Multifocal Osteoblastoma of the Jaws: A Very Rare Case Report

Abstract

Osteoblastoma is a solitary benign bone-forming neoplasm, which comprises 1% of all primary bone tumors. Multifocal benign osteoblastoma of the jaws is very rare. Osteoblastoma must be differentiated from other similar bone-forming lesions such as osteoid osteoma and osteosarcoma for correct diagnosis and proper treatment planning. Therefore, precise examination of the patient and correlation with radiographic and histological features are essential for the best treatment and prognosis. This study reports a rare case of multifocal osteoblastoma in a 30-year-old female, involving the mandible and the maxilla, which was treated by surgical excision, iliac bone graft reconstruction, and implantation. Complete surgical excision is necessary to treat osteoblastoma with a good prognosis. The patient was followed-up for four years postoperatively, and there were no signs of recurrence in the panoramic view or the clinical examination.

Keywords: Enucleation; Jaws; Multifocal; Osteoblastoma; Peripheral ostectomy.

Figure 1

Pre-operative panoramic view, arrows show multifocal lesion. Periapical view of maxilla lesion

Figure 2

Pre-operative cone-beam computed tomography (CBCT) view, buccal and lingual bone thinning, and perforation, push the inferior alveolar nerve toward the lower border

Figure 3

Histopathological images showed stroma containing osteoblasts, scattered dilated vascular channels, and large sheets of irregular trabeculae in osteoid material rimmed by osteoblast with ample cytoplasm and hyperchromatic nuclei

Figure 4

Pre-operative medical stereolithography (3D printing model of the mandible)

Figure 5

Intra-operative view, pre-bent reconstruction plate was fixed intraorally; the inferior alveolar nerve was preserved

Figure 6

Post-operative panoramic view, 6 months after operation

Figure 7

Cone-beam computed tomography (CBCT) after reconstruction with iliac bone graft

Figure 8

Intra-operative view (secondary surgery), iliac bone graft, the line shows inferior alveolar nerve and the circle shows new mental foramen

Figure 9

Post-operative panoramic view, reconstruction of the right mandible with implantation, arrow shows the new mental foramen position