A 27-year-old female with a chief complaint of pain and swelling of the mandibular left region was referred to the Kashani Educational Hospital of Isfahan University of Medical Sciences, Isfahan, Iran. The study protocol was approved by the Ethics Committee of Isfahan University of Medical Sciences (approval No. IR.MUI.RESEARCH.REC.1400.440).
In the initial examinations, paresthesia in the left corner of the lower lip was determined. Physical examination revealed a moderately sized left mandibular mass, causing facial asymmetry (Fig. 1). However, the investigation did not reveal any decayed teeth.
The panoramic view represented a well-defined, unilocular, expansive lesion on the left side of the mandibular body area with no sign of teeth displacement or root resorption (Fig. 2). According to CBCT assessments, the lesion had caused buccal and lingual expansion (Fig. 3).
Pathological evaluations of the patient were also performed through incisional biopsy, and the process was reported as a trabecular type of JOF based on the presence of trabeculae of fibrillar osteoid and woven bone fragments (Fig. 4).
The patient underwent partial resection with a 5 mm safe margin, using the extra oral approach, and the lesion was resected entirely followed by forming and placing the reconstruction plate on the lower border of the mandible and histopathologic evaluation of the resected lesion. In the next step, bone grafting was used for proper continuity of the mandible. The anterior iliac crest bone was harvested autogenously in an appropriate size and grafted at the lesion site, and then fixed with screws to the reconstruction plate. The pathological findings of final biopsies approved the JOF (Fig. 5).
The patient was followed for six months and re-evaluated through pathological analysis, panoramic view, and CBCT. However, no recurrence was observed during this period, and the autogenous iliac bone was successfully grafted to the mandibular bone as was demonstrated in the panoramic and CBCT imaging modalities (Fig. 6).
Six months after surgery patient was evaluated for implant placement. Since there were no signs of recurrence and the anterior iliac crest bone was successfully fused to the mandibular bone, the patient underwent a second stage of the surgery for removing the reconstruction plate and placing the dental implants in the grafted area for functional rehabilitation of the occlusion (Fig. 7). The final panoramic imaging of the patient is shown in Fig. 8.