Piezoelectric-assisted removal of a benign fibrous histiocytoma of the mandible: an innovative technique for prevention of dentoalveolar nerve injury

Abstract

In this article, we present our experience with a piezoelectric-assisted surgical device by resection of a benign fibrous histiocytoma of the mandible.A 41 year-old male was admitted to our hospital because of slowly progressive right buccal swelling. After further radiographic diagnosis surgical removal of the yellowish-white mass was performed. Histologic analysis showed proliferating histiocytic cells with foamy, granular cytoplasm and no signs of malignancy. The tumor was positive for CD68 and vimentin in immunohistochemical staining. Therefore the tumor was diagnosed as primary benign fibrous histiocytoma. This work provides a new treatment device for benign mandibular tumour disease. By using a novel piezoelectric-assisted cutting device, protection of the dentoalveolar nerve could be achieved.

Figure 1

Preoperative panoramic radiograph.

Figure 2

Preoperative CT and MRI scans showing the heterogeneous lesion in the right mandible with no vascular signs.

Figure 3

Histopathological examination of the obtained tissue showing spindle-shaped fibroblasts, arranged in a storiform pattern (hematoxylin-eosin-staining, magnification 25×).

Figure 4

While in other parts of the specimen proliferating histiocytic cells with foamy, granular cytoplasm and no signs of malignancy dominate (hematoxylin-eosin-staining, magnification 100×).

Figure 5

Immunohistochemical staining positive for CD68 (magnification 100×).

Figure 6

mmunohistochemival staininga also positive for vimentin (magnification 100×), and negative for sm-actin, desmin, cytokeratin, S-100 protein or CD-56.

Figure 7

Intraoperative image of the original mandible.

Figure 8

Intraoperative image showing the removal of the bone with the piezosurgery device.

Figure 9

Intraoperative image after removal of the tumor.

Figure 10

Postoperative CBCT showing the defect and the titanium plate.