Soft tissue osteolytic tumors in children

1. CASE
PRESENTATION
BY
DR SAQBA ALAM (BDS,FCPS)MAX
FAC

2. Your best quote that reflects your
approach… “It’s one small step for
man, one giant leap for mankind.”
- NEIL ARMSTRONG

3. HISTORY
Case of 5 year old boy
resident of Gilgit orientedx3
presented to dept of Maxfac
on 13.05.23 at 15.00 hrs with
a left sided facial swelling
since 19 months

4. HISTORY OF PRESENTING COMPLAIN
5 year old boy presented to AKUH with a history of left sided facial
swelling since 19 months gradually increasing in side with a sudden
onset.
Initially the swelling was double the size and resembled a left sided
odontogenic cellulitis so the local dentist removed an associated lower
deciduous molar tooth the next day which later resulted in a non healing
wound with yellow discharge from the left submandibular region since 19
months uptil now.The extraction and discharge was however followed by
the regression in size of the pathology

5. The swelling was a cricket ball size initially which reduced to a tennis ball size after extraction with
associated fever, mild continuous pain,fatigue and facial discharge both extra and intraorally since
19 months.The swelling had no association with meals or has associated otalgia,vision disturbances
or headache.
The swelling since months is diffuse,soft, non tender and mobile and increasing in size from mid
facial region to neck.
Pain is mild to moderate in nature increased on touch at the discharging sinus while cleaning the
face ,mid cheek swelling is non tender and painless. Pain is associated with low grade
undocumented fever that is intermittent in nature and sometimes accompanied by cough and runny
nose.
Systemic history is insignificant with no history of bony aches and pains or discharge from any other
site.
No history of any significant habbit,sleep patterns and appetite normal.

6. Past treatment
Long course of iv and oral antibiotics (5 months on and off)
Cheek aspiration revealed fresh blood? (vascular osteolytic?)
Incisional biopsy from discharging sinuses? (CONSIDER RE DO BIOPSY INTRAORAL MID
CHEEK
PLUS INTRAORAL MANDIBULAR BONY LESION?)

7. EXAMINATION

10. BIOPSY

11. CT

12. POINTS TO CONSIDER
The high prevalence of dental disease in children results in inflammatory, infective, and reactive
processes having substantial overlap in imaging features with more serious locally aggressive
tumors or malignant conditions, thereby requiring invasive tissue diagnosis for proper
management in some cases.
Occlusal and panoramic radiographs revealed ill-defined Lytic lesions involving premolar-molar
region Cortex and periosteum was characterized by erosion,thinning and discontinuity on buccal
cortex; irregular thinning of lower cortical plate seen.

13. Differential diagnosis:
Juvenile mandibular chronic osteomyelitis (JMCO)secondary
to?
-Benign odontogenic tumors
-Benign soft tissue osteolytic tumors (CGG,Myxoma?)
-Rhabdomyosarcoma
-Osteosarcoma
-Vascular osteolytic tumors

14. Conclusion
TBM Decision required because of:
- aggressive destructive pathology
-5 year old
- possible long term planning post Resection infected mandible?
-staged resection of infected jaw?
-possible diminished host defenses
-primary closure with wait and watch policy for recurrence?
-long term team management required.