam ²; Marek Brumla ³; Ctirad Macháček ³; Tomáš Nebeský ⁴; Zdeněk Řehák ⁵; Luděk Pour ²; Renata Koukalová ⁵; Marta Krejčí ²; Zdeněk Král ²
Authors‘ workplace: Klinika ústní, čelistní a obličejové chirurgie LF MU a FN Brno, pracoviště Bohunice ¹; Interní hematologická a onkologická klinika LF MU a FN Brno, pracoviště Bohunice ²; Radiodiagnostická oddělení nemocnice Třebíč ³; Ústav patologie LF MU a FN Brno, pracoviště Bohunice ⁴; Radiodiagnostická klinika LF MU a FN Brno, pracoviště Bohunice ⁵; Oddělení PET CT a RECAMO Masarykova onkologického ústavu Brno ⁶
Published in: Vnitř Lék 2020; 66(1): 78-86
Category: Case Report

Overview

A case of fibrous dysplasia of the mandible is reported. The condition started with toothache and swelling of the jaw and adjacent portion of the neck. A panoramic jaw radiograph and a CT scan of the jaw revealed mandibular deformation that may have been associated with both osteomyelitis and a tumorous process. Histological examination of the material taken from the mandible and histological study of regional lymph nodes showed fibrous dysplasia of the mandible and inflammatory changes in the regional nodes. An FDG-PET/CT scan showed a single-site form of the disease. After having considered all the information published on the benefit of the bisphosphonate drug class, a decision was made to provide treatment with oral ibandronate in order to reduce pain intensity in the jaw area. If pain reduction with the oral form of the drug is inadequate, we will test the effect of intravenous bisphosphonates on pain intensity at standard doses that we employ in patients with a malignant form of osteolysis. The patient is kept under long-term surveillance at the Department of Oral and Maxillofacial Surgery of the Masaryk University Faculty of Medicine and University Hospital Brno, Bohunice affiliate, because there is a risk of both disease progression and its transformation into sarcoma. The risk of malignant transformation, however, is lower than 1% per year.

Keywords:

fibrous dysplasia – ibandronate – mandible

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